Aortic Diastolic Blood Pressure Research Articles

Identifying Isolated Systolic Hypertension From Upper-Arm Cuff Blood Pressure Compared With Invasive Measurements.

Isolated systolic hypertension (ISH) is the most common form of hypertension and is highly prevalent in older people. We recently showed differences between upper-arm cuff and invasive blood pressure (BP) become greater with increasing age, which could influence correct identification of ISH. This study sought to determine the difference between identification of ISH by cuff BP compared with invasive BP. Cuff BP and invasive aortic BP were measured in 1695 subjects (median 64 years, interquartile range [55-72], 68% male) from the INSPECT (Invasive Blood Pressure Consortium) database. Data were recorded during coronary angiography among 29 studies, using 21 different cuff BP devices. ISH was defined as ≥130/<80 mm Hg using cuff BP compared with invasive aortic BP as the reference. The prevalence of ISH was 24% (n=407) according to cuff BP but 38% (n=642) according to invasive aortic BP. There was fair agreement (Cohen κ, 0.36) and 72% concordance between cuff and invasive aortic BP for identifying ISH. Among the 28% of subjects (n=471) with misclassification of ISH status by cuff BP, 20% (n=96) of the difference was due to lower cuff systolic BP compared with invasive aortic systolic BP (mean, -16.4 mm Hg [95% CI, -18.7 to -14.1]), whereas 49% (n=231) was from higher cuff diastolic BP compared with invasive aortic diastolic BP (+14.2 mm Hg [95% CI, 11.5-16.9]). In conclusion, compared with invasive BP, cuff BP fails to identify ISH in a sizeable portion of older people and demonstrates the need to improve cuff BP measurements.

Parathyroid hormone may play a role in the pathophysiology of primary hypertension.

Parathyroid hormone has been related with the risk of hypertension, but the matter remains controversial. We examined the association of parathyroid hormone with central blood pressure and its determinants in 622 normotensive or never-treated hypertensive subjects aged 19–72 years without diabetes, cardiovascular or renal disease, or cardiovascular medications. The methods were whole-body impedance cardiography and analyses of pulse wave and heart rate variability. Cardiovascular function was examined in sex-specific tertiles of plasma parathyroid hormone (mean concentrations 3.0, 4.3 and 6.5 pmol/L, respectively) during head-up tilt. Explanatory factors for haemodynamics were further investigated using linear regression analyses. Mean age was 45.0 (s.d. 11.7) years, BMI 26.8 (4.4) kg/m2, seated office blood pressure 141/90 (21/12) mmHg, and 309 subjects (49.7%) were male. Only five participants had elevated plasma parathyroid hormone and calcium concentrations. Highest tertile of parathyroid hormone presented with higher supine and upright aortic diastolic blood pressure (P < 0.01) and augmentation index (P < 0.01), and higher upright systemic vascular resistance (P < 0.05) than the lowest tertile. The tertiles did not present with differences in pulse wave velocity, cardiac output, or measures of heart rate variability. In linear regression analyses, parathyroid hormone was an independent explanatory factor for aortic systolic (P = 0.005) and diastolic (P = 0.002) blood pressure, augmentation index (P = 0.002), and systemic vascular resistance (P = 0.031). To conclude, parathyroid hormone was directly related to central blood pressure, wave reflection, and systemic vascular resistance in subjects without cardiovascular comorbidities and medications. Thus, parathyroid hormone may play a role in the pathophysiology of primary hypertension.

Abstract 13873: Arterial Stiffness in Response to Eight Weeks of Exercise Training in African Americans versus Caucasians

