Aortic Systolic Pressure Research Articles

ASSOCIATION OF CAROTID-FEMORAL PULSE WAVE VELOCITY AND RISK THRESHOLDS OF INDEX OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE (ASCVD) IN HYPERTENSION

Objective: As index of arterial stiffness, carotid-femoral pulse wave velocity (cfPWV) is strongly associated with cardiovascular risk. This study aimed to assess association of cfPWV and cardiovascular disease (CVD) in a Chinese hypertensive cohort and determine the cfPWV threshold value for assessment of future risk of CVD. Design and method: This cross-sectional study was conducted in hospital in-patients with multiple CVD risk factors or complications due to target organ damage. cfPWV was measured with the Complior device (Alam Medical, France) and central aortic pressure (cAP) with the SphygmoCor device (AtCor Medical [CardieX], Sydney) giving cAP indices: augmented pressure (AP), augmentation index (Aix), aortic pulse pressure, (aPP) aortic systolic pressure (aSBP). Framingham Risk Scores (FRS) were computed for all participants. Criteria specified by American College of Cardiology and American Heart Association were used to calculate atherosclerotic cardiovascular disease (ASCVD) risk scores. Patients were stratified by ASCVD risk threshold of 10% and divided into two groups: ASCVD >10% or ASCVD<10%. cfPWV cut-off value associated with or without ASCVD risk was obtained by receiver operating characteristics (ROC) curve. Results: All participants (n = 630; age 63.6 ± 8.6 years, 61.7% male) had primary hypertension. aAP, AIx, aPP, aSBP and were greater in females than in males (p < 0.001); ASCVD risk scores and brachial diastolic pressure (DBP) were higher in males (p<0.05). All hemodynamic indices showed significant correlation with ASCVD and FRS, except for AIx with no correlation with ASCVD. In multivariate logistic analysis, cfPWV was significantly associated with ASCVD risk (OR: 1.324, [1.119–1.565], p < 0.001) after adjusting for age, gender, smoking, body mass index, total cholesterol, fasting blood glucose, antihypertensive treatment, statin treatment, DBP. Area under the ROC curve was 0.758 and 0.672 for cfPWV and aortic SBP (p < 0.001 and p < 0.001, respectively); the critical value of cfPWV and aSBP was 12.5 m/s (sensitivity 63.2%; specificity: 77.8%) and 124.5 mmHg (sensitivity 63.9%; specificity: 65.3%). cfPWV significantly correlated with the ASCVD risk. Conclusions: The optimal cut-off value of cfPWV for assessing future CVD risk in the hypertensive population in China is 12.5 m/s.

FACTORS RELATED TO SKIN MICROVASCULAR DYSFUNCTION IN INDIVIDUALS WITH DIFFERENT RANGE OF GLUCOSE LEVELS

Objective: Existing data confirm the presence of microvascular dysfunction in hypertension and diabetes mellitus (DM). Prediabetes is recognized as a significant metabolic status, being a key factor in the occurrence of DM and there is increasing evidence concerning microvascular complications in prediabetes. Laser speckle contrast analysis (LASCA) is a non-invasive technique that can be used to evaluate skin microvascular function. The aim of our study was to assess cardiovascular factors that are possibly associated with microvascular reactivity in a population from normoglycaemia to DM. Design and method: Individuals with normoglycemia, prediabetes and diabetes without established cardiovascular disease were included in the study. In all participants, forearm skin blood flow was recorded under standardized conditions using a laser speckle contrast imager (PeriCam PSI NR System, Perimed). Post-occlusive reactive hyperaemia (PORH) was assessed following a standardized protocol and data were analyzed with a signal processing software (PIMSoft, Perimed). Skin microvascular reactivity was expressed as a percentage increase between baseline and peak perfusion (%). Office BP was measured in each participant according to a standard methodology and aortic blood pressure was assessed using the Sphygmocor device. Results: Fifty individuals (18 patients with prediabetes, 16 patients with DM and 16 controls) were included in the study. In the univariate model both glucose levels and aortic systolic blood pressure (aSBP) correlated inversely with microvascular reactivity (r = -0.382 and r = -0.349, p<0.01 for both comparisons) However, in the multivariate model only the association with aSBP remained statistically significant (beta = -0.363, p<0.05). Conclusions: Only central SBP, but not glucose predicted skin microvascular dysfunction in individuals with normoglycemia, prediabetes and diabetes and without established cardiovascular disease.

