Brachial Artery Blood Pressure Research Articles

Increases in cardiac vagal modulation following a single session of passive calf stretching

Autonomic cardiovascular responses to mechanoreflex activation by passive muscle stretching have been shown in numerous investigations. These cardiovascular adjustments include cardiac vagal inhibition, sympathetic activation, pressor response, and baroreflex resetting. However, it is currently unclear how the autonomic system responds after a single session of passive muscle stretching. Therefore, we aimed to test the hypothesis that there would be parasympathetic dominance after stretching cessation. Twenty-four volunteers (14 men; 22±3 yr) performed two protocols: 1) five sets of 1 minute of unilateral passive calf stretching with 15 s of rest; and 2) control condition (six minutes of resting at the same position). The autonomic cardiac responses of both control and experimental conditions were assessed before, and immediately, 15 minutes and 30 minutes after stretching cessation. Passive stretching was performed on an isokinetic dynamometer (Biodex System 4, USA). Heart rate, systolic and diastolic blood pressure were continuously measured on a beat-to-beat basis using lead II electrocardiography (BioAmp, MLA2540) and finger photoplethysmography (Human NIBP, Australia). Brachial arterial blood pressure was also measured with an automated digital sphygmomanometer (Dixtal, DX2022, Brazil). Heart rate variability (HRV) was determined following the guidelines of the Task Force of the European Society of Cardiology and the North American Society of Pacing. With regards to the hemodynamics variables, there was no significant difference in the heart rate before and after passive stretching, while mean blood pressure (MBP) was slightly higher (±2mmHg) 30 min following both protocols (control, p=0.027 and stretch, p=0.035). Regarding HRV analysis, in the time domain, RMSSD was significantly increased 30 min following passive stretching (+15%; p=0.029), and this effect was also detected when using the frequency domain (high frequency: +37%, p=0.039). Of note, our major findings were not affected by sex. In conclusion, autonomic cardiovascular control shifts to a parasympathetic dominant state following passive calf stretch, and the effect peaks around 30 minutes after stretching. Passive stretching seems to be a safe, easy, and effective form of exercise that evokes autonomic cardiovascular responses during and following its cessation, even if it is performed in a single session of stretch. CNPq 307764/2022-2; CAPES (001) QUT South America Scholarship. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Hypertension Severity and Declines in Left Ventricular Ejection Fraction Among Women Receiving Adjuvant Chemotherapy for Breast Cancer (WF-97415 UPBEAT).

Hypertension is a risk factor for experiencing left ventricular ejection fraction (LVEF) declines during receipt of potentially cardiotoxic breast cancer (BC) treatment. We sought to determine whether the hypertension stage is associated with LVEF decline during BC treatment. Across 24 centers, cardiac magnetic resonance measures of LVEF and brachial arterial blood pressure (BP) measurements were performed in women with stages I to III BC before and 3 months after initiating potentially cardiotoxic chemotherapy. Using multivariable analysis, we assessed in a blinded fashion the association between 3-month ΔLVEF and precancer treatment American Heart Association/American College of Cardiology stages of hypertension. Among 204 women, age averaged 56±1 years with 75% being White and 20% of Black race. Participants received anthracycline (45.6%), trastuzumab (22.5%), cyclophosphamide (52.9%), or paclitaxel (50%). After accounting for pretreatment LVEF, diabetes status, tobacco use, age, the number of antihypertensive medications, and body mass index, those with stage II hypertension experienced an LVEF decline of -2.89% ([95% CI, -0.69% to -5.19%]; P=0.01) relative to individuals with normal BP. Other stages saw nonsignificant declines relative to normal BP to elevated BP (-1.63% [95% CI, -0.62% to 3.88%]; P=0.16) and stage I hypertension (-0.94% [95% CI, -0.90% to 2.78%]; P=0.32). Compared with women receiving treatment for BC with normal BP, there is a stronger association of decline in LVEF in women with stage II hypertension relative to women with other hypertension stages. This raises the possibility that stage along with hypertension presence may be associated with an increased risk for the LVEF decline among women receiving potentially cardiotoxic chemotherapy for BC. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02791581 and NCT01719562.

Circulating catecholamines, endothelin-1, and nitric oxide releases do not explain the preserved FMD following acute resistance exercise in strength-trained men.

