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Govender KC, Naidoo M. Prevalence and determinants of apparent treatment-resistant hypertension among patients in South African primary care: a single-centre observational study. BMC Cardiovasc Disord 2025; 25:373. [PMID: 40389824 PMCID: PMC12087234 DOI: 10.1186/s12872-025-04813-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2025] [Accepted: 05/02/2025] [Indexed: 05/21/2025] Open
Abstract
INTRODUCTION The surge in cardiovascular disease across Sub-Saharan Africa is largely driven by hypertension along with other cardiometabolic risk factors. South Africa, like other low-middle-income countries, faces a disproportionate burden due to the increasing prevalence of hypertension, exacerbated by low awareness, treatment, and control rates. Treatment-resistant hypertension (TRH) is a complex clinical entity and poses significant obstacles to achieving therapeutic goals. The prevalence of TRH in South Africa and its associated factors remain underexplored despite its significant cardiovascular and economic burden. Accordingly, we aimed to evaluate the prevalence, clinical and biochemical profiles, and therapeutic patterns associated with TRH among hypertensives in primary care. METHODS An observational analytical study was conducted at a district hospital in KwaZulu-Natal, South Africa, from March to April 2024. Data from 400 systematically randomised hypertensive patients aged > 30 years were analysed. Participants underwent automated office blood pressure monitoring, anthropometric assessments and completed structured interviews on health behaviours and medication adherence. Clinical parameters and antihypertensive medication profiles were reviewed. Determinants of apparent TRH were identified using multivariate logistic regression. RESULTS The mean age of the participants was 64.4 years (SD = 10.8), with a female preponderance (n = 260,65%), and nearly two-thirds comprised of Black Africans (35.3%) and Indians (30.5%). The prevalence of apparent TRH was 18.8%, comprising 11% uncontrolled and 7.8% controlled TRH. Factors significantly associated with TRH included Black African ethnicity (Odds Ratio (OR) = 2.33, p < 0.001), waist circumference (OR = 1.03, p < 0.001), left ventricular hypertrophy (OR = 3.57, p < 0.001), chronic kidney disease (OR = 3.12, p < 0.001), and dyslipidaemia (OR = 2.46, p = 0.039). Mineralocorticoid receptor antagonists were underused (10.8%). CONCLUSION This first report of apparent TRH prevalence in South African primary care underscores its complex association with cardiometabolic risk factors and the disproportionate burden among Black Africans. These findings highlight the urgent need for targeted, multifaceted interventions and the development of locally relevant TRH-specific guidelines to mitigate cardiovascular risks among this high-risk population.
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Affiliation(s)
- Kellicia Courtney Govender
- Department of Family Medicine, School of Nursing and Public Health, University of KwaZulu- Natal, Durban, South Africa.
| | - Mergan Naidoo
- Department of Family Medicine, School of Nursing and Public Health, University of KwaZulu- Natal, Durban, South Africa
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Hellqvist H, Rietz H, Grote L, Hedner J, Sommermeyer D, Kahan T, Spaak J. Overnight stiffness index from finger photoplethysmography in relation to markers of cardiovascular risk and vascular ageing. Heart Vessels 2025:10.1007/s00380-025-02537-3. [PMID: 40085218 DOI: 10.1007/s00380-025-02537-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Accepted: 03/05/2025] [Indexed: 03/16/2025]
Abstract
Wearable technology, such as photoplethysmography (PPG), enables easily accessible individual health data with the potential for improved risk assessment. We hypothesized that the overnight stiffness index (OSI), derived from nocturnal finger PPG, could be used to assess cardiovascular risk and vascular ageing. Subjects with confirmed or suspected hypertension (n = 79, 56 males) underwent simultaneous ambulatory blood pressure monitoring (ABPM) and overnight sleep polygraphy with a continuous PPG registration. Overnight PPG-based pulse propagation time was used to calculate OSI. Associations between OSI and markers of cardiovascular risk, blood pressure, and indices of arterial stiffness, as indicators of vascular ageing, were assessed. Subjects were stratified into low and high OSI (according to median, 10.9 m/s). SCORE2/SCORE2-OP and Framingham risk scores were calculated. The high OSI group had higher SCORE2/SCORE2-OP (9.5 [5.5;12.5] vs 5.0 [4.0;6.5]), and OSI correlated with SCORE2/SCORE2-OP and Framingham risk score (rs = 0.40 and rs = 0.41; both P < 0.01). Indices of arterial stiffness were increased in the high OSI group including ABPM awake and asleep pulse pressures (59 ± 14 vs 50 ± 9 mmHg, P < 0.01, and 54 ± 14 vs 45 ± 7 mmHg, P < 0.001), and ambulatory arterial stiffness index (0.47 ± 0.12 vs 0.37 ± 0.11, P < 0.001), respectively. OSI correlated with 24-h and asleep pulse pressure also after adjusting for confounders. OSI was related to systolic ABPM (awake r = 0.42, asleep r = 0.55; both P < 0.001) and diastolic ABPM (asleep r = 0.36, P < 0.01). OSI, a novel PPG-based measure of nocturnal arterial stiffness, correlates with established cardiovascular risk scores and with blood pressure-derived indices of vascular ageing. This simple method may facilitate cardiovascular risk assessment using readily available medical and wearable consumer devices.
