Assessment Of Central Blood Pressure Research Articles

Invasively measured and estimated central blood pressure using the oscillometric algorithm Antares in patients with and without obesity

Background Obesity is a global health concern and risk factor for cardiovascular disease. The assessment of central blood pressure (cBP) has been shown to improve prediction of cardiovascular events. However, few studies have investigated the impact of obesity on cBP in adults, and invasive data on this issue are lacking. This study aimed to evaluate cBP differences between patients with and without obesity, identify cBP determinants, and evaluate the accuracy of the algorithm Antares for non-invasive cBP estimation. Methods A total of 190 patients (25% female; 39% with BMI ≥30kg/m2; age: 67±12 years) undergoing elective cardiac catheterization were included. cBP was measured invasively and simultaneously estimated non-invasively using the custo screen 400 device with integrated Antares algorithm. Results No significant cBP differences were found between obese and non-obese patients. However, females, especially those with obesity, had higher systolic cBP compared to males (P<0.05). Multiple regression analysis showed that brachial mean arterial pressure, pulse pressure, BMI, and heart rate predicted cBP significantly (adjusted R2 = 0.82, P<0.001). Estimated cBP correlated strongly with invasive cBP for systolic, mean arterial, and diastolic cBP (r = 0.74–0.93, P<0.001) and demonstrated excellent accuracy (mean difference <5 and SD <8 mmHg). Conclusions This study discovered no significant difference in cBP between obese and non-obese patients. However, it revealed higher cBP values in women, especially those with obesity, which requires further investigation. Additionally, the study highlights Antares’ effectiveness in non-invasively determining cBP in obese individuals. This could improve the diagnosis and treatment of hypertension in this special patient population.

SIMULTANEOUS RECORDING OF CENTRAL BP AND ARTERIAL STIFFNESS DURING ECHO CORRELATES BETTER WITH LV DIASTOLIC FUNCTION THAN ROUTINE EXAMINE

Objective: ASE guidelines for the diagnostics of the left ventricle (LV) of diastolic dysfunction in 2016 suggested using the method of non-invasive assessment of central blood pressure (CBP) and the augmentation index (Aix) in order to obtain more detailed information in patients with arterial hypertension (AH). Routine determination of CBP does not allow the procedure to be performed simultaneously with ultrasound, so that can affect the results of the study because hemodynamics can change significantly during this time. The BAT 41-2 device, developed in Ukraine, allows the performing of two studies at the same time. The purpose of this analysis was to determine whether this approach is better than routine research. Design and method: We included 37 patients with AH grade 2. An echocardiographic examination was done according to ASE guidelines for the diagnosis of diastolic dysfunction of the left ventricle in 2016, including evaluation of transmitral E/A and E/e’ ratios, deceleration time (Dt) and isovolumic relaxation time (IVRT). Routine examination of CBP and Aix standardized for heart rate 75 (Aix@75) was measured with Sphygmocor (ArCor, Australia) according to a standardized protocol. Simultaneous measurement of CBP and Aix@75 was done with BAT41-2 device (IKS-Techno, Ukraine). Simultaneous measurement was done during standard echo views were recorded while the routine examination was done 30-90 min after the ultrasound diagnostic was done. To evaluate associations we used Spearman correlation analysis with the IBM SPSS 26.0 software package. Results: In our analysis, we did not find any correlations of E/A with any of the other parameters. Both routine and simultaneous CBP measurement were associated with LV IVRT but for simultaneous CBP measurement, this association was greater (R = 0.197, P = 0.043, and R = 0.340, P = 0.049 respectively). E/e’ significantly correlated with routine Aix@75 and simultaneous Aix@75, but again the last association was more strong (R = 0.495, P = 0.037 and R = 0.504, P = 0.014 respectively). Simultaneous Aix@75 was also more associated with IVRT (R = 0.438, P = 0.010) than routine (R = 0.210, P = 0.038). Conclusions: Simultaneous registration of CBP and AiX during echocardiography is more associated with LV diastolic function parameters than a routine examination.

