Aortic Systolic Blood Pressure Research Articles

Short-Term Variability of Both Brachial and Aortic Blood Pressure is Increased in Patients with Immune-mediated Chronic Inflammation.

Blood pressure (BP) variability (BPV) has emerged as an indicator of subclinical organ damage and an independent predictor of cardiovascular disease (CVD) morbidity and mortality in high-risk populations. We aimed to assess short-term variability of both brachial and aortic BP in psoriasis, a common immune-mediated inflammatory disorder characterized by increased CVD risk. Psoriasis patients and non-psoriasis individuals had their BP assessed throughout a 24h period (Mobil-O-Graph device). Brachial and aortic BPV during the 24h and the respective daytime and nighttime periods was calculated from relevant ambulatory BP profiles. In-house software was applied to automatically calculate average real variability (ARV) of brachial and aortic systolic (bSBP, aSBP) and diastolic BP (bDPB, aDBP), and the weighted standard deviation (wSD) of 24h bSBP/aSBP. 24h pulse wave velocity (PWV) and augmentation index (AIx) were used as widely applied markers of arterial stiffness. Psoriasis patients (n = 74) presented increased ARV of 24h and daytime bSBP/aSBP, and increased ARV of 24h and daytime bDBP/aDBP, compared to controls (n = 40). PWV and AIx correlated with ARV of 24h bSBP/aSBP, daytime bSBP/aSBP, while PWV further correlated with ARV of nighttime aSBP. The observed associations with PWV, yet not AIx, with indices of BPV remained significant after adjusting for CVD risk factors. This is the first study reporting increased 24h variability of both brachial and aortic BP in psoriasis. The association of short-term BPV with arterial stiffness implies a potential role of BPV in terms of CVD risk stratification in patients with chronic immune-mediated inflammation.

#220 Acute vascular response to hemodialysis as measured by serum syndecan-1 and endothelin-1 levels, as well as vascular stiffness

Abstract Background and Aims End-stage kidney disease (ESKD) patients on chronic hemodialysis (HD) have very high cardiovascular risk. Acute vascular changes during dialysis mediated partially by factors of the endothelium may have a crucial role in the cardiovascular (CV) disease of HD patients. Aim To study acute vascular changes during HD measured by applanation tonometry and to assess the role of syndecan-1 (SDC-1), endothelin-1 (ET-1), and traditional and non-traditional CV risk factors in these changes. Method 29 consecutive chronic HD patients (median age: 65.6 ± 10.4 years; 52% men) were included in the study. Pre-, mid-, and post-HD plasma SDC-1 and ET-1 levels and routine biochemical parameters were measured. Applanation tonometry (SphygmoCor, AtCor Medical) was performed before HD. Results As assessed by trend analysis, SDC-1 levels increased significantly during HD (p = 0.004). ET-1 levels were decreasing during HD. Male patients had significantly higher ET-1 levels than women. Patients were divided into 2 groups based on their pulse wave velocity (PWV): PWV ≥12 m/s and PWV <12 m/s. Pre-HD and mid-HD SDC-1 levels were significantly higher in the group with PWV ≥12 m/s (10.174 ± 2.568 vs. 7.928 ± 1.794 ng/ml, p = 0.013, and 10.319 ± 3.482 vs. 8.248 ± 1.793 ng/ml, p = 0.044, respectively). Post-HD ET-1 levels were significantly higher in the patient group having PWV ≥12 m/s (10.88 ± 3.00 vs. 8.05 ± 3.48 pg/l, p = 0.027). Patients having PWV ≥12 m/s had significantly higher pre-HD peripheral and aortic systolic blood pressure than the patients having lower PWV (147.4 ± 73.3 vs. 134.1 ± 72.2 mmHg, p = 0.038, and 130.7 ± 16.6 vs. 122.5 ± 14.9 mmHg, p = 0.016, respectively). Mid-HD and post-HD blood pressures were not different. We found a positive correlation between total cholesterol and the decrease in SDC-1 levels during HD (r = 0.539; p = 0.008). Pre-, mid-, and post-HD SDC-1 correlated significantly with the ultrafiltration volume during HD (r = 0.432, p = 0.019; r = 0.377, p = 0.044; and r = 0.401, p = 0.012, respectively). Conclusion SDC-1 and ET-1 may contribute to the vascular changes observed during HD, and they have correlations with some traditional and non-traditional CV risk factors.

