[OP.7D.07] 24-HOUR CENTRAL BLOOD PRESSURE IS BETTER ASSOCIATED WITH TARGET ORGAN DAMAGE OF HYPERTENSION THAN BRACHIAL BLOOD PRESSURE
Stefano OmboniI.N. PosokhovGianfranco ParatiВ. С. БарканE. Cardona MuñozE.A. GrigorichevaI. E. MinyukhinaM.L. MuiesanGiuseppe MulèYа. A. OrlovaTânia Pereira
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Objective: The VASOTENS international, multicenter, observational, non-randomized, prospective study aims at evaluating the impact of 24-hour pulse wave analysis of ambulatory blood pressure (BP) recordings on target organ damage and cardiovascular prognosis of hypertensive patients. In the present analysis of study baseline data we checked whether organ damage of hypertension i) is better associated with 24-hour central than peripheral BP and ii) is related to ambulatory arterial stiffness, estimated by pulse wave velocity (PWV) and augmentation index (AIx). Design and method: In 334 hypertensive patients (mean age 53+/−15, 52% males, 45% treated) we obtained 24-hour ABPMs, echocardiograms, carotid ultrasonograms and serum creatinine. Hypertensive organ damage was estimated by calculation of left ventricular mass index (LVMI, cardiac damage), intima-media thickness (IMT, vascular damage) and creatinine clearance (CC, renal damage). 24-hour hemodynamics and stiffness were estimated through the validated VASOTENS technology, based on transfer function analysis of brachial oscillograms. 24-hour brachial (bSBP) and aortic systolic BP (aSBP), standard deviation of bSBP, PWV and AIx were obtained. Relation of vascular indices with LVMI, IMT and CC was evaluated by bivariate and multivariate analysis (stepwise linear regression analysis). Results: In the bivariate analysis a statistically significant relation was found for age, bSBP and aSBP vs. LVMI and IMT (see table, correlation coefficients or r). IMT was also significantly related to SBP variability and arterial stiffness, whereas increasing age, SBP variability and AIx were significantly associated with a decline of renal function.In the multivariate analysis, including all variables entered in the bivariate model, adjusted by sex, statistically significant (p < 0.001) association was observed for aSBP and age with LVMI (standardized regression coefficient 0.25 and 0.18, respectively), and for age with IMT (0.56) and CC (−0.53). Conclusions: In hypertensive patients age appears to be the major determinant of organ damage, with central SBP, and marginally peripheral SBP, PWV and AIx, also playing a significant role. Our results suggest that estimation of 24-hour central hemodynamics and arterial stiffness in ambulatory conditions may help improve the individualized assessment of the BP-associated organ damage of hypertensionKeywords:
Pulse pressure
Background: The arterial system stiffens over lifetime and correlates positively with the development of cardiovascular disease (CVD). Obesity and inactivity enhance this process. Currently diagnostic devices measuring arterial stiffness are applied in clinical settings and research studies. Nevertheless, there are still difficulties in selecting the most appropriate methodology to measure effects of physical activity and fitness on cardiovascular health.
Methods: To answer this question, we measured arterial stiffness with two commonly applied non-invasive devices in three different groups: Healthy old active (HOA), healthy old sedentary (HOS) and old sedentary at risk (OSR). The SphygmoCor® device measured the carotidfemoral – and the femoral-tibial pulse wave velocity (cfPWV and ftPWV) and the VaSera device measured the cardio-ankle vascular index (CAVI). From the CAVI-data the brachialankle pulse wave velocity (baPWV) was calculated. The main outcome of the study is the comparison of the four parameters.
Result: cfPWV and baPWV showed a significant difference between all groups (cfPWV: F(2.143) = 8.583, p < 0.05; baPWV: F(2.154) = 3.350, p < 0.05). CAVI (p = 0.41) and ftPWV (p = 0.86) were nonsignificant. cfPWV showed a moderate, positive association with baPWV (r = 0.59, p < 0.05).
Conclusion: The beneficial effects of a normal-healthy life can be demonstrated by cfPWV and baPWV on a macrovascular level. Concluding, that cfPWV and baPWV can be implemented as diagnostic devices for population wide cardiovascular risk stratification. There was no significant effect of physical activity and fitness on arterial stiffness.