Study on Clinical Assessment of Central Blood Pressure in Healthy Volunteers, and its Relation to Clinical Phenotyping

The Unani system of Medicine is a holistic system of medicine and does not confine to molecular approach but refers to knowledge as a total recognition of the person and stresses on health of body, mind and soul. Unani medicine states that disease is a natural process and that symptoms are the reactions of the body to disease. The individual humoural balance is influenced by lifestyle factors. It employs the humoral theory which presupposes the presence of four akhlaat (humours) in the body – dam (blood), balgham (phlegm), safra (yellow bile) and sauda (black bile). The Unani philosophy has 4 humours under clinical phenotyping such as Sanguine (Damavi), Phlegmatic (Balghami), Bilious (Safravi) and Melancholic (Saudavi). The 400 Healthy volunteers with 100 each from four different temperaments (balghami, saudavi, safravi, damavi) were selected.The present study validates some of the Unani concepts of humours or temperament with central hemodynamic parameters or Pulse Wave Analysis (PWA). A specially designed case record form as per the Unani classical text was designed for assessment of humours and the information obtained were recorded from healthy volunteers as subjects and determination of central hemodynamic parameters was performed by SphygmoCor technology (AtCor Medical, Sydney, Australia). The temperament of the present study showed that the Pulse Wave Analysis in healthy volunteers although showed the results in physiological range but the analysis in safravi (bilious) subjects is found to be significant when compared to other clinical phenotypes.

Comparison between invasive and non-invasive assessment of blood pressure in hypertensive disorders of pregnancy

BackgroundThe management of hypertensive disorders of pregnancy (HDP) during hospitalization requires an accurate blood pressure (BP) measurement, mainly by invasive intra-arterial reading. Nevertheless, little is known about the precision of non-invasive (NI) central BP measurements in HDP. We aimed to assess the accuracy of NI central BP assessment in comparison to invasive BP measurement in HDP.This cross-sectional study included all patients with HDP that were admitted to university hospitals for high BP control, from December 2018 till December 2019, and 10 healthy matched non-hypertensive controls. Patients were compared for demographic, anthropometric, and echocardiographic data. In all subjects, invasive BP assessment was done by radial arterial cannulation and NI assessment of BP was performed by an oscillometric automated device (Mobil-O-Graph); the comparison was done after initial control of BP.ResultsOne hundred patients were included and divided into 3 groups (pre-existing hypertension (HTN), gestational HTN, and pre-eclampsia). There was no statistically significant difference between NI central and invasive methods in measuring both systolic BP (SBP) (126.39 ± 14.5 vs 127.43 ± 15.3, p = 0.5) and diastolic BP (82.41 ± 9.0 vs 83.78 ± 8.9, p = 0.14) among the total studied population. A strong positive correlation was found between NI central and invasive SBP (r = 0.96, p < 0.001). HDP was associated with an increase in arterial stiffness, left ventricular diastolic dysfunction, and complications.ConclusionNon-invasive measurement of BP using oscillometric automated devices is as accurate as the invasive method, and it is a practical safe method in pregnant women with hypertensive disorders (CTR no. = NCT04303871).

Feasibility of non-invasive measurement of central blood pressure and arterial stiffness in shock.

Patients in haemodynamic shock are in need for an intensive care treatment. Invasive haemodynamic monitoring is state of the art for these patients. However, evolved, non-invasive blood pressure monitoring devices offer advanced functions like the assessment of central blood pressure and arterial stiffness. We analysed the feasibility of two oscillometric blood pressure devices in patients with shock. We performed a monocentre prospective study, enrolling 57 patients admitted to the intensive care unit (ICU), due to septic and/or cardiogenic shock. We assessed invasive and non-invasive peripheral and central blood pressure <24hours and 48hours after admission on the ICU. Additional haemodynamic parameters such as pulse wave velocity (PWV), augmentation pressure and augmentation index were obtained through Mobil-o-Graph PWA (IEM) and SphygmoCor XCEL (AtCor Medical). A complete haemodynamic assessment was successful in all patients (48) with the Mobil-o-Graph 24hours PWA and in 29 patients with the SphygmoCor XCEL (P=.001), when cases of death or device malfunction were excluded. Reasons for failure were severe peripheral artery disease, haemodynamic instability, oedema and agitation. Invasive blood pressure showed a sufficient correlation with both devices; however, large differences between invasive and non-invasive techniques were recorded in Bland-Altmann analysis (P<.05 for all parameters). PWV differed between the two devices. Non-invasive peripheral blood pressure measurement remains a rescue technique. However, non-invasive assessment of arterial stiffness and central blood pressure is possible in patients with septic or cardiogenic shock. Further studies are required to assess their clinical significance for patients in shock.