G-PROTEIN-COUPLED RECEPTORS ANTIBODIES HAVE SUBSTANTIAL VASOREGULATIVE IMPLICATIONS IN LONG-COVID

Objective: The Long-COVID syndrome is associated with the generation of autoantibodies to vasoregulative G-protein coupled receptors (GPCR), playing a potential key role in this disease. How far GPCR are related to vascular dysfunction in this context remains elusive. Design and method: We performed a cross-sectional study, enrolling 80 patients with Long-COVID. GPCR antibodies encompassed autoantibodies against Angiotensin-II-Receptor-1 (AGTR2), Beta-1 Adrenergic Receptor (ADRB1), Beta-2 Adrenergic Receptor (ADRB2), Endothelin Receptor (EDNRA), Muscarinergic Choline Receptor 3 (CHRM3), and Muscarinergic Choline Receptor 4 (CHRM4), all measured by ELISA. Vascular endothelial function was assessed by flow mediated dilation (FMD). We checked for vascular and systemic inflammation by measuring lipoprotein-associated phospholipase A2 (Lp-PLA2) and high-sensitive C-reactive protein (hsCRP). We performed a non-invasive pulse wave analysis to investigate central aortic blood pressure as well as nailfold capillaroscopy. Results: 52 (65%) patients had positive antibody findings above previously established cut-off values. The median concentrations for AGTR2, ADRB1, ADRB2, EDNRA, CHRM3 and CHRM4 were 13.21 (interquartile range [IQR] 11.57-18.51) U/ml, 19.12 (IQR 16.03-27.54) U/ml, 14.18 (IQR 10.83-31.26) U/ml, 14.07 (IQR 11.30-25.19) U/ml, 13.73 (IQR 12.04-25.30) U/ml and 9.27 (IQR 7.15-13.02) U/ml, respectively. Correlation analysis showed strong and significant negative correlation of several GPCR antibodies with aortic systolic blood pressure (AGTR2 p=0.026, ADRB1 p=0.001, ADRB2 p=0.012) and aortic diastolic blood pressure (ADRB1 p=0.005, CHRM4 p=0.046). High EDNRA antibodies titers were associated with increasing FMD (p=0.038). ATGR2, ADRB2 and EDNRA had substantial negative correlation with inflammation as seen by lower hsCRP concentrations (p=0.025, p=0.001, p=0.017, respectively). None of the above mentioned antibodies were associated with Lp-PLA2 (p>0.05 each). None of the investigated subentities of nailfold capillaroscopy were significant for GPCR-antibodies. Conclusions: GPCR antibodies are present in Long-COVID and show various vascular implications in terms of vasorelaxation as seen in lower aortic systolic and diastolic blood pressure as well as in an amelioration of FMD. If this is the result of anti-inflammatory properties remains elusive.

Vascular Dysfunction and Inflammation in Liver Transplant Recipients

INTRODUCTION Liver transplant (LT) recipients have an increased risk of developing cardiovascular disease (CVD) after transplant. The physiological mechanisms driving this risk are not fully understood. Vascular endothelial dysfunction is the initial pathophysiological step in the development of atherosclerosis. The objective of this study was to characterize vascular endothelial function in LT recipients. It was hypothesized that compared to matched healthy controls (HC), LT recipients would have impaired vascular function. METHODS. Conduit artery endothelial function was measured by flow-mediated dilation of the brachial artery (FMDBA) with duplex ultrasound in 40 LT patients (18 male, 22 female; mean ± SD: Age, 56±11 years) and 10 age matched HC (4 male, 6 female; Age 51±16 years). Central aortic blood pressures were derived from radial arterial tonometry and the use of the generalized transfer function. A venous blood sample was obtained for nuclear magnetic resonance spectroscopy assessment of the inflammation biomarker GlycA, and high-density lipoprotein (HDL) particle subspecies. A novel metabolic inflammation index was derived from plasma GlycA and HDL subparticle concentrations. RESULTS. LT recipients had higher peripheral (Median [IQR]: HC vs. LT, 119 [111-136] vs. 135 [124-147] mmHg, p=0.01) and central aortic (113 [102-126] vs. 124 [116-139] mmHg, p=0.03) systolic blood pressures. LT recipients had impaired vascular endothelial function (HC vs. LT, FMDBA: 6.08 [5.01-7.61] vs. 4.54 [3.31-6.24] %, p = 0.04). In LT recipients, the inflammation index (55 [45-62] AU) was negatively associated with vascular endothelial function ( r=-0.4, p=0.03). CONCLUSIONS. Despite optimal pharmacological intervention, LT recipients had higher systolic blood pressures and worse vascular endothelial dysfunction compared to HC. In LT recipients, a higher inflammation index was associated with worse endothelial function, suggesting that chronic low-grade inflammation may partly contribute to endothelial dysfunction in this patient population. These findings provide support for the vascular endothelium as a potential therapeutic target to improve cardiovascular health in LT recipients. Supported by CTSA award No. UM1TR004360 from the National Center for Advancing Translational Sciences. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Differences between brachial and aortic blood pressure in adolescence and their implications for diagnosis of hypertension.

