Assessment Of Pulse Wave Velocity Research Articles

Non-Invasive Methods for PWV Measurement in Blood Vessel Stiffness Assessment.

In recent years, statistical studies highlighted an increasing incidence of cardiovascular diseases (CVD) which reflected on additional costs on the healthcare systems worldwide. Pulse wave velocity (PWV) measurement is commonly considered a CVD predictor factor as well as a marker of Arterial Stiffness (AS) since it is closely related to the mechanical characteristics of the arterial wall. An increase in PWV is due to a more rigid arterial system. Because of the prevalence of the elastic component, in young people the PWV is lower than in the elderly. Nowadays, invasive and non-invasive methods for PWV assessment are employed: there is an increasing attention in the development of non-invasive devices which mostly perform a regional PWV measurement (over a long arterial portion) rather than local (over a short arterial portion). The accepted gold-standard for non-invasive AS measurement is the carotid-femoral PWV used to evaluate the arterial damage, the corresponding cardiovascular risk and to adapt the proper therapy. This review article considers the main commercially available devices underlining their operating principles in terms of sensors, execution mode, pulse waveforms acquired, site of measurement, distance and time estimation methods, as well as their main limitations in clinical practice.

Organoprotective properties of combination therapy with ramipril and indapamide in hypertensive patients with non-alcoholic fatty liver disease

Objective. To assess the effect of combined antihypertensive therapy with ramipril and indapamide on the structural and functional state of the heart, blood vessels, kidneys, autonomic nervous system and liver in hypertensive patients with non-alcoholic fatty liver disease (NAFLD). Design and methods. We performed a prospective controlled study including 30 patients with hypertension (HTN) stages I–II, 1–2 degrees with NAFLD (fatty liver index (FLI) > 60) aged 45 to 65 years. Five-seven days before the initial examination, patients discontinued antihypertensive drugs, after the washout period one of the fixed combinations of ramipril (2,5/5 mg/day) and indapamide (0,625/1,25 mg) was prescribed depending on the required dosage and recommendations on lifestyle changes and weight loss were given. Clinical examination, measurement of “office” blood pressure (BP), ambulatory BP monitoring (ABPM), central aortic pressure (CAP), pulse wave velocity (PWV), echocardiography and heart rate variability assessment were performed. The functional state of the kidneys and the structural and functional state of the liver were also assessed before and after treatment. Results. After 24-week therapy with a fixed combination of ramipril and indapamide (an average dosage 4,04 ± 1,24 and 1,01 ± 0,31 mg, respectively) target BP levels was achieved. According to ABPM, both daytime and nocturnal systolic BP (SBP) and diastolic BP (DBP) decreased. In addition, CAP (SBPao, DBPa) and augmentation index decreased. There was also a decrease in the stiffness of the arterial wall in muscle-type vessels (PWVm) (p = 0,0166) and in the number of patients with paradoxical test (p = 0,0320). There was a significant increase in creatinine clearance (Cockroft–Gault) after treatment (p = 0,0439) with no increase in glomerular filtration rate (CKD-EPI) (p = 0,1617). There was a significant change in the structural and functional indicators of the heart: increased left ventricular (LV) ejection fraction (p = 0,0398), decreased LV posterior wall thickness (p = 0,0457), LV end-systolic diameter (p = 0,0286), relative wall thickness (p = 0,0419) and LV myocardial mass index (p = 0,0002). There was a decrease in SDNN < 50 (p < 0,0001) and increase in RMSSD (p < 0,0001), which indicates a decrease in the sympathetic activity and an increase in parasympathetic regulation. Also the number of patients with normotonic type of autonomic reactivity in the orthostatic test increased after treatment (12 (24,0%) vs 19 (63,3%), p = 0,0456). The liver function and structure also improved showing decrease in total bilirubin (p = 0,0038) and gamma-glutamyltransferase (p = 0,0498), as well as the indices of liver steatosis (p = 0,0278) and fibrosis (p = 0,0166). Conclusions. Thus, combined antihypertensive therapy with ramipril and indapamide is well tolerated by patients, highly effective and demonstrates organoprotective properties regarding the heart, blood vessels, kidneys, autonomic nervous system and liver.

Aortic hemodynamic parameters as predictors of incident or deteriorating hypertension during carfilzomib therapy in patients with relapsed multiple myeloma

