Cross-sectional and longitudinal assessment of arterial stiffening with age in European and chinese populations

Association Between Central-Peripheral Blood Pressure Amplification and Structural and Functional Cardiac Properties in Children, Adolescents, and Adults: Impact of the Amplification Parameter, Recording System and Calibration Scheme

INTRODUCTION

Systolic blood pressure (SBPA) and pulse pressure amplification (PPA) were quantified using different methodological and calibration approaches to analyze (1) the association and agreement between different SBPA and PPA parameters and (2) the association between these SBPA and PPA parameters and left ventricle (LV) and atrium (LA) structural and functional characteristics.

METHODS

In 269 healthy subjects, LV and LA parameters were echocardiography-derived. SBPA and PPA parameters were quantified using: (1) different equations (n = 9), (2) methodological approaches (n = 3): brachial sub-diastolic (Mobil-O-Graph®) and supra-systolic oscillometry (Arteriograph®) and aortic diameter waveform re-calibration (RCD; ultrasonography), and (3) using three different calibration schemes: systo-diastolic (SD), calculated mean (CM) and oscillometric mean (OscM).

RESULTS

SBPA and PPA parameters obtained with different equations, techniques, and calibration schemes show a highly variable association level (negative, non-significant, and/or positive) among them. The association between SBPA and PPA with cardiac parameters were highly variable (negative, non-significant, or positive associations). Differences in BPA parameter data between approaches were more sensitive to the calibration method than to the device used. Both, SBPA and PPA obtained with brachial sub-diastolic technique and calibrated to CM or OscM showed higher levels of association with LV and LA structural characteristics.

CONCLUSIONS

Our data show that many of the parameters that assume to quantify the same phenomenon of BPA are not related to each other in the different age groups. Both, SBPA and PPA obtained with brachial sub-diastolic technique and calibrated to CM or OscM showed higher levels of association with LV and LA structural characteristics.

Relation of blood pressure and organ damage: comparison between feasible, noninvasive central hemodynamic measures and conventional brachial measures

OBJECTIVE

The present cross-sectional study investigated whether central SBP and pulse pressure (PP) measured noninvasively with a novel cuff-based stand-alone monitor are more strongly associated with hypertensive end-organ damage than corresponding brachial measures.

METHODS

We investigated the cross-sectional association of central versus brachial SBP and PP with echocardiographic left ventricular mass index (LVMI), LV hypertrophy (LVH), carotid intima-media thickness (IMT), and increased IMT (IMT ≥ 75th percentile) among 246 participants drawn from the general population (mean age 57.2 years, 55.3% women).

RESULTS

All blood pressure (BP) measures were positively correlated with LVMI and IMT (P < 0.001 for all). Brachial and central SBP correlated equally strongly with LVMI (r = 0.42 versus 0.40, P for difference 0.19) and IMT (r = 0.32 versus 0.33, P = 0.60). However, brachial PP correlated more strongly than central PP with LVMI (r = 0.34 versus 0.27, P = 0.03) and IMT (r = 0.40 versus 0.35, P = 0.04). In multivariable-adjusted logistic models, all four BP measures were significantly associated with LVH and increased IMT (P ≤ 0.03 for all). However, the diagnostic accuracy of logistic regression models that included brachial or central hemodynamic parameters was similar for LVH [area under curve (AUC) for SBP: 0.74 versus 0.76, P = 0.16; AUC for PP: 0.75 versus 0.73, P = 0.35] and IMT (AUC for SBP: 0.61 versus 0.61, P = 0.67; AUC for PP: 0.63 versus 0.61, P = 0.29).

CONCLUSION

Our findings suggest that central SBP and PP measured with a stand-alone noninvasive BP monitor do not improve diagnostic accuracy for end-organ damage over corresponding brachial measures.