Blood pressure (BP) is the leading global cause of mortality, and its prevalence is increasing in children and adolescents. Aortic BP is lower than brachial BP in adults. We aimed to assess the extent of this difference and its impact on the diagnosis of hypertension among adolescents. We used data from 3850 participants from a UK cohort of births in the early 1990s in the Southwest of England, who attended their ∼17-year follow-up and had valid measures of brachial and aortic BP at that clinic [mean (SD) age 17.8 (0.4) years, 66% female individuals]. Data are presented as mean differences [95% prediction intervals] for both sexes. Aortic systolic BP (SBP) was lower than brachial SBP [male, -22.3 (-31.2, -13.3) mmHg; female, -17.8 (-25.5, -10.0) mmHg]. Differences between aortic and brachial diastolic BP (DBP) were minimal. Based on brachial BP measurements, 101 male individuals (6%) and 22 female individuals (1%) were classified as hypertensive. In contrast, only nine male individuals (<1%) and 14 female individuals (<1%) met the criteria for hypertension based on aortic BP, and the predictive value of brachial BP for aortic hypertension was poor (positive-predictive value = 13.8%). Participants with aortic hypertension had a higher left ventricular mass index than those with brachial hypertension. Brachial BP substantially overestimates aortic BP in adolescents because of marked aortic-to-brachial pulse pressure amplification. The use of brachial BP measurement may result in an overdiagnosis of hypertension during screening in adolescence.

The relative potential contribution of volume load and vascular mechanisms to hypertension in non-dialysis and dialysis chronic kidney disease patients.

Hypertension is highly prevalent and particularly difficult to treat adequately in patients with chronic kidney disease (CKD). The relative contribution of volume overload and vascular mechanisms to blood pressure measures in CKD and whether these effects differ in non-dialysis compared to dialysis patients is unknown. We determined the potential impact of volume load (stroke volume) and vascular mechanisms (inverse of total arterial compliance (inv TAC) and systemic vascular resistance (SVR)) on mean and brachial and aortic systolic blood pressures in 67 non-dialysis and 48 dialysis chronic kidney disease (CKD) patients. Relationships were determined in confounder adjusted regression models. Stroke volume (p value = 0.003) was more strongly associated with mean arterial pressure than SVR (p value = 0.9) (p value for difference = 0.03). When stroke volume and SVR were entered in the same regression model (model R2 = 0.324), they contributed equally to the variation in mean arterial pressure (p value for difference = 0.5). Stroke volume (p value ≤ 0.002) and inv TAC (p value ≤ 0.001) contributed equally to the variation in systolic pressures (p value for difference ≥ 0.9). When stroke volume and inv TAC were entered in the same regression model (model R2 = 0.752 to 0.765), they contributed equally to the variation in systolic blood pressures (p value for difference = 0.7). Stroke volume, TAC and SVR were similar (p value ≥ 0.5) and associated to the same extent with blood pressure measures in non-dialysis and dialysis CKD patients (p value for difference ≥ 0.1). In receiver operator characteristic curve analysis, elevated systolic blood pressure was determined by stroke volume (p value = 0.005) and inv TAC (p value = 0.03) but not SVR (p value = 0.8). The calculated power of the study was 0.999 based on α = 0.05. The present investigation suggests that both volume load and vascular mechanisms should be considered in the management of hypertension among patients with CKD. The extent and relative potential impact of volume load and vascular mechanisms on blood pressure measures are as large in non-dialysis compared to dialysis CKD patients.

Endothelial dysfunction influences augmented aortic hemodynamic responses to metaboreflex activation in postmenopausal women.

Postmenopausal women experience augmented aortic hemodynamic responses to isometric handgrip (IHG) exercise and metaboreflex activation post-exercise muscle ischemia (PEMI). Relationships between endothelial function brachial artery flow-mediated dilation (FMD) and aortic stiffness carotid-femoral pulse wave velocity (cfPWV) with aortic pulsatile hemodynamics during IHG and PEMI have not been determined. The relationships between aortic hemodynamic responses to PEMI were evaluated. Aortic blood pressure (BP), wave reflection, and pressure of forward (Pf) and backward (Pb) waves were measured using arterial tonometry at rest, IHG at 30% maximal force, and PEMI in 30 (15/group) postmenopausal women with low (≤ 4.5%) and normal (≥ 5.5%) FMD. Hemodynamic responses were analyzed as the change (Δ) from rest to the last minute of IHG and PEMI. Brachial and aortic systolic BP (SBP) responses to IHG were higher in the low vs normal FMD group (P < 0.05). Aortic SBP (Δ20 ± 8 vs Δ11 ± 7mmHg), pulse pressure (PP) (Δ12 ± 8 vs Δ6 ± 4mmHg), augmented pressure (AP) (Δ5 ± 3 vs Δ2 ± 2mmHg), and Pb (Δ6 ± 4 vs Δ3 ± 2mmHg) responses to PEMI were greater (P < 0.05) in women with low vs. normal FMD. FMD was negatively correlated with aortic SBP, PP, AP, and Pb (P < 0.05) responses to PEMI. cfPWV was not correlated with responses to PEMI. Endothelial dysfunction relates to augmented aortic pulsatile load during metaboreflex activation, which may increase cardiovascular risk in postmenopausal women.