Abstract Background Carfilzomib (CFZ) improves survival in relapsed/refractory multiple myeloma but is associated with cardiovascular adverse events, among which hypertension is commonly reported. Purpose To evaluate aortic hemodynamics as possible predictors for CFZ-associated hypertension. Methods In a prospective study of 48 patients treated with Kd (CFZ 20/56 mg/m2 and dexamethasone) followed until disease progression or cycle 6 for a median of 10 months, patients underwent peripheral hemodynamic assessment, including applanation tonometry, which allows estimation of aortic blood pressure and arterial wave reflections and assessment of pulse wave velocity, which allows estimation of aortic stiffness. Hemodynamic parameters were examined at baseline and at pre-specified time points before and 24 hours after drug infusion. Results Thirteen patients (27.1%) developed hypertension or merited more intensive anti-hypertensive treatment (grade I or II: 6.25%, grade III: 20.8%). Patients with new onset or worsening hypertension had increased aortic [130±12.9 mmHg versus 115±16.7 mmHg, p=0.004] and peripheral systolic blood pressure (SBP) [145±15.7 mmHg versus 130±19.5 mmHg, p=0.001] at baseline. Patients distributed at highest tertile of baseline aortic SBP (log-rank test p=0.0001, Figure) or baseline peripheral SBP (log-rank test p=0.002) had significantly higher risk for CFZ associated hypertension as compared to those distributed at lower tertiles. After adjustment for age, gender and baseline hypertension, increased aortic [HR=8.0, 95% CIs 2.4–26.6, p=0.001] and peripheral SBP [HR=4.85, 95% CIs 1.53–15.4, p=0.007] remained significantly associated with hypertension. After adjustment for both baseline peripheral and aortic SBP in the same multivariable core model, aortic SBP was the only independent predictor of the study outcome (p=0.041). Accordingly, baseline aortic SBP was associated with higher discriminative value as compared to peripheral SBP [AUC: 0.819, 95% CIs 0.722–0.916 versus 0.724, 95% CIs 0.570–0.878, respectively]. Further adjustment for all cardiotoxicity risk factors using forced inclusion in non-parsimonious multivariable Cox regression models, revealed that increased aortic and peripheral SBP remained independent predictors of hypertensive events (p<0.05 for both). Conclusion Baseline aortic hemodynamics are associated with hypertension during CFZ treatment. Aortic SBP at baseline was the strongest predictor of CFZ-associated hypertensive adverse events, suggesting that an initial assessment of aortic blood pressure may facilitate discrimination of patients in need of close monitoring during treatment. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Funding from the Hellenic Foundation for Research and Innovation (HFRI) and the General Secretariat for Research and Technology (GSRT), under grant agreement No [1285].

Артеріальна жорсткість та синдром обструктивного апное сну в пацієнтів з артеріальною гіпертензією на фоні терапії постійним позитивним тиском у дихальних шляхах

Актуальність. Синдром обструктивного апное сну (СОАС), особливо тяжкого ступеня, пов’язаний із фатальними та нефатальними серцево-судинними подіями. СОАС та артеріальна гіпертензія (АГ) мають достовірні взаємозв’язки, і дана супутня патологія є дуже поширеною та пов’язана зі збільшеним ризиком серцево-судинних захворювань. Однією з причин є підвищена жорсткість артерій. Неінвазивним показником жорсткості артерій є швидкість поширення пульсової хвилі в аорті, що рекомендована сучасними настановами для оцінки серцево-судинного ризику. Метою дослідження було оцінити зміни жорсткості артерій у пацієнтів з АГ та СОАС та можливості її корекції при лікуванні постійним позитивним тиском у дихальних шляхах (СРАР-терапія). Матеріали та методи. У дослідження були включені 185 пацієнтів із легкою та середньою АГ (49,8 ± 0,8 року), які були розподілені на групи: 1-ша — пацієнти, у яких був СОАС (n = 148), 2-га — пацієнти без СОАС (контрольна група, n = 37). Вони пройшли клінічне та спеціальне обстеження: сомнологічне дослідження за допомогою двоканального портативного монітора, оцінку денної сонливості за опитувальною шкалою Епворта, вимірювання офісного артеріального тиску та добове моніторування артеріального тиску, ехокардіографію, вимірювання швидкості поширення пульсової хвилі. За 10 місяців подальшого дослідження були включені 105 пацієнтів, які були розподілені на 4 підгрупи: А — пацієнти із середнім та тяжким ступенями СОАС на СРАР-терапії (n = 23), В — пацієнти із середнім та тяжким ступенями СОАС без СРАР-терапії (n=29), С— пацієнти з легким ступенем СОАС (n = 29), D — пацієнти без СОАС (контрольна група, n =24). Усі пацієнти отримували подібну антигіпертензивну терапію відповідно до Рекомендацій ESC/ESC 2013 року. Результати. У пацієнтів з АГ та СОАС (середній індекс апное/гіпопное — 38,10±2,51 події/год) порівняно з пацієнтами без СОАС (середній рівень AГI — 3,02 ± 0,25 події/год) був значно вищий індекс маси тіла (35,20 ± 0,57 проти 30,60 ± 0,79 кг/м2, Р < 0,001), а також рівень глюкози в крові (107,2 ±2,2 проти 98,0 ± 2,5 мг/дл, Р = 0,045), рівень сечової кислоти (6,17 ± 0,10 проти 5,5 ± 0,3мг/дл, Р = 0,048) та індекс маси міокарда лівого шлуночка (115,80 ± 2,39 проти 104,60 ± 4,56 г/м2, Р = 0,035). Протягом 10 місяців спостереження в пацієнтів з АГ та СОАС на фоні CPAP-терапії спостерігалося достовірне зниження швидкості поширення пульсової хвилі по артеріях еластичного типу (із 12,20±0,63 до 10,05±0,43м/с, Р = 0,009), офісного систолічного артеріального тиску (від 143,80±132,70 до 132,70±2,33 мм рт.ст., Р= 0,021) та офісного діастолічного артеріального тиску (від 93,80 ± 3,31 до 86,00 ± 3,19 мм рт.ст., Р=0,012). У пацієнтів центральний систолічний артеріальний тиск зменшився з 130,30 ± 3,97 до 119,70± 2,97 мм рт.ст., Р = 0,012). Висновки. Поєднання терапії постійним позитивним тиском у дихальних шляхах та антигіпертензивної терапії покращує еластичність артерій та допомагає досягти цільового рівня артеріального тиску в пацієнтів з артеріальною гіпертензією та синдромом обструктивного апное сну середнього та тяжкого ступенів.