Prediction of all-cause and cardiovascular mortality using central hemodynamic indices among elderly people: systematic review and meta-analysis.

Despite widespread usage of central blood pressure assessment its predictive value among elderly people remains unclear. To ascertain the capacity of central hemodynamic indices for predicting future all-cause and cardiovascular hard outcomes among elderly people. Systematic review and meta-analysis developed at the Del Cuore cardiology clinic, in Antonio Prado, Rio Grande do Sul, Brazil. 312 full-text articles were analyzed, from which 35 studies were included for systematic review. The studies included needed to report at least one central hemodynamic index among patients aged 60 years or over. For all-cause mortality, aortic pulse wave velocity (aPWV) and central systolic blood pressure (SBP) were significant, respectively with standardized mean difference (SMD) 0.85 (95% confidence interval, CI 0.69-1.01; I2 96%; P < 0.001); and SMD 0.27 (95% CI 0.15-0.39; I2 77%; P 0.012). For cardiovascular mortality brachial-ankle PWV (baPWV), central SBP and carotid-femoral PWV (cfPWV) were significant, respectively SMD 0.67 (95% CI 0.40-0.93; I2 0%; P 0.610); SMD 0.65 (95% CI 0.48- 0.82; I2 80%; P 0.023); and SMD 0.51 (95% CI 0.32-0.69; I2 85%; P 0.010). The meta-analysis results showed that aPWV was promising for predicting all-cause mortality, while baPWV and central SBP demonstrated consistent results in evaluating cardiovascular mortality outcomes. Thus, the findings support usage of central blood pressure as a risk predictor for hard outcomes among elderly people. RD42018085264.

Pulsatile and resistive systolic loads as determinants of left ventricular remodelling after physical training

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation Barts Cardiovascular Biomedical Research Centre onbehalf The Marathon Study Consortium Introduction Cardiovascular function depends on the inter-relation between heart and vasculature. The contribution of aorta and peripheral vessels to the total systolic load of the left ventricle (LV) can be represented respectively by a "pulsatile" and a "resistive" component. We sought to understand their interrelation by exploring how LV remodelling occurred with altered load associated with an external stimulus (training). Methods: 237 untrained healthy male and female subjects volunteering for their first-time marathon were recruited. At baseline and after 6 months of unsupervised training, race completers underwent 1.5T cardiac magnetic resonance, brachial and non-invasive central blood pressure assessment. For analysis, runners were divided into 4 groups according to the variation (positive versus null or negative) in Total Arterial Compliance Index (TACi), representing the pulsatile component of the LV load, and in Systemic Vascular Resistance Index (SVRI), representing the resistive component of the LV load. Results: 138runners (age 21-69 years; F: 51%) completed the race. Data are reported for each variable as Δ mean [95% Confidence Interval]. In the whole cohort, training was associated with a small increase in LV mass index (+3g/m2, [0, 6 g/m2]), indexed LV end-diastolic volume (EDVi) (+3ml/m2, [-2, 5 3ml/m2]), in LV mass/LVEDV ratio (+0.02g/ml, [0.00, 0.04 g/ml]) and in TACi (+0.02ml/m2, [0.02, 0.38 ml/m2]). SVRi mildly fell (-43dyn·s/cm2[-103, 17dyn·s/cm2]). TACi increase was associated with LVEDVi increase and no change in LV mass/EDV (eccentric remodelling). On the other hand, both TACi reduction and SVRi increase were associated with increase in LV mass/EDV and no significant change in LVEDVi (concentric remodelling). A similar increase in LV mass was observed in all groups. See Table. Conclusion: Cardiac remodelling observed after mild, medium term, unsupervised training seems to be related to the modifications of aorta and peripheral vessels. In particular, a reduction in pulsatile load seems associated with eccentric LV remodelling, while an increase in both pulsatile and resistive with concentric LV remodelling. Further research is needed to understand the interaction between TACi and SVRi. Table 1 LV EDVi (ml/m2) LV mass index (g/m2) LV mass/EDV TACi increase (n = 75) +4 [0, 9] +3 [0, 7] 0 [-0.03, 0.03] TACi decrease (n = 62) -1 [-6, 4] +3 [0, 8] 0.04 [0.01, 0.07] SVRi increase (n = 63) 0 [-4,4] +3 [0, 7] +0.03 [0, 0.06] SVRi decrease (n = 73) +3 [-3, 7] +3 [-1, 6] +0.01 [-0.02, 0.04]

Reference values of office central blood pressure, pulse wave velocity, and augmentation index recorded by means of the Mobil-O-Graph PWA monitor.