Acute resistance exercise decreases endothelial function in sedentary individuals but not in strength-trained (ST) individuals. However, the underlying mechanism(s) of vascular protection in ST individuals remains unclear. Herein, we compared catecholamines, endothelin-1 (ET-1), and nitric oxide (NOx) releases after acute resistance exercise between sedentary and ST individuals. The untrained (UT) group comprised 12 male individuals with no regular training, while the ST group comprised 12 male individuals. Participants performed a session of resistance exercise, which consisted of 3 sets of 10 repetitions at 75% of one repetition maximum. Heart rate (HR) and blood pressure were measured during resistance exercise. Brachial artery flow-mediated dilation (FMD), blood pressure, HR, and blood collection were undertaken before and 10, 30, and 60 min after the resistance exercise. No significant difference was found in baseline brachial artery FMD between the groups (P > 0.05). Brachial artery FMD was significantly reduced in the UT group (P < 0.05) but it was prevented in the ST group after the resistance exercise. Significant differences were found at 10, 30, and 60 min after the resistance exercise in brachial artery ΔFMD from baseline between groups (P < 0.05). Blood pressure, HR, plasma epinephrine, norepinephrine, dopamine, serum endothelin-1, and plasma NOx responses did not differ between groups throughout the experimental period. In conclusion, preserved endothelial function in response to acute resistance exercise in ST male individuals is independent of catecholamines, ET-1, and NOx responses.

Peripheral artery disease diagnosis based on deep learning-enabled analysis of non-invasive arterial pulse waveforms

This paper intends to investigate the feasibility of peripheral artery disease (PAD) diagnosis based on the analysis of non-invasive arterial pulse waveforms. We generated realistic synthetic arterial blood pressure (BP) and pulse volume recording (PVR) waveform signals pertaining to PAD present at the abdominal aorta with a wide range of severity levels using a mathematical model that simulates arterial blood circulation and arterial BP-PVR relationships. We developed a deep learning (DL)-enabled algorithm that can diagnose PAD by analyzing brachial and tibial PVR waveforms, and evaluated its efficacy in comparison with the same DL-enabled algorithm based on brachial and tibial arterial BP waveforms as well as the ankle-brachial index (ABI). The results suggested that it is possible to detect PAD based on DL-enabled PVR waveform analysis with adequate accuracy, and its detection efficacy is close to when arterial BP is used (positive and negative predictive values at 40 % abdominal aorta occlusion: 0.78 vs 0.89 and 0.85 vs 0.94; area under the ROC curve (AUC): 0.90 vs 0.97). On the other hand, its efficacy in estimating PAD severity level is not as good as when arterial BP is used (r value: 0.77 vs 0.93; Bland-Altman limits of agreement: −32%-+32 % vs −20%-+19 %). In addition, DL-enabled PVR waveform analysis significantly outperformed ABI in both detection and severity estimation. In sum, the findings from this paper suggest the potential of DL-enabled non-invasive arterial pulse waveform analysis as an affordable and non-invasive means for PAD diagnosis.

The impact of age on the vascular response to acute sauna exposure

Passive heat exposure has been shown to be a promising method to improve endothelial health. Sauna usage specifically, has been linked to reduced risk of cardiovascular disease in young and middle-aged populations. Increases in blood flow and shear rates associated with heat exposure are often considered to have a major influence on the observed improved endothelial function following repeated heat exposure; however, the magnitude of these shear and flow responses may potentially vary with age or starting endothelial function. Purpose: The purpose of this study was to determine if the vascular response to acute sauna heating is similar between healthy young and middle-aged adults and if the response is related to baseline endothelial function. Methods: 10 young (24.9 ± 4.2 years, 6 male and 4 female) and 8 middle aged adults (55.6 ± 3.9 years 4 males and 4 females) underwent 40 min of sauna exposure at 80ºC. Esophageal temperature was recorded throughout the duration of the experiment. Brachial artery flow-mediated dilation (FMD) blood flow, artery diameter, shear rates and blood pressure were recorded at baseline and following heat exposure. Results: The increase in core temperature (Tc) followed similar trends in both the young and middle-aged adults (young ΔTc = 1.386 ± 0.52 ºC vs middle-Age Δ Tc = 1.637 ± 0.56 ºC). Heat-induced brachial artery dilation and brachial artery shear rate also increased similarly in both age groups (young Δ diameter = 0.048 ± 0.022 cm vs middle-age Δ diameter = 0.074 ± 0.036 cm, young Δ shear = 164.5± 106.8 sec- 1 vs middle-age Δ shear = 150.3 ± 56.29 sec -1 ). Heat induced dilation was strongly correlated to baseline endothelial function in the young (r = 0.86, P=0.006). This relationship was not observed in the brachial artery of middle-aged adults (r = 0.257, P=0.539). Systolic blood pressure (SBP) was significantly reduced following sauna in the middle-aged participants from 135.25 ± 17.50 mmHg to 122.38 ± 19.7 mmHg (P=0.017). There was a slight elevation in SBP following sauna in the young participants from 119.4 ± 6.38 mmHg to 123.1 ± 7.65 mmHg (P=0.017). Diastolic blood pressure (DBP) was significantly reduced in both age groups (P&lt;0.001) with middle age seeing greater reductions (P=0.05) from 80.63 ± 10.97 mmHg to 69.75 ± 8.41 mmHg vs the young 71.2 ± 8.24 mmHg to 66.9 ± 4.56 mmHg. Conclusion: Young and middle-aged adults have similar changes in shear rate and brachial artery dilation in response to acute sauna heating, but the middle-aged adults exhibit significantly greater decreases in SBP and DBP than young adults. In young adults, endothelial function is strongly correlated to heat induced dilation in the brachial artery. This relationship is not present in the middle age population suggesting that heat-induced dilation may rely on mechanisms other than endothelial function in middle-aged adults. 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.