Accuracy of Estimated Central Systolic Blood Pressure and Augmentation Index in Patients With Type 2 Diabetes Mellitus

It has been suggested that transfer functions to estimate central aortic systolic blood pressure (SBP) and central BP waveform parameters (i.e., augmentation index) may be less accurate in patients with type 2 diabetes mellitus (T2DM). However, these observations have not been confirmed in a large sample, which was the aim of this study. Consecutive patients with and without T2DM undergoing coronary angiography at the Royal Hobart Hospital had BP recorded at the ascending aorta and radial artery with a fluid-filled catheter. Radial BP waveforms were processed using the SphygmoCor Cardiovascular Management System (CVMS) transfer function (AtCor, Sydney) to estimate central BP. Two invasive waveform calibration methods were used: 1) aortic mean arterial pressure/diastolic BP (MAP/DBP); and 2) radial SBP and DBP (SBP/DBP). between-group analyses were performed unadjusted and adjusted for age, sex, hypertension, hypercholesterolaemia, body mass index, and coronary artery disease. Data from 64 patients with T2DM (61±11 years, 73% male) and 186 patients without T2DM (62±8 years, 70% male) were analysed. There was no difference in the accuracy of estimated central SBP between groups when compared with invasive aortic SBP from MAP/DBP calibration (T2DM –1.8±6 mmHg vs –1.1±5 mmHg; p=0.37; adjusted p=0.59) or radial SBP/DBP calibration (T2DM –1.2±9 mmHg vs –2.0±9 mmHg; p=0.57; adjusted p=0.66). Augmentation index was not significantly different between patients with and without T2DM 0.8±12% vs 3.7±14%; p=0.13, respectively). Estimated central SBP and augmentation index do not appear to be less accurate in patients with T2DM when waveforms are calibrated with invasive BP.

RANDOMIZED PILOT STUDY ON THE EFFECTS OF SARCOCORNIA AS A SALTSUBSTITUTE IN ARTERIAL BLOOD PRESSURE AND VASCULAR FUNCTION INHEALTHY YOUNG ADULTS

Objective: Previous studies have shown that excessive salt intake is strongly associated with highblood pressure (HT), vascular dysfunction, and the overall risk of cardiovascular diseases. The aimof this study was to evaluate Sarcocornia effectiveness as a salt substitute, addressing its effect oncardiovascular function in healthy young individuals. Design and method: Thirty healthy participants, aged 18 to 26 years,were randomized into two groups: the control group (CG) and the intervention group (IG). The IGused Sarcocornia powder as a salt substitute for cooking, and the CG used regular salt, during a periodof 1 month. A baseline evaluation was performed before the participants started the interventionphase, and was repeated after a 30-day intervention period. Each evaluation included blood pressure (BP) measurement, carotid-femoral pulse wave velocity (PWV), and carotid pulse wave analysis(PWA), and blood samples were also collected for analysis. Sodium excretion was measured atbaseline and after intervention through spot urine collection and analysis, a method suitable forthis population but with known limitations. Results: Baseline parameters were similar between groups and were within normal range. Sodium excretion remained unchanged in the two evaluations in the CG, but significantly decreased after intervention in the IG. The reduction in sodium excretion in the IG was followed by a significant reduction in brachial and aortic systolic (-7.0± 0.9 mmHg and -5.6 ± 1.0 mmHg, respectively; p<.001) and diastolic (-5.9 ± 1.0 mmHg; p<.001) blood pressure, with no differences observed in the CG. Also in the IG, PWV decreased from 6.0 ± 0.6 m/s at baseline to 5.7 ± 0.6 m/s after intervention (p = .042), with no significant changes in the CG. Conclusions: This preliminary study conveys positive results in favor of Sarcocornia as a dietary substitute for regular salt, providing added evidence on the negative cardiovascular effects of high salt intake in young and healthy adults. The overall nutritional value of Sarcocornia, also known for its high phenolic content, may also add to the observed benefits.

THE RELATIONSHIP BETWEEN ARTERIAL STIFFNESS, SUBCLINICAL HEART FAILURE, CARDIAC FIBROSIS AND RENAL FUNCTION IN CHRONIC KIDNEY DISEASE, IGA NEPHROPATHY

