Brachial Blood Pressure Measurements Research Articles

Central blood pressure obtained by cuff-based oscillometry as a determinant of left ventricular hypertrophy in hypertensive patients.

Limited and conflicting data have been reported on the prognostic relevance of central blood pressure (CBP) compared with brachial blood pressure (BP) in the anticipation of hypertension-mediated organ damage and the majority of data derived using applanation tonometry with its known complexities. The objective of the present study was to investigate the diagnostic factors of left ventricular hypertrophy (LVH) with a special highlight on the utility of non-invasive oscillometric CBP measurement and derived hemodynamic indices compared to brachial BP as indicators of LVH. This cross-sectional study included 300 hypertensive patients (mean age 55.3 years, 61.3% female, 51.7% obese) with a mean duration of hypertension was 5.8 years. They underwent measurement of brachial BP, using a mercury sphygmomanometer, and CBP, using a Mobil-O-Graph, alongside the determination of left ventricular (LV) mass by two-dimensional transthoracic echocardiography. LVH and LV geometric patterns were defined by LV mass index/height 2.7 and relative wall thickness. Bivariate then multivariate analysis showed that age, BMI, central systolic BP (SBP), and pulse wave velocity (PWV) were significant determinants of LVH and optimally controlled brachial BP was a significant negative determinant for LVH. Central SBP had an acceptable diagnostic performance to determine LVH in patients with hypertension (AUC = 0.722, 95% confidence interval: 0.618-0.824, SE = 0.21, P -value <0.001). Using one-way ANOVA, a comparison of means among age groups showed that the steady increase in central SBP and PWV with aging was greater among LVH patients than non-LVH patients. Estimated central SBP using Mobil-O-Graph showed a significantly higher correlation to LVH than brachial SBP values. The consistent increase in central SBP and PWV with aging was greater among LVH patients than non-LVH patients.

Vascular determinants of hippocampal viscoelastic properties in healthy adults across the lifespan

Arterial stiffness and cerebrovascular pulsatility are non-traditional risk factors of Alzheimer’s disease. However, there is a gap in understanding the earliest mechanisms that link these vascular determinants to brain aging. Changes to mechanical tissue properties of the hippocampus (HC), a brain structure essential for memory encoding, may reflect the impact of vascular dysfunction on brain aging. We tested the hypothesis that arterial stiffness and cerebrovascular pulsatility are related to HC tissue properties in healthy adults across the lifespan. Twenty-five adults underwent measurements of brachial blood pressure (BP), large elastic artery stiffness, middle cerebral artery pulsatility index (MCAv PI), and magnetic resonance elastography (MRE), a sensitive measure of HC viscoelasticity. Individuals with higher carotid pulse pressure (PP) exhibited lower HC stiffness (β = −0.39, r = −0.41, p = 0.05), independent of age and sex. Collectively, carotid PP and MCAv PI significantly explained a large portion of the total variance in HC stiffness (adjusted R2 = 0.41, p = 0.005) in the absence of associations with HC volumes. These cross-sectional findings suggest that the earliest reductions in HC tissue properties are associated with alterations in vascular function.

Aortic-brachial stiffness mismatch as potential marker of subclinical arterial damage in patients with rheumatoid arthritis