Assessment of central blood pressure (BP), pulse wave velocity (PWV), and augmentation index (AIx) measurements may improve cardiovascular risk stratification. This study aimed to establish reference office values for central BP, PWV, and AIx by means of a Mobil-O-Graph PWA monitor and to evaluate the impact of cardiovascular risk factors (CVRFs) on these measurements. We cross-sectionally evaluated clinical characteristics, central BP, PWV, AIx, and peripheral BP measurements among 867 apparently healthy individuals (age = 46.0 ± 15.5 years, 39% males) who were free of obesity, hypertension, active smoking, dyslipidemia, and diabetes (CVRF-No) and 5632 individuals (age = 57.0 ± 14.7 years, 44% males) with at least one of these major CVRFs (CVRF-Yes). Reference values for central BP, PWV, and AIx were provided for the CVRF-No and CVRF-Yes groups, stratified by age and sex. PWV and AIx exhibited curvilinear increases with age, and there was an interaction between age and sex for central systolic BP and PWV in both the CVRF-No and CVRF-Yes groups. The results of a multivariable analysis including the whole sample (n = 6499) showed that obesity had a direct association with central BP, while diabetes was directly related to PWV. In addition, alcohol intake was directly associated with central BP, while performance of physical activity was inversely related to AIx. In conclusion, values of office-measured central BP, PWV, and AIx obtained in an apparently healthy population and in a population with CVRFs are now available according to age and sex and may be useful to build thresholds for use in clinical practice.

Age matters: differences in exercise-induced cardiovascular remodelling in young and middle aged healthy sedentary individuals

Remodelling of the cardiovascular system (including heart and vasculature) is a dynamic process influenced by multiple physiological and pathological factors. We sought to understand whether remodelling in response to a stimulus, exercise training, altered with healthy ageing. A total of 237 untrained healthy male and female subjects volunteering for their first time marathon were recruited. At baseline and after 6 months of unsupervised training, race completers underwent tests including 1.5T cardiac magnetic resonance, brachial and non-invasive central blood pressure assessment. For analysis, runners were divided by age into under or over 35 years (U35, O35). Injury and completion rates were similar among the groups; 138 runners (U35: n = 71, women 49%; O35: n = 67, women 51%) completed the race. On average, U35 were faster by 37 minutes (12%). Training induced a small increase in left ventricular mass in both groups (3 g/m2, P < 0.001), but U35 also increased ventricular cavity sizes (left ventricular end-diastolic volume (EDV)i +3%; left ventricular end-systolic volume (ESV)i +8%; right ventricular end-diastolic volume (EDV)i +4%; right ventricular end-systolic volume (ESV)i +5%; P < 0.01 for all). Systemic aortic compliance fell in the whole sample by 7% (P = 0.020) and, especially in O35, also systemic vascular resistance (-4% in the whole sample, P = 0.04) and blood pressure (systolic/diastolic, whole sample: brachial -4/-3 mmHg, central -4/-2 mmHg, all P < 0.001; O35: brachial -6/-3 mmHg, central -6/-4 mmHg, all P < 0.001). Medium-term, unsupervised physical training in healthy sedentary individuals induces measurable remodelling of both heart and vasculature. This amount is age dependent, with predominant cardiac remodelling when younger and predominantly vascular remodelling when older.