Introduction: Arterial stiffness predicts risks of cardiovascular disease in apparently healthy individuals. Exercise training decreases risks of cardiovascular disease, potentially via reductions in arterial stiffness. Compared with Caucasians, African Americans have higher risks of cardiovascular disease. However, lack of evidence supports the beneficial effects of arterial stiffness in African Americans. We hypothesize that arterial stiffness decreases in African Americans following eight weeks of exercise training and the effect is similar compared with Caucasians. Methods: A total of 13 African American and 10 Caucasian men and women, free of cardiovascular disease participated this study (age: 38±2 yrs; body mass index: 31.0±1.1 kg/m 2 ; systolic blood pressures: 125±2 mmHg, diastolic blood pressure: 78±2 mmHg; mean±SE). Participants performed either aerobic exercise (65-85% of heart rate reserve) or resistance exercise (8-12 repetitions at 65-85% of 10-RM) for 30-45 minutes/time, three times/week for eight weeks. Arterial stiffness, assessed by carotid-to-femoral pulse wave velocity (cfPWV), and aortic blood pressure (BP) were measured by using the cuff-based SphygmoCor Xcel before and after the exercise training. Results: After the eight weeks of exercise training, cfPWV did not change in all participants, regardless of African Americans (6.7±0.3 vs. 6.5±0.3 m/sec; pre- vs. post-intervention) or Caucasians (6.3±0.4 vs. 6.0±0.3 m/sec; P=0.9 for raceхtime interaction, P=0.08 for time, and P=0.3 for race effect). Aortic systolic BP (African Americans: 123±5 vs. 120±3 mmHg and Caucasians: 111±2 vs. 110±3 mmHg; P=0.6 for raceхtime interaction, P=0.2 for time, and P=0.02 for race effect) and aortic diastolic BP (African Americans: 85±3 vs. 83±2 mmHg and Caucasians: 75±3 vs. 74±3 mmHg; P=0.6 for raceхtime interaction, P=0.5 for time, and P=0.01 for race effect) remained unchanged with the exercise training. Conclusions: An eight-week exercise training may not improve arterial stiffness in African Americans, and the effect appears to be similar in Caucasians.

Physiological determinants of residual cerebral arterial pulsatility on best medical treatment after TIA or minor stroke

Cerebral arterial pulsatility is strongly associated with cerebral small vessel disease and lacunar stroke yet its dependence on central versus local haemodynamic processes is unclear. In a population-based study of patients on best medical managment, 4–6 weeks after a TIA or non-disabling stroke, arterial stiffness and aortic systolic, diastolic and pulse pressures were measured (Sphygmocor). Middle cerebral artery peak and trough flow velocities and Gosling’s pulsatility index were measured by transcranial ultrasound. In 981 participants, aortic and cerebral pulsatility rose strongly with age in both sexes, but aortic diastolic pressure fell more with age in men whilst cerebral trough velocity fell more in women. There was no significant association between aortic systolic or diastolic blood pressure with cerebral peak or trough flow velocity but aortic pulse pressure explained 37% of the variance in cerebral arterial pulsatility, before adjustment, whilst 49% of the variance was explained by aortic pulse pressure, arterial stiffness, age, gender and cardiovascular risk factors. Furthermore, arterial stiffness partially mediated the relationship between aortic and cerebral pulsatility. Overall, absolute aortic pressures and cerebral blood flow velocity were poorly correlated but aortic and cerebral pulsatility were strongly related, suggesting a key role for transmission of aortic pulsatility to the brain.

Association between vascular measures and cognitive function in type 2 diabetes

AimTo examine correlation between vascular measures and cognitive performance in type 2 diabetes (T2D). MethodsThis was a cross-sectional study on patients (N = 1167) aged ≥45 years attending Diabetes Centre in a tertiary hospital and primary care polyclinic. The following vascular measures were measured: systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), pulse wave velocity (PWV) and augmentation index (AI). Cognition was assessed by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Multiple linear regression was used to examine relationships between vascular measures and cognition, adjusting for demographics, education, depression, clinical covariates and presence of APOE Ɛ4 allele. ResultsIn unadjusted analyses, all the vascular measures, except for MAP, were associated with RBANS total score. In fully adjusted analyses, the association with RBANS total score persisted for peripheral PP, aortic PP and aortic DBP with βs −0.05 (95%CI -0.07 to −0.02; p = 0.001), −0.04 (95%CI −0.06 to −0.01; p = 0.002) and 0.05 (95%CI 0.00 to 0.09; p = 0.033). Association between peripheral and aortic PP and RBANS total score was unaffected by age-stratification (age <60 and ≥60 years). In contrast, significant association between aortic DBP and RBANS total score was only observed for those ≥60 years. Peripheral and aortic PP (which estimate pulsatility) are negatively associated with attention, visuospatial/constructional and language ability. ConclusionsPeripheral and aortic PP, and aortic DBP were independently correlated with cognitive performance globally and in multiple domains. Further research should be conducted to establish the clinical relevance and importance.