Objective: IgA nephropathy (IgAN) is the most common primary glomerular disease worldwide. Arterial stiffness may predict cardiovascular (CV) mortality and morbidity in chronic kidney disease (CKD). Heart failure is very common in advanced CKD stages. Onset of myocardial fibrosis may be a pathophysiological alteration in CKD patients with heart failure. Design and method: In our cross-sectional study, we examined 90 patients who cared for IgAN in our clinic. Arterial stiffness was determined by measuring carotis-femoral pulse wave velocity (cfPWV) using the ShygmoCor device. N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and carboxy-terminal telopeptide of collagen type I (CITP) were measured using ELISA kits. Renal function was detected by the estimated glomerular filtration rate (eGFR-CKD-EPI). Furthermore, a routine echocardiography examination was performed. Results: Of the 90 patients included in the study, 50 were male, with a mean age of 54.9 ± 14.4 years. Patients were divided into two groups based on eGFR (CKD 1-2 and CKD 3-5). There were significantly higher NT-proBNP (p = 0.035), cfPWV (p = 0.004), and central aortic systolic pressure (p = 0.037), but not CITP, in the CKD 3-5 group. The number of patients with combined biomarker positivity (NT-proBNP and CITP) was also significantly higher in the CKD3-5 group (p = 0.035) compared to the CKD 1-2 group. The central aortic systolic pressure was significantly higher in the diastolic dysfunction group (p = 0.034), but the systolic blood pressure was not. eGFR and hemoglobin level showed a strong negative correlation, while left ventricular mass index (LVMI), aortic pulse pressure, central aortic systolic pressure, and cfPWV showed a positive correlation with NT-proBNP. cfPWV, aortic pulse pressure, and LVMI showed a strong positive correlation with CITP by Spearman's correlation. Only eGFR was an independent predictor of NT-proBNP by linear regression analysis. Conclusions: A possible mechanism for the development of heart failure in CKD patients may be an elevation of central aortic systolic pressure. NT-proBNP and CITP biomarkers may help to identify IgAN patients at high risk for subclinical heart failure and further atherosclerotic disease.

Sex Differences in Left Ventricular Wall Stress in Apparently Healthy Adults with Similar Cuff-Measured Blood Pressure.

Outcome-based evidence shows that women have a higher risk of heart failure than men at a similar level of blood pressure. Left ventricular wall stress (Ó) or afterload is an important determinant of myocardial performance. Thus, it might play a key role in determining the sex differences in heart failure.The Ó at the beginning of aortic valve opening (Ó-AVO), the systolic peak value of the Ó (Ó-peak), and the Ó at the end systole (Ó-ES) were determined using transthoracic echocardiography combined with cuff-measured brachial blood pressure in 990 age- and heart rate- and cuff-measured blood pressure-matched apparently healthy adults (495 men). The sex differences in the aortic pressure, the ratio of left ventricular wall volume to cavity volume (VW/VC), and Ó were analyzed.Compared with men, women demonstrated higher aortic systolic blood pressure (106.7 versus 101.7 mmHg), smaller VW/VC (1.12 versus 1.25 for the end-diastole VW/VC, 3.49 versus 3.82 for the end-systole VW/VC), and greater Ó (340.0 versus 315.6 for Ó-AVO, 471.9 versus 412.5 for Ó-peak, and 256.2 versus 230.3 kdynes/cm2 for Ó-ES) (all P < 0.001).At the same level of cuff-measured blood pressure, women have a greater Ó or afterload than men in consequence of the sex differences in left ventricular geometry and pulse pressure amplification. The evidence indicates that non-sex-specific categories of blood pressure factitiously impose a relatively higher afterload on the left ventricle in women and may therefore increase potential risk of heart failure in women.

Effects of whole-body cryotherapy and static stretching are maintained 4 weeks after treatment in most patients with chronic fatigue syndrome

In the previous study, whole-body cryotherapy (WBC)+static stretching (SS) has been shown to reduce the severity of some symptoms in Chronic Fatigue Syndrome (CFS) noted just after the therapy. Here we consider the effects of treatment and explore the sustainability of symptom improvements at four weeks (one-month) follow-up. Twenty-two CFS patients were assessed one month after WBC + SS programme. Parameters related to fatigue (Chalder Fatigue Questionnaire (CFQ), Fatigue Impact Scale (FIS), Fatigue Severity Scale (FSS)), cognitive function (Trial Making test part A and B (TMT A and TMT B and its difference (TMT B-A)), Coding) hemodynamic, aortic stiffness (aortic systolic blood pressure (sBP aortic)) and autonomic nervous system functioning were measured. TMT A, TMT B, TMT B-A and Coding improved at one month after the WBC + SS programme. WBC + SS had a significant effect on the increase in sympathetic nervous system activity in rest. WBC + SS had a significant, positive chronotropic effect on the cardiac muscle. Peripheral and aortic systolic blood pressure decreased one month after WBC + SS in comparison to before. Effects of WBC + SS on reduction of fatigue, indicators of aortic stiffness and symptoms severity related to autonomic nervous system disturbance and improvement in cognitive function were maintained at one month. However, improvement in all three fatigue scales (CFQ, FIS and FSS) was noted in 17 of 22 patients. In addition, ten patients were treated initially but they were not assessed at 4 weeks, and are thus not included in the 22 patients who were examined on follow-up. The overall effects of WBC + SS noted at one month post-treatment should be interpreted with caution.

Percutaneous closure of ventricular septal rupture after myocardial infarction: A retrospective study of 81 cases.