Aortic-brachial stiffness mismatch is a potential new marker of a subclinical vascular damage that has never been studied in patients with rheumatic diseases. The aim of the study was to assess the frequency of arterial stiffness mismatch in rheumatoid arthritis (RA) and to evaluate its clinical associations. Materials and Methods. The study group included 85 patients with RA (males 22.4 %, aged 59.7 ± 14.3 years, hypertension in 65 %, mean disease activity score (DAS-28 (C-reactive protein) 3.7 ± 1.1), and the control group included 40 subjects matched by gender, age and risk factors. The study methods included measurements of clinical and ambulatory brachial and aortic blood pressure (BP) (BPLab-Vasotens), arterial stiffness parameters parameters (applanation tonometry, SphygmoCorAtCor), cardio-ankle vascular index (VaSera) and cardio-vascular risk assessments using the SCORE, American College of Cardiology/American Heart Association (ACC/AHA) 2013 pooled cohort equations and QRisk2 scoring systems. The arterial stiffness gradient was calculated as a ratio between carotid-femoral (cf) and carotid-radial (cr) pulse wave velocity, and its elevation of ≥ 1 was considered as arterial stiffness mismatch. A p-value of 0.05 was considered significant. Results and Discussion. The mean stiffness gradient in RA patients without and with hypertension was 1.1 ± 0.1 and 1.4 ± 0.4, respectively (р 0.001); in controls, 0.99 ± 0.2 and 1.3 ± 0.3, respectively (р 0.001). The frequency of stiffness mismatch in the RA group was significantly higher compared to the controls in the whole study population (88.2 % vs 65 % (р = 0.002)) and in both normotensive and hypertensive subgroups (76.7 % vs 43.8 % (p = 0.03), and 94.5 % vs 79.2 % (p = 0.04), respectively). The same trend was observed in the subgroups with normal carotid-femoral pulse wave velocity: arterial stiffness mismatch was present in 82.1 % of RA patients vs. 51.9 % control subjects (p = 0.004). The stiffness gradient was associated with age (r = 0.63), hypertension duration (r = 0.56), cardio-vascular risk by the ACC/AHA 2013 (r = 0.69) and Qrisk2 (r = 0.7) scoring systems, nocturnal aortic systolic BP (r = 0.53), cardio-ankle vascular index (r = 0.60) and diurnal index of brachial systolic BP (r = -0.4). Significant differences in stiffness gradient values were observed in the subgroups based on elevation of aortic systolic BP and pulse wave velocity above individual reference values, aortic pulse pressure 50 mmHg, cardio-ankle vascular index 9, presence of high cardio-vascular risk, masked and nocturnal hypertension, and non-dipping. Conclusion. Patients with RA are characterized by higher frequency of arterial stiffness mismatch compared to controls, irrespective of the history of hypertension or the values of carotid-femoral pulse wave velocity. Arterial stiffness mismatch is associated with unfavorable 24-h BP profile, higher frequency of nocturnal hypertension and cardio-vascular risk.

Incremental value of continuous non-invasive blood pressure control to assess hypotension during atrial fibrillation ablation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atrial Fibrillation (AF) ablation is associated with continuous blood pressure (BP) variations related to anesthesiological regimen and energy delivery. Conventional BP monitoring with non-invasive periodic brachial BP controls can miss potential hypotensive events. Continuous non-invasive blood pressure (CNBP) measurement using the volume-clamp method (Clearsight) was demonstrated to be a reliable and effective tool for the assessment of BP during AF ablation. Purpose Aim of the study was to investigate the incidence of hypotensive events during AF ablation. Methods We included consecutive patients scheduled for AF ablation and monitored in parallel with a periodic (10 minutes) brachial BP cuff and in continuous with the CNBP System (Clearsight). All CNBP data were analyzed with the Acumen Analytics software for hypotension evaluation. According to the anesthesiological regimen, patients were divided in 2 Groups, the General Anesthesia (GA) and the Deep Sedation (DS) group. Area under the threshold (AUT, mmHg x min) of 65 mmHg and Time Weighted Average (TWA, mmHg, i.e., the AUT divided by the total duration of procedure in minutes) of area under threshold (MAP &amp;lt;65 mmHg) were compared between the two groups. Results Forty-eight patients were included, 10 (21%) in the General Anesthesia Group and 38 (79%) in the Sedation Group. Hypotension was detected in 18 patients, 9/10 (90%) were recorded in the GA group and 9/38 (23.7%) in the DS one. A total of 85 hypotensive events were recorded, 68 (80%) in the GA and 17 (20%) in the DS Group. In the overall population, mean duration of hypotensive events was 4.87 minutes (range 0 – 14.73 minutes), mean MAP &amp;lt; 65 mmHg was 54.25 ± 7.2 mmHg, mean AUT (MAP &amp;lt;65 mmHg) was 79.4 mmHg x min (range 0 – 1237.7) and mean TWA was 0.41 mmHg (range 0 – 6.9). Hypotensions were more often documented in GA than in DS patients (mean difference 6.35 events/procedure, C.I. 2.66 – 10.10, p&amp;lt;0.05) so as AUTs (mean difference 319.90 mmHg x min, C.I. 30.00 – 609.80, p=0.034) and TWAs (mean difference 1.64 mmHg, C.I. 0.18 – 3.09, p=0.032) which were significantly higher in the GA group. Brachial periodic BP measurement every 10 minutes missed the majority (n=52, 61.2%) of hypotensive events. Conclusions CNBP demonstrated a high incidence of hypotension during AF ablation, specially under GA, which are usually missed by the standard intermittent brachial non-invasive BP monitoring. Real time hypotension predictive CNBP indexes could be valuable in this setting.