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Affiliation(s)
- Henrik Hellqvist
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Hermine Rietz
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ludger Grote
- Department of Internal Medicine and Clinical Nutrition, Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Hedner
- Department of Internal Medicine and Clinical Nutrition, Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dirk Sommermeyer
- Department of Internal Medicine and Clinical Nutrition, Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Spaak
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Mesquita Bastos J, Ferraz L, Pereira FG, Lopes S. Systolic Blood Pressure and Pulse Pressure Are Predictors of Future Cardiovascular Events in Patients with True Resistant Hypertension. Diagnostics (Basel) 2023; 13:diagnostics13101817. [PMID: 37238300 DOI: 10.3390/diagnostics13101817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
Given the increased risk of cardiovascular events associated with resistant hypertension, predictive cardiovascular prognosis is extremely important. Ambulatory blood pressure monitoring (ABPM) is mandatory for resistant hypertension diagnosis, but its use for prognosis is scarce. This observational longitudinal study included 258 patients (mean age of 60.4 ± 11.2 years; 61.2% male), who underwent 24 h ABPM in a hypertension unit from 1999 to 2019. The outcomes were global cardiovascular events (cerebrovascular, coronary, and other cardiovascular events). The mean follow-up period was 6.0 ± 5.0 years. Sixty-eight cardiovascular events (61 nonfatal) were recorded. Patients who experienced cardiovascular events were generally older, with higher rates of chronic kidney disease and prior cardiovascular events. The 24 h systolic blood pressure (hazard ratio 1.44; 95% CI 1.10-1.88), night systolic blood pressure (1.35; 95% CI 1.01-1.80), and 24 h pulse pressure (2.07; 95% CI 1.17-3.67) were independent predictors of global cardiovascular events. Multivariate Cox analysis revealed a higher risk of future cardiovascular events, particularly in patients with a 24 h daytime and nighttime pulse pressure > 60 mm Hg with respective hazard ratios of 1.95; 95% CI 1.01-3.45; 2.15; 95% CI 1.21-3.83 and 2.07; 95% CI 1.17-3.67. In conclusion, APBM is a fundamental tool not only for the diagnosis of resistant hypertension, but also for predicting future cardiovascular events.
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Affiliation(s)
- J Mesquita Bastos
- School of Health Sciences and Institute of Biomedicine-iBiMED, University of Aveiro, 3810-193 Aveiro, Portugal
- Cardiology Department, Centro Hospitalar do Baixo Vouga, 3810-164 Aveiro, Portugal
| | - Lisa Ferraz
- Internal Medicine Department, Centro Hospitalar do Baixo Vouga, 3810-164 Aveiro, Portugal
| | - Flávio G Pereira
- Internal Medicine Department, Centro Hospitalar do Baixo Vouga, 3810-164 Aveiro, Portugal
| | - Susana Lopes
- School of Health Sciences and Institute of Biomedicine-iBiMED, University of Aveiro, 3810-193 Aveiro, Portugal
- Polytechnic of Coimbra, ESTeSCoimbra Health School, Physiotherapy Department, 3040-854 Coimbra, Portugal
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Podrug M, Šunjić B, Bekavac A, Koren P, Đogaš V, Mudnić I, Boban M, Jerončić A. The effects of experimental, meteorological, and physiological factors on short-term repeated pulse wave velocity measurements, and measurement difficulties: A randomized crossover study with two devices. Front Cardiovasc Med 2023; 9:993971. [PMID: 36712242 PMCID: PMC9873998 DOI: 10.3389/fcvm.2022.993971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
Background Large longitudinal studies with repeated pulse wave velocity (PWV) measurements, a direct measure of arterial stiffness, are required to realize the full potential of arterial stiffness in clinical practice. To facilitate such studies it is important to increase the power of a study by reducing within-subject variability of PWV, and to ease the use of a PWV device in clinical settings by minimizing PWV measurement difficulties. Methods We systematically investigated experimental setting and meteorological conditions, as well as physiological factors and participant characteristics, to determine whether and to what extent they affected: between- and within-subjects variability of PWV recordings, and measurement difficulties of a particular device. We conducted a 2-week longitudinal block-randomized cross-over study with two blinded observers and two commonly used devices: applanation tonometry SphygmoCor CvMS and oscillometric Arteriograph to assess carotid-femoral (cfPWV) or aortic (PWVao) PWV, respectively. Our sample had uniform and wide-spread distribution of age, blood pressures, hypertensive status and BMI. Each participant (N = 35) was recorded 12 times over 3 visiting days, 7 days apart. On each day, recordings were made twice in the morning (7-10 a.m.) and afternoon (16-18 p.m.). Data were analyzed using multilevel mixed-effects models, separately for each device. Results In addition to age and mean arterial pressure (MAP) that strongly affected both cfPWV and PWVao, other significant factors appeared to indicate a measurement approach. cfPWV as a more direct measure of arterial stiffness was additionally affected by hypertension status, outdoor temperature, interaction of MAP with outdoor temperature and the order of visit, with MAP within-subject variability contributing on average 0.27 m/s to difference in repeated measurements at 5°C and 0.004 m/s at 25°C. PWVao measurements derived at a single brachial site were more dependent on age than cfPWV and also depended on personal characteristics such as height and sex, and heart rate; with within-subject MAP variability adding on average 0.23 m/s to the difference in repeated measures. We also found that female sex significantly increased, and recording in afternoon vs. morning significantly decreased measurement difficulties of both devices. Conclusion We identified factors affecting PWV recordings and measurement-difficulties and propose how to improve PWV measuring protocols.
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Affiliation(s)
- Mario Podrug
- Laboratory of Vascular Aging, University of Split School of Medicine, Split, Croatia,University Department of Health Studies, University of Split, Split, Croatia
| | - Borna Šunjić
- Laboratory of Vascular Aging, University of Split School of Medicine, Split, Croatia,University Department of Health Studies, University of Split, Split, Croatia
| | - Anamarija Bekavac
- PhD Study Programme, University of Split School of Medicine, Split, Croatia
| | - Pjero Koren
- Laboratory of Vascular Aging, University of Split School of Medicine, Split, Croatia,Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Varja Đogaš
- Department of Psychological Medicine, University of Split School of Medicine, Split, Croatia
| | - Ivana Mudnić
- Department of Basic and Clinical Pharmacology, University of Split School of Medicine, Split, Croatia
| | - Mladen Boban
- Department of Basic and Clinical Pharmacology, University of Split School of Medicine, Split, Croatia
| | - Ana Jerončić
- Laboratory of Vascular Aging, University of Split School of Medicine, Split, Croatia,Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia,*Correspondence: Ana Jerončić,
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Zhang Y, Zhou C, Huang Z, Ye X. Study of cuffless blood pressure estimation method based on multiple physiological parameters. Physiol Meas 2021; 42. [PMID: 33857923 DOI: 10.1088/1361-6579/abf889] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/15/2021] [Indexed: 11/11/2022]
Abstract
Objective.Noninvasive blood pressure (BP) measurement technologies have been widely studied, but they still have the disadvantages of low accuracy, the requirement for frequent calibration and limited subjects. This work considers the regulation of vascular activity by the sympathetic nervous system and proposes a method for estimating BP using multiple physiological parameters.Approach.The parameters used in the model consist of heart rate variability (HRV), pulse transit time (PTT) and pulse wave morphology features extracted from electrocardiogram (ECG) and photoplethysmogram (PPG) signals. Through four classic machine learning algorithms, a hybrid data set of 3337 subjects from two databases is evaluated to verify the ability of cross-database migration. We also recommend an individual calibration procedure to further improve the accuracy of the method.Main results.The mean absolute error (MAE) and the root mean square error (RMSE) of the proposed algorithm is 10.03 and 14.55 mmHg for systolic BP (SBP), and 5.42 and 8.19 mmHg for diastolic BP (DBP). With individual calibration, the MAE and standard deviation (SD) is -0.16 ± 7.96 (SBP) and -0.13 ± 4.50 (DBP) mmHg, which satisfied the Advancement of Medical Instrumentation (AAMI) standard. In addition, the models are used to test single databases to evaluate their performance on different data sources. The overall performance of the Adaboost algorithm is better on the Multi-parameter Intelligent Monitoring in Intensive Care Unit (MIMIC) database; the MAE between its predicted value and true value reaches 6.6mmHg (SBP) and 3.12mmHg (DBP), respectively.Significance.The proposed method considers the regulation of blood vessels and the heart by the autonomic nervous system, and verifies its effectiveness and robustness across data sources, which is promising for improving the accuracy of continuous and cuffless BP estimation.