To investigate the efficacy and safety of percutaneous closure of ventricular septal rupture (VSR) after acute myocardial infarction (AMI). This retrospective study included 81 patients who underwent transcatheter closure for postinfarction VSR. We analyzed clinical data from hospitalization and the 30-day follow-up, compared clinical data from the survival and death groups, and explored the best closure time and the safety and efficacy of occlusion. The risk factors for death at 30 days were analyzed by logistic regression. C-reactive protein (CRP), white blood cell counts, N-terminal pro brain natriuretic peptide (NT-ProBNP), and aspartate aminotransferase were higher in the death group than in the survival group (p < .01), with a higher rate of application of vasoactive drugs, and a shorter time from AMI to operation (p < .05). At 30 days postocclusion, 19 patients (23.5%) had died. The mortality rate was significantly lower for operation performed 3 weeks after AMI than for operation performed within 3 weeks of AMI (12.5% vs. 48%, p < .001). Devices were successfully implanted in 76 patients, with 16 (21.1%) operation-related complications and 12 (15.8%) valve injuries. Cardiac function improved significantly (p < .001) at discharge (N = 66) and 30 days after procedure (N = 62). Qp/Qs and pulmonary artery systolic pressure decreased significantly, while aortic systolic pressure increased significantly (p < .001). Additionally, EF and LVDd improved (p < .05) after occlusion. Increases in CRP and NT-ProBNP were risk factors for death at 30 days after closure (p < .05). Percutaneous VSR closure can be a valuable treatment option for suitable patients with VSR.

Beta-Blockers and Hypertension: Some Questions and Answers.

International guidelines have removed b-blockers from first-line treatment of hypertension, limiting their use to patients with compelling indications. The position of guidelines stems from the results of studies performed with the 1st and 2nd generation of b-blockers, which concluded that these drugs have lower cardiovascular protection, compared with other antihypertensive agents. The aim of our mini review is to answer to some questions about the effect of b-blockers on hypertension and cardiovascular protection and if these effects are different from those of other antihypertensive drugs, particularly in young and elderly patients. We evaluated the relevant systematic reviews and meta-analyses, which reported the effectiveness of b-blockers on blood pressure and cardiovascular outcomes, compared with placebo/no treatment and with other antihypertensive agents. Beta-blockers, decreased high blood pressure with no significant difference from other common antihypertensive agents. Moreover b-blockers, compared with placebo, lowered the risk of major cardiovascular outcomes, while, compared with other drug classes, the reported results are very heterogeneous. Therefore it is difficult, globally, to find a difference between b-blockers and other drug classes. Rather than looking for differences in the cardiovascular protective effect between b-blockers and other antihypertensive agents, we have to consider the different pathophysiology of hypertension in young [sympathetic hyperactivity] and elderly patients [arterial stiffness, high aortic systolic pressure]. Considering these aspects, non-vasodilating b-blockers are preferred, as first-line, in young/middle aged hypertensive subjects, while vasodilating b-blockers, are most appropriate, in elderly patients, for the favourable hemodynamic profile.

Post-Prandial Cognitive and Blood Pressure Effects of a DHA-Rich Omega-3 Powder in Middle-Aged Males: A Pilot Study

The use of omega-3 polyunsaturated fatty acid (ω-3 PUFA) supplements is increasingly common among middle-aged and older adults. Users of ω-3 PUFA supplements often report using such supplements to support cognitive health, despite mixed findings reported within the ω-3 PUFA literature. To date, very few studies have explored cognitive effects in distinctly middle-aged (40 to 60 years) adults, and none have examined the acute effects (in the hours following a single dose) on cognitive performance. The current study evaluated whether a single dose of ω-3 PUFA (4020 mg docosahexaenoic acid and 720 mg eicosapentaenoic acid) influences cognitive performance and cardiovascular function in middle-aged males. Cognitive performance and cardiovascular function were assessed before and 3.5–4 h after consumption of a high dose of ω-3 PUFA (DHA + EPA) or placebo, incorporated into a standardized meal (i.e., single serve of Greek yogurt). In this study of middle-aged males, no significant differential treatment effects were observed for cognitive performance. However, a significant reduction in aortic systolic blood pressure (pre-dose to post-dose) was apparent following consumption of the ω-3 PUFA (DHA + EPA) treatment (mean difference = −4.11 mmHg, p = 0.004) but not placebo (mean difference = −1.39 mmHg, p = 0.122). Future replication in a sample comprising females, as well as patients with hypertension, is merited.