Preliminary Study Of Ethnic Differences In Hemodynamic Responses Following High Intensity Exercise: Wave Separation Analysis

The Hispanic population is at a high risk of developing cardiovascular disease (CVD), especially cerebrovascular disease. High blood pressure (BP) and inadequate BP regulation are related to future CVD events. Sympathoexcitatory stimulation through high intensity exercise temporarily increases risk of cardiovascular events and alters hemodynamics. It is unknown whether there is an ethnic difference in the regulation of BP and pulse wave characteristics—including forward or reflected pressure waves—between Hispanic and White populations. PURPOSE: To investigate the ethnic differences in BP and pulse wave characteristics measured with wave separation analysis in response to high intensity exercise. METHODS: 10 male volunteers (9 Hispanic; 23 ± 3 yr, 1 White; 21 yr) completed the study. Aerobic capacity was measured by indirect calorimetry and a treadmill graded exercise test (GXT). Brachial BP was measured by an automated BP monitor. Central hemodynamic variables and pulse waves were obtained by tonometer at baseline, 15-minute, and 30-minute after high intensity treadmill exercise (GXT). Pulse waves were further separated into forward pulse height (FH) and reflected pulse height (RH) for analysis. A 2 x 3 repeated measure analysis of variance was performed to investigate ethnic differences in BP and pulse wave responses to high intensity exercise. RESULTS: (See table 1) There were no significant ethnic differences in brachial systolic BP, brachial diastolic BP, aortic systolic BP, aortic diastolic BP, and aortic mean arterial pressure (p > 0.05 for all). Furthermore, FH and RH were not statistically different between Hispanic and White males at rest and following high intensity exercise (p > 0.05). CONCLUSION: Results suggest that blood pressure, forward and reflected pulse height exhibited similar at rest and following high intensity exercise in young, healthy, casually active Hispanic and white males.

Primary aldosteronism: Higher volume load, cardiac output and arterial stiffness than in essential hypertension.

The diagnostics of primary aldosteronism (PA) are usually carried out in patients taking antihypertensive medications. We compared haemodynamics between medicated PA, medicated essential hypertension (EH), never-medicated EH and normotensive controls (n=130 in all groups). The hypertensive groups were matched for age (53years), sex (84 male/46 female) and body mass index (BMI) (30kgm-2 ); normotensive controls had similar sex distribution (age 48years, BMI 27kgm-2 ). Haemodynamics were recorded using whole-body impedance cardiography and radial pulse wave analysis, and the results were adjusted as appropriate. Radial blood pressure recordings were calibrated by brachial blood pressure measurements from the contralateral arm. Radial and aortic systolic and diastolic blood pressure was similar in PA and never-medicated EH, and higher than in medicated EH and normotensive controls (P≤0.001 for all comparisons). Extracellular water balance was~4% higher in PA than in all other groups (P<0.05 for all), whilst cardiac output was~8% higher in PA than in medicated EH (P=0.012). Systemic vascular resistance and augmentation index were similarly increased in PA and both EH groups when compared with controls. Pulse wave velocity was higher in PA and never-medicated EH than in medicated EH and normotensive controls (P≤0.033 for all comparisons). Medicated PA patients presented with corresponding systemic vascular resistance and wave reflection, but higher extracellular water volume, cardiac output and arterial stiffness than medicated EH patients. Whether the systematic evaluation of these features would benefit the clinical diagnostics of PA remains to be studied in future.

Attenuated aortic blood pressure responses to metaboreflex activation in older adults with dynapenia.