Racial Differences in Blood Pressure and Autonomic Recovery Following Acute Supramaximal Exercise in Women.

Despite the growing popularity of high-intensity anaerobic exercise, little is known about the acute effects of this form of exercise on cardiovascular hemodynamics or autonomic modulation, which might provide insight into the individual assessment of responses to training load. The purpose of this study was to compare blood pressure and autonomic recovery following repeated bouts of acute supramaximal exercise in Black and White women. A convenience sample of twelve White and eight Black young, healthy women were recruited for this study and completed two consecutive bouts of supramaximal exercise on the cycle ergometer with 30 min of recovery in between. Brachial and central aortic blood pressures were assessed by tonometry (SphygmoCor Xcel) at rest and 15-min and 30-min following each exercise bout. Central aortic blood pressure was estimated using brachial pressure waveforms and customized software. Autonomic modulation was measured in a subset of ten participants by heart-rate variability and baroreflex sensitivity. Brachial mean arterial pressure and diastolic blood pressure were significantly higher in Blacks compared to Whites across time (race effect, p = 0.043 and p = 0.049, respectively). Very-low-frequency and low-frequency bands of heart rate variability, which are associated with sympathovagal balance and vasomotor tone, were 22.5% and 24.9% lower, respectively, in Blacks compared to Whites (race effect, p = 0.045 and p = 0.006, respectively). In conclusion, the preliminary findings of racial differences in blood pressure and autonomic recovery following supramaximal exercise warrant further investigations of tailored exercise prescriptions for Blacks and Whites.

Arterial hypertension and its covariates among nomadic Raute hunter-gatherers of Western Nepal: a mixed-method study

ObjectivesTo determine the prevalence of, and understand the factors associated with, hypertension among the nomadic Raute hunter-gatherers of Western Nepal.DesignA mixed-method study.SettingThe study was carried out at Raute temporary campsites...

PS-C11-11: DEGREE OF BRACHIAL AND CENTRAL ARTERIAL BLOOD PRESSURE IN HYPERTENSIVE PATIENTS WITH INTER-ARM BLOOD PRESSURE DIFFERENCE(IAD)&lt; 10MMHG VERSUS≧ 10MMHG

RuFei Liu, WenLi Cheng(Email:chengwenli2000@163.com) Objective: IAD ≧ 10mmHg has been proven to be a predictor of cardiovascular morbidity and mortality, especially in people with hypertension. Compared with brachial blood pressure, central blood pressure was more effective in reflecting hemodynamic changes and had a stronger relationship with target organ damage. No study has analyzed the degree of central blood pressure in hypertensive patients with IAD &lt; 10mmHg versus ≧ 10mmHg. The objective of this study was to analyze differences in central and brachial arterial blood pressure and the proportion of brachial systolic blood pressure ≧ 140mmHg or central systolic blood pressure ≧ 130mmHg in hypertensive patients grouped by IAD. Methods: The study cohort comprised of 2103 eligible individuals. Their BPs were assessed simultaneously in both arms using an Omron BP-203RPEIII vascular profiler, and the IAD was measured as the absolute difference in these values (absolute value of left minus right). The CBP was noninvasively measured using an Omron HEM-9000AI device. Multivariate regression analysis was used to assess the association between the central SBP (cSBP) and the inter-arm systolic blood pressure difference (IASBPD). Results: Applying 130/140 mmHg as cSBP/bSBP thresholds delineated concordant central and brachial normotension (n = 1131;53.8%) and hypertension (n = 702;33.4%) versus isolated brachial hypertension (n = 178;8.5%) and isolated central hypertension (n = 92;4.4%). Women made up close to 70% of the patient with central systolic hypertension but normal bSBP. After adjusting for brachial SBP, brachial DBP, sex, age and BMI, patients with IAD ≧ 10mmHg had a higher risk of cSBP ≧ 130mmHg [OR (95%CI): 1.6 (1.3, 2.1), P &lt; 0.001]. Conclusion: Hypertensive patients with IAD *&amp;ge* 10mmHg had higher cSBP, cDBP and a higher proportion of central systolic blood pressure.