Determinants and prognostic value of albuminuria in adult patients with congenital heart disease

The determinants and prognostic value of albuminuria remain unclear in patients with adult congenital heart disease (ACHD), especially in those with Fontan circulation (FC). We retrospectively reviewed 512 consecutive ACHD patients and investigated the determinants of urinary albumin-to-creatinine ratio (ACR) and albuminuria (MAU) and their association with all-cause mortality. Demographic data and laboratory and hemodynamic parameters were collected. Regression analysis and Cox proportional hazard models were used to identify the relationship between log ACR and variables, and clinical factors and all-cause mortality, respectively. Body mass index, aortic systolic blood pressure (ASP), arterial oxygen saturation (SaO2), glycated hemoglobin (HbA1c), B-type natriuretic peptide, and diuretic use were independently associated with log ACR. ASP, SaO2, and HbA1c were independently associated with MAU (p < 0.05 - 0.001). The prevalence of MAU was highest in unrepaired patients with low SaO2 (50%; p < 0.0001). Log ACR and MAU were associated with exercise capacity and all-cause mortality (p < 0.0001 for both) independent of renal function. Patients with ACHD, MAU, and renal dysfunction (n = 23) had the highest risk of all-cause mortality, while those without MAU or renal dysfunction had the lowest risk (p < 0.0001). These prognostic values remained significant in separate analyses of Fontan and biventricular circulation (p < 0.0001). ASP, SaO2, and HbA1c levels were independently associated with MAU in ACHD patients. MAU and log ACR were associated with all-cause mortality in patients with Fontan and biventricular circulation, independent of renal dysfunction.

Biological sex influences aortic hemodynamic responses to maximal exercise in healthy older adults

Aging is associated with stiffening of large elastic arteries resulting in early wave reflection, which increases aortic systolic blood pressure (BP) and left ventricular afterload. These age-related alterations predispose older adults to cardiovascular disease (CVD). Exercise is recommended for reducing CVD risk in older adults, but the acute aortic hemodynamic responses to exercise have not been fully described. We have previously shown that exercise intensity influences acute aortic hemodynamic responses to submaximal exercise in older adults, however, the responses to maximal exercise have not been investigated. In young adults, the influence of maximal exercise on aortic wave characteristics is impacted by sex. Therefore, the objective of this study was to investigate the acute effects of maximal exercise on aortic wave characteristics in healthy older adults and to test the hypothesis that the acute aortic hemodynamic responses to maximal exercise will be influenced by sex. Twenty-two older men and postmenopausal women (66.4±1.0 yrs, mean±SE, 11M/11W) completed the study. Research participants were free of major clinical disease, were not using hormone replacement therapy or participating in endurance exercise training. Aortic wave characteristics were assessed using wave separation analysis (SphygmoCor XCEL) before and immediately after maximal exercise, based on a modified Balke treadmill test. We found that wave reflection, assessed as augmentation index (AIx) at heart rate of 75 bpm (AIx@75), was not different between older men and women prior to maximal exercise ( P=0.2). Following maximal exercise, AIx@75 increased in older men (21.1±2.6 vs. 28.2±2.4 %, pre- vs. post-exercise, P=0.02) and women (27.4±3.3 vs. 33.9±3.2 %, P=0.03), but the response was not influenced by sex ( P=0.9 for sex × time interaction). Aortic systolic and diastolic BP (AoSBP and AoDBP) were not different in older men compared with women prior to maximal exercise ( P≥0.4). In response to maximal exercise, AoSBP and AoDBP significantly increased in older men (AoSBP: 113±3 vs. 118±2 mmHg, P=0.01 and AoDBP: 75±2 vs. 80±2 mmHg, P&lt;0.01), but not in women (AoSBP: 113±4 vs. 113±4 mmHg, P=0.9; P=0.04 for sex × time interaction and AoDBP: 73±2 vs. 74±2 mmHg, P=0.054; P=0.02 for sex × time interaction). In conclusion, sex influences the aortic BP response to maximal exercise, but not the wave reflection response in older adults. This finding suggests that left ventricular afterload remains elevated during recovery from maximal exercise in older men which may differentially expose them to a transient risk of experiencing a cardiac complication. This work was supported by National Institute of Aging grant AG063143. This is the full abstract presented at the American Physiology Summit 2023 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.

Role of Chemerin and Perivascular Adipose Tissue Characteristics on Cardiovascular Risk Assessment by Arterial Stiffness Markers in Patients with Morbid Obesity.