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Affiliation(s)
- Yiming Zhang
- Department of Biomedical Engineering, Key Laboratory for Biomedical Engineering of Education Ministry, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Congcong Zhou
- Department of Biomedical Engineering, Key Laboratory for Biomedical Engineering of Education Ministry, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Zhongyi Huang
- Department of Biomedical Engineering, Key Laboratory for Biomedical Engineering of Education Ministry, Zhejiang University, Hangzhou 310027, People's Republic of China
| | - Xuesong Ye
- Department of Biomedical Engineering, Key Laboratory for Biomedical Engineering of Education Ministry, Zhejiang University, Hangzhou 310027, People's Republic of China.,Cyrus Tang Center for Sensor Materials and Applications, Zhejiang University, Hangzhou 310058, People's Republic of China
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Guo X, Li Y, Yang Y, Wang W, Liang S, Zheng Y, Chen X, Cai G. Noninvasive markers of arterial stiffness and renal outcomes in patients with chronic kidney disease. J Clin Hypertens (Greenwich) 2021; 23:823-830. [PMID: 33523570 PMCID: PMC8678811 DOI: 10.1111/jch.14185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/22/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Abstract
Our study aimed to explore the intercorrelations of brachial‐ankle pulse wave velocity (baPWV), ankle‐brachial index (ABI), ambulatory arterial stiffness index (AASI), 24‐hour mean pulse pressure (24‐h PP), and augmentation index (AIx, AIx@75, the AIx standardized to a heart rate of 75) and compare the effectiveness of these markers for predicting renal outcomes. A total of 117 patients with chronic kidney disease (CKD) who received noninvasive arterial stiffness examinations were enrolled. We used correlation analysis and linear regression to explore the correlations between these five arterial stiffness markers and the Cox proportional hazards model and receiver operator characteristic (ROC) curve to assess the associations of markers with kidney disease outcomes. The median (interquartile range) of age and eGFR were 61 (49‐65) years and 50.5 (35.5‐84.1) ml/min/1.73 m2, respectively. In Pearson correlation analysis, baPWV was significantly associated with 24‐h PP (r = .531, p < .001), AIx@75 (r = .306, p < .001). Additionally, 24‐h PP was associated with AASI (r = .507, p < .001) and AIx@75 (r = .217, p = .019). During follow‐up for a median of 25 months, 26.5% (n = 31) of patients had a composite outcome; of these, 10 initiated dialysis, 17 had 40% eGFR loss, and 4 died. Increased AASI, 24‐h PP, and baPWV were associated with poor renal outcomes in a univariate Cox analysis. After adjusting for age, sex, MAP, eGFR, and 24 hours proteinuria, 1‐SD increase in AASI and 24‐h PP was associated with renal outcomes. The ROC analysis yielded the largest area under the curve (AUC) of 0.727 (95% CI: 0.624 to 0.831; p < .001) for 24 ‐h PP. When the Youden's index was at its maximum, the 24‐h PP value was 52 mmHg. In conclusion, 24‐h PP, baPWV, and AIx@75 were linked well to one another. Arterial stiffness is a target for delaying the decline in kidney function. The use of 24‐h PP as an arterial stiffness marker should be valued in CKD clinical practice.
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Affiliation(s)
- Xinru Guo
- Department of Nephrology, Medical School of Chinese PLA, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yisha Li
- Department of Nephrology, Medical School of Chinese PLA, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ying Yang
- Department of Nephrology, Medical School of Chinese PLA, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Wenling Wang
- Department of Nephrology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shuang Liang
- Department of Nephrology, Medical School of Chinese PLA, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ying Zheng
- Department of Nephrology, Medical School of Chinese PLA, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiangmei Chen
- Department of Nephrology, Medical School of Chinese PLA, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, Medical School of Chinese PLA, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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Xing X, Ma Z, Zhang M, Gao X, Li Y, Song M, Dong WF. Robust blood pressure estimation from finger photoplethysmography using age-dependent linear models. Physiol Meas 2020; 41:025007. [DOI: 10.1088/1361-6579/ab755d] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Ambulatory arterial stiffness index and its role in assessing arterial stiffness in dialysis patients. J Hypertens 2017; 35:1297-1301. [PMID: 28441698 DOI: 10.1097/hjh.0000000000001309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Ambulatory arterial stiffness index (AASI) is a parameter derived from ambulatory blood pressure (ABP) readings. It is calculated as 1 minus the linear slope of DBP on SBP. We tested its value in assessing arterial stiffness in dialysis patients. METHODS We performed a cross-sectional analysis of the baseline data from a cohort study. A total of 344 patients on maintenance hemodialysis from six tertiary hospitals were included. All patients underwent ABP monitoring and carotid-femoral pulse wave velocity (cfPWV) measurement. Clinical determinants of AASI were analyzed, and the ability of AASI for assessing arterial stiffness was compared with ambulatory pulse pressure (PP). RESULTS Multiple regression analysis revealed that ambulatory PP (β = 0.003), current smoker (β = -0.069), age (β = 0.003) and ambulatory SBP (β = 0.001) were independent determinants of AASI. Ambulatory PP correlates better with cfPWV than AASI (r = 0.28 for AASI and 0.59 for PP; P for difference: <0.001). When cfPWV was treated as a categorical variable, receiver operating characteristic curve analysis also showed a more potent predictive value of PP over AASI (area under the curve: 0.64 for AASI, 0.80 for PP; P for difference: <0.001). Net reclassification improvement and integrated discrimination improvement analysis demonstrated no added predictive value of AASI to PP (net reclassification improvement = -2.2%, P = 0.26; integrated discrimination improvement = 0.001, P = 0.51). Sensitivity analysis in patients with more ABP readings (≥49) yielded similar results. CONCLUSION For dialysis patients, AASI has very limited value in assessing arterial stiffness, whether used alone or added to PP. Our results suggest that this index should not be used as a surrogate marker of arterial stiffness for dialysis patients in future practice and studies.