Validation of a Suprasystolic Cuff System for Static and Dynamic Representation of the Central Pressure Waveform.

Noninvasive pulse waveform analysis is valuable for central cardiovascular assessment, yet controversies persist over its validity in peripheral measurements. Our objective was to compare waveform features from a cuff system with suprasystolic blood pressure hold with an invasive aortic measurement. This study analyzed data from 88 subjects undergoing concurrent aortic catheterization and brachial pulse waveform acquisition using a suprasystolic blood pressure cuff system. Oscillometric blood pressure (BP) was compared with invasive aortic systolic BP and diastolic BP. Association between cuff and catheter waveform features was performed on a set of 15 parameters inclusive of magnitudes, time intervals, pressure-time integrals, and slopes of the pulsations. The evaluation covered both static (subject-averaged values) and dynamic (breathing-induced fluctuations) behaviors. Peripheral BP values from the cuff device were higher than catheter values (systolic BP-residual, 6.5 mm Hg; diastolic BP-residual, 12.4 mm Hg). Physiological correction for pressure amplification in the arterial system improved systolic BP prediction (r2=0.83). Dynamic calibration generated noninvasive BP fluctuations that reflect those invasively measured (systolic BP Pearson R=0.73, P<0.001; diastolic BP Pearson R=0.53, P<0.001). Static and dynamic analyses revealed a set of parameters with strong associations between catheter and cuff (Pearson R>0.5, P<0.001), encompassing magnitudes, timings, and pressure-time integrals but not slope-based parameters. This study demonstrated that the device and methods for peripheral waveform measurements presented here can be used for noninvasive estimation of central BP and a subset of aortic waveform features. These results serve as a benchmark for central cardiovascular assessment using suprasystolic BP cuff-based devices and contribute to preserving system dynamics in noninvasive measurements.

Assessment of inflammatory biomarkers and risk factors for cardiovascular diseases in overweight and obesity

Aim. To study biomarkers of inflammation in overweight and obese individuals.Material and methods. A total of 180 people with overweight or obesity were included. Anthropometric and biochemical parameters were determined in all patients. The concentrations of C-reactive protein (CRP), fibrinogen, interleukin (IL)-6, IL-10, and tumor necrosis factor alpha (TNF-α) were studied.Results. The following significant correlations have been established: IL-6 — with the levels of central aortic pressure, systolic and diastolic blood pressure (BP), heart rate (HR), levels of glucose, uric acid, low-density lipoprotein cholesterol (LDL-C); TNF-α — with concentrations of uric acid, triglycerides, cystatin C, creatinine and glomerular filtration rate; CRP — with body mass index, diastolic BP, heart rate, levels of uric acid, LDL-C, cystatin C. A significant correlation of IL-6, IL-10 and TNF-α with the proteinuria level was established.Conclusion. In individuals with overweight or obesity, a direct correlation was found between serum concentrations of IL-6 and levels of BP, heart rate, lipids, carbohydrates, uric acid and proteinuria. In overweight or obesity, the serum TNF-α level has a direct correlation with hyperuricemia, hyperfibrinogenemia, hypertriglyceridemia, proteinuria and reduced renal filtration function, and the level of CRP is associated with an increase in diastolic BP, heart rate, uric acid, fibrinogen, LDL-C and cystatin C.

Arterial stiffness assessment in obese black South African patients.

Increased arterial stiffness is a determinant of cardiovascular mortality and an independent marker of cardiovascular disease. The objective of this study was to asses arterial elasticity by determination of pulse-wave velocity (PWV) and augmentation index (Aix) in obese black patients. PWV and Aix were assessed non-invasively using the AtCor SphygmoCor® system (AtCor Medical, Inc, Sydney, Australia). The study participants were divided into four groups; healthy volunteers (HV) (n = 29), patients with concomitant diseases but normal body mass index (Nd) (n = 23), obese patients without concomitant diseases (OB) (n = 29) and obese patients with concomitant diseases (OBd) ( n = 29). The difference in the mean levels of PWV was statistically significant in the obese group with and without concomitant disease. The PWV in the OB group (7.9 ± 2.9 m/s) and in the OBd group (9.2 ± 4.4 m/s) was, respectively, 19.7 and 33.3% higher than in the HV group (6.6 ± 2.1 m/s). PWV was directly correlated with age, glycated haemoglobin level, aortic systolic blood pressure and heart rate. The risk of cardiovascular diseases in the obese patient without additional diseases was increased by 50.7%. The presence of concomitant diseases (type 2 diabetes mellitus and hypertension) in addition to obesity increased arterial stiffness by a further 11.4% and therefore also increased the risk of cardiovascular diseases by a further 35.1%. Aix was increased in the OBd and Nd groups by 8.2 and 16.5%, respectively, however the increase was not statistically significant. Aix was directly correlated with age, heart rate and aortic systolic blood pressure. The obese black patients had a higher PWV, indicating increase in arterial stiffness and therefore a higher risk for cardiovascular disease. In addition, aging, increased blood pressure and type 2 diabetes mellitus contributed further to arterial stiffening in these obese patients.