Low muscle strength (dynapenia) is a primary characteristic of sarcopenia, the age-related loss of muscle mass and strength or low walking speed. New evidence suggests that muscle strength positively affects blood pressure (BP) responses to exercise. As older adults with lowest handgrip strength also have lowest BP at rest, those with dynapenia may experience attenuated BP responses during physical activity. The purpose of this study was to test the hypothesis that dynapenic older adults would exhibit lower BP response to post-exercise muscle ischemia (PEMI). Brachial and aortic systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were measured in older adults (age, 80±5 y) with dynapenia (n=16) and non-dynapenia (n=9) at rest and during PEMI following 2min of isometric handgrip exercise at 30% maximal voluntary contraction. Walking speed was assessed by an 8-foot (2.44m) walk course. Increases in aortic SBP (11±2 vs. 23±6mmHg, p=.03), DBP (6±2 vs.14±4mmHg, p=.04), and MAP (8±1 vs. 17±5mmHg, p=.02) were lower in dynapenic compared to non-dynapenic adults. Aortic MAP (r=0.52, p<.05) response to PEMI was correlated with MVC in dynapenic adults. Gait speed was correlated with aortic DBP response to PEMI (r=0.698, p=.05) in non-dynapenic adults. Our findings indicate that aortic DBP response to muscle metaboreflex activation is attenuated in older adults with dynapenia. Normal aortic DBP response during metaboreflex activation may positively affect walking performance in non-dynapenic older adults.

Aortic Hemodynamics and Cognitive Performance in Postmenopausal Women: Impact of Pregnancy History.

BACKGROUNDStudies demonstrate an association between aortic hemodynamics and cognitive function. The impact of pregnancy history on this association is unknown.METHODSPostmenopausal women (age 59 ± 5 years; years since last pregnancy 35 ± 3) with either a history of preeclampsia (PE; n = 34) or a history of a normotensive pregnancy (NP; n = 30) underwent cognitive testing: Letter-Number Sequencing, Digit Span, Trail Making Test, and letter and category fluency. Applanation tonometry was used to derive aortic systolic and diastolic blood pressure and augmentation index.RESULTSDistribution of cognitive scores and aortic hemodynamic measures was similar between the PE and NP groups. Principal component (PC) analysis was used to reduce the 3 aortic hemodynamic measures and the 5 cognitive variables to single summary indices, each representing a weighted average of their respective constituent variables. Using a multivariable linear model based on these PCs that adjusted for pregnancy history and body mass index, the composite index of aortic hemodynamics was associated with the summary cognitive index, whether taking into account a potential interaction with pregnancy history (P = 0.035) or not (P = 0.026) (interaction P = 0.178). Multivariable modeling of individual cognitive tests revealed a differential association for letter fluency by pregnancy history (test for interaction P = 0.023); this score correlated with the aortic hemodynamic index in the PE (partial R2 = 0.20), but not the NP (partial R2 = 0.00) group.CONCLUSIONSElevated aortic hemodynamics may negatively impact cognitive function in postmenopausal women with specific executive functions, such as letter fluency, being impacted more by a pregnancy history of PE.

Acute Vascular Responses to All‐Extremity Aerobic Exercise

Endothelial function and central arterial stiffness are independent predictors of future cardiovascular events. High‐intensity interval training (HIIT) is a popular and oftentimes superior exercise strategy for decreasing cardiovascular disease risk than moderate‐intensity continuous training (MICT). We have recently adapted HIIT on a non‐weight‐bearing all‐extremity ergometer to reduce impact on the joints and involve muscles in the whole body to activate a larger amount of muscle mass than in lower‐extremity HIIT. However, the acute vascular responses to all‐extremity HIIT and MICT remain unexplored and may be important for optimizing exercise prescription. Therefore, the purpose of this study was to investigate the acute effects of all‐extremity HIIT and MICT on endothelial function, central arterial stiffness and hemodynamics. Sixteen young men (21±1 years of age, means±SE) who were free of clinical disease and did not use tobacco products or medications participated in this study. Vascular measures were assessed at pre‐exercise, at the end of a single session of HIIT and MICT and following recovery. HIIT and MICT were matched for caloric expenditure and were performed on an all‐extremity non‐weight‐bearing ergometer, at least one week apart. HIIT consisted of 4×4‐min intervals at 90% peak heart rate (HRpeak) interspersed by 3‐min intervals at 70% HRpeak for a total of 40 min. MICT consisted of 47 min at 70% HRpeak. Endothelial function was assessed using brachial artery flow‐mediated dilation (FMD) via high resolution ultrasonography in response to 5 min forearm blood flow occlusion. Arterial stiffness (carotid to femoral pulse wave velocity; cfPWV), aortic wave reflection (augmentation index normalized at heart rate 75; AIx75) and aortic systolic and diastolic blood pressure (aoSBP and aoDBP) were assessed using a validated cuff‐based device. HIIT did not result in significant changes in FMD (P=0.08), cfPWV (P=0.3), aoSBP (P=0.1) or aoDBP (P=0.2) within one hour from exercise cessation. AIx75 and heart rate were increased at the end of HIIT and remained elevated following recovery (P≤0.002 vs. pre‐exercise). In response to MICT, FMD remained unchanged (P=0.1). However, cfPWV decreased at the end of MICT (P=0.003) and returned to the pre‐exercise level following recovery (P=0.5). AIx75 increased at the end of MICT (P&lt;0.0001) and returned to the pre‐exercise level following recovery (P=0.3). aoSBP decreased following recovery compared with end of MICT (P=0.04), but was not different than the pre‐exercise level (P=0.3). aoDBP did not significantly change in response to MICT (P=0.09). In conclusion, all‐extremity HIIT and MICT did not attenuate endothelial function or result in adverse changes in aortic blood pressure. MICT, but not HIIT, slightly reduced central arterial stiffness. These findings may have important implications for exercise prescription.