Pulse Wave Velocity Assessments Derived From Photoplethymography: Reliability And Agreement With A Referent Device

PURPOSE: Pulse wave velocity (PWV) is a common measure of arterial stiffness. Photoplethysmography (PPG) permits continuous measurement of PWV at multiple arterial segments simultaneously. The purpose of this study was to determine whether a simple, non-invasive PPG PWV method agrees with a referent measure, and to determine whether a posture-mediated change in PPG PWV agrees with change in the referent. METHODS: PPG, with electrocardiogram, measured heart-toe (htPWV) and heart-finger (hfPWV) PWV. Referent measurements were carotid-ankle PWV (caPWV) and carotid-wrist PWV (cwPWV) determined using the Vicorder device. In 30 adults (24.6 ± 4.8 y, body mass index 25.2 ± 5.9 kg/m2, 18 F), three measurements were made: i) two baseline measurements and ii) one measurement 5 minutes after a modified head-up tilt test (mHUTT, 78°). Baseline measurements were used to calculate measurement reliability via intraclass coefficient correlation (ICC). Mixed-models were used to calculate between-measure (overall agreement between PPG and referent), and between-condition (change in PPG versus change in referent) agreement between devices. RESULTS: All measures were reliable (ICC > 0.75). For hfPWV there was strong (ICC 0.7–0.9) between-measure agreement (ICC: 0.78, 95%CI: 0.67 – 0.85), but negligible (ICC < 0.2) and non-significant between-condition agreement (ICC: 0.10, 95%CI: 0.12 – 0.31). The lack of between-condition agreement may be attributable to the non-change in hfPWV and cwPWV with mHUTT. For htPWV, there was moderate (ICC 0.4–0.7) between-measure agreement (ICC:0.51, 95%CI: 0.32 – 0.65) and very strong between-condition agreement (ICC: 0.90, 95%CI: 0.85 – 0.94). CONCLUSION: PPG can be used to continuously measure PWV at multiple arterial segments with acceptable reliability and agreement with a referent.

Estimated pulse wave velocity (ePWV) as a potential gatekeeper for MRI-assessed PWV: a linear and deep neural network based approach in 2254 participants of the Netherlands Epidemiology of Obesity study

Pulse wave velocity (PWV) assessed by magnetic resonance imaging (MRI) is a prognostic marker for cardiovascular events. Prediction modelling could enable indirect PWV assessment based on clinical and anthropometric data. The aim was to calculate estimated-PWV (ePWV) based on clinical and anthropometric measures using linear ridge regression as well as a Deep Neural Network (DNN) and to determine the cut-off which provides optimal discriminative performance between lower and higher PWV values. In total 2254 participants from the Netherlands Epidemiology of Obesity study were included (age 45–65 years, 51% male). Both a basic and expanded prediction model were developed. PWV was estimated using linear ridge regression and DNN. External validation was performed in 114 participants (age 30–70 years, 54% female). Performance was compared between models and estimation accuracy was evaluated by ROC-curves. A cut-off for optimal discriminative performance was determined using Youden’s index. The basic ridge regression model provided an adjusted R2 of 0.33 and bias of < 0.001, the expanded model did not add predictive performance. Basic and expanded DNN models showed similar model performance. Optimal discriminative performance was found for PWV < 6.7 m/s. In external validation expanded ridge regression provided the best performance of the four models (adjusted R2: 0.29). All models showed good discriminative performance for PWV < 6.7 m/s (AUC range 0.81–0.89). ePWV showed good discriminative performance with regard to differentiating individuals with lower PWV values (< 6.7 m/s) from those with higher values, and could function as gatekeeper in selecting patients who benefit from further MRI-based PWV assessment.