Impact of a cuff-based device calibration method on the agreement between invasive and noninvasive aortic and brachial pressure.

Brachial cuff-based methods are increasingly used to estimate aortic systolic blood pressure (aoSBP). However, there are several unresolved issues. to determine to what extent the scheme used to calibrate brachial records (1) can affect noninvasive obtained aoSBP levels, and consequently, the level of agreement with the aoSBP recorded invasively, and (2) how different ways of calibrating ultimately impact the relationship between aoSBP and cardiac properties. brachial and aortic blood pressure (BP) was simultaneously obtained by invasive (catheterisation) and noninvasive (brachial oscillometric-device) methods (89 subjects). aoSBP was noninvasive obtained using three calibration schemes: 'SD': diastolic and systolic brachial BP, 'C': diastolic and calculated brachial mean BP (bMBP), 'Osc': diastolic and oscillometry-derived bMBP. Agreement between invasive and noninvasive aoSBP, and associations between BP and echocardiographic-derived parameters were analysed. 'C' and 'SD' schemes generated aoSBP levels lower than those recorded invasively (mean errors: 6.9 and 10.1 mmHg); the opposite was found when considering 'Osc'(mean error: -11.4 mmHg). As individuals had higher invasive aoSBP, the three calibration schemes increasingly underestimated aoSBP levels; and viceversa. The 'range' of invasive aoSBP in which the calibration schemes reach the lowest error level (-5-5 mmHg) is different: 'C': 103-131 mmHg; 'Osc': 159-201 mmHg; 'SD':101-124 mmHg. The calibration methods allowed reaching levels of association between aoSBP and cardiac characteristics, somewhat lower, but very similar to those obtained when considering invasive aoSBP. There is no evidence of a clear superiority of one calibration method over another when considering the association between aoSBP and cardiac characteristics.

Acute Vascular Response to Hemodialysis as Measured by Serum Syndecan-1 and Endothelin-1 Levels as Well as Vascular Stiffness

Background: Chronic hemodialysis (HD) patients have a very high cardiovascular risk. Acute vascular changes during dialysis mediated by factors of the endothelium may have a crucial role in this. The aim of this article is to study the acute vascular changes during HD. Methods: In 29 consecutive chronic HD patients (age: 65.6 ± 10.4 years), their pre-, mid-, and post-HD plasma syndecan-1 (SDC-1) and endothelin-1 (ET-1) levels were measured. Applanation tonometry was performed before HD. Results: Their SDC-1 levels increased during HD (p = 0.004). Males had higher ET-1 levels. The patients were divided into two groups based on their pre-HD pulse wave velocity (PWV): PWV ≥ 12 m/s and PWV &lt; 12 m/s. The pre-HD and mid-HD SDC-1 levels were higher in the group with a PWV ≥ 12 m/s (10.174 ± 2.568 vs. 7.928 ± 1.794 ng/mL, p = 0.013, and 10.319 ± 3.482 vs. 8.248 ± 1.793 ng/mL, p = 0.044, respectively). The post-HD ET-1 levels were higher in the patient group with a PWV ≥ 12 m/s (10.88 ± 3.00 vs. 8.05 ± 3.48 pg/l, p = 0.027). Patients with a PWV ≥ 12 m/s had higher pre-HD peripheral and aortic systolic blood pressures (p &lt; 0.05). The total cholesterol correlated with the SDC-1 decrease during HD (r = 0.539; p = 0.008). The pre-, mid-, and post-HD SDC-1 correlated with ultrafiltration (r = 0.432, p = 0.019; r = 0.377, p = 0.044; and r = 0.401, p = 0.012, respectively). Conclusion: SDC-1 and ET-1 contribute to the vascular changes observed during HD, and they have correlations with some cardiovascular risk factors.