Abstract P525: The Effect of Weight Loss Combined With Aerobic Exercise Training on Arterial Stiffness: Results From the PREVAIL Pilot Study

Objective: The OPTIFAST diet has known effects for weight loss, but little data exists on the effects of the diet on arterial stiffness. Methods: Overweight and obese (BMI: 34.5 + 4.0) adults (N=17) participated in a 10-week OPTIFAST™ weight loss program and supervised aerobic exercise training (50%-75% VO 2 max). The diet consisted of OPTIFAST meal replacement products with a goal of reducing total caloric intake to 800 kcals/day and attending a weekly weight management class. Aerobic exercise was performed 3 times per week and the exercise volume was progressed from 300 to 700 MET mins. per week at an intensity of 50%-75% VO2 max. The goal of study participants was to achieve a 7% weight loss. Carotid-to-femoral pulse wave velocity, blood pressure (aortic and brachial), vascular age, augmentation index and blood samples were measured in the morning after an overnight fast at baseline and follow-up. A paired t-test was performed to evaluate the change in outcomes variables. Results: The mean percent weight loss in the sample was 9.0% (-8.5 kg), with 83.3% of participants achieving 7% weight loss (94.1% achieving ≥5%). The adherence to the exercise program was 94.9% and attendance in the weight loss classes was 81.8%. There was a reduction in pulse wave velocity (-0.44 m/s, p=0.030), aortic systolic blood pressure (-10.5 mmHg, p&lt;0.001), aortic diastolic blood pressure (-7.8 mmHg, p&lt;0.001), brachial systolic blood pressure (-11.2 mmHg , p&lt;0.001), brachial diastolic blood pressure (-7.7 mmHg, p&lt;0.001), vascular age (-13.4 yrs., p=0.008), resting heart rate (-4.7 bpm, p=0.005), and augmentation index (-7.5%, p=0.008) after the intervention. Change in resting heart rate from the intervention was associated with improvements in augmentation index (r=0.60, p=0.010) and approached significance for pulse wave velocity (r=0.45, p=0.07). Weight loss was associated with reduction in augmentation index (r= 0.56, p=0.02), but not change in PWV (r=-0.07, p=0.78). Changes in other cardiometabolic risk factors (e.g. glucose, insulin, lipids, and body fat) were not associated with improvements in arterial stiffness or blood pressure measures (all ps&gt;0.05). Discussion: A hypo-caloric dietary program in combination with aerobic exercise training improves arterial stiffness, aortic blood pressure, and brachial blood pressure in overweight and obese adults An important limitation of the present study is that we cannot separate the health benefits of the diet from the exercise.

Deep learning for prediction of cardiac indices from photoplethysmographic waveform: A virtual database approach.