Are portable ankle brachial pressure index measurement devices suitable for hypertension screening?

In a large-scale population cardiovascular screening programme, peripheral artery disease (PAD) and hypertension would ideally be rapidly assessed using a single device. The ankle-brachial pressure index (ABPI) is calculated by comparing the ankle and brachial blood pressure (BP). However, it is currently unclear whether brachial BP measurements provided by automated PAD screening systems are sufficiently accurate for simultaneous hypertension screening. Two portable PAD screening devices, the MESI ABPI MD and Huntleigh's Dopplex ABIlity, were evaluated following the European Society of Hypertension International Protocol (ESH-IP) Revision 2010 using a mercury-free sphygmomanometer as a reference device. On average, the MESI slightly underestimated brachial systolic blood pressure (BP) with a bias and standard deviation (SD) of -3.5 (SD: 3.3) mmHg and diastolic BP with a bias of -1.5 (SD: 2.3) mmHg. For systolic BP estimates, the Dopplex was more accurate than the MESI with a lower bias of -0.5 (SD: 4.2) mmHg but less precise. The MESI successfully fulfilled all the requirements of the ESH-IP for hypertension screening. The Dopplex device failed the ESH-IP due to the absence of DBP measurements. The MESI device appears to be suitable for simultaneous PAD and hypertension screening as part of a preventative care programme. Huntleigh's Dopplex ABIlity failed to pass the ESH-IP validation test. Further clinical trials are underway to assess the use of the MESI for simultaneous screening for hypertension and PAD in a population screening setting.

PS-C08-5: VALIDATE-CKD - PRELIMINARY FINDINGS ON CENTRAL BLOOD PRESSURE DEVICES ACCURACY IN PATIENTS WITH STAGES G4-G5 CHRONIC KIDNEY DISEASE

Objective: Measurement of brachial cuff blood pressure (BP) was designed as a convenient surrogate to the aortic BP, which is the BP that dictates perfusion to target organs. In the general population, brachial cuff systolic BP (SBP) has a somewhat acceptable accuracy towards aortic BP but less is know in populations with marked high arterial stiffness, such as in G4-G5 CKD. Central BP devices were designed to directly estimate the aortic BP through pulse wave analysis to a greater accuracy than brachial cuff BP. The aim of the ongoing VALIDATE-CKD study is to compare the accuracy of brachial and central BP readings towards the intraarterial aortic SBP, in patients with and without Stage G4-G5 CKD. Design and method: In patients with and without Stage G4-G5 CKD (eGFR &lt; 30 ml/min/1.73m2) undergoing non-urgent coronary angiograms, invasive aortic and non-invasive (WatchBP and Mobil-o-graph devices) BPs were measured simultaneously following the ARTERY Society protocol. Accuracy was defined by the mean difference (± SD) between the aortic SBP and the corresponding non-invasive SBP. Results: To date, 8 individuals with Stage G4-G5 CKD and 26 control subjects are enrolled. The following table presents clinical characteristics and non-invasive BPs accuracies in patients with and without Stage G4-G5 CKD. Conclusion: These preliminary results indicate that brachial SBP significantly underestimates aortic SBP in patients with Stage G4-5 CKD as compared to control subject. Furthermore, central BP devices provide a highly accurate estimation of aortic SBP in this population. The ongoing VALIDATE-CKD study may support that the use of central BP devices could be beneficial for the management of patients with advanced CKD.

CENtral blood pressure Targeting: a pragmatic RAndomized triaL in advanced Chronic Kidney Disease (CENTRAL-CKD): A Clinical Research Protocol.