Blood pressure phenotypes in young patients with type 1 diabetes

Aim. To study phenotypes of clinic and 24-hour ambulatory blood pressure (BP), to determine their associations with arterial stiffness parameters, and to assess global cardiovascular risk (CVR) in young patients with type 1 diabetes (T1D).Material and methods. The presented cross-sectional single-center study included 81 T1D patients without a history of hypertension (HTN) and other cardiovascular diseases (CVD) (men — 39%; median age — 27 years; median duration of T1D — 6 years). All participants underwent a routine clinical and laboratory testing, measurement of clinic and 24-hour ambulatory BP (BPLab Vasotens), assessment of central BP and arterial stiffness parameters using applanation tonometry technique. BP phenotypes were analyzed with diagnostic criteria for HTN by ESC/ESH 2018 guidelines. CVR was assessed using the SCORE 10-year risk calculator (ESC 2019). The differences were considered significant at p&lt;0,05.Results. The prevalence of true HTN was 6,2%, masked HTN — 38,3%. Isolated nocturnal HTN was revealed in 30,7% of patients with clinic BP &lt;140/90 mm Hg. The subgroup with masked HTN was dominated by patients with normal clinic BP (58,1%) and in most cases was characterized by isolated diastolic BP increase (64,5%). Masked HTN was associated with a higher carotid-femoral pulse wave velocity (PWV) (median — 7,2 versus 6,3 m/s, p=0,002). The most common profiles of nocturnal BP decrease were non-dipper (63.9%) and night-picker (16.6%). High and very high CVR was recorded in 87,7% of patients. Conclusion. Hypertension occurs in 44,5% of young patients with type 1 diabetes and is characterized by a high prevalence of masked isolated nocturnal HTN and non-dipping. Masked HTN is associated with a higher carotid-femoral PWV. High and very high 10-year CVR was recorded in 87,7% of patients.

Non-Invasive Assessment of Central Blood Pressure: Clinical Relevance of Current Methodologies

Non-Invasive Assessment of Central Blood Pressure: Clinical Relevance of Current Methodologies

Comparison of the SphygmoCor XCEL device with applanation tonometry for pulse wave velocity and central blood pressure assessment in youth.

Vascular phenotype by assessing carotid-femoral pulse wave velocity (cf-PWV) and central SBP (cSP) in the young could be used as an intermediate cardiovascular outcome measure. Tonometry is considered the gold-standard technique, but its use is challenging in clinical practice, especially when used in children. The purpose of this study was to validate cf-PWV and cSP assessment with novel oscillometric device (SphygmoCor XCEL) in children and adolescents. cf-PWV and cSP were measured in 72 children and adolescents aged 6-20 years. Measurements were performed by applanation tonometry and by the SphygmoCor XCEL device at the same visit under standardized conditions. Regression analysis and Bland-Altman plots were used for comparison of the tonometer-based with oscillometric-based method. Mean cf-PWV measured by applanation tonometry was 4.85 ± 0.81 m/s and measured by SpygmoCor XCEL was 4.75 ± 0.81 m/s. The mean difference between the two devices was 0.09 ± 0.47 m/s (P = NS). cSP measured by SpygmoCor XCEL was strongly correlated with cSP measured by applanation tonometry (R = 0.87, P < 0.001). Mean cSP measured by applanation tonometry was 103.23 ± 9.43 mmHg and measured by SpygmoCor XCEL was 103.54 ± 8.87 mmHg. The mean cSP difference between the two devices was -0.30 ± 3.34 mmHg (P = NS), and fulfilled the AAMI criterion 1. The estimated intersubject variability was 2.17 mmHg. The new oscillometric SphygmoCor XCEL device provides equivalent results for cf-PWV and cSP values to those obtained by tonometry in children and adolescents. Thus, the SphygmoCor XCEL device could be appropriate for assessing cf-PWV and cSP in the pediatric population.

Isolated systolic hypertension in the young

: Whether isolated systolic hypertension in the young (ISHY) implies a worse outcome and needs antihypertensive treatment is still a matter for dispute. ISHY is thought to have different mechanisms than systolic hypertension in the elderly. However, findings from previous studies have provided inconsistent results. From the analysis of the literature, two main lines of research and conceptualization have emerged. Simultaneous assessment of peripheral and central blood pressure led to the identification of a condition called pseudo or spurious hypertension, which was considered an innocent condition. However, an increase in pulse wave velocity has been found by some authors in about 20% of the individuals with ISHY. In addition, obesity and metabolic disturbances have often been documented to be associated with ISHY both in children and young adults. The first aspect to consider whenever evaluating a person with ISHY is the possible presence of white-coat hypertension, which has been frequently found in this condition. In addition, assessment of central blood pressure is useful for identifying ISHY patients whose central blood pressure is normal. ISHY is infrequently mentioned in the guidelines on diagnosis and treatment of hypertension. According to the 2013 European Guidelines on the management of hypertension, people with ISHY should be followed carefully, modifying risk factors by lifestyle changes and avoiding antihypertensive drugs. Only future clinical trials will elucidate if a benefit can be achieved with pharmacological treatment in some subgroups of ISHY patients with associated risk factors and/or high central blood pressure.