Deep learning methods combined with large datasets have recently shown significant progress in solving several medical tasks. However, collecting and annotating large datasets can be a very cumbersome and expensive task. We tackle these problems with a virtual database approach where training data is generated using computer simulations of related phenomena. Specifically, we concentrate on the following problem: can cardiovascular indices such as aortic elasticity, diastolic and systolic blood pressures, and blood flow from heart be predicted continuously using wearable photoplethysmographic sensors? We simulate the blood flow using a haemodynamic model consisting of the entire human circulation. Repeated evaluation of the simulator allows us to create a database of "virtual subjects" with size that is only limited by available computational resources. Using this database, we train neural networks to predict the cardiac indices from photoplethysmographic signal waveform. We consider two approaches: neural networks based on predefined input features and deep convolutional neural networks taking waveform directly as the input. The performance of the methods is demonstrated using numerical examples, thus carrying out a preliminary assessment of the approaches. The results show improvements in accuracy compared with the previous methods. The improvements are especially significant with indices related to aortic elasticity and maximum blood flow. The proposed approach would provide new means to measure cardiovascular health continuously, for example, with a simple wrist device.

Influence of Age on Upper Arm Cuff Blood Pressure Measurement.

Blood pressure (BP) is a leading global risk factor. Increasing age is related to changes in cardiovascular physiology that could influence cuff BP measurement, but this has never been examined systematically and was the aim of this study. Cuff BP was compared with invasive aortic BP across decades of age (from 40 to 89 years) using individual-level data from 31 studies (1674 patients undergoing coronary angiography) and 22 different cuff BP devices (19 oscillometric, 1 automated auscultation, 2 mercury sphygmomanometry) from the Invasive Blood Pressure Consortium. Subjects were aged 64±11 years, and 32% female. Cuff systolic BP overestimated invasive aortic systolic BP in those aged 40 to 49 years, but with each older decade of age, there was a progressive shift toward increasing underestimation of aortic systolic BP (P<0.0001). Conversely, cuff diastolic BP overestimated invasive aortic diastolic BP, and this progressively increased with increasing age (P<0.0001). Thus, there was a progressive increase in cuff pulse pressure underestimation of invasive aortic PP with increasing decades of age (P<0.0001). These age-related trends were observed across all categories of BP control. We conclude that cuff BP as an estimate of aortic BP was substantially influenced by increasing age, thus potentially exposing older people to greater chance for misdiagnosis of the true risk related to BP.

Abnormal phenotypes of 24-h blood pressure monitoring and their associations with inflammation and arterial stiffness in patients with rheumatoid arthritis

Abstract Objective. To evaluate the 24‑h profile of brachial and aortic blood pressure (BP) in patients with rheumatoid arthritis (RA) compared to the controls and to investigate the associations of the abnormalities. Design and methods. The cross-sectional study included 85 patients with RA (males 22,4 %, aged 59,7 ± 14,3 years, hypertension (HTN) in 65 %, mean DAS‑28 (C‑reactive protein, CRP) 3,7 ± 1,1) and control group (40 patients matched by gender, age and risk factors). Office brachial BP was measured with a validated oscillometric device, 24-hour ambulatory blood pressure monitoring (ABPM) by BPLab Vasotens, arterial stiffness and aortic BP by applanation tonometry. Cardiovascular (CV) risk was calculated as mSCORE (EULAR recommended modified version). P < 0,05 was considered significant. Results. The rate of BP control was 58 % in RA and 67 % in the control group (p = 0,48). Patients with RA and HTN compared to matched controls had higher levels of brachial and aortic office, mean daytime, nighttime and 24‑h systolic BP (SBP), patients with RA without HTN showed higher brachial night SBP (113 ± 10 vs 105 ± 9 mmHg, р = 0,02). All patients with RA had higher rate of masked HTN (28,2 % vs 7,5 %, p = 0,009), night SBP and DBP elevation (56,5 % vs 17,5 %, p < 0,001; 26,7 % vs 0 %, p = 0,02, in the group without HTN, respectively), isolated nocturnal HTN (30,6 % vs 5 %, p = 0,001) and non-dipping (83,5 % vs 62,5 %, p = 0,02). Univariate analysis revealed significant associations of night brachial SBP with age (r = 0,5), office SBP (r = 0,6) and diastolic BP (DBP) (r = 0,3), carotid-femoral (cf) pulse wave velocity (PWV) (r = 0,5) and mSCORE (r = 0,5); non-dipping pattern was associated with age (r = 0,22) and night brachial and aortic DBP (r = 0,36 and 0,35, respectively), р < 0,05 for trend. Multivariate analysis confirmed independent associations of night brachial SBP with cfPWV (β = 0,43, p = 0,009) and non-dipping with night brachial DBP (β = 0,57, p = 0,007). Non-dippers with elevated night SBP had the highest levels of cfPWV, CRP and mSCORE compared to dippers and non-dippers with normal night SBP. Conclusions. High incidence of night SBP elevation does not depend on the history of HTN and is associated with cfPWV increase. Non-dipping state correlates with elevation of night brachial DBP. Combination of non-dipping state with night HTN is associated with arterial stiffness and higher CV risk. Inflammation might mediate these associations.