The development of arterial stiffness (AS) in obesity is a multifactorial and complex process. The pleomorphic actions of adipokines and their local activity in perivascular adipose tissue (PVAT) are potential modulators of AS appearance and progression. We aimed to assess the correlations between two adipokines (chemerin, adiponectin), PVAT morphological changes (adipocyte size, blood vessel wall thickness) and AS parameters in the special subgroup of patients with morbid obesity. We enrolled 25 patients with morbid obesity and 25 non-obese patients, who were age- and gender-matched, untreated for cardiovascular risk factors, and admitted to hospital for laparoscopic surgical procedures (bariatric surgery for morbid obesity and non-inflammatory benign pathology surgery for non-obese patients). Before the surgical procedures, we evaluated demographic and anthropometric data and biochemical parameters including the studied adipokines. Arterial stiffness was evaluated using a Medexpert ArteriographTM TL2 device. In both groups, adipocyte size and vascular wall thickness as well as local adiponectin activity were analyzed in PVAT from intraoperative biopsies. In our study, adiponectin (p = 0.0003), chemerin (p = 0.0001) and their ratio (p = 0.005) had statistically significant higher mean values in patients with morbid obesity compared to normal-weight patients. In patients with morbid obesity there were significant correlations between chemerin and AS parameters such as aortic pulse wave velocity (p = 0.006) and subendocardial viability index (p = 0.009). In the same group adipocyte size was significantly correlated with another AS parameter, namely, aortic systolic blood pressure (p = 0.030). In normal-weight patients, blood vessel wall thickness positively correlated with AS parameters such as brachial (p = 0.023) and aortic augmentation index (p = 0.023). An important finding was the negative adipoR1 and adipoR2 immunoexpression in PVAT adipocytes of patients with morbid obesity. Additionally, we found significant correlations between blood vessel wall thickness and blood fasting glucose (p < 0.05) in both groups. Chemerin and adipocyte size could be predictive biomarkers for AS in patients with morbid obesity. Given the small number of patients included, our results need further validation.

Daily profile of arterial and central aortic pressure in patients with arterial hypertension and non-alcoholic fatty liver disease

Оbjective : to evaluate the features of daily monitoring of arterial and central aortic pressure in patients with arterial hypertension and non-alcoholic fatty liver disease. Materials and methods: a comparative cross-sectional study was conducted, which involved 120 patients (continuous sample, unorganized population), aged 45 to 65 years (mean age 56.2±8.8 years), including men (34 (28.3%) with AH stage I–II, 1–2 degree. The main group included 60 patients with hypertension and NAFLD, the control group included 60 patients with isolated hypertension. When examining patients, a clinical examination was carried out: taking an anamnesis, measuring "office" blood pressure, anthropometric parameters, calculating body mass index (BMI), WC. 24-hour monitoring of arterial (ABPM) and central aortic pressure (CAP) was assessed using the BPLab complex and Vasotens 24 software (LLC Petr Telegin, Russia). The SCORE scale was used to calculate total cardiovascular risk and 10-year fatal risk. Results : all patients of the study groups underwent ABPM. It was proved that in the patients of the main group, the IV SBP and IV DBP during the day and night significantly exceeded the similar parameters of patients in the comparison group (IV SBP: p=0.0019, p=0.007; IV DBP: p=0.009, p=0.009, respectively). One of the important criteria for assessing blood pressure was the determination of the degree of nighttime decrease in SBP and DBP — the daily index (SI), characterizing the balance in the work of the sympathetic and parasympathetic parts of the autonomic nervous system. In the main group, compared with the control group, there were more patients with SI DBP in the range from 0.0% to 10.0% (non-dipper) (p=0.034), with an increase in SBP at night (night-picker) (p=0.031). When assessing the parameters of CAP, in patients with AH and NAFLD, statistically significantly higher values of mean daily systolic (SADAo) and diastolic (DADo) aortic pressure were observed (p=0.016, p=0.039, respectively), SBP in the daytime (p=0.027), SADao and DADAO at night (p=0.002, p=0.003, respectively), compared with patients with isolated hypertension. Calculation of the risk of cardiovascular complications, in patients with hypertension and NAFLD, a significant increase in the 10-year risk of cardiovascular events was determined, compared with patients with isolated hypertension (3.7 (1.6; 6.0) vs 2.0 (0.6 ;4.3) %, p=0.013). Conclusion : according to the results of 24-hour BP monitoring, in patients with AH and NAFLD, compared with patients with isolated AH, a more significant increase in mean SBP and DBP, an increase in the rate of morning rise and BP variability, and the hypertension time index were revealed. In the main group, patients with a nocturnal increase in SBP were detected significantly more often, which indicates a greater risk of cardiovascular complications in patients with hypertension and NAFLD. In addition, compared with patients with isolated AH, patients with AH and NAFLD showed more significant increases in average daily and nighttime SBPao and DADAO.