Emerging data favor central blood pressure (BP) over brachial cuff BP to predict cardiovascular and kidney events, as central BP more closely relates to the true aortic BP. Considering that patients with advanced chronic kidney disease (CKD) are at high cardiovascular risk and can have unreliable brachial cuff BP measurements (due to high arterial stiffness), this population could benefit the most from hypertension management using central BP measurements. To assess the feasibility and efficacy of targeting central BP as opposed to brachial BP in patients with CKD G4-5. Pragmatic multicentre double-blinded randomized controlled pilot trial. Seven large academic advanced kidney care clinics across Canada. A total of 116 adults with CKD G4-5 (estimated glomerular filtration rate [eGFR] < 30 mL/min) and brachial cuff systolic BP between 120 and 160 mm Hg. The key exclusion criteria are 1) ≥ 5 BP drugs, 2) recent acute kidney injury, myocardial infarction, stroke, heart failure or injurious fall, 3) previous kidney replacement therapy. Double-blind randomization to a central or a brachial cuff systolic BP target (both < 130 mm Hg) as measured by a validated central BP device. The study duration is 12 months with follow-up visits every 2 to 4 months, based on local practice. All other aspects of CKD management are at the discretion of the attending nephrologist. Primary Feasibility: Feasibility of a large-scale trial based on predefined components. Primary Efficacy: Carotid-femoral pulse wave velocity at 12 months. Others: Efficacy (eGFR decline, albuminuria, BP drugs, and quality of life); Events (major adverse cardiovascular events, CKD progression, hospitalization, mortality); Safety (low BP events and acute kidney injury). May be challenging to distinguish whether central BP is truly different from brachial BP to the point of significantly influencing treatment decisions. Therapeutic inertia may be a barrier to successfully completing a randomized trial in a population of CKD G4-5. These 2 aspects will be evaluated in the feasibility assessment of the trial. This is the first trial to evaluate the feasibility and efficacy of using central BP to manage hypertension in advanced CKD, paving the way to a future large-scale trial. clinicaltrials.gov (NCT05163158).

S-46-6: COMPARING OFFICE, CENTRAL, HOME AND AMBULATORY BLOOD PRESSURE IN PREDICTING LEFT VENTRICULAR MASS

The blood pressure measurement method that more accurately predicts a left ventricular mass is controversial, and the evidence suggesting superiority of central over brachial measurements is contradictory. The aim of this study was to compare the relationship between the different clinic and out-of-clinic blood pressure measurements methods with left ventricular mass in patients who attended a specialised hypertension centre for a central blood pressure measurement. An analysis was performed on the correlations between left ventricular mass and central and brachial blood pressure measurements made in the clinic, and home, as well as 24-h systolic blood pressure measurements. A linear regression analysis was then performed to assess the independent relationship of each blood pressure measurement with left ventricular mass. The results on 824 treated and 123 untreated patients showed no significant differences between correlations, although home readings tended to have the best correlations. In regression adjusted models, for each 10 mmHg increase in systolic home blood pressure the left ventricular mass increased 10 g/m2 (95% CI; 3.7–27, P = .01, adjR2 0.38), and for 24-h ambulatory systolic blood pressure it increased 2.3 g/m2 (95% CI 0.76–3.9, P &lt; .01, adjR2 0.15) in treated and untreated patients, respectively. The association of systolic blood pressure with left ventricular mass was better explained by home and 24-h ambulatory monitoring than to clinic-based measurements in treated and untreated patients, respectively. In the clinic, however, the central measurement was not superior to brachial blood pressure.