Central Blood Pressure Assessment in Atrial Fibrillation

Central Blood Pressure Assessment in Atrial Fibrillation

Associations between glycaemic deterioration and aortic stiffness and central blood pressure: the ADDITION-PRO Study.

In the context of screening for diabetes, we examined levels of central haemodynamics among individuals with different levels of diabetes risk and analysed the impact of glycated haemoglobin A (HbA1c) and HbA1c changes on central haemodynamics. A Danish population-based stepwise screening programme for diabetes including a diabetes risk score (DRS) questionnaire and glucose measurements identified seven groups of individuals at increasing levels of diabetes risk. After 7.8 years of follow-up, 2048 individuals underwent aortic stiffness assessment by carotid-femoral pulse wave velocity (aPWV) and assessment of central blood pressure (BP). We compared differences in central haemodynamics at follow-up between the diabetes risk groups and analysed the impact of HbA1c at screening and HbA1c change on central haemodynamics at follow-up adjusting for relevant confounders. At screening, median age was 59.0 years, and median HbA1c was 5.7%. At follow-up, median aPWV was 8.0 m/s, and median central SBP was 123.5 mmHg. Among individuals with high DRS, aPWV, central SBP and DBP, and pulse pressure were higher in individuals with impaired glucose tolerance than normal glucose tolerance. Per 1%-point higher HbA1c at screening, aPWV was 0.23 m/s (95% confidence interval: 0.00; 0.46) higher, and central DBP was 1.35 mmHg (95% confidence interval: 0.19; 2.51) lower, whereas HbA1c change was not associated with any of the central haemodynamics. Dysglycaemia is associated with future aortic stiffness. However, glycaemic deterioration over 7.8 years does not affect aortic stiffness or central BP independently of other cardiometabolic risk factors.

Assessment of Central Blood Pressure and Arterial Stiffness in Practicing Long-Distance Walking Race

Abstract Background: An ecological hiking occurs yearly in Brazil. It is a unique event because of its distance (310 km) and dynamics (mean of 62 km/day for 5 days with mean pace of 7.6 km/h). Although beneficial effects of moderate-intensity exercises are well-known, the effects of intense and long-duration exercise still require study. Objective: To evaluate the effects of mixed walking/running race on various blood pressure (BP) parameters 30 days before (A0), on the 2nd (A2), 3rd (A3), and 4th (A4) days after completing the day's stage. Methods: Central systolic (cSBP) and diastolic BP (cDBP), peripheral systolic (pSBP) and diastolic BP (pDBP), central pulse pressure (cPP), peripheral pulse pressure (pPP), amplified pulse pressure (aPP), corrected augmentation index (AIx75%) and pulse wave velocity (PWV) were measured using an oscillometric Mobil-O-Graph® (IEM, Stolberg, Germany) in 25 male athletes (mean age of 45.3 ± 9.1 years). A p value < 0.05 was considered a statistically-significant difference. Results: cSBP decreased from A0 to A2 (109.5 to 118.1 mmHg) and from A0 to A3 (109.5 to 102.5 mmHg); pPP decrease from A0 to A2 (49.2 to 38.2 mmHg) and from A0 to A4 (49.2 to 41.2 mmHg); aPP decrease from A0 to A1 (15.6 to 9.5 mmHg), from A0 to A2 (15.6 to 8.0 mmHg) and from A0 to A3 (15.6 to 11.2 mmHg). PWV correlated with age. Conclusions: Blood pressure dropped on the first days of the race and returned to close to baseline values at the end. PWV correlates strongly with age. This type of exercise promotes effects on BP and PWV similar to those seen in long-duration, high-intensity sports. These changes in trained healthy individuals do not seem to increase cardiovascular risks. This was the first study to assess the effects of this type of exercise on the cardiovascular system.

Carotid distension waves acquired with a fiber sensor as an alternative to tonometry for central arterial systolic pressure assessment in young subjects

Abstract In this work it is evaluated the possibility of central blood pressure assessment using distension waves, obtained with a low cost optical fiber sensor, instead of regular arterial tonometry. Carotid distension and pressure waveforms were acquired in 15 young subjects. Form factors, root-mean-square error (RMSE), harmonic decomposition and central systolic pressures for both techniques were analysed. The pressure waves assessed by the piezoelectric probe had lower form factors than the ones assessed by the optical fiber sensor, due to the different nature of the waves (51.05 ± 5.15% versus 40.53 ± 5.70%), translating in a RMSE of 14 ± 2%. Regarding the harmonic analysis, paired t -tests shown that the first four harmonics are not significant different (p ⩽ 0.05), and Pearson correlation studies retrieve that the 2nd–7th harmonics are correlated (p ⩽ 0.03). Central systolic pressures were also obtained with both techniques displaying a very strong Pearson correlation (0.99) and a small difference of 0.63 ± 2.40 mmHg. These pre-clinical results support a future clinical validation study in larger and broader cohorts.