PS-BPP02-1: EFFECTS OF INCREASED ARTERIAL STIFFNESS ON HEMODYNAMIC RESPONSE DURING AND AFTER SUBMAXIMAL STEP EXERCISE TEST IN MIDDLE-AGED NORMOTENSIVE INDIVIDUALS

Objective: This study was designed to examine the effects of increased arterial stiffness on hemodynamic response during and after simple step exercise test in middle-aged normotensive individuals. Design and method: The study participants consisted of 819 untreated normotensive individuals (aged 54.8 years; 39.6% men) without a history of cardiovascular disease, stroke, and renal disease. The participants underwent a submaximal step exercise test (25 steps/min for 2 min). Brachial arterial blood pressure (BP) and pulse rate were measured at 1-min interval before, during, and after the step exercise test. During the end of exercise (exercise SBP) and 2 min after exercise (recovery SBP) were evaluated. Brachial-ankle pulse wave velocity (baPWV) was measured as an index of arterial stiffness using an oscillometric device. Results: The mean values of resting SBP, exercise SBP, and recovery SBP were 121 ± 12 mmHg, 153 ± 17 mmHg, and 130 ± 14 mmHg, respectively. The individuals with increased baPWV (&gt; = 1400 cm/s, n = 305) showed significantly higher exercise SBP and recovery SBP than those with normal baPWV (Exercise, 162 ± 16 mmHg vs. 148 ± 16 mmHg, P &lt; 0.001; Recovery, 138 ± 13 mmHg vs. 125 ± 13 mmHg, P &lt; 0.001). The odds ratios for an exaggerated exercise SBP (&gt; = 180 mmHg) and delayed recovery SBP (&gt; = 150 mmHg) in individuals with increased baPWV were 2.7 (95%CI, 1.8–4.9; P = 0.001) and 3.3 (95%CI, 1.8–6.2; P &lt; 0.001) after adjusting for age, gender, body mass index, and resting SBP. When participants were divided according to a combination of exercise SBP and recovery SBP, the baPWV of the subgroup with exaggerated exercise SBP and delayed SBP recovery was higher than that of those with only exaggerated exercise SBP and delayed SBP recovery (Both, 1585 ± 301 cm/s; Exercise, 1505 ± 232 cm/s; Recovery, 1475 ± 160 cm/s). Conclusion: Exaggerated BP increase and delayed BP recovery during submaximal step exercise test are associated with increased arterial stiffness in normotensive individuals. Subclinical vascular impairment may influence vascular reactivity to a greater degree than basal tone and could be identified by an abnormal BP response to exercise even before clinical manifestation of hypertension.

PS-P13-11: ASSOCIATION BETWEEN SPOT URINE SODIUM-TO-POTASSIUM RATIO AND BLOOD PRESSURE IN HEALTHY ADOLESCENTS: THE WAKAYAMA STUDY