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Woodiwiss AJ, Norton GR, Ben-Dov IZ, Gavish B, Bursztyn M. Association of Blood Pressure Variability Ratio With Glomerular Filtration Rate Independent of Blood Pressure and Pulse Wave Velocity. Am J Hypertens 2017; 30:1177-1188. [PMID: 28992192 DOI: 10.1093/ajh/hpx122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/13/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Blood pressure variability ratio (BPVR)(derived from within-subject SD of 24-hour ambulatory blood pressure [BP]) predicts all-cause mortality independent of BP and has a similar prognostic ability to ambulatory arterial stiffness (AASI). Whether BPVR, and AASI, offer prognostic information beyond measurements of arterial stiffness at a given pressure, as indexed by pulse wave velocity (PWV), is not known. METHODS We assessed whether BPVR and AASI were associated with indices of subclinical organ damage (TOD) [estimated glomerular filtration rate (eGFR), left ventricular mass index, early-to-late transmitral velocity (E/A), carotid intima-media thickness (IMT)] independent of BP, and whether BPVR-TOD and AASI-TOD relations were independent of PWV (applanation tonometry) in 772 randomly selected participants from an urban, developing community. AASI was derived from 24-hour diastolic BP vs. systolic BP standard linear regression. RESULTS On bivariate analyses, BPVR, AASI, and PWV were correlated with all indices of TOD (P < 0.0005). However, after adjustments for potential confounders including age and 24-hour mean BP, BPVR, and PWV (P < 0.005 to P < 0.0001), but not AASI (P > 0.25), were independently associated with eGFR, but not other indices of TOD. Importantly, the BPVR-eGFR relation was independent of BP variability (P < 0.005) and PWV (P < 0.001). CONCLUSIONS BPVR was negatively associated with eGFR independent of mean BP, BP variability, and PWV. Therefore, in the prediction of cardiovascular risk, measurements of arterial stiffening (BPVR) may provide information beyond the impact of arterial stiffness.
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Affiliation(s)
- Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Iddo Z Ben-Dov
- The Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Michael Bursztyn
- Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Li GY, He Q, Jia L, He P, Luo J, Cao Y. An Inverse Method to Determine Arterial Stiffness with Guided Axial Waves. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:505-516. [PMID: 27908486 DOI: 10.1016/j.ultrasmedbio.2016.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 10/09/2016] [Accepted: 10/19/2016] [Indexed: 05/26/2023]
Abstract
Many cardiovascular diseases can alter arterial stiffness; therefore, measurement of arterial wall stiffness can provide valuable information for both diagnosis of such diseases in the clinic and evaluation of the effectiveness of relevant drugs. However, quantitative assessment of the in vivo elastic properties of arterial walls in a non-invasive manner remains a great challenge. In this study, we found that the elastic modulus of the arterial wall can be extracted from the dispersion curve of the guided axial wave (GAW) measured using the ultrasound elastography method. It is shown that the GAW in the arterial wall can be well described with the Lamb wave (LW) model when the frequency exceeds a critical value fc, whose explicit form is determined here based on dimensional analysis method and systematic finite-element simulations. Further, an inverse procedure is proposed to determine both fc and the elastic modulus of the arterial wall. Phantom experiments have been performed to validate the inverse method and illustrate its potential use in the clinic.
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Affiliation(s)
- Guo-Yang Li
- Institute of Biomechanics and Medical Engineering, AML, Department of Engineering Mechanics, Tsinghua University, Beijing, China
| | - Qiong He
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Lin Jia
- Institute of Biomechanics and Medical Engineering, AML, Department of Engineering Mechanics, Tsinghua University, Beijing, China
| | - Ping He
- Department of Ultrasonography, Peking University Third Hospital, Beijing, China
| | - Jianwen Luo
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Yanping Cao
- Institute of Biomechanics and Medical Engineering, AML, Department of Engineering Mechanics, Tsinghua University, Beijing, China.
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Wu CF, Liu PY, Wu TJ, Hung Y, Yang SP, Lin GM. Therapeutic modification of arterial stiffness: An update and comprehensive review. World J Cardiol 2015; 7:742-753. [PMID: 26635922 PMCID: PMC4660469 DOI: 10.4330/wjc.v7.i11.742] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/09/2015] [Accepted: 09/25/2015] [Indexed: 02/06/2023] Open
Abstract
Arterial stiffness has been recognized as a marker of cardiovascular disease and associated with long-term worse clinical outcomes in several populations. Age, hypertension, smoking, and dyslipidemia, known as traditional vascular risk factors, as well as diabetes, obesity, and systemic inflammation lead to both atherosclerosis and arterial stiffness. Targeting multiple modifiable risk factors has become the main therapeutic strategy to improve arterial stiffness in patients at high cardiovascular risk. Additionally to life style modifications, long-term ω-3 fatty acids (fish oil) supplementation in diet may improve arterial stiffness in the population with hypertension or metabolic syndrome. Pharmacological treatment such as renin-angiotensin-aldosterone system antagonists, metformin, and 3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors were useful in individuals with hypertension and diabetes. In obese population with obstructive sleep apnea, weight reduction, aerobic exercise, and continuous positive airway pressure treatment may also improve arterial stiffness. In the populations with chronic inflammatory disease such as rheumatoid arthritis, a use of antibodies against tumor necrosis factor-alpha could work effectively. Other therapeutic options such as renal sympathetic nerve denervation for patients with resistant hypertension are investigated in many ongoing clinical trials. Therefore our comprehensive review provides knowledge in detail regarding many aspects of pathogenesis, measurement, and management of arterial stiffness in several populations, which would be helpful for physicians to make clinical decision.