A Culinary Dose of Herbs and Spices Improves 24-Hour Blood Pressure in Adults at Risk for Cardiometabolic Diseases: A Randomized, Crossover, Controlled-Feeding Study

Abstract Objectives Intake of a herb/spice containing meal attenuates post-prandial lipemia, hyperglycemia and oxidative stress, and improves endothelial function. No randomized controlled trials have examined the cardiometabolic effects of longer-term intake of mixed herbs and spices. We aimed to assess the effect of an average American diet containing herbs and spices at 0.5 (Low Spice Diet; LSD), 3.3 (Moderate Spice Diet; MSD) and 6.6 (High Spice Diet; HSD) g/day/2100 kcal on lipids/lipoproteins as well as other risk factors for cardiometabolic diseases in at-risk adults. Methods A three-period, randomized, crossover, controlled-feeding study including 71 participants (55% female; 44 ± 11 years, BMI 29.7 ± 2.9 kg/m2; waist circumference 102.4 ± 7.3 cm) was conducted. Each diet was provided for 4-weeks with a minimum 2-week wash-out period. Outcomes were assessed at baseline and the end of each diet period. On 2 separate days at each time point a fasting blood draw was taken for analysis of lipids/lipoproteins, glucose and insulin. A SphygmoCor XCEL was used for pulse wave analysis and pulse wave velocity assessment, and participants wore an ambulatory blood pressure monitor for a 24-hour period. Results No between-diet effects were observed for LDL-cholesterol, the primary outcome. Between-diet differences were observed for mean 24-hour systolic (P &amp;lt; 0.001) and diastolic (P &amp;lt; 0.001) blood pressure. The HSD lowered mean 24-hour systolic and diastolic blood pressure compared to the MSD (−2.2 mmHg; 95% CI −0.7, −3.8; P = 0.002 and −1.6 mmHg; 95% CI −0.6, −2.5; P &amp;lt; 0.001, respectively) and LSD (−2.1 mmHg; 95% CI −3.6, −0.6; P = 0.004 and −1.7 mmHg; 95% CI −0.7, −2.7; P &amp;lt; 0.001, respectively); no differences were detected between the LSD and MSD. No between-diet effects were observed for clinic measured blood pressure, markers of glycemia, or vascular function. Conclusions In the context of a suboptimal U.S. style diet, addition of a culinary dose of mixed herbs and spices (6.6 g/day/2100kcal) improved 24-hour blood pressure after 4-weeks, compared to lower doses (0.5 and 3.3 g/day/2100 kcal), in adults at elevated risk for cardiometabolic diseases. Funding Sources McCormick Science Institute and the National Center for Advancing Translational Sciences, National Institutes of Health (1UL1TR002014–01).

Sex and the G Protein-Coupled Estrogen Receptor Impact Vascular Stiffness.

[Figure: see text].

Association between H-type arterial hypertension and vascular stiffness (a pilot study)

Increased arterial stiffness is an important determinant of cardiovascular risk. Elevated total homocysteine (HC) levels appeared to be an independent risk factor for cardiovascular disease (CVD). To date, clinical studies on the relationship between HC and pulse wave velocity (PWV) assessment have shown conflicting results. Aim. To estimate the prevalence of hyperhomocystinemia (HHc) among patients with mild to moderate arterial hypertension and the effect of HHc on the vascular wall stiffness. Materials and methods. Our study was carried out as a part of the HYPSTER study in Ukraine. The study included 40 patients with I and II degree of arterial hypertension (AH) (average office systolic blood pressure (SBP)/diastolic (DBP) – 155.88/92.60 ± 1.63/1.43 mm Hg), heart rate – 71.40 ± 1.29 beats/min. The average age of the patients was 55.85 ± 2.09 (26–74) years. Patients with HC levels ≥10 μmol/l were defined as patients with H-type AH (HHc). Arterial stiffness was determined by PWV. Results. We found that at the beginning of the study, 75 % (30 patients with mild and moderate hypertension) had H-type hypertension with an increased level of HC. Patients with H-type AH and AH patients without HHc did not differ in age and AH duration. At the same time, patients with H-type AH had higher body weights and BMI. Office SBP in patients with H-type hypertension was higher compared to patients without HHc (156.45 ± 1.04 mm Hg vs. 152.55 ± 1.41 mm Hg at the beginning (P &lt; 0.05) and 130.65 ± 0.96 mm Hg vs. 126.97 ± 1.08 mm Hg after 6 months (P &lt; 0.05)) of treatment, respectively. BMI in H-type AH was 30.72 ± 0,39 kg/m2 vs. 28.34 ± 0.69 kg/m2 without HHc (P &lt; 0.05) at the beginning of the study. It was difficult to achieve target levels of BP in the patients with H-type hypertension during the treatment and they had high initial blood pressure values. In contrast to the patients without HHc, H-type AH patients had a more pronounced degree of insulin resistance (according to the HOMA index), lower GFR both at the beginning and at the end of the treatment. According to ambulatory BP monitoring, H-type AH patients presented with a significantly higher SBP level before starting the treatment compared to those with AH without HHc. The regression analysis revealed an association between HC and PWVel, regardless of the degree of BP reduction (PWVel (6 months), m/s, β = 0.307, P = 0.001). Conclusions. Hyperhomocystinemia was observed in 75 % of patients with arterial hypertension. Homocysteine levels were associated with vascular stiffness, regardless of the reduction in blood pressure level.