Objective: Spot urine sodium to potassium ratio (Na/K) is a simple measure of sodium loading and has been shown to be associated with blood pressure (BP) levels. This study aimed to evaluate the association between spot urine Na/K and BP in a cross sectional sample of healthy adolescent population. Design and method: The study participants consisted of 457 healthy adolescents (217 males and 240 females) aged 12 to 15 years (mean age: 13.9 years). Brachial arterial BP was measured in the supine position using digital BP monitor with an appropriate cuff size. Urinary Na, K, and creatinine levels were measured using spot urine specimens collected in the early morning of the sampling day. Results: The spot urine Na/K levels of participants was 4.99 ± 2.76 (Na, 148.1 ± 58.4 mEq/L; K, 36.1 ± 18.7 mEq/L), and there was no significant difference between males and females. When the participants were stratified based on the quartiles of urinary Na/K distribution (&lt; 2.95, 2.95 to 4.54, 4.55 to 6.59, &gt; = 6.6), systolic and diastolic BP gradually increased with an increase in Na/K levels (systolic BP, 106.1, 106.9, 108.2, and 111.5 mmHg, P for trend &lt; 0.001; diastolic BP, 62.0, 62.4, 63.1, 64.3 mmHg, P for trend = 0.022). The Na/K was more closely associated with BP than urinary Na and K levels, as well as daily salt intake estimated from urinary Na. In multiple regression analysis, Na/K was significantly associated with systolic BP (β; = 0.144, P &lt; 0.001) and diastolic BP (β; = 0.114, P = 0.015), independent of potential confounding factors. The BP of the subgroup with high Na/K (&gt; = 6.6) and high salt intake (&gt; = 8.5 g/day) was significantly higher than that of those with only high salt intake (systolic BP, 115.0 mmHg vs. 109.1 mmHg, P &lt; 0.001; diastolic BP, 66.0 mmHg vs. 62.5 mmHg, P = 0.017). Conclusions: High Na/K levels is associated with elevated BP in healthy adolescents, and Na/K may be useful in assessing the effect of salt loading on BP than Na excretion alone.

Value of measuring central blood pressure in clinical practice

This article is an invited piece to provide a “pro” point of view on the clinical value of measuring central blood pressure (BP) over and above-standard cuff BP. Evidence to support the clinical value of cuff BP is among the strongest in medicine. However, a common misconception is that because cuff BP is measured at the site of the upper arm, it is upper arm BP that causes the adverse effects of hypertension—the heart attacks, strokes, and kidney disease. On the contrary, these outcomes are caused by the BP exposure at the central arterial beds near the organs (i.e., aorta, carotid artery), which can differ from upper arm (brachial artery) BP.

Non-Invasive Blood Pressure Total Waveform Monitoring Using Information Extracted by an Extended Kalman Filter Algorithm from Pulsations in an Oscillatory Cuff

This paper describes a novel approach designed for non-invasive, routine screening of patients for cardiovascular disorders without the complexities of using an electrocardiogram or invasive probes. Specifically, an oscillographic-view of the brachial artery blood pressure waveform, including the dicrotic notch, is extracted from information in the pressure pulsations from an ordinary blood pressure cuff. The novelty of this approach is that the total continuous shape of the waveform, not just two numbers for pressures, is generated. A computer algorithm processes the cuff pressure pulsations and provides a near real-time visual estimate of the continuous shape of the blood pressure waveform to be viewed on oscilloscopes commonly used in hospitals and medical clinics. A model-based Extended Kalman Filter (EKF) algorithm is used to process the information and identify the coefficients of a Fourier transform model for the waveform and the coefficients for an empirical model for artery stiffness. By viewing the total waveform, variations or disorders in the waveform during a series of pulse cycles can be observed and easily recognized. Simulations of two-case studies demonstrate successful convergence of the algorithm for a variety of waveform disorders including arrhythmia, variations in the shape of the dicrotic notch, changing systolic and diastolic pressure levels, and stiff arteries. Experimental verification of this proposed procedure will require invasive pressure measurements while simultaneously processing the algorithm for non-invasive waveform comparisons. Once the algorithm is verified experimentally, the end goal is to use the procedure on patients with known cardiovascular diseases in order to easily create a database of waveform disorders correlated with disorders of specific cardiovascular diseases.

Calculations of mean ocular perfusion pressure before and after exercise are conditioned by the formula used

AbstractPurpose: Blood pressure is a key parameter associated with ocular health and glaucoma. Additionally, brachial blood pressure serves to calculate ocular perfusion pressure. The main aim was to evaluate differences between the most used formulas to calculate mean brachial arterial blood pressure and the effects that physical exercise may have in this parameter.Methods: Fifteen physically active, healthy subjects (9 male 6 female, 24.07 ± 3.65 years) voluntarily performed a 15‐minute protocol consisting of combined exercise including, mobility, bodyweight exercises, running, dynamic stretching, and three sets of barbell back squat at low intensities. The formulas compared were 1) diastolic blood pressure (DBP) + 1/3 * (systolic blood pressure [SBP] ‐ DBP); 2) DBP + 0.412 * (SBP – DBP); 3) DBP + (0.333 + (0.0012 * heart rate)) * (SBP ‐ DBP); 4) DBP + (25.361 + 0.047 * heart rate + 0.163 * DBP) * (SBP ‐ DBP); 5) (SBP * DBP) ^ 1/2. A two‐way analysis of variance evaluated the effect of the exercise and the formula used to calculate the mean blood pressure.Results: Significant effects of the exercise (F(1, 14) = 88.66, p &lt; 0.001, η2 = 0.86), formula used (F(1.06, 14.86) = 250.23, p &lt; 0.001, η2 = 0.95), and their interaction (F(1.37, 19.11) = 54.75, p &lt; 0.001, η2 = 0.80) were observed in the resulting values. The post‐hoc results showed significant differences between most of the formulas both preexercise and postexercise.Conclusions: The results presented suggest that caution should be applied when using indirect formulas to estimate mean brachial arterial pressure. Future research should objectively evaluate mean blood pressure with a direct method to find the most reliable formula. Meanwhile, this study is published to raise awareness on the importance of choosing one or other methods when aiming to estimate with formulas physiological parameters related to ocular health.