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Affiliation(s)
- Ching-Fen Wu
- Ching-Fen Wu, Department of Internal Medicine, Mennonite Christian Hospital, Hualien 97144, Taiwan
| | - Pang-Yen Liu
- Ching-Fen Wu, Department of Internal Medicine, Mennonite Christian Hospital, Hualien 97144, Taiwan
| | - Tsung-Jui Wu
- Ching-Fen Wu, Department of Internal Medicine, Mennonite Christian Hospital, Hualien 97144, Taiwan
| | - Yuan Hung
- Ching-Fen Wu, Department of Internal Medicine, Mennonite Christian Hospital, Hualien 97144, Taiwan
| | - Shih-Ping Yang
- Ching-Fen Wu, Department of Internal Medicine, Mennonite Christian Hospital, Hualien 97144, Taiwan
| | - Gen-Min Lin
- Ching-Fen Wu, Department of Internal Medicine, Mennonite Christian Hospital, Hualien 97144, Taiwan
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Takata M, Amiya E, Watanabe M, Yamada N, Watanabe A, Kawarasaki S, Ozeki A, Nakao T, Hosoya Y, Ando J, Komuro I. The association between orthostatic increase in pulse pressure and ischemic heart disease. Clin Exp Hypertens 2015; 38:23-9. [PMID: 26287795 DOI: 10.3109/10641963.2015.1047948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The clinical meaning of changes in PP with posture remains unclear. We performed treadmill exercise testing on 144 subjects to diagnose ischemic heart disease, and measured the PPs in the supine and standing positions. The differences in the two PPs ranged between -35 and 45 mmHg. Eleven subjects were diagnosed with significant coronary ischemia. The differences in the PPs were significantly increased, and PP in the standing position was significantly elevated in these subjects. A large difference in the PPs in the standing and supine positions was associated with significant coronary ischemia, independent of significant covariables.
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Affiliation(s)
- Munenori Takata
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan .,b Department of Clinical Research Support Center , The University of Tokyo Hospital , Tokyo , Japan
| | - Eisuke Amiya
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
| | - Masafumi Watanabe
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
| | - Namie Yamada
- c General Education Center, The University of Tokyo Hospital , Tokyo , Japan , and
| | - Aya Watanabe
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
| | - Shuichi Kawarasaki
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan .,b Department of Clinical Research Support Center , The University of Tokyo Hospital , Tokyo , Japan
| | - Atsuko Ozeki
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
| | - Tomoko Nakao
- d Department of Clinical Laboratory , The University of Tokyo Hospital , Tokyo , Japan
| | - Yumiko Hosoya
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
| | - Jiro Ando
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
| | - Issei Komuro
- a Department of Cardiovascular Medicine , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
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Dégi A, Kerti A, Cseprekál O, Kis É, Sallay P, Szabó AJ, Reusz GS. Ambulatory arterial stiffness index in children after kidney transplantation. Pediatr Transplant 2013; 17:598-604. [PMID: 23855604 DOI: 10.1111/petr.12123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/28/2022]
Abstract
Given the increase in CV morbidity after RTx and the scarcity of CV events in pediatrics, surrogate markers should be assessed to characterize CV damage in this population. AASI is a marker of arterial stiffness in adults, predicting cardio- and cerebrovascular morbidity. Our aim was to assess the determinants of AASI in RTx children (n = 54, 15.5 ± 3.5 yr) and to examine its relationship to central PWV. AASI was calculated from 24 h ABPM. PWV was determined by applanation tonometry, body composition by multifrequency bioimpedance measurement. The dipping state, volume overload, and time on dialysis were the main predictors of AASI (p < 0.05). Children with established HT (n = 34) had increased AASI, extracellular body water, and BNP (p < 0.05). In contrast to AASI, PWV did not differ between HT and normotensive RTx patient groups. There was no correlation between AASI and PWV. PWV was increased in children who spent more than one yr on dialysis prior to RTx. In conclusion, increased AASI in HT RTx children better characterizes the actual volume- and pressure-dependent arterial rigidity rather than long-term morphological changes in large arteries as reflected by PWV.
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Affiliation(s)
- Arianna Dégi
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
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14
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Kim H, Kim HS, Yoon HJ, Park HS, Cho YK, Nam CW, Hur SH, Kim YN, Kim KB. Association of cardio-ankle vascular index with diastolic heart function in hypertensive patients. Clin Exp Hypertens 2013; 36:200-5. [DOI: 10.3109/10641963.2013.804544] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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15
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de Souza F, Muxfeldt ES, Salles GF. Prognostic factors in resistant hypertension: implications for cardiovascular risk stratification and therapeutic management. Expert Rev Cardiovasc Ther 2013; 10:735-45. [PMID: 22894630 DOI: 10.1586/erc.12.58] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Resistant hypertension (RH) is defined as uncontrolled office blood pressure (BP) in spite of the use of at least three antihypertensive medications. Although its condition has a high prevalence, it is still understudied, and its prognosis is not well established. Some prospective studies evaluated the prognostic value of ambulatory BP monitoring, ECG and renal parameters. They pointed out that ambulatory BPs are important predictors of cardiovascular morbidity and mortality, whereas office BP has no prognostic value. The diagnosis of true RH and the nondipping pattern are also valuable predictors of cardiovascular outcomes. Moreover, several ECG (prolonged ventricular repolarization, serial changes in the strain pattern and left ventricular hypertrophy) and renal parameters (albuminuria and reduced glomerular filtration rate) are also powerful cardiovascular risk markers in RH. These markers and others yet unexplored, such as arterial stiffness and serum biomarkers, may improve cardiovascular risk stratification in these very high-risk patients.