Abstract 11902: Hypertension Severity Impacts Declines in Left Ventricular Ejection Fraction Among Women Receiving Adjuvant Chemotherapy for Breast Cancer (UPBEAT WF-97415)

Introduction: AHA/ACC hypertension guidelines do not clearly address pharmacological treatment of increases in blood pressure (BP) in women receiving potentially cardiotoxic chemotherapy for treatment of breast cancer. Methods and Results: Magnetic resonance measures of left ventricular ejection fraction (LVEF) were performed in women with stage I-III breast cancer prior to and three months after initiating potentially cardiotoxic chemotherapy. Measurements of brachial BP were collected according to AHA recommendations. Using multivariable analysis, we assessed the association between change in LVEF and pre-existing ACC/AHA stages of hypertension (HTN) after accounting for pre-treatment LVEF, diabetes status, age, and body mass index (BMI). All analyses were performed by those blinded to all participant identifiers. Participants (n=259, female) were aged 56±11 (Mn + SD) years and were 76% white &amp; 19% black (NCT02791581 and NCT01719562). Cancer therapies included combinations of anthracyclines (23%), trastuzumab (10%), paclitaxel (22%) and cyclophosphamide (30%). After accounting for pre-treatment LVEF, diabetes status, age, and BMI, participants with stage 2 HTN experienced a significant decline (p=0.037, Figure) in LVEF relative to individuals with normal blood pressure. Conclusion: Relative to women with normal blood pressure, women with stage 2 HTN experienced a larger decline in LVEF (p=0.037) three months after initiating potentially cardiotoxic chemotherapy for breast cancer. This finding raises the possibility that lower blood pressure targets among women receiving adjuvant treatment for breast cancer may be associated with improved preservation of LVEF.

Five-Year Outcomes of the Danish Cardiovascular Screening (DANCAVAS) Trial

BackgroundLimited data suggest a benefit of population-based screening for cardiovascular disease with respect to the risk of death.MethodsWe performed a population-based, parallel-group, randomized, controlled trial involving men 65 to 74 years of age living in 15 Danish municipalities. The participants were randomly assigned in a 1:2 ratio to undergo screening (the invited group) or not to undergo screening (the control group) for subclinical cardiovascular disease. Randomization was based on computer-generated random numbers and stratified according to municipality. Only the control group was unaware of the trial-group assignments. Screening included noncontrast electrocardiography-gated computed tomography to determine the coronary-artery calcium score and to detect aneurysms and atrial fibrillation, ankle–brachial blood-pressure measurements to detect peripheral artery disease and hypertension, and a blood sample to detect diabetes mellitus and hypercholesterolemia. The primary outcome was death from any cause.ResultsA total of 46,611 participants underwent randomization. After exclusion of 85 men who had died or emigrated before being invited to undergo screening, there were 16,736 men in the invited group and 29,790 men in the control group; 10,471 of the men in the invited group underwent screening (62.6%). In intention-to-treat analyses, after a median follow-up of 5.6 years, 2106 men (12.6%) in the invited group and 3915 men (13.1%) in the control group had died (hazard ratio, 0.95; 95% confidence interval [CI], 0.90 to 1.00; P=0.06). The hazard ratio for stroke in the invited group, as compared with the control group, was 0.93 (95% CI, 0.86 to 0.99); for myocardial infarction, 0.91 (95% CI, 0.81 to 1.03); for aortic dissection, 0.95 (95% CI, 0.61 to 1.49); and for aortic rupture, 0.81 (95% CI, 0.49 to 1.35). There were no significant between-group differences in safety outcomes.ConclusionsAfter more than 5 years, the invitation to undergo comprehensive cardiovascular screening did not significantly reduce the incidence of death from any cause among men 65 to 74 years of age. (Funded by the Southern Region of Denmark and others; DANCAVAS ISRCTN Registry number, ISRCTN12157806.)

Invasive validation of pressure-volume loops derived from cardiovascular magnetic resonance imaging and brachial blood pressure in heart failure patients