Aortic stiffness increases during prolonged sitting independent of intermittent standing or prior exercise.

Adverse vascular responses can occur during prolonged sitting, including stiffening of the aortic artery which may contribute to cardiovascular disease. Few studies have investigated the impact of intermittent standing and/or prior exercise as strategies to attenuate these potentially deleterious vascular changes. To investigate central vascular health responses during prolonged sitting, with and without intermittent standing and/or prior exercise. Fifteen males aged 18 to 31years were recruited. Subjects completed a control condition [Sitting Only (SO)], and three randomized strategy conditions [Sitting Plus Standing (SSt), Exercise Plus Sitting (ES), Exercise Plus Sitting Plus Standing (ESSt)]. For all conditions, measurements of carotid-femoral pulse wave velocity (cfPWV) were taken at pre- and post-intervention, and brachial and central blood pressure (BP) at pre-, 1-h, 2-h, and 3-h intervention. cfPWV significantly increased from pre- to post-intervention for all conditions (all p ≤ 0.043), as did brachial mean arterial pressure (MAP) and diastolic BP, and central MAP and diastolic BP for the control condition (all p ≤ 0.022). Brachial and central systolic BP were significantly higher during SO compared to ESSt at 1h, and compared to ES for central systolic BP (all p ≤ 0.036). Strategies of intermittent standing and/or prior exercise may not prevent aortic stiffening during sitting but may attenuate BP elevations in the brachial and aortic arteries. Future research should investigate causal mechanistic links between sitting and aortic stiffening, and other attenuation strategies.

Effects of One Night of Forced Wakefulness on Morning Resting Blood Pressure in Humans: The Role of Biological Sex and Weight Status.

Permanent night shift work is associated with adverse health effects, including elevated blood pressure (BP) and hypertension. Here, we examined the BP response to one night of forced wakefulness in a sitting position in a cohort without night shift work experience. According to a counterbalanced crossover design, 47 young adults with either obesity (N = 22; 10 women) or normal weight (N = 25; 11 women) participated in one night of sleep and one night of forced wakefulness under in-laboratory conditions. Resting ankle and brachial arterial BP were assessed in the morning, i.e., the time of the day when adverse cardiovascular events peak. After forced wakefulness, diastolic and mean arterial BP were ~4 mmHg higher at the ankle site and ~3 mmHg higher at the brachial site than after regular sleep (p < 0.05). The increase in BP following overnight forced wakefulness was more pronounced among men vs. women and more significant for diastolic BP at both sites among participants with normal weight vs. those with obesity. If confirmed in larger cohorts, including 24 h BP monitoring, people with occupations involving night shifts might benefit from regular BP monitoring. Particular attention should be paid to possible sex- and weight-specific effects of night shift work on BP.

Quantitative assessment of left ventricular systolic function in patients with systemic lupus erythematosus: a non-invasive pressure-strain loop technique.