EFFECTS OF EXERCISE TRAINING ON ARTERIAL STIFFNESS IN PATIENTS WITH HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: This review aims to determine the effects of exercise training on arterial stiffness, namely Pulse Wave Velocity (PWV), in patients with hypertension. The identification of possible moderator variables of the effect of exercise on PWV was defined as a secondary objective. Design and Methods: For this systematic review and meta-analysis (PROSPERO CRD42019138658), MEDLINE, Scopus, Cochrane and Web of Science were searched up until July 2019. Randomized controlled trials assessing the effect of exercise interventions lasting 4 or more weeks on PWV in (pre)hypertensive subjects were included. The standardized mean difference between the pre-post of the intervention group versus the control group was calculated for PWV using the Cohen's d index as the effect size statistic. The type of exercise, PWV assessment site, use of medication, baseline PWV and study quality assessment score were used to perform subgroup analysis. Design and method: Fourteen trials, involving 15 exercise groups (5 aerobic, 2 dynamic resistance, 6 combined, and 2 isometric resistance groups), totaling 694 subjects with pre- and hypertension (374 exercise). Exercise program duration ranged from 4 to 26 weeks, with a mean duration of 13.1 ± 6.1 weeks. The overall effect size showed statistically significant differences in PWV [(d (95% CI) = 1.35 (0.72, 1.98)] in favor of the exercise group. Aerobic exercise [d (95% CI) = 1.93 (0.31, 3.55)], combined exercise [d (95% CI) = 0.79 (0.09, 1.49)] and isometric resistance exercise [d (95% CI) = 2.23 (1.66, 2.81)] reduced PWV for the exercise group when compared to the control group. There was no significant reduction in PWV in subjects undertaking dynamic resistance training [d (95% CI) = 0.69 (-2.32, 3.69)]. Subgroup analysis demonstrated that the positive effects of exercise training on PWV are independent of medication use, PWV assessment site, study quality assessment score and baseline PWV, although higher baseline PWV values presented a more significant reduction with exercise. Results: Aerobic, combined and isometric resistance exercise significantly decreased PWV in (pre)hypertensive patients. Despite the small number of studies, data from the isometric resistance exercise has the potential for the largest reductions in PWV.

Dyslipidemia, Insulin Resistance, Ectopic Lipid Accumulation, and Vascular Function in Resistance to Thyroid Hormone β.

PurposeIn resistance to thyroid hormone due to mutations in thyroid hormone receptor β, peripheral tissues are variably refractory to the action of circulating thyroid hormones. We evaluated parameters contributing to atherosclerotic risk in this disorder.MethodsWe measured low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), nonesterified fatty acids (NEFA), intrahepatic lipid (IHL) and intramyocellular lipid (IMCL), Homeostasis-model assessment of insulin resistance (HOMA-IR), augmentation index (AIx) and pulse wave velocity (PWV), flow-mediated dilatation, and carotid intima-media thickness (cIMT) in an unselected, genetically confirmed cohort of adult RTHβ patients (n = 27-77) and compared these with measurements in healthy subjects (up to n = 100) and thyrotoxic patients (n = 40).ResultsResistance to thyroid hormone beta (RTHβ) patients exhibited higher LDL-C (P = 0.008) and TG (P = 0.002) and lower HDL-C concentrations (P = 0.015 × 10–2) than control subjects, with LDL-C being higher than in thyrotoxic patients with comparable hyperthyroxinemia. Proprotein convertase subtilisin/kexin 9 (P = 0.002) and apolipoprotein B (P = 0.0009) levels were reduced in thyrotoxic patients but not lower in RTHβ patients or control subjects. Intrahepatic lipid (P = 0.02 × 10–4), IMCL (P = 0.002), HOMA-IR (P = 0.01 × 10–2), and NEFA (P = 0.04 × 10–6) were significantly higher in RTHβ patients than control subjects. Flow-mediated dilatation was increased (P = 0.04) but cIMT (P = 0.71), PWV P = 0.81), and AIx (P = 0.95) were unaltered in RTHβ patients.ConclusionsWe have documented mixed dyslipidemia with hepatic and IMCL accumulation in RTHβ, suggesting that surveillance for these metabolic abnormalities is warranted. How they combine with enhanced endothelial function and unaltered vessel wall thickness and compliance to determine overall cardiometabolic risk in this disorder remains to be defined.

A New Noninvasive System for Clinical Pulse Wave Velocity Assessment: The Athos Device.