Endothelial PPARγ Is Crucial for Averting Age-Related Vascular Dysfunction by Stalling Oxidative Stress and ROCK

Aging plays a significant role in the progression of vascular diseases and vascular dysfunction. Activation of the ADP-ribosylation factor 6 and small GTPases by inflammatory signals may cause vascular permeability and endothelial leakage. Pro-inflammatory molecules have a significant effect on smooth muscle cells (SMC). The migration and proliferation of SMC can be promoted by tumor necrosis factor alpha (TNF-α). TNF-α can also increase oxidative stress in SMCs, which has been identified to persuade DNA damage resulting in apoptosis and cellular senescence. Peroxisome proliferator-activated receptor (PPAR) acts as a ligand-dependent transcription factor and a member of the nuclear receptor superfamily. They play key roles in a wide range of biological processes, including cell differentiation and proliferation, bone formation, cell metabolism, tissue remodeling, insulin sensitivity, and eicosanoid signaling. The PPARγ activation regulates inflammatory responses, which can exert protective effects in the vasculature. In addition, loss of function of PPARγ enhances cardiovascular events and atherosclerosis in the vascular endothelium. This appraisal, therefore, discusses the critical linkage of PPARγ in the inflammatory process and highlights a crucial defensive role for endothelial PPARγ in vascular dysfunction and disease, as well as therapy for vascular aging.

Vascular aging and hypertension: Implications for the clinical application of central blood pressure

Vascular aging may be responsible for the high residual lifetime risk for hypertension in the middle-aged and elderly individuals. Increased arterial stiffness and wave reflection has been recognized as the dominant hemodynamic manifestations of vascular aging, and both are major determinants of central blood pressure (BP) and independent predictors for incident hypertension. Because central BP is strongly linearly associated with age, it can be regarded as an integrated marker for vascular aging. Central BP can be measured noninvasively using various techniques, including the convenient cuff-based oscillometric central BP monitors. Noninvasive central BP is likely better than the conventional brachial BP in association with target organ damages and long term cardiovascular outcomes. Based on the analysis of the long-term events of derivation and validation cohorts, the central BP threshold of 130/90mmHg for defining hypertension has been proposed. Recent studies suggest that the central BP strategy for confirming a diagnosis of hypertension may be more cost-effective than the conventional brachial BP strategy, and guidance of hypertension management with central BP may result in less use of medications to achieve BP control. Vascular aging-related hypertension is expected to become the dominant phenotype in many countries, especially in the Asian regions. Although noninvasive measurement of brachial BP is inaccurate and central BP has been shown to carry superior prognostic value beyond brachial BP, the use of central BP should be justified by studies comparing central blood pressure-guided therapeutic strategies with classic guidelines-guided strategies for preventing cardiovascular events. Future randomized control trials are required to support that the diagnosis and monitoring of vascular aging-related hypertension is best managed with the central BP strategy.

American Society of Hypertension position paper: central blood pressure waveforms in health and disease

A number of devices are available which noninvasively estimate central aortic blood pressure using a variety of approaches such as tonometry or oscillometry. In this position paper, we discuss how the central pressure waveform is generated and measured, how central pressure waveforms appear in health and disease, the predictive value of central blood pressure measurements, the effects of interventions on waveforms, and areas of future need in this field of clinical and research endeavor.

Prospective risk factors for increased central augmentation index in men and women

BACKGROUND

Arterial wave reflections are important determinants of central pressure pulsatility and left ventricular afterload. The augmentation index (AIx) is the most widely used surrogate of arterial wave reflections. Despite multiple cross-sectional studies assessing the correlates of AIx, little prospective data exist regarding changes in AIx over time. We aimed to assess the predictors of changes in AIx over time in adults from the general population.

METHODS

We performed radial arterial tonometry assessments a median of 3.18 ± 0.4 years apart on 143 nondiabetic adult participants in the population-based PREVENCION study. Central AIx was obtained using the generalized transfer function of the Sphygmocor device.

RESULTS

Predictors of the change in AIx over time were investigated. Among men (n = 67), the change in AIx was predicted by abdominal obesity (standardized β for waist circumference = 0.34; P = 0.002), impaired fasting glucose (standardized β = 0.24; P = 0.009), and the change in heart rate (standardized β = -0.78; P < 0.001). Among women (n = 76), the change in AIx was predicted by non-high-density lipoprotein cholesterol (standardized β = 0.33; P = 0.001), C-reactive protein levels (standardized β = 0.24; P = 0.02), change in mean arterial pressure (standardized β = 0.33; P = 0.001), and change in heart rate (standardized β = -0.52; P < 0.001).

CONCLUSIONS

Metabolic and inflammatory factors predicted changes in AIx over time, with important sex differences. Metabolic factors, such as abdominal obesity and impaired fasting glucose, predicted changes in AIx in men, whereas C-reactive protein and non-high-density lipoprotein cholesterol levels predicted changes in women. Our findings highlight the impact of sex on arterial properties and may guide the design of interventions to favorably impact changes in late systolic pressure augmentation.