Clinical relevance of central blood pressure - a critical review.

Vital organs are exposed to the central rather than the brachial blood pressure. To date, central blood pressure can be assessed noninvasively through the use of several devices. In this review, we critically discuss the clinical relevance of central blood pressure assessment. Considerable evidence suggests that central blood pressure is a better predictor of end-organ damage than brachial blood pressure. However, there is still uncertainty concerning the value of central pressure for predicting cardiovascular outcomes, as the existing studies are underpowered to address this issue. A full synthesis of the available data is needed in this regard. Among the different antihypertensive drug classes, beta-blockers appear to lower central blood pressure less than brachial blood pressure. This difference may, at least in part, explain the reduced efficacy of beta-blockers in the prevention of cardiovascular outcomes compared with the other antihypertensive drug classes, which may lower central and brachial blood pressure to a similar extent. Nevertheless, this differential effect might not be relevant to the newer beta-blockers with vasodilating properties, including nebivolol, celliprolol and carvedilol. However, whether a preferential reduction of central blood pressure results in better outcomes should be further assessed by appropriately powered clinical trials. Other emerging challenges include the assessment of the potential predictive value of central blood pressure variability and the development of new antihypertensive medications based on central blood pressure rather than brachial blood pressure.

Comparison of brachial and central blood pressures using an oscillometric device with 2 or 6 metre tubing lengths for assessment of central pressure during MRI exam

Background Magnetic resonance imaging (MRI) offers the possibility to measure local and regional indices of aortic function. However calculations of these indices usually require blood pressure (BP) values. Up to now, because of its easier availability, brachial BP was used instead of local aortic pressure. The SphygmoCor Xcel system (AtCor Medical, Australia) estimates aortic pressure noninvasively. It consists in a MRI compatible brachial cuff connected via a hose to a recording unit and computer. The aim of this study was to compare brachial and central BP values given by SphgymoCor Xcel with the standard 2 meters hose and a 6 meters hose more suitable for central BP assessment during MRI.

Assessment of central blood pressure as a predictor of target organ damage in children with primary hypertension

Introduction. Central systolic blood pressure (cSBP) is assumed to be the best indicator of cardiovascular risk caused by elevated blood pressure. However, there are no data on the usefulness of cSBP measurments in the assessment of the risk of target organ damage (TOD) in hypertensive children. Aim. The aim of study was to evaluate the usefulness of noninvasive measurements of cSBP, AugP and AugInd as predictors of increased left ventricular hypertrophy (LVH) and increased carotid intima-media thickness (cIMT) in children with primary hypertension. Material and methods. 114 children (25 girls), mean age 15.2 ± 2.5 years, referred because of elevated blood pressure and with excluded secondary hypertension, were included in the study. In all patients, 24h ambulatory blood pressure monitoring (ABPM), cSBP, central pulse pressure (cPP), AugP, AugInd, cardiac index (CI), total peripheral resistance (TPR), pulse wave velocity (PWV), LVMI and cIMT were measured. Results. In 62 patients white coat hypertension was diagnosed, 9 had ambulatory hypertension and 43 had severe ambulatory hypertension. Children with severe ambulatory hypertension had greater AugP, CI and carotid wall cross sectional area (WCSA) and lower TPR. cSBP correlated with WCSA (p = 0.015; r = 0.255) and AugP with LVMI (p = 0.02; r = 0.220). ABPM had greater sensitivity and lower specificity for predicting LVH than cSBP. ABPM and cSBP had similar sensitivity and specificity as predictors of cIMT and WCSA. Conclusions. Although sensitivity and specificity of cSBP and ABPM as predictors of arterial injury were similar, ABPM performed better as a predictor of LVH. The results of our study indicate a much higher risk of TOD in children with severe ambulatory hypertension and show that the assessment of cSBP, which is also a predictor of LVH, may be a new criterion for drug therapy implementation.