Pulsatile flow
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Cardiovascular Health
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Artery stiffness is a risk factor for cardiovascular disease (CVD). The measurement of pulse wave velocity (PWV) between the carotid artery and the femoral artery (cfPWV) is considered the gold standard in the assessment of arterial stiffness. A relationship between cfPWV and regional PWV has not been established. The aim of this study was to evaluate the influence of gender on arterial stiffness measured centrally and regionally in the geriatric population. The central PWV was assessed by a SphygmoCor XCEL, and the regional PWV was assessed by a new device through the photoplethysmographic measurement of multi-site arterial pulse wave velocity (MPPT). The study group included 118 patients (35 males and 83 females; mean age 77.2 ± 8.1 years). Men were characterized by statistically significantly higher values of cfPWV than women (cfPWV 10.52 m/s vs. 9.36 m/s; p = 0.001). In the measurement of regional PWV values using MPPT, no such relationship was found. Gender groups did not statistically differ in the distribution of atherosclerosis risk factors. cfPWV appears to be more accurate than regional PWV in assessing arterial stiffness in the geriatric population.
Arteriosclerosis
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We investigated whether there was a correlation between the simultaneous assessments of augmentation index (AI) and pulse wave velocity (PWV), undertaken by the SphygmoCor system, and what were the principal factors responsible for differences in these two putative assessments of arterial stiffness, in 105 offspring (41 men, 64 women) aged 19-71 years, of patients with familial hypertension. Arterial stiffness was measured using the SphygmoCor pulse wave analysis system. AI and PWV correlated significantly and positively (r = 0.29, p < 0.005) and the strength of the correlation was greater when each gender was examined separately. This led us to observe several-fold higher AI in women (22.04 +/- 12) than in men (8.59 +/- 13) (p < 0.001); the difference could be explained only in part by an inverse regression correlation between AI and height (r = -0.45; p < 0.001), but not PWV. AI was also more influenced than PWV by heart rate and blood pressure. AI is strongly correlated with a previously validated estimate of arterial stiffness, PWV. It is probable that separate normal ranges should be established for men and women, while further studies determine what parameters other than height are responsible for the gender difference.
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Introduction: Chronic kidney disease (CKD) is associated with increased arterial stiffness. Identification of arterial stiffness in early chronic kidney disease patients is important as they are at risk of developing cardiovascular disease. This will allow risk stratification and allocation of resource in managing this high risk group. Existing literature revealed variable findings on arterial stiffnes in early CKD patients.
Objective: We aim to compare arterial stiffness using pulse wave velocity (PWV) among patients with chronic kidney disease stage 2-4 and those with normal renal function.
Methodology: This is a case-control study of CKD and normal renal function patients. Patients with confirmed chronic kidney disease stage 2 to 4 were recruited from various clinics in the Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Malaysia from 1st August 2015 until 31th January 2016. Sociodemographic and anthropometric indices were recorded at recruitment. Each patient underwent a carotid-femoral (aortic) PWV measurement to determine the arterial stiffness. PWV is determined automatically with a dedicated one-probe device (SphygmoCore XCEL) in which the recorded pulse wave forms were obtained transcutaneously over the common carotid artery.
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Objective: To compare the pulse wave velocity (PWV) results obtained by Sphygmocor AtCor Medical, by radial tonometry, and Mobil-Ambulatory Blood Pressure Monitor-Pulse Wave Velocity (Mobil-ABPM-PWV) 24 hours, an oscillometric method. Design and method: Sixty-three controlled hypertensive (41 female and 22 male) and sixty-three resistant hypertensive (36 female and 27 male) patients were recruited and submitted to evaluation of arterial stiffness by the SphygmoCor (radial tonometry) and by Mobil-ABPM-PWV (oscillometric method). Linear regression and Bland-Altmann test were used to statistics analysis. Results: The correlations of the PWV as assessed with Mobil-ABPM-PWV 24 hours with the values obtained using the SphygmoCor radial tonometry were significant (controlled hypertensive patients: r = 0.54, P < 0001; resistant hypertensive patients: r = 0.48, P < 0.001). Comparison Bland-Altman plot showed concordance correlation coefficient (controlled hypertensive patients = 5.0, P < 0.0001 and resistant hypertensive patients = 4.8, P < 0.0001). Figures 1–4. Conclusions: The oscillometric method Mobil-ABPM-PWV is an easy-to-use and time-effective method for assessing arterial stiffness compared with the SphygmoCor AtCor radial tonometry.