The characteristics of elevated blood pressure in abdominal obesity correspond to primary hypertension: a cross-sectional study

BackgroundObesity-related hypertension and the associated metabolic abnormalities are considered as a distinct hypertensive phenotype. Here we examined how abdominal fat content, as judged by waist:height ratio, influenced blood pressure and hemodynamic profile in normotensive subjects and never-treated hypertensive patients.MethodsThe 541 participants (20–72 years) underwent physical examination and laboratory analyses and were divided into age and sex-adjusted quartiles of waist:height ratio. Supine hemodynamics were recorded using whole-body impedance cardiography, combined with analyses of radial tonometric pulse wave form and heart rate variability.ResultsMean waist:height ratios in the quartiles were 0.46, 0.51, 0.55 and 0.62. Radial and aortic blood pressure, systemic vascular resistance, pulse wave velocity, markers of glucose and lipid metabolism, leptin levels and C-reactive protein were higher in quartile 4 when compared with quartiles 1 and 2 (p < 0.05 for all). Cardiac index was lower in quartile 4 versus quartile 1, while no differences were seen in heart rate variability, augmentation index, plasma renin activity, and aldosterone concentration between the quartiles. Linear regression analyses showed independent associations of abdominal obesity with higher aortic systolic and diastolic blood pressure, systemic vascular resistance, and pulse wave velocity (p < 0.05 for waist:height ratio in all regression models).ConclusionHigher waist:height ratio was associated with elevated blood pressure, systemic vascular resistance, and arterial stiffness, but not with alterations in cardiac sympathovagal modulation or activation of the circulating renin-angiotensin-aldosterone system. Although obesity-related elevation of blood pressure has distinct phenotypic features, these results suggest that its main characteristics correspond those of primary hypertension.Trial registrationClinicalTrails.gov NCT01742702 (date of registration 5th December 2012).

Afterload reduction after non-invasive vagus nerve stimulation in acute heart failure.

While central blood pressure (BP) has been recognized as a major indicator of left ventricular (LV) afterload, the reduction of central pressure decreases LV afterload and may prevent heart failure (HF) decompensation. Non-invasive transcutaneous vagus nerve stimulation (tVNS) was shown to improve cardiac function in HF patients. In this study, the relationship between active tVNS and reduction of central BP was investigated in patients with acute HF (AHF). The 22 patients hospitalized for AHF after initial stabilization (median 80 yrs, males 60%) were randomly assigned to active or sham group. For 1 h daily over 5 days, low-level transcutaneous electrical stimulation (LLTS) (20 Hz, 1 mA) was performed after attaching an ear clip to the tragus (active group) or the earlobe (sham control group). Before and after stimulation, central aortic systolic pressure (CASP), brachial systolic BP (SBP), diastolic BP (DBP) as well as heart rate (HR) were noninvasively measured. No significant differences in baseline characteristics were observed between the active and sham groups. In the active group, CASP, SBP, DBP, and HR each decreased significantly after stimulation (all p < 0.05), whereas in the sham group, CASP, SBP, DBP, and HR each increased significantly after stimulation (all p < 0.05). All the changes in CASP, SBP, DBP and HR before and after stimulation were also significantly different between active and sham groups (all p < 0.01). There were no device-related side effects. In this study, the left tragus tVNS resulted in an acute afterload reduction in the elderly AHF patients. Non-invasive LLTS may be useful and safe for reducing afterload in AHF. ClinicalTrials.gov, identifier UMIN000044121.

Prospective analysis of the major risk factors and vascular status in students during the period of education at a medical university

Aim. To study the changes of the major risk factors (RFs) and vascular status in students over six years of their education at a medical university.Material and methods. A total of 667 students aged 17,8±1,2 years were examined in the 1st year and 6th year (162 men, 505 women). Students who entered in the same year were combined into one cohort, while in total 5 cohorts were recruited. The screening examination was carried out as part of the annual intra-university events "Freshman Week", "Graduate Week" by staff of the University Health Center and included the collection of complaints and history, height, body weight, the measurement of peripheral and central blood pressure, as well as the assessment vascular stiffness and metabolic status. Statistical analysis of the material was carried out using SPSS Statistics 23.0.Results. Analysis of RFs in medical students over 6 years showed a significant increase of the prevalence of hypertension/prehypertension, resting tachycardia, obesity/overweight, malnutrition and physical inactivity. An assessment of cen­tral and peripheral hemodynamics, as well as vascular stiffness of students, revealed an increase in the level of aortic systolic pressure, combined with an increase in peripheral systolic blood pressure and pulse. At the same time, there was no significant increase in some parameters of vascular stiffness, against the background of a 2-fold increase in the prevalence of overweight. Analysis of the metabolic status reveals a significant change in total cholesterol and triglycerides but no alterations in capillary blood glucose.Conclusion. The data obtained indicate an increase in the prevalence of not only behavioral, but also biological RFs among medical students, as well as the development of preclinical vascular remodeling in them during a six-year education, which can later lead to early cardiovascular diseases. Therefore, widespread screening system of risk factors among students should be developed.

Blood pressure measurement modalities and indexed left ventricular mass in men with low-risk hypertension confirmed by ambulatory monitoring.