This paper presents a low cost, noninvasive, clinical-grade Pulse Wave Velocity evaluation device. The proposed system relies on a simultaneous acquisition of femoral and carotid pulse waves to improve estimation accuracy and correctness. The sensors used are two high precision MEMS force sensors, encapsulated in two ergonomic probes, and connected to the main unit. Data are then wirelessly transmitted to a standard laptop, where a dedicated graphical user interface (GUI) runs for analysis and recording. Besides the interface, the Athos system provides a Matlab algorithm to process the signals quickly and achieve a reliable PWV assessment. To better compare the results at the end of each analysis, a detailed report is generated, including all the relevant examination information (subject data, mean PTT, and obtained PWV). A pre-clinical study was conducted to validate the system by realizing several Pulse Wave Velocity measurements on ten heterogeneous healthy subjects of different ages. The collected results were then compared with those measured by a well-established and largely more expensive clinical device (SphygmoCor).

Local transversal aortic strain is impaired in ascending aorta dilatation.

Ascending aorta dilatation is found in 13% of hypertensive patients. Little is known about elastic properties of ascending aorta in such patients. Echo-based transverse aortic strain analysis can describe mechanical properties of ascending aorta but has never been applied to patients with ascending aorta dilatation. To assess mechanical properties of ascending aorta by transverse aortic strain analysis (as β2-stiffness index) in hypertensive patients with ascending aorta dilatation and association between mechanical properties of ascending aorta and cardiovascular damage. A total of 100 hypertensive outpatients underwent transthoracic echocardiography and assessment of pulse wave velocity (PWV). Strain analysis of ascending aorta was performed with echocardiographic speckle-tracking software. Patients were divided in three groups based on ascending aorta diameter: less than 40, 40-45, and at least 45 mm. Beta-SI increased exponentially with ascending aorta dimensions (P < 0.001). Patients with ascending aorta dilatation had Beta-SI significantly higher than those with normal ascending aorta diameter. A greater proportion of patient with impaired (i.e., elevated) Beta-SI was present in groups with larger ascending aorta (18.2 vs. 48.4 vs. 80%, respectively, P < 0.05). On multivariate logistic regression only impaired Beta-SI predicted ascending aorta dilatation (P < 0.001). Beta-SI was related to cardiovascular damage in terms of left ventricular (LV) mass (LV mass indexed to BSA, P = 0.030) and PWV (P = 0.028). Patients with high Beta-SI had greater LV mass indexed to BSA (117 ± 47 vs. 94 ± 24 g/m2; P = 0.010) and PWV (10.20 ± 2.99 vs. 8.63 ± 1.88 m/s; P = 0.013). Ascending aorta dilatation is associated with increased local aortic stiffness in hypertensive patients. Strain analysis adds functional information to the mere morphological evaluation of aortic diameter and could be a useful tool to better define cardiovascular risk in this population.

Optimal Organ Protection and Blood Pressure Control with the Single Pill Combination Lisinopril, Amlodipine and Indapamide in Arterial Hypertension

Aim. To evaluate the single pill combination with lisinopril, amlodipine and indapamide ability in additional angioprotection achievement in patients with arterial hypertension and high pulse wave velocity (PWV) regardless on previous antihypertensive therapy (AHT).Material and methods. To the open non-randomized study duration 12 weeks 40 patients were included taking triple AHT during 6 months. All participants underwent ambulatory 24 hour blood pressure (BP) monitoring, applanation tonometry (augmentation index and central BP), pulse wave velocity assessment, laboratory tests (HbA1c, serum uric acid, high sensitive C-reactive protein [hsCRP], serum uric acid).Results. We observed additional systolic BP (SBP) and diastolic BP (DBP) reduction by 16.9% and 22.11% on lisinopril, amlodipine and indapamide single pill combination. Lisinopril, amlodipine and indapamide single pill combination decreased 24 h mean SBP by 16.77%, and 24 h mean DBP -23.5% (ABPM data), PWV by 19.7%, augmentation index by 14.81%, central SBP by 11.9% (p&lt;0,05). There were positive changes in hsCRP level (-13.0%, p&lt;0.05) and serum uric acid (-9.0%, p&lt;0.05).Conclusion. Lisinopril, amlodipine and indapamide single pill combination provided control BP, arterial elastic properties improving (augmentation index, PWV, central BP) and favorable influence on inflammation and serum uric acid level.

Supine blood pressure-A clinically relevant determinant of vascular target organ damage in hypertensive patients.

Night‐time blood pressure (BP) is an important predictor of cardiovascular outcomes. Its assessment, however, remains challenging due to limited accessibility to ambulatory BP devices in many settings, costs, and other factors. We hypothesized that BP measured in a supine position during daytime may perform similarly to night‐time BP when modeling their association with vascular hypertension‐mediated organ damage (HMOD). Data from 165 hypertensive patients were used who as part of their routine clinic workup had a series of standardized BP measurements including seated attended office, seated and supine unattended office, and ambulatory BP monitoring. HMOD was determined by assessment of kidney function and pulse wave velocity. Correlation analysis was carried out, and univariate and multivariate models were fitted to assess the extent of shared variance between the BP modalities and their individual and shared contribution to HMOD variables. Of all standard non‐24‐hour systolic BP assessments, supine systolic BP shared the highest degree of variance with systolic night‐time BP. In univariate analysis, both systolic supine and night‐time BP were strong determinants of HMOD variables. In multivariate models, supine BP outperformed night‐time BP as the most significant determinant of HMOD. These findings indicate that supine BP may not only be a clinically useful surrogate for night‐time BP when ambulatory BP monitoring is not available, but also highlights the possibility that unattended supine BP may be more closely related to HMOD than other BP measurement modalities, a proposition that requires further investigations in prospective studies.