Liquorice ingestion attenuates vasodilatation via exogenous nitric oxide donor but not via β2-adrenoceptor stimulation.

We examined the effect of liquorice ingestion on haemodynamic responses to exogenous nitric oxide donor (nitroglycerin) and β2-adrenoceptor agonist (salbutamol), and 11β-hydroxysteroid dehydrogenase activity, in 21 volunteers and 21 reference subjects. Haemodynamic data was captured before and after sublingual nitroglycerin (0.25 mg) and inhaled salbutamol (400 μg) during orthostatic challenge utilising radial pulse wave analysis and whole-body impedance cardiography. The recordings were performed at baseline and following two weeks of liquorice intake (290–370 mg/d glycyrrhizin). Urinary cortisone and cortisol metabolites were examined. Liquorice intake elevated aortic systolic and diastolic blood pressure and systemic vascular resistance when compared with the reference group. Following research drug administration the liquorice-induced increase in systemic vascular resistance was observed in the presence of nitroglycerin (p<0.05) but no longer in the presence of salbutamol. Liquorice ingestion decreased cardiac chronotropic response to upright posture (p = 0.032) in unadjusted analysis, but when adjusted for age and sex the difference in the upright change in heart rate was no longer significant. The urinary cortisone to cortisol metabolite ratio decreased from 0.70 to 0.31 (p<0.001) after liquorice intake indicating significant inhibition of the 11β-hydroxysteroid dehydrogenase type 2. In the reference group the haemodynamic variables remained virtually unchanged. These results suggest that liquorice exposure impaired vasodilatation in vivo that was induced by exogenous nitric oxide donor but not that induced by β2-adrenoceptor stimulation.Trial registration: EU Clinical Trials Register 2006-002065-39ClinicalTrials.gov NCT01742702.

Pulse transit time estimation of aortic pulse wave velocity and blood pressure using machine learning and simulated training data.

Recent developments in cardiovascular modelling allow us to simulate blood flow in an entire human body. Such model can also be used to create databases of virtual subjects, with sizes limited only by computational resources. In this work, we study if it is possible to estimate cardiovascular health indices using machine learning approaches. In particular, we carry out theoretical assessment of estimating aortic pulse wave velocity, diastolic and systolic blood pressure and stroke volume using pulse transit/arrival timings derived from photopletyshmography signals. For predictions, we train Gaussian process regression using a database of virtual subjects generated with a cardiovascular simulator. Simulated results provides theoretical assessment of accuracy for predictions of the health indices. For instance, aortic pulse wave velocity can be estimated with a high accuracy (r > 0.9) when photopletyshmography is measured from left carotid artery using a combination of foot-to-foot pulse transmit time and peak location derived for the predictions. Similar accuracy can be reached for diastolic blood pressure, but predictions of systolic blood pressure are less accurate (r > 0.75) and the stroke volume predictions are mostly contributed by heart rate.

Relationship of growth differentiation factor-15 with aortic stiffness in essential hypertension.

Aim:We aimed to assess the relationship between echocardiographic parameters of aortic elasticity, namely aortic strain, aortic distensibility and aortic β-index, and serum growth differentiation factor (GDF)-15 in patients with newly diagnosed essential hypertension (HT).Methods:Grade-1 HT patients (n = 50), grade-2 HT (n = 70) patients and 35 healthy controls were included.Results:GDF-15 was greater in grade-2 HT group compared with the other groups. All aortic elasticity parameters were worse in grade-2 HT group compared with the other groups. GDF-15 correlated positively with E/E′ ratio (the ratio of transmitral E velocity to mean diastolic mitral annular velocity) and β-index; and aortic strain and aortic distensibility correlated negatively with serum GDF-15. β-index, aortic diastolic diameter and diastolic blood pressure were independently associated with GDF-15.Conclusion:GDF-15 may be utilized in the prediction of increased aortic stiffness.