Blood pressure (BP) measurement modalities such as ambulatory monitoring (ABPM) and noninvasive central aortic systolic pressure (CASP), have been reported to improve prediction of hypertension-mediated organ damage (HMOD) compared with conventional clinic BP. However, clinic BP is often confounded by poor measurement technique and 'white-coat hypertension' (WCH). We compared prediction of cardiac MRI (cMRI)-derived left ventricular mass index (LVMI) by differing BP measurement modalities in young men with elevated BP, confirmed by ABPM. One hundred and forty-three treatment-naive men (<55 years) with hypertension confirmed by ABPM and no clinical evidence of HMOD or cardiovascular disease (37% with masked hypertension) were enrolled. Relationships between BP modalities and cMRI-LVMI were evaluated. Men with higher LVMI (upper quintile) had higher clinic, central and ambulatory SBP compared with men with lower LVMI. Regression coefficients for SBP with LVMI did not differ across BP modalities ( r = 0.32; 0.3; 0.31, for clinic SBP, CASP and 24-h ABPM, respectively, P < 0.01 all). Prediction for high LVMI using receiver-operated curve analyses was similar between measurement modalities. No relationship between DBP and LVMI was seen across measurement modalities. In younger men with hypertension confirmed by ABPM and low cardiovascular risk, clinic SBP and CASP, measured under research conditions, that is, with strict adherence to guideline recommendations, performs as well as ABPM in predicting LVMI. Prior reports of inferiority for clinic BP in predicting HMOD and potentially, clinical outcomes, may be due to poor measurement technique and/or failure to exclude WCH.

Association between Serum Soluble Urokinase-Type Plasminogen Activator Receptor Level and Arterial Stiffness in Chronic Hemodialysis Patients

Cardiovascular diseases (CVDs) remain a significant cause of death in hemodialysis (HD) patients. To explore their associations, we examine the role of soluble urokinase-type plasminogen activator receptor (suPAR) in arterial stiffness in chronic HD patients. From June to August 2020, we recruited 135 chronic HD patients. The arterial stiffness group included patients with a carotid-femoral pulse-wave velocity (cfPWV) of >10 m/s. Fifty-five HD patients (40.7%) were in the arterial stiffness group. They had a higher prevalence of diabetes (p = 0.001) and hypertension (p = 0.039), were older (p = 0.007) and had higher aortic systolic blood pressure (p = 0.034), brachial systolic blood pressure (p = 0.025), glucose (p = 0.019), C-reactive protein (p = 0.039), and AIx75 (p = 0.003) and suPAR (p < 0.001) levels than the control group. After we performed multivariable logistic regression analysis, except age and glucose, serum suPAR (odds ratio [OR]: 2.05; 95% confidence interval [CI]: 1.48-2.70, p < 0.001) was independently associated with arterial stiffness in chronic HD patients. In the multivariable linear regression analysis, suPAR positively correlated with cfPWV (β = 0.475, p < 0.001) and could serve as a biomarker for arterial stiffness development in patients undergoing HD.

Role of angiography procedure for assessment the type of patent ductus arteriosus in children under 18 years.

Objective: To determine the role of angiography for the assessment the type of patent ductus arteriosus in children under 18 years. Study Design: Observational Retrospective study. Setting: Children’s Hospital Lahore. Period: October 2021 to February 2022. Material &amp; Methods: The sample size calculated was 245 but, at the end of the period of four months only 120 patients fulfilled the criteria and were included in this study convenient sampling technique was used to collect the data. Patients with patent ductus arteriosus were included in this study. Patients with other congenital heart diseases were excluded. Essential measurements included Types of Patent Ductus Arteriosus (PDA), (PDA) Size, Ampulla Size, Aortic and Pulmonary systolic and diastolic pressures. Results: In this study 120 patients with PDA were included. Out of 120, 38 (31.7%) patients were male and 82 (68.3%) patients were female. The age range of the patients was 8 months to 18 years (mean;5.44 ± 3.972 years). The weight range of the patients was 5.3 to 41 Kg (mean;16.05 ± 8.38Kg). The mean PDA size was 4.01 ± 1.80. The mean Ampulla size was 9.92 ± 3.13. The types of PDA detected by angiography were Type A 59(49%), Type B 15(12.5%), Type C 20(16.7%), Type D 20(16.7%), Type E 5(4%), Type F 1(0.8%). The mean Aortic systolic pressure was 105.5±18.99 and diastolic pressure was 57.2 ±14.4. The mean Pulmonary Artery systolic pressure was 47.4 ± 23.3 and diastolic pressure was 27.7 ±14.2. Conclusion: Angiography was found more accurate for the assessment of all the anatomical types of PDA especially TYPE B, C, D and F. More precise measurements of the ampulla and PDA sizes were obtained using angiography. We may conclude that Angiography is a much better and good modality than other modalities for the assessment of the types of PDA.