Implementation of the organoprotective properties of fixed combinations of valsartan, amlodipine and hydrochlorothiazide (Vamloset® and Co-Vamloset) in patients with grade 2 and 3 hypertension in the Russian clinical study VICTORY II

Aim.Assessment of Vamloset and Co-Vamloset effects on blood pressure target levels and indicators associated with organ protection: albuminuria; elasticity of arteries and central aortic pressure (CAP); endothelial function; tumor necrosis factor-a, interleukin (IL) IL-6 and IL-10, vascular cell adhesion molecule 1 and vascular endothelial growth factor (VEGF-A).&#x0D; Materials and methods.The Russian multicenter open-label prospective clinical study VICTORY II which was conducted in 8 clinical centers included 103 patients 18 years with grade 23 essential arterial hypertension (AH), who were previously untreated office systolic blood pressure (SBP) 160mmHg and/or office diastolic blood pressure (DBP) 100 mm Hg or have not reached the target office blood pressure with mono- or dual therapy. The active phase of the study included 100 patients; the per-protocol (PP) population 80 patients completing the study without major protocol deviations. Patients were not randomized. The target office BP for patients without diabetes were: SBP139 mm Hg, DBP89 mm Hg; for patients with diabetes: SBP139 mm Hg, DBP84 mm Hg. All patients with grade 2 hypertension (group 1) were administrated Vamloset (amlodipine/valsartan, 5/80mg), with grade 3 hypertension Vamloset (amlodipin/valsartan, 5/160 mg). Up-titration of the dose of amlodipine/valsartan to 5/160 mg and 10/160 mg, the administration of Co-Vamloset (amlodipine/valsartan/hydrochlorothiazide) in doses of 10/160/12.5 mg, 10/160/25 mg (LLC KRKA-RUS) was carried out every 4 weeks according to the prescribed schemes. In the total group, the effect of studied therapy on the level of albumin in the urine was assessed. Before starting treatment and after 16 weeks of treatment, 40 patients in the subgroup with additional examinations underwent daily monitoring of blood pressure, assessment of pulse wave velocity and augmentation index; CAP; levels of tumor necrosis factor-, IL-6 and IL-10, vascular cell adhesion molecule 1and VEGF-A.&#x0D; Results.The active phase of the study included 100 patients aged 59.510.9 years (59% of women) with a duration of AH 83.48.4 months. 83% of patients received prior antihypertensive therapy by the time of enrollment in the study. The treatment duration for all patients was 15.9 weeks. After 16 weeks, therapy with Vamloset and Co-Vamloset provided an optimal decrease in BP: 90% of patients with grade 23 AH in the PP population reached the target level of office BP, the mean change in SBP / DBP was -32.2/-16.0 mm Hg. According to the data of daily monitoring of BP in the subgroup with additional examinations, the target levels of average daily SBP/DBP were reached in 52.9/67.6% of patients, respectively. Along with reliable control of blood pressure, additional organ protection with studied antihypertensive drugs after 16 weeks of therapy was shown by assessment data: albuminuria in 58.8% of patients with an initially elevated level of albuminuria (n=17), a positive effect of the studied therapy on the level of albumin in the urine was determined, augmentation index improvement in 57.1% of patients in the study group, CAP improvement in 73% of patients in the study group; positive dynamics of endothelial damage markers (IL-6, IL-10, VEGF-A) was achieved. The data on the good tolerability of AHT corresponded to the previously established safety profile of these drugs.&#x0D; Conclusion.In the VICTORY II clinical study in patients with grade 23 hypertension, along with high antihypertensive efficacy, a spectrum of organoprotective effects of Vamloset and Co-Vamloset on aortic stiffness with improved augmentation index and CAP, markers of endothelial damage (IL-6, IL-10, VEGF-A), the severity of albuminuria was shown.

Arterial Stiffness Preceding Diabetes: A Longitudinal Study.