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Affiliation(s)
- Fabio de Souza
- Internal Medicine Department, University Hospital Clementino Fraga Filho, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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16
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Guasch B, Torguet P, Garcia I, Calabia J, Martín N, Maté G, Faur D, Barreiro Y, Molina C, Noboa C, Vallès M. Utilidad de la monitorización ambulatoria de la presión arterial en la evaluación de la rigidez arterial. Correlaciones con la velocidad de onda de pulso y las tensiones arteriales centrales. HIPERTENSION Y RIESGO VASCULAR 2013. [DOI: 10.1016/j.hipert.2012.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Kollias A, Stergiou GS, Dolan E, O'Brien E. Ambulatory arterial stiffness index: A systematic review and meta-analysis. Atherosclerosis 2012; 224:291-301. [DOI: 10.1016/j.atherosclerosis.2012.03.039] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 03/30/2012] [Accepted: 03/31/2012] [Indexed: 11/25/2022]
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18
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Matsui Y, O'Rourke MF, Ishikawa J, Shimada K, Kario K. Association of changes in ambulatory arterial stiffness index and pulse wave velocity during antihypertensive treatment: the J-CORE study. Am J Hypertens 2012; 25:862-8. [PMID: 22647783 DOI: 10.1038/ajh.2012.64] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We aimed to investigate the association of the change in the ambulatory arterial stiffness index (AASI) with that in carotid-femoral pulse wave velocity (cfPWV) during treatment with antihypertensive medication. METHODS We enrolled 207 hypertensive patients treated with olmesartan monotherapy for 12 weeks. Patients were randomly assigned to treatment with hydrochlorothiazide (HCTZ; n = 104) or azelnidipine (n = 103) for 24 weeks. The cfPWV and 24-h ambulatory blood pressure monitoring (ABPM) results were assessed at baseline and 24 weeks later. The AASI was defined as 1 minus the regression slope of diastolic blood pressure (DBP) on systolic BP (SBP), and was calculated by standard and symmetric regression. RESULTS The changes in the AASI and symmetrical AASI were similar between the two groups, while cfPWV in the azelnidipine group decreased more than in the HCTZ group (P < 0.001). The change in AASI was not significantly correlated with change in cfPWV (r = 0.08, P = 0.26), whereas the change in symmetrical AASI was significantly but weakly correlated with change in cfPWV (r = 0.22, P < 0.001). The multivariable linear regression analysis revealed that the association of the change in symmetrical AASI with change in cfPWV remained significant even after adjustments for covariates derived from ABPM (regression coefficient (95% confidence interval): 1.33 (0.35-2.30), P = 0.01). CONCLUSIONS The present study demonstrated that neither AASI nor symmetrical AASI may be an unequivocal marker of arterial stiffness during antihypertensive treatment.
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Zang XY, Zhang H, Cheng SL, Gao YJ, Cao YJ, Zhao Y, Mårtensson J. Pivotal factors interfering in 24-hour blood pressure fluctuation and arterial stiffness in a community of Chinese elderly hypertensive patients. J Clin Nurs 2012; 22:379-88. [DOI: 10.1111/j.1365-2702.2011.04047.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wang Y, Hu Y, Li Y, Li H, Chu S, Zhu D, Gao P. Association of renal function with the ambulatory arterial stiffness index and pulse pressure in hypertensive patients. Hypertens Res 2011; 35:201-6. [DOI: 10.1038/hr.2011.167] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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21
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The relationship between systolic and diastolic blood pressure: a clinically meaningful slope? Hypertens Res 2011; 34:1175-8. [PMID: 21937994 DOI: 10.1038/hr.2011.161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Assessment of arterial stiffness from ambulatory blood pressure monitoring in children with diabetes mellitus type-1 (DMT1). J Hum Hypertens 2011; 26:357-64. [PMID: 21544085 DOI: 10.1038/jhh.2011.38] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pulse pressure (PP) and ambulatory arterial stiffness index (AASI) can be calculated from ambulatory blood pressure (BP) monitoring (ABPM) and have been suggested as markers of arterial stiffness and predictors of cardiovascular mortality. We retrospectively evaluated PP and AASI from ABPM records in 84 children (43 boys) with diabetes mellitus type-1 (DMT1) compared with 27 non-diabetic normotensive children. Based on office BP and ABPM, patients with DMT1 were divided into three groups: 24/84 (29%) had hypertension (DM HTN), 33/84 (39%) were normotensive (DM NT) and 27/84 (32%) had white-coat hypertension (DM WCH). DM WCH and DM HTN patients had significantly higher PP when compared with DM NT and NT patients alone (47.62 ± 7.31 and 47.43 ± 8.68 versus 41.45 ± 4.44 and 42.18 ± 5.97, respectively, P=0.0002). Similarly, AASI was significantly elevated in both DM WCH and DM HTN patients when compared with NT patients (0.35 ± 0.14 and 0.36 ± 0.15 versus 0.23 ± 0.15, respectively, P=0.007). In conclusion, children with DMT1 and hypertension, including WCH, had significantly higher PP and AASI levels when compared with normotensive patients. This suggests that these children may be at an increased risk for developing cardiovascular complications later on in life.
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Garcia-Ortiz L, Ramos-Delgado E, Recio-Rodriguez JI, Agudo-Conde C, Martínez-Salgado C, Patino-Alonso MC, Rodriguez-Sanchez E, Gomez-Marcos MA. Peripheral and central arterial pressure and its relationship to vascular target organ damage in carotid artery, retina and arterial stiffness. Development and validation of a tool. The Vaso risk study. BMC Public Health 2011; 11:266. [PMID: 21524299 PMCID: PMC3096907 DOI: 10.1186/1471-2458-11-266] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 04/27/2011] [Indexed: 12/22/2022] Open
Abstract
Background Ambulatory blood pressure monitoring (ABPM) shows a better correlation to target organ damage and cardiovascular morbidity-mortality than office blood pressure. A loss of arterial elasticity and an increase in carotid artery intima-media thickness (IMT) has been associated with increased cardiovascular morbidity-mortality. Tools have been developed that allow estimation of the retinal arteriovenous index but not all studies coincide and there are contradictory results in relation to the evolution of the arteriosclerotic lesions and the caliber of the retinal vessels. The purpose of this study is to analyze the relationship between peripheral and central arterial pressure (clinic and ambulatory) and vascular structure and function as evaluated by the carotid artery intima-media thickness, retina arteriovenous index, pulse wave velocity (PWV) and ankle-brachial index in patients with and without type 2 diabetes. In turn, software is developed and validated for measuring retinal vessel thickness and automatically estimating the arteriovenous index. Methods/Design A cross-sectional study involving a control group will be made, with a posterior 4-year follow-up period in primary care. The study patients will be type 2 diabetics, with a control group of non-diabetic individuals. Consecutive sampling will be used to include 300 patients between 34-75 years of age and no previous cardiovascular disease, one-half being assigned to each group. Main measurements: age, gender, height, weight and abdominal circumference. Lipids, creatinine, microalbuminuria, blood glucose, HbA1c, blood insulin, high sensitivity C-reactive protein and endothelial dysfunction markers. Clinic and ambulatory blood pressure monitoring. Carotid ultrasound to evaluate IMT, and retinography to evaluate the arteriovenous index. ECG to assess left ventricle hypertrophy, ankle-brachial index, and pulse wave analysis (PWA) and pulse wave velocity (PWV) with the Sphigmocor System. Discussion We hope to obtain information on the correlation of different ABPM-derived parameters and PWA to organ target damage - particularly vascular structure and function evaluated from the IMT and PWV - and endothelial dysfunction in patients with and without type 2 diabetes. We also hope to demonstrate the usefulness of the instrument developed for the automated evaluation of retinal vascularization in the early detection of alterations in vascular structure and function and in the prognosis of middle-term cardiovascular morbidity. Trial Registration Clinical Trials.gov Identifier: NCT01325064
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Affiliation(s)
- Luis Garcia-Ortiz
- Unidad de Investigación de Atención Primaria La Alamedilla, Salamanca, Spain.