Invasively Measured Aortic Systolic Blood Pressure and Office Systolic Blood Pressure in Cardiovascular Risk Assessment in CKD

IntroductionCentral aortic blood pressure (BP) could be a better risk predictor than brachial BP. This study examined whether invasively measured aortic systolic BP improved outcome prediction beyond risk prediction by conventional cuff-based office systolic BP in patients with and without chronic kidney disease (CKD). MethodsIn a prospective, longitudinal cohort study aortic and office systolic BPs were registered in patients undergoing elective coronary angiography. CKD was defined as estimated glomerular filtration rate <60 ml/min/1.73 m2. Multivariable Cox models were used for the association with incident myocardial infarction (MI), stroke, and death. ResultsAortic and office systolic BPs were available in 39,866 patients (mean age: 64 years; 58% males; 64% with hypertension) out of which 6,605 (17%) had CKD. During a median follow-up of 7.2 years (interquartile range: 4.6-10.1 years), 1,367 strokes (CKD: 353), 1,858 MIs (CKD: 446) and 7,551 deaths (CKD: 2,515) occurred. CKD increased the risk of stroke, MI and death significantly. Office and aortic systolic BP were both associated with stroke in non-CKD patients (adjusted hazard ratios with 95% confidence interval per 10 mmHg: 1.08 (1.05–1.12) and 1.06 (1.03–1.09), respectively) and with MI in CKD patients (adjusted hazard ratios: 1.08 (1.03–1.13) and 1.08 (1.04–1.12), respectively). There was no significant difference between prediction of outcome with office or aortic systolic BP when adjusted models were compared with C-statistics. ConclusionRegardless of CKD status, invasively measured central aortic systolic BP does not improve the ability to predict outcome compared with brachial office BP measurement.

Abstract 14586: Early Life Trauma Exposure and Subclinical Cardiovascular Disease Risk in Black Men and Women

Introduction: Childhood trauma is associated with a greater risk of developing hypertension in adulthood. Black individuals develop hypertension at younger ages, have more aggressive hypertension, and are more likely to experience childhood trauma compared to White individuals. Yet, the impact of childhood trauma on vascular stiffness in Black individuals remains less clarified; thus, we examined the association between childhood trauma and arterial stiffness in Black individuals. Hypothesis: Childhood trauma exposure will be associated with vascular dysfunction and this association may differ by sex. Methods: Childhood trauma exposure and vascular function were assessed in a cohort of healthy Black participants without known CVD [n=404] from a large metropolitan city. Childhood trauma was assessed using the Early Trauma Inventory short form [ETISR-SF] consisting of four-physical, sexual, emotional, and general-domains, with higher scores indicative of higher traumatic life events assessed before age 18 years. Outcomes of central augmentation index [CAIx] and carotid femoral pulse wave velocity [CfPWV] were measured as indices of wave reflections and arterial stiffness using applanation tonometry [Sphygmocor Inc.], and central pulse pressure [CPP] was calculated as the difference between the aortic systolic and diastolic blood pressures. Relationships between ETISR-SF and outcomes were assessed using multivariate-adjusted and sex-stratified linear regression models. Results: Mean age of the cohort was 53(SD=10.3), 61% women. Cumulative childhood trauma was associated with CAIx β =0.33%, 95%CI: 0.04,0.62 and CPP β =0.24mmHg, 95%CI:0.04,0.45, but not CfPWV β =-0.02m/s, 95%CI:-0.07,0.02 after adjusting for demographic, BMI, BP, lipids, glucose, clinical history, health behaviors, and depression. Significant traumaxSex interactions were identified for CAIx P=0.01 and CPP P=0.02 . Among women, childhood trauma was associated with higher CAIx β =0.32%, 95%CI: 0.04, 0.60 and CPP β =0.19 mmHG, 95%CI: -0.02, 0.41, but not in men. Conclusion: Exposure to childhood trauma is associated with measures of arterial stiffness in Black women, noting the detrimental effects of childhood trauma on future CVD risk in Black women.

Pulse wave analysis measurements: important, underestimated and undervalued parameters in cardiovascular health problems.

Central aortic stiffness is established as a reliable measure of cardiovascular disease. While pulse wave velocity (PWV) analysis measures arterial distensibility, risk profile of cardiovascular diseases can be expanded with following pulse wave analysis measurements: central aortic systolic blood pressure (CABPS), central aortic pulse pressure (CAPP), central aortic reflection magnitude (CARM), central aortic augmented pressure (CAAP) and central aortic augmentation index (CAAIx). The aim of this study is to evaluate the clinical usefulness and importance of pulse wave analysis measurements in specific cardiovascular conditions and diseases, both in term of diagnosis and therapeutic monitoring. One thousand sixty-six subjects were included. According to age bracket, four cohorts were investigated-healthy subjects (NL), hypertensive patients (HP), ischemic heart disease (IHD) and valvular heart disease (VHD) patients. Arterial stiffness was analyzed through Sphygmocor XCEL Central Blood Pressure Measurement System and Sphygmocor XCEL PWV Measurement System. Furthermore we observed the pulse wave analysis measurements of 14 patients with diagnose of ADHD who were referred by a child psychiatrist, in order to investigate the initiation of methylphenidate treatment. Statistically significant differences were found between NL and HP cohorts, across almost all age brackets, regarding pulse wave analysis measurements. In the risk stratification of arterial stiffness hypertension and especially central aortic blood pressure systolic (CABPS) seems a determining factor. Pulse wave analysis measurements for IHD and VHD cohort comparisons with NL counterparts, revealed non- statistically significant variations. Elevated CAAP, CAAIx and CARM within the youngest age group (0-10 years) in attention-deficit-hyperactivity-disorder (ADHD) patients warrant attention. Following such investigations, CABPS appears as a robust predominant factor in problems of arterial stiffness. Pulse wave analysis and PWV are important parameters in the evaluation and monitoring of arterial hypertension and cardiovascular diseases. There is a hypothesis that CAAP could be an important and even decisive parameter in the diagnosis of ADHD. Further investigation needed.