Abstract Introduction Left ventricular (LV) pressure-volume (PV) loops provide gold-standard physiological information but require invasive measurements of ventricular intracavity pressure, limiting clinical and research applications. Recent development has seen the introduction of non-invasively computed PV loops from cardiovascular magnetic resonance (CMR) volumetry and a brachial blood pressure measurement. The approach combines LV volumes with a time-varying elastance function to compute time-resolved LV pressures and was validated on invasive pressure data from a porcine model. The method is readily implemented using standard CMR sequences and provides measures of hemodynamic parameters including stroke work, myocardial efficiency, and contractile state. However, the method remains to be validated in patients using invasive left ventricular pressure recordings. Purpose To validate for the first time in human patients the performance of non-invasively computed PV loops against invasive measures. Methods Four heart failure patients underwent two subsequent sessions of CMR cine imaging and simultaneous brachial blood pressure measurement, with intravenous administration of two different vasoactive drugs, resulting in two different haemodynamic states for each patient. LV catheterization was then conducted with repeat administration of the same infusions. Pressure-volume loops were computed from CMR volumes combined with 1) a time-varying elastance function scaled to brachial blood pressure and temporally stretched to match volume data, and 2) invasive pressures averaged from multiple sampled beats. Method comparison was conducted using linear regression and Bland-Altman analysis. Results Figure 1 shows non-invasively derived PV loop parameters compared to invasive data. The non-invasive method demonstrated strong correlations and low bias for stroke work (R2=0.97, bias 4.6%, p&amp;lt;0.0001), potential energy (R2=0.83, bias 1.5%, p=0.001), end-systolic pressure-volume relationship (R2=0.90, bias 5.4%, p=0.0003), energy per ejected volume (R2=0.93, bias 3.5%, p=0.0001), ventricular efficiency (R2=0.99, bias 1.1%, p&amp;lt;0.0001), arterial elastance (R2=0.87, bias −7.8%, p=0.0006), and mean external power (R2=0.89, bias 4.6%, p=0.0005). Conclusions Pressure-volume loops can be precisely and accurately computed from cardiovascular magnetic resonance imaging and brachial cuff blood pressure in humans, and is ready for use in research applications. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Swedish Heart Lung Foundation

Twenty-Four-Hour Central Hemodynamic Load in Adults With and Without a History of COVID-19.

BACKGROUNDAlthough hypertension is an established risk factor for severe COVID-19 illness, little is known about the effects of COVID-19 on blood pressure (BP). Central BP measures taken over a 24-hour period using ambulatory blood pressure monitoring (ABPM) adds prognostic value in assessing cardiovascular disease (CVD) risk compared to brachial BP measures taken at a single time point. We assessed CVD risk between adults with and without a history of COVID-19 via appraisal of 24-hour brachial and central hemodynamic load from ABPM.METHODSCross-sectional analysis was performed on 32 adults who tested positive for COVID-19 (29±13 years, 22 females) and 43 adults without a history of COVID-19 (28±12 years, 26 females). Measures of 24-hour hemodynamic load included brachial and central systolic and diastolic BP, pulse pressure, augmentation index (AIx), pulse wave velocity (PWV), nocturnal BP dipping, the ambulatory arterial stiffness index (AASI), and the blood pressure variability ratio (BPVR).RESULTSParticipants who tested positive for COVID-19 experienced 6±4 COVID-19 symptoms, were studied 122±123 days after testing positive, and had mild-to-moderate COVID-19 illness. The results from independent samples t-tests showed no significant differences in any of our 24-hour, daytime, or nighttime measures of central or peripheral hemodynamic load across those with and without a history of COVID-19 (p > 0.05 for all).CONCLUSIONSNo differences in 24-hour brachial or central ABPM measures were detected between adults recovering from mild-to-moderate COVID-19 and controls without a history of COVID-19. Adults recovering from mild-to-moderate COVID-19 do not have increased 24-hour central hemodynamic load.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Association of Perceived Stress and Physical Activity Level with Severity of Coronary Artery Disease in Gaza Strip, Palestine: A Cross-Sectional Study