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Hietanen HJ, Pääkkönen R, Salomaa V. Ankle blood pressure and pulse pressure as predictors of cerebrovascular morbidity and mortality in a prospective follow-up study. Stroke Res Treat 2011; 2010:729391. [PMID: 21318164 PMCID: PMC3026983 DOI: 10.4061/2010/729391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Revised: 11/24/2010] [Accepted: 12/23/2010] [Indexed: 11/20/2022] Open
Abstract
Background and Objective. We examined the association of elevated ankle blood pressure (ABP), together with exercise blood pressure, with incident cerebrovascular (CV) morbidity and mortality in a prospective follow-up study of 3,808 patients. The results were compared with pulse pressure, another indicator of arterial stiffness. Methods. Patients with normal ankle and exercise brachial blood pressures were taken as the reference group. Pulse pressure was considered as quartiles with the lowest quartile as the reference category. Results. A total of 170 subjects had a CV event during the follow-up. Multivariate adjusted hazard ratio of a CV event was 2.24 (95% CI 1.43–3.52, P < .0001) in patients with abnormal ABP. The pulse pressure was significant only in the model adjusted for age and sex. Conclusion. The risk of a future CV event was elevated already in those patients among whom elevated ABP was the only abnormal finding. As a risk marker, ABP is superior to the pulse pressure.
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Affiliation(s)
- Heikki J Hietanen
- Department of Clinical Physiology, Helsinki Deaconess Institute, Alppikatu 2, 00530 Helsinki, Finland
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Relationship between ambulatory arterial stiffness index and subclinical target organ damage in hypertensive patients. Hypertens Res 2010; 34:180-6. [PMID: 20962781 DOI: 10.1038/hr.2010.195] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Increased arterial stiffness has been shown to predict cardiovascular risk in hypertensive patients. Our objective was to evaluate the relationship between the ambulatory arterial stiffness index (AASI) and subclinical organ damage (SOD). The design was a cross-sectional study. Subjects included 554 hypertensive patients with and without drug treatment (mean age 57±12 years, 60.6% men). The AASI was defined as 1 minus the regression slope of diastolic over systolic blood pressure (BP) readings obtained from 24-h recordings. Renal damage was evaluated on the basis of glomerular filtration rate (GFR) and microalbuminuria; vascular damage was measured by carotid intima-media thickness (IMT) and ankle/brachial index (ABI); and cardiac damage was evaluated on the basis of the Cornell voltage-duration product (VDP) and left ventricular mass index. The mean AASI was 0.38±0.07 (0.39±0.07 in treated patients and 0.37±0.06 in nontreated subjects). The AASI showed a positive correlation with IMT (r=0.417, P<0.001) and Cornell VDP (r=0.188, P<0.001), and a negative correlation with GFR (r=-0.205, P=0.001) and the ABI. The variables associated with the presence of SOD were AASI (odds ratio (OR)=3.89) and smoking (OR=1.55). The variables associated with IMT were smoking and waist circumference, whereas those associated with GFR were AASI, body mass index and waist circumference. In turn, smoking, total cholesterol and glycosylated hemoglobin A1c were associated with the ABI. Increased AASI implies a greater presence of SOD in primary hypertensive patients with or without BP-lowering drug treatment.
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Wang MY, Huang CJ, Wu YL, Liu JC, Tsai PS. The influence of baroreflex sensitivity on ambulatory arterial stiffness index in individuals with cardiovascular risk. Blood Press Monit 2010; 15:262-7. [DOI: 10.1097/mbp.0b013e32833c8a7f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ambulatory arterial stiffness index, pulse pressure and pulse wave velocity in children and adolescents. Hypertens Res 2010; 33:1272-7. [PMID: 20882025 DOI: 10.1038/hr.2010.178] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Arterial stiffness, assessed by carotid-femoral pulse wave velocity (PWV) or indirectly by pulse pressure (PP) or ambulatory arterial stiffness index (AASI), is an independent predictor of cardiovascular disease in adults. However, in children limited evidence is available. This study investigated the usefulness of AASI and PP as indices of arterial stiffness in children and adolescents, by taking PWV as the reference method. Eighty-two children and adolescents (mean age 13.1±2.9 years) had 24-h ambulatory blood pressure (ABP) monitoring, PWV measurement and echocardiography. Compared with normotensives, subjects with hypertension (n=16) had higher 24-h ABP, 24-h PP and PWV, but not AASI. 24-h, PP was strongly correlated with age, weight, height, 24-h systolic ABP, PWV, left ventricular mass (LVM), LVM index, stroke volume and inversely with 24-h heart rate. AASI was also correlated with weight, height, systolic ABP and LVM, yet these associations were weaker than those of PP, and no significant correlations were found with PWV or LVM index. Moreover, closer agreement of PWV was observed with 24-h PP (71%, kappa 0.21) than with 24-h AASI (61%, kappa -0.06) in detecting subjects at the top quartile of the respective distributions. In children and adolescents, 24-h PP compared with AASI appears to be more closely associated with: (i) arterial stiffness assessed by PWV; (ii) target organ damage assessed by LVM index; and (iii) the presence of essential hypertension. These data suggest that the usefulness of AASI as an index of arterial stiffness in the pediatric population is questionable.