Longitudinal profiling and tracking stability in the Singapore study of macro-angiopathy and microvascular reactivity in type 2 diabetes cohort.

The Singapore Study of Macro-Angiopathy and microvascular Reactivity in Type 2 Diabetes (SMART2D) is a prospective cohort study which was started in 2011 to investigate the effect of risk factors on vascular function and diabetes-related complications in Asians. We aimed to compare the longitudinal change in risk factors by accounting for batch effect and assess the tracking stability of risk factors over time in patients recruited for SMART2D. In this study, we (1) described batch effect and its extent across a heterogenous range of longitudinal data parameters; (2) mitigated batch effect through statistical approach; and (3) assessed the tracking stability of the risk factors over time. A total of 2258 patients with type 2 diabetes mellitus (T2DM) were recruited at baseline. The study adopted a three-wave longitudinal design with intervals of 3years between consecutive waves. The changes in a few selected risk factors were assessed after calibration, assuming patients with similar demographic and anthropometry profile had similar physiology. The tracking pattern of the risk factors was determined with stability coefficients derived from generalised estimating equations. The medians of the longitudinal differences in risk factors between the waves were mostly modest at <10%. Larger increases in augmentation index (AI), aortic systolic blood pressure (BP) and aortic mean BP were consistently observed after calibration. The medians of the longitudinal differences in AI, aortic systolic BP and aortic mean BP between the waves were <2% before calibration, but increased slightly to <5% after calibration. Most of the risk factors had moderate to high tracking stability. Muscle mass and serum creatinine were among those with relatively high tracking stability. The longitudinal differences in parameters between the waves were overall modest after calibration, suggesting that calibration may attenuate longitudinal differences inflated by non-biological factors such as systematic drift due to batch effect. Changes of the hemodynamic parameters are robust over time and not entirely attributable to age. Our study also demonstrated moderate to high tracking stability for most of the parameters.

Angiopoietin-2 Is Associated with Aortic Stiffness in Diabetes Patients in Ghana: A Case-Control Study.

Impaired angiogenesis, measured as serum levels of angiogenic growth factors, may be among the mechanisms underlining aortic stiffness in diabetes patients. We studied the association between aortic stiffness and circulating angiogenic growth factors in type 2 diabetes (T2DM) patients without any organ damage. In a case-control design, aortic pulse wave velocity (PWV), augmentation index (AIx), and aortic blood pressures (BPs) were measured in 140 T2DM patients and 110 nondiabetic controls. Fasting blood samples were collected to measure the levels of angiopoietin- (Ang-) 1, Ang-2, and vascular endothelial growth factor-A (VEGF). Compared to nondiabetes participants, T2DM patients had increased PWV (8.7 ± 1.5 vs. 7.6 ± 1.3, p = 0.031), aortic pulse BP (58 ± 20 vs. 49 ± 17, p = 0.011), Ang-2 (838 (473-1241) vs. 597 (274-1005), p = 0.018), and VEGF (72.2 (28-201.8) vs. 48.4 (17.4-110.1), p = 0.025) but reduced levels of AIx (21.7 ± 13.8 vs. 34 ± 12.9, p < 0.001) and Ang-1 (33.1 (24.7-42.1) vs. 41.1 (30-57.3), p = 0.01). In all study participants, compared to those in the lower tertile, participants in the upper tertile of Ang-2 had increased odds of PWV (2.01 (1.17-3.84), p = 0.004), aortic systolic BP (1.24 (1.04-1.97), p = 0.011), and aortic pulse BP (1.19 (1.04-1.82), p = 0.041) but reduced odds of AIx (0.84 (0.71-0.96), p = 0.014) in multivariable-adjusted models. In our study population, increased circulating Ang-2 was associated with increased levels of aortic stiffness parameters.