Systemic lupus erythematosus (SLE) is associated with a variety of cardiovascular diseases, even in the early stage of disease development. The purpose of this study was to quantitatively evaluate left ventricular (LV) systolic function in patients with SLE using a novel non-invasive pressure-strain loop (PSL) technique. This prospective case-control study included 132 patients with SLE and 99 normal controls, all of whom underwent traditional transthoracic echocardiography. The LV myocardial work was evaluated with the PSL technique based on speckle tracking and brachial artery blood pressure. The differences among groups were compared, and the correlations between myocardial work, laboratory data, and disease activity were analyzed in the SLE group. Compared with the normal group, SLE patients had significantly higher global wasted work {GWW; SLE: 109 [82-150] mmHg%; controls: 66 [45-109] mmHg%; P<0.001} and impaired global work efficiency [GWE; SLE: 95% (94-97%); controls: 97% (96-98%); P<0.001]. Global work index (GWI) and global constructive work (GCW) did not show significant differences (P>0.05). Further subdivision analysis found that the increase of GWW and the damage of GWE were more obvious in SLE patients with high disease activity or severe diastolic dysfunction. Multivariate analysis revealed that increased erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-phospholipid antibodies, peak strain dispersion, and SLE Disease Activity Index (SLEDAI) were independently associated with increased GWW (β=0.189, 0.230, 0.444, 0.111, and 0.180, respectively; all P<0.05) and damaged GWE (β=-0.184, -0.130, -0.468, -0.149, and -0.191, respectively; all P<0.05). The non-invasive PSL can quantitatively evaluate the LV systolic function in SLE patients. This technique may provide a new method for monitoring cardiac function in chronic diseases.

Continuous PPG-Based Blood Pressure Monitoring Using Multi-Linear Regression.

In this work, we present a photoplethy smography-based blood pressure monitoring algorithm (PPG-BPM) that solely requires a photoplethysmography (PPG) signal. The technology is based on pulse wave analysis (PWA) of PPG signals retrieved from different body locations to continuously estimate the systolic blood pressure (SBP) and the diastolic blood pressure (DBP). The proposed algorithm extracts morphological features from the PPG signal and maps them to SBP and DBP values using a multiple linear regression (MLR) model. The performance of the algorithm is evaluated on the publicly available Multiparameter Intelligent Monitoring in Intensive Care (MIMIC I) database. We utilize 28 data-sets (records) that contain both PPG and brachial arterial blood pressure (ABP) signals. The collected PPG and ABP signals are synchronized and divided into intervals of 30 seconds, called epochs. In total, we utilize 47153 clean 30-second epochs for the performance analysis. Out of the 28 data-sets, we use only 2 data-sets with a total of 2677 clean 30-second epochs to build the MLR model of the algorithm. For the SBP, a mean absolute error (MAE) of 6.10 mmHg between the arterial line and the PPG-based values are achieved, with a Pearson correlation coefficient r = 0.90, p = .001. For the DBP, and an MAE of 4.65 mmHg between the arterial line and the PPG-based values are achieved, with a Pearson correlation coefficient r = 0.85, p .001. We also use a binary classifier for the BP values with the positives indicating SBP ≥ 130 mmHg and/or DBP ≥ 80 mmHg and the negatives indicating otherwise. The classifier results generated by the PPG-based SBP and DBP estimates achieve a sensitivity and a specificity of 79.11% and 92.37%, respectively.

Age‐related impairment in dynamic cerebrovascular compliance responses to standing despite preserved cerebrovascular resistance responses

During transient reductions in blood pressure induced by standing upright, a rapid increase in cerebrovascular compliance represents a fundamental response in addition to reductions in cerebrovascular resistance. Age‐related reductions in central arterial compliance are known but how ageing affects the cerebrovascular compliance response to standing remains unknown. Therefore, the present study tested the hypothesis that older adults would demonstrate attenuation of cerebrovascular compliance during standing relative to young adults. Ten young healthy adults (24 ± 3 years, 5 females) and 10 older healthy adults (57 ± 11 years, 4 females) completed a sit‐to‐stand protocol involving at least three minutes of sitting and at least two minutes of standing while brachial artery blood pressure (BP; Finapres) and middle cerebral artery blood velocity (BV; Multigon) were collected. Individual BP waveforms were time aligned to corresponding BV waveforms and were input into a four‐element lumped parameter Windkessel model to calculate an index of cerebrovascular compliance (Ci). Cerebrovascular resistance (Ri) was calculated as the quotient of BP and BV. Beginning 20 beats prior to standing and continuing 40 beats following the stand, every other heartbeat was extracted so that a total of 30 beats were analyzed (i.e., 10 beats during sitting, 20 beats during standing). Seated baseline Ci was calculated as the average of the 10 beats of sitting. Peak Ci (maximum value) minus seated baseline Ci determined the change in (∆) Ci. In the sitting posture, older adults demonstrated similar baseline Ci compared with young adults (7.2e‐4 ± 2.2e‐4 vs. 7.3e‐4 ± 1.5e‐4 cm∙s‐1·mmHg‐1, P= 0.97). Upon standing, Ci increased in all participants, but peak Ci was attenuated in older adults relative to young adults (1.4e‐3 ± 3.2e‐4 vs. 2.2e‐3 ± 4.8e‐4 cm∙s‐1·mmHg‐1, P&lt; 0.001, d= 1.96). Therefore, the change in Ci from sitting to standing was less in older adults compared with young adults (7.1e‐4 ± 2.9e‐4 vs. 1.5e‐3 ± 4.3e‐4 cm∙s‐1·mmHg‐1, P&lt; 0.001, d= 2.15; 109 ± 56 vs. 205 ± 71 %, P= 0.004, d= 1.50) despite both groups showing no difference in the drop in BP (older: ‐21 ± 7 mmHg, young: ‐22 ± 8 mmHg; P= 0.76). Further, no differences were observed between groups in the change in Ri between sitting and standing (older: ‐0.4 ± 03 mmHg∙cm‐1∙s‐1, young: ‐0.3 ± 0.2 mmHg∙cm‐1∙s‐1; P= 0.67). Therefore, older adults demonstrate similar alterations to cerebrovascular resistance upon standing but attenuated cerebrovascular compliance responses. As such, age‐related changes to the cerebral vasculature may be masked by evaluating cerebrovascular resistance alone.