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Tuttolomondo A, Di Sciacca R, Di Raimondo D, Serio A, D’Aguanno G, Pinto A, Licata G. Arterial stiffness indexes in acute ischemic stroke: Relationship with stroke subtype. Atherosclerosis 2010; 211:187-94. [DOI: 10.1016/j.atherosclerosis.2010.02.010] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 01/14/2010] [Accepted: 02/10/2010] [Indexed: 11/28/2022]
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Parati G, Revera M. Information on arterial properties from home blood pressure monitoring: work still in progress. Hypertens Res 2010; 33:662-5. [DOI: 10.1038/hr.2010.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Muxfeldt ES, Cardoso CRL, Dias VB, Nascimento ACM, Salles GF. Prognostic impact of the ambulatory arterial stiffness index in resistant hypertension. J Hypertens 2010; 28:1547-1553. [PMID: 20467326 DOI: 10.1097/hjh.0b013e328339f9e5] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The ambulatory arterial stiffness index (AASI), derived from ambulatory blood pressure (BP) monitoring recordings, is an indirect marker of arterial stiffness and a potential predictor of cardiovascular risk. Resistant hypertension is defined as uncontrolled office BP despite the use of at least three antihypertensive drugs. The aim of this prospective study was to investigate the AASI prognostic value in patients with resistant hypertension. METHODS At baseline, 547 patients underwent clinical-laboratory, and 24-h ambulatory BP monitoring examinations. AASI was defined as 1 minus the regression slope of DBP on SBP, and was calculated by standard and symmetric regression. Primary endpoints were a composite of fatal and nonfatal cardiovascular events and all-cause and cardiovascular mortalities. Multiple Cox regression was used to assess associations between AASI and subsequent endpoints. RESULTS After median follow-up of 4.8 years, 101 patients (18.4%) reached the primary endpoint, and 65 all-cause deaths (11.9%) occurred (45 from cardiovascular causes). 24-h AASI was the best independent predictor of composite endpoint (hazard ratio 1.46, 95% confidence interval 1.12-1.92, for increments of 1-SD = 0.14), whereas cardiovascular mortality was best predicted by night-time AASI (hazard ratio 1.73, 95% confidence interval 1.13-2.65), after adjustments for cardiovascular risk factors, including mean ambulatory BPs and nocturnal BP reduction. Symmetric AASI was not superior to standard AASI. In sensitivity analysis, 24-h AASI was a better predictor of cardiovascular outcomes in women, in younger individuals, and in nondiabetic individuals. CONCLUSION AASI is a predictor of cardiovascular morbidity and mortality in resistant hypertension, over and beyond traditional risk factors and other ambulatory BP monitoring parameters.
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Affiliation(s)
- Elizabeth S Muxfeldt
- University Hospital Clementino Fraga Filho, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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31
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The dynamic relationship between systolic and diastolic blood pressure: yet another marker of vascular aging? Hypertens Res 2010; 33:659-61. [PMID: 20520611 DOI: 10.1038/hr.2010.95] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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32
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Correlation Between Arterial Stiffness Index and Arterial Wave Pattern and Incidence of Stroke. INT J GERONTOL 2010. [DOI: 10.1016/s1873-9598(10)70027-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Stergiou GS, Kollias A, Rarra VC, Nasothimiou EG, Roussias LG. Arterial stiffness index based on home (HASI) vs. ambulatory (AASI) blood pressure measurements. Hypertens Res 2010; 33:731-6. [DOI: 10.1038/hr.2010.62] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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34
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Time rate of blood pressure variation is superior to central hemodynamics as an associate of carotid intima–media thickness. J Hypertens 2010; 28:51-8. [DOI: 10.1097/hjh.0b013e328331b6c8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Castelpoggi CH, Pereira VS, Fiszman R, Cardoso CRL, Muxfeldt ES, Salles GF. A blunted decrease in nocturnal blood pressure is independently associated with increased aortic stiffness in patients with resistant hypertension. Hypertens Res 2009; 32:591-596. [PMID: 19444279 DOI: 10.1038/hr.2009.71] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Increased arterial stiffness may be causally related to resistant hypertension. Our objective was to investigate the variables, particularly those derived from ambulatory blood pressure (BP) monitoring (ABPM), associated with increased aortic stiffness in resistant hypertensives. In a cross-sectional study, 600 resistant hypertensive patients without peripheral arterial disease were evaluated. Arterial stiffness was assessed by aortic pulse wave velocity (PWV), and was considered increased if >12 m s(-1). Statistical analyses included multiple linear and logistic regressions to assess the independent correlates of increased aortic stiffness. One hundred and sixty-eight patients (28%) had aortic PWV >12 m s(-1). Patients with increased PWV were older and had a higher prevalence of cardiovascular risk factors than did those patients with low PWV. On ABPM, patients with elevated PWV had higher daytime and night time systolic BP (SBP) and pulse pressures (PP), less nocturnal decrease in SBP and a higher prevalence of non-dipping pattern. On multiple linear regression, the independently associated variables with aortic PWV were age (P<0.001), 24-h PP (P<0.001), high-density lipoprotein (HDL)-cholesterol (P<0.001), microalbuminuria (P<0.001), fasting glycemia (P=0.001) and a decrease in nocturnal SBP (P=0.002). Multivariate logistic regression confirmed these results, with the non-dipping patients having a 72% higher likelihood of presenting with increased aortic stiffness (95% confidence interval: 1.12-2.65, P=0.013). This association was observed in both the reduced and reverted dipping patterns, but not in the extreme dipping pattern. In conclusion, a blunted nocturnal decrease in BP is independently associated with increased aortic stiffness in resistant hypertensive patients. Other independent correlates are older age, diabetes, microalbuminuria, low HDL-cholesterol and a widened 24-h PP.
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Affiliation(s)
- Carlos H Castelpoggi
- Department of Internal Medicine, University Hospital Clementino Fraga Filho, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brasil
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