Previous studies on the relationship between diabetes and arterial stiffness were mostly cross-sectional. A few longitudinal studies focused on one single direction. Whether the association between arterial stiffness and diabetes is bidirectional remains unclear to date. To explore the temporal relationship between arterial stiffness and fasting blood glucose (FBG) status. Included were 14 159 participants of the Kailuan study with assessment of brachial-ankle pulse wave velocity (baPWV) from 2010 to 2015, and free of diabetes, cardiovascular and cerebrovascular diseases, and chronic kidney disease at baseline. FBG and baPWV were repeatedly measured at baseline and follow-ups. Cox proportional hazard regression model was used to estimate hazard ratios and 95% confidence intervals (CIs) of incident diabetes across baseline baPWV groups: <1400 cm/s (ref), 1400≤ baPWV <1800 cm/s, and ≥1800 cm/s. Path analysis was used to analyze the possible temporal causal relationship between baPWV and FBG, among 8956 participants with repeated assessment of baPWV and FBG twice in 2010 to 2017. The mean baseline age of the observed population was 48.3±12.0 years. During mean 3.72 years of follow-up, 979 incident diabetes cases were identified. After adjusting for potential confounders, the hazard ratio (95% CI) for risk of diabetes was 1.59 (1.34-1.88) for the borderline arterial stiffness group and 2.11 (1.71-2.61) for the elevated arterial stiffness group, compared with the normal ideal arterial stiffness group. In the path analysis, baseline baPWV was associated with follow-up FBG (the standard regression coefficient was 0.09 [95% CI, 0.05-0.10]). In contrast, the standard regression coefficient of baseline FBG for follow-up baPWV (β=0.00 [95% CI, -0.02 to 0.02]) was not significant. Arterial stiffness, as measured by baPWV, was associated with risk of developing diabetes. Arterial stiffness appeared to precede the increase in FBG.

Automated pulse wave velocity assessment using a professional oscillometric office blood pressure monitor.

Carotid-femoral pulse wave velocity (cfPWV) is the gold standard method for assessing arterial stiffness. This study evaluated automated brachial-ankle PWV (baPWV) taken by a professional oscillometric blood pressure monitor (Microlife WatchBP Office Vascular) versus reference cfPWV (Complior device). Subjects recruited from a hypertension outpatient clinic had duplicate baPWV and cfPWV measurements (randomized crossover design) and carotid ultrasonography. Of 102 subjects recruited, 101 had valid baPWV measurements. Four subjects were excluded and 97 were analyzed (age 58.3±11.4years, men 70%, hypertensives 76%, diabetics 17%, cardiovascular disease 10%, smokers 23%). The mean difference between baPWV (13.1±1.8m/s) and cfPWV (9.1±1.8m/s) was 4.0±1.4m/s (P<.01) with close association between them (r=0.70, P<.01). baPWV and cfPWV were correlated with age (r 0.54/0.49 respectively), systolic blood pressure (0.45/0.50), carotid intima-media thickness (0.31/0.44), and carotid distensibility coefficient (-0.47/-0.34) (all P<.05; no difference between the two methods, z test). There was reasonable agreement (77%) between the two methods in identifying subjects at the top quartile of their distributions (kappa 0.39, P<.01). The areas under the receiver operating characteristic curves for the identification of carotid plaques were comparable for cfPWV and baPWV (0.79 and 0.74 respectively, P=NS). Automated baPWV measurement by a professional oscillometric blood pressure monitor is feasible and observer-independent. baPWV values differ from those by cfPWV, yet they are closely correlated, have reasonable agreement in detecting increased arterial stiffness and give similar associations with carotid stiffness and atherosclerosis.

Echocardiographic assessment of aortic pulse wave velocity for left ventricular diastolic dysfunction.

Echocardiographic assessment of aortic pulse wave velocity for left ventricular diastolic dysfunction.

Comprehensive assessment of coronary pulse wave velocity in anesthetized pigs.

BackgroundCoronary stiffness represents a new paradigm for interventional cardiology and can be assessed by coronary pulse wave velocity (CoPWV). Assessing CoPWV is complex because of the coexistence of backward and forward waves.ObjectivesEvaluate the feasibility, repeatability, and capacity of methods assessing CoPWV to detect predictable velocity changes.MethodsCoPWV was measured from distal and proximal pressure guidewires in the left anterior descending artery of 10 pigs under general anesthesia. Four methods were studied: the tangent intersection method applied to the forward (FW) and backward (BK) waves, as well as the dicrotic notch (DIC) and template matching (TM) methods. All were evaluated at baseline, during various arterial pressure and heart rate conditions, during simulated flow limitation (balloon inflation), and after increasing coronary stiffness (stent insertion).ResultsAll the methods were significantly different between them (p ≤ .05) showing a systematic trend toward higher CoPWV when compared to the FW method (.05 < p<.10). Results were found to be significantly correlated only between the BK and FW methods and between the DIC and TM methods (p ≤ .05). CoPWV increased with arterial pressure increase, this increase being significant for the DIC and TM methods and partly for the FW method (p ≤ .05). Conversely, heart rate had no systematic impact on CoPWV. The lowest variability was found for the DIC and TM methods (p ≤ .05). Only the BK and TM methods remained applicable during flow limitation; stent increased CoPWV when measured by the BK method only (p ≤ .05).ConclusionAlthough CoPWV can be measured by various methods, the BK and TM methods seem the most appropriate for clinical studies.