Elasticity and Lipids Changes in Children with Type I Diabetes Mellitus Compared with Controls and the Effect of Lipids on Elasticity in Diabetic Children

Abstract Background Increased atrial elasticity is a marker of cardiovascular events. This study aimed to compare the parameters of elasticity and lipids in children with type 1 diabetes mellitus (TIDM) compared with controls and the effect of lipids on elasticity in children with diabetes. Method This case-control study was performed in 186 children aged 6 to 18 years. The aortic diameter was obtained from 3 cm above the aortic valve using M mode and was calculated as the distance between the medial edge of the anterior and posterior walls of the aorta at systole and diastole. AoS and AoD were recorded when the aortic wall was fully open. The parameters of aortic elasticity, aortic stiffness beta index, aortic tension, and elastic modulus of pressure were measured. Cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein were measured. For data analysis, SPSS 20 considers the applicable error to be 0.05. Results The participants were matched by sex and age. The right CHO, LDL, HDL, and MPI lipids, systolic, diastolic, and aortic systolic blood pressure were different among patients. The analysis also showed that ASβI (MWU = 1582.50, p &lt; 0.001) and PSEM (MWU = 1381.00 and p &lt; 0.001) were higher when AS (MWU = 1204 and p &lt; 0.001) and AoD (MWU = 1672.00 and p &lt; 0.001) and AoD (MWU = 1672.00 and p &lt; 0.001) were lower in patients than in controls. No lipid profiles were significantly correlated with stiffness parameters before and after controlling for age. Conclusion It was concluded that lipid profiles were different, and ASβI and PSEM were lower when AoS and AoD were higher in children with diabetes. None of the lipid profiles were significantly correlated with stiffness parameters before and after controlling for age.

Central and Peripheral Hemodynamics in Young Adults Who Use Water Pipes and the Acute Effects of Water-Pipe Use

Tobacco use via water pipe (commonly referred to as water-pipe smoking [WPS]) is popular among young adults globally and exposes those who smoke to toxicants. Is WPS associated with impaired measures of arterial function and does WPS acutely impair these measures in young adults? We assessed heart rate (HR), brachial and aortic BP, HR-adjusted augmentation index (AI), and carotid-femoral pulse wave velocity (CFPWV) in 62 individuals who use water pipes and 34 individuals who have never used a water pipe recruited from the community (mean age, 22.5 ± 3.0 years; 48%female). Measurements were obtained before and after an outdoor session of WPS among participants who use water pipes and among the control group of participants who have never used a water pipe. Measurements were compared after vsbefore exposure and between those who use and those who do not use water pipes, adjusting for possible confounders using linear regression. Participants who use water pipes and control participants had similar demographic characteristics. BP and HR increased acutely after WPS (brachial systolic BP by 4.13mmHg [95%CI, 1.91-6.36mmHg]; aortic systolic BP by 2.31mmHg [95%CI, 0.28-4.33mmHg]; brachial diastolic BP by 3.69mmHg [95%CI, 1.62-5.77mmHg]; aortic diastolic BP by 3.03mmHg [95%CI, 0.74-5.33mmHg]; and HR by 7.75 beats/min [95%CI, 5.46-10.04 beats/min]), but not in the control group. AI was significantly higher in participants who use water pipes compared with those who do not (9.02%vs3.06%; P= .03), including after adjusting for BMI and family history of cardiovascular disease (β= 6.12; 95%CI, 0.55-11.69; P= .03) and when assessing habitual tobacco use via water-pipe extent (water pipes used/day× water-pipe use duration) in water-pipe-years (β= 2.51/water-pipe-year; 95%CI, 0.10-4.92/water-pipe-year; P= .04). However, CFPWV was similar in those who use water pipes and those who do not, and AI and CFPWV did not change acutely after WPS. In apparently healthy young individuals from the community, habitual WPS was associated with increased AI, a predictor of cardiovascular risk, and one WPS session acutely increased HR and brachial and aortic BP.

Direct estimation of central aortic pressure from measured or quantified mean and diastolic brachial blood pressure: agreement with invasive records.

Recently it has been proposed a new approach to estimate aortic systolic blood pressure (aoSBP) without the need for specific devices, operator-dependent techniques and/or complex wave propagation models/algorithms. The approach proposes aoSBP can be quantified from brachial diastolic and mean blood pressure (bDBP, bMBP) as: aoSBP = bMBP2/bDBP. It remains to be assessed to what extent the method and/or equation used to obtain the bMBP levels considered in aoSBP calculation may affect the estimated aoSBP, and consequently the agreement with aoSBP invasively recorded. Brachial and aortic pressure were simultaneously obtained invasively (catheterization) and non-invasively (brachial oscillometry) in 89 subjects. aoSBP was quantified in seven different ways, using measured (oscillometry-derived) and calculated (six equations) mean blood pressure (MBP) levels. The agreement between invasive and estimated aoSBP was analyzed (Concordance correlation coefficient; Bland-Altman Test). The ability of the equation "aoSBP = MBP2/DBP" to (accurately) estimate (error <5 mmHg) invasive aoSBP depends on the method and equation considered to determine bMBP, and on the aoSBP levels (proportional error). Oscillometric bMBP and/or approaches that consider adjustments for heart rate or a form factor ∼40% (instead of the usual 33%) would be the best way to obtain the bMBP levels to be used to calculate aoSBP.