Ambulatory blood pressure and arterial stiffness web-based telemonitoring in patients at cardiovascular risk. First results of the VASOTENS (Vascular health ASsessment Of The hypertENSive patients) Registry.

The VASOTENS Registry is an international telehealth-based repository of 24-hour ambulatory blood pressure monitorings (ABPM) obtained through an oscillometric upper-arm BP monitor allowing combined estimation of some vascular biomarkers. The present paper reports the results obtained in 1200 participants according to different categories of CV risk. Individual readings were averaged for each recording and 24-hour mean of brachial and aortic systolic (SBP) and diastolic blood pressure (DBP), pulse wave velocity (PWV), and augmentation index (AIx) obtained. Peripheral and central BP, PWVand AIx values were increased in older participants (SBP only) and in case of hypertension (SBP and DBP). BP was lower and PWVand AIx higher in females. PWV was increased and BP unchanged in case of metabolic syndrome. Our results suggest that ambulatory pulse wave analysis in a daily life setting may help evaluate vascular health of individuals at risk for CV disease.

A Traumatic Pulseless Electrical Activity Model: Mortality Increases With Hypovolemia Time

BackgroundThere currently are no well-defined animal models for traumatic pulseless electrical activity (PEA). Our objective was to develop a swine model of traumatic PEA that would be useful for laboratory research where mortality is an outcome of interest. In this pilot study, we hypothesized that animals that remained in PEA without intervention for a longer period would have increased mortality. Materials and methodsSixteen Yorkshire swine were alternately allocated to either 5 or 10 min of traumatic PEA without intervention. After the nonintervention period, basic life support (BLS) with mechanical cardiopulmonary resuscitation was initiated and performed for 10 min followed by advanced life support (ALS) for an additional 10 min. Hemodynamic and laboratory values are reported for baseline, posthemorrhage, end of BLS, and end of ALS periods. ResultsMortality in the 10-min PEA group (100%) was higher than the 5-min group (38%) (P = 0.03). Animals in the 5-min group had improved aortic diastolic blood pressure, coronary perfusion pressure, and end-tidal CO2 at the end of both the BLS (P = 0.02, 0.002, and 0.02, respectively) and ALS (P = 0.009, 0.005, and 0.008, respectively). The 10-min animals had increased hyperkalemia at the end of the BLS (P = 0.004) and ALS (P = 0.005) periods. All animals in the 10-min group developed ventricular fibrillation (VF) and 38% of the 5-min animals developed VF (P = 0.03). ConclusionsIn our pilot study of traumatic PEA in a swine model, a shorter period of nonintervention resulted in increased survival, improved hemodynamics during resuscitation, decreased hyperkalemia, and less incidence of conversion to VF arrest.

Inflammatory, Serological and Vascular Determinants of Cardiovascular Disease in Systemic Lupus Erythematosus Patients.

Background and aim: Systemic lupus erythematosus (SLE) is associated with increased risk of cardiovascular disease (CVD). Among many mechanisms, accelerated atherosclerosis, endothelial dysfunction, and hypercoagulability play a main role. Here, we investigate whether inflammatory, serological and clinical markers of SLE determine and correlate with arterial stiffness in SLE patients. Materials and methods: Routine blood samples, inflammatory mediators, specific antibodies, and 24 h proteinuria were measured in 43 SLE patients and 43 age and sex-matched controls using routine laboratory assays. We also assessed arterial stiffness by measuring radial artery applanation tonometry-derived augmentation index (AI), normalized AI (AIx@75), aortic pulse pressure, central systolic, diastolic and peripheral blood pressure. Results: SLE patients showed a significantly greater arterial stiffness vs. controls, as demonstrated by the significantly higher AIx@75 and aortic pulse pressure. Interestingly, regression analysis showed that age, systolic pulse pressure, inflammatory markers (erythrocyte sedimentation rate and C-reactive protein), daily dose of glucocorticoids, and cumulative organ damage positively correlated with arterial stiffness. Conclusions: SLE patients show increased arterial stiffness which correlates with markers of inflammation, that is involved in early alterations in arterial walls. Applanation tonometry can be used to screen SLE patients for subclinical vascular damage to implement prevention strategies for CVD.