Impact of a Novel Training Approach on Hemodynamic and Vascular Profiles in Older Adults.

Exercise training beneficially moderates the effects of vascular aging. This study compared the efficacy of Peripheral Remodeling through Intermittent Muscular Exercise (PRIME), a novel training regimen, versus aerobic training on hemodynamic profiles in participants ≥70years at risk for losing functional independence. Seventy-five participants (52 females, age: 76 ± 5years) were assessed for hemodynamic and vascular function at baseline, after 4 weeks of either PRIME or aerobic training (Phase 1) and again after a further 8 weeks of aerobic and resistance training (Phase 2). Data were analyzed using 2 × 2 repeated-measures analysis of variance models on the change in each dependent variable. PRIME demonstrated reductions in brachial and aortic mean arterial pressure and diastolic blood pressure (p < .05) from baseline after Phase 1, which were sustained throughout Phase 2. Earlier and greater reductions in blood pressure following PRIME support the proposal that peripheral muscular training could beneficial for older individuals commencing an exercise program.

Performance of non-invasive myocardial work to predict the first hospitalization for de novo heart failure with preserved ejection fraction (HFpEF)

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Dr. Paolisso, Dr. Esposito, Dr. Fabbricatore are supported by a research grant from the CardioPaTh PhD Program of University of Naples Federico II Background Non-invasive myocardial work (MW) is a validated index of left ventricular (LV) systolic performance, incorporating afterload and myocardial metabolism. The role of MW in predicting the first hospitalization for de novo heart failure with preserved ejection fraction (HFpEF) is still unknown. Purpose To investigate the diagnostic performance of MW to predict the first de novo HFpEF hospitalization in ambulatory individuals with preserved LVEF. Methods Twenty-nine patients with trans-thoracic echocardiography performed at least 6 months before the first HFpEF hospitalization were compared with 29 matched controls. MW was derived as the area of pressure-strain loop using speckle-tracking and brachial artery blood pressure. Global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were collected. First HFpEF hospitalization and its combination with cardiovascular death (MACE) and all-cause of death (MAE) were assessed. Results At baseline, future HFpEF patients showed lower GWI, GCW, GWE and higher GWW than controls (all p &amp;lt; 0.05). At admission versus baseline, GWE significantly decreased, and GWW increased in the HFpEF group (p &amp;lt; 0.05), whereas no significant difference was observed in the controls over time. GWW, with a cut-off of 170 mmHg%, showed the largest AUC to predict first HFpEF hospitalization (AUC = 0.80, 95% CI 0.69–0.91, p &amp;lt; 0.001), MACE (AUC = 0.80, 95% CI 0.66–0.90, p &amp;lt; 0.001) and MAE (AUC = 0.79, 95% CI 0.62–0.88, p = 0.001). GWW &amp;gt; 170 mmHg% was associated with a 4-fold increase of MACE (HR = 4.5, 95% CI 1.59–13.12, p = 0.005) and a 3-fold higher risk of MAE (HR = 2.9, 95% CI 1.24–6.6, p = 0.014). Conclusions In ambulatory patients with preserved LVEF and risk factors, GWW showed high accuracy to predict the first HFpEF hospitalization and its combination with mortality. The GWW routine assessment may be clinically helpful in patients with dyspnea. Abstract Figure 1: Serial changes of LARs, LV GLS Abstract Figure 2:Kaplan–Meier survival curves fo