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Background Oscillometric pulse wave velocity (o-PWV) represents an attractive, non invasive and non operator-dependent method to estimate arterial stiffness. Tonometric carotid-femoral measurements (cf-PWV),are considered the gold-standard for non-invasive aortic stiffness assessment. To date, no studies in the general population comparing the two methods have been performed.Methods and Results 1162 subjects were analysed. O-PWV and cf-PWV showed a mean difference of −0.31 m/sec(p ≤ 0.001). No significant differences between cf-PWV and o-PWVs were observed in patients without cardiovascular risk factors. The Bland and Altman analysis showed a moderate agreement between 24 h-o-PWV and cf-PWV (mean difference −0.99, LoA 4.23 to −6.22m/s). O-PWVs underestimate and overestimate arterial stiffness under and over 50 years respectively(p ≤ 0.001). Systolic blood pressure (SBP) and age differently impact cf-PWV and in office o-PWV variability (r2 0.35 and 0.88 respectively). In younger subjects a strong relationship between o-PWV and SBP reducing as age increases was found. Analysing the impact of age, an opposite trend was noticed.Conclusions Oscillometric PWV estimates provide reliable values in the general population. An o-PWV tendency to underestimate arterial stiffness in younger subjects and in subjects with diseases known to increase arterial stiffness and to overestimate it with increasing age was found, even if scarcely relevant in clinical perspective. Overall the present findings underline an acceptable and satisfactory agreement between oscillometric and tonometric methods for the PWV assessment.KEY MESSAGESOscillometric and tonometric PWV estimates showed a good and satisfactory agreement in the general population, above all in subjects without cardiovascular risk factors or a documented vascular damage.In comparison with tonometric values, oscillometric PWV estimates showed, however, the tendency to underestimate arterial stiffness in younger subjects and to overestimate it with increasing age, while diverging when diseases known to increase arterial stiffness are present.The magnitude of differences in PWV estimates between tonometric and oscillometric methods found in the general population appears most likely not to be significant in everyday clinical practice.
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For the elderly, arterial stiffening is a good marker for aging evaluation and it is recommended that the arterial stiffness be determined noninvasively by the measurement of carotid to femoral pulse wave velocity (cf-PWV) (Class I; Level of Evidence A). In literature, numerous community-based or disease-specific studies have reported that higher cf-PWV is associated with increased cardiovascular risk. Here, we discuss strategies to evaluate arterial stiffness with cf-PWV. Following the well-defined steps detailed here, e.g., proper position operator, distance measurement, and tonometer position, we will obtain a standard cf-PWV value to evaluate arterial stiffness. In this paper, a detailed stepwise method to record a good quality PWV and pulse wave analysis (PWA) using a non-invasive tonometry-based device will be discussed.
Applanation tonometry
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Objective: To find out the potential of indices of arterial stiffness in risk stratification and the need to introduce such measures into clinical practice. Design and method: A cross sectional study was conducted on elderly subjects aged 60–80 years with prehypertension (n = 35) and age matched normotensives (n = 30). We measured PWV (Pulse Wave Velocity) by Periscope™.The arterial stiffness was assessed by measuring (1) Pulse Wave Velocity between carotid-femoral (c-f PWV) and brachial ankle (b-aPWV) (2) Augmentation Index (AIx) (3) Arterial Stiffness Index (ASI) at brachial (bASI) and tibial artery (aASI). Results: We found a significant increase in c-f PWV (p < 0.001), b-aPWV (p < 0.001) and AIx @75%(p < 0.001) in prehypertensives than normotensive elderly individuals. There was no significant difference in the ASI at brachial and tibial arteries. The significant predictor of c-f PWV and [email protected] (%) was Systolic BP, and aASI was Pulse pressure (PP). Conclusions: These findings show an augmentation of age related arterial stiffness in elderly with prehypertension.The Aortic Pulse Wave Velocity reflects central arterial stiffness. Aortic Pulse Wave Velocity predicted Cardiovascular outcomes over and beyond BP and traditional risk factors.
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Prehypertension
Wave velocity
Brachial artery
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