BackgroundThe association between life-event stressors and low physical activity linked to the severity of coronary artery disease (CAD) is poorly understood. Therefore, this study aimed to determine the perceived stress status and physical activity level associated with the severity of CAD.MethodsThe study was conducted among 423 patients with newly discovered CAD (both sexes, aged 35–65 years) confirmed by coronary angiography results. CAD severity was classified according to the Gensini score as severe or non-severe. The fasting blood glucose and lipid profiles were also investigated. Anthropometric and brachial blood pressure measurements were obtained. A structured questionnaire including participants’ characteristics, the Perceived Stress Scale (PSS-14), and the International Physical Activity Questionnaire were used via face-to-face interviews. Multivariable binary logistic regression was used to assess the predictors of CAD severity using IBM SPSS ver. 24.0 (IBM Corp., Armonk, NY, USA).ResultsMost participants were classified as having severe CAD (63.8%). Adjusting for age, sex, smoking status, systolic blood pressure, body mass index, and history of hypertension, the severity of CAD increased by 9% for a onescore increase in the PSS (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.01–1.14; P=0.030). Moreover, sufficiently active (600–1,500 metabolic equivalents [METs]/wk) patients had lower odds of severe CAD (OR, 0.43; 95% CI, 0.23–0.72; P=0.027) than those with insufficient activity. However, no significant association was found between physical activity (≥1,500 METs/wk) and CAD severity.ConclusionThe odds of CAD severity significantly increased with increasing perceived stress score but decreased with sufficient physical activity.

Accuracy Difference of Noninvasive Blood Pressure Measurements by Sex and Height

Women are at higher risk of cardiovascular events than men with similar blood pressure (BP). Whether this discrepancy in risk is associated with the accuracy of brachial cuff BP measurements is unknown. To examine the difference in brachial cuff BP accuracy in men and women compared with invasively measured aortic BP and to evaluate whether noninvasive central BP estimation varies with sex. This cross-sectional study enrolled 500 participants without severe aortic stenosis or atrial fibrillation from January 1 to December 31, 2019, who were undergoing nonurgent coronary angiography at a tertiary care academic hospital. Simultaneous measurements of invasive aortic BP and noninvasive BP. Sex differences in accuracy were determined by calculating the mean difference between the noninvasive measurements (brachial and noninvasive central BP) and the invasive aortic BP (reference). Linear regression and mediation analyses were performed to identify mediators between sex and brachial cuff accuracy. This study included 500 participants (145 female [29%] and 355 male [71%]; 471 [94%] White; mean [SD] age, 66 [10] years). Baseline characteristics were similar for both sexes apart from body habitus. Despite similar brachial cuff systolic BP (SBP) (mean [SD], 124.5 [17.7] mm Hg in women vs 124.4 [16.4] in men; P = .97), invasive aortic SBP was higher in women (mean [SD], 130.9 [21.7] in women vs 124.7 [20.1] mm Hg in men; P < .001). The brachial cuff was relatively accurate compared with invasive aortic SBP estimation in men (mean [SD] difference, -0.3 [11.7] mm Hg) but not in women (mean [SD] difference, -6.5 [12.1] mm Hg). Noninvasive central SBP (calibrated for mean and diastolic BP) was more accurate in women (mean [SD] difference, 0.6 [15.3] mm Hg) than in men (mean [SD] difference, 8.3 [14.2] mm Hg). This association of sex with accuracy was mostly mediated by height (3.4 mm Hg; 95% CI, 1.1-5.6 mm Hg; 55% mediation). In this cross-sectional study, women had higher true aortic SBP than men with similar brachial cuff SBP, an association that was mostly mediated by a shorter stature. This difference in BP measurement may lead to unrecognized undertreatment of women and could partly explain why women are at greater risk for cardiovascular diseases for a given brachial cuff BP than men. These findings may justify the need to study sex-specific BP targets or integration of sex-specific parameters in BP estimation algorithms.

HIDDEN CENTRAL HYPERTENSION AND SPURIOUS HYPERTENSION IN ELDERLY PEOPLE

Objective: Determination of brachial systolic blood pressure (SBP-b) and central systolic blood pressure (SBP-c) in the elderly could contribute to their better management by the identification of hidden central hypertension (HCH) and spurious hypertension (SH). Objectives: a) to analyse SBP-b and SBP-c relationship, b) to determine prevalence and phenotypes of HCH and SH, c) to evaluate antihypertensive treatment; d) to identify risk of orthostatic hypotension (OH). Methods: We included patients older than 65 years old who consecutively consulted to the participating sites (2014–2019) retrospectively and accordingly to their previous hypertension diagnosis were classified as hypertensives or normotensives. Brachial and central blood pressure measurements allow us to identify four phenotypes: 1) normal SBP-b with high SBP-c, 2) high SBP-b with normal SBP-c, 3) both normal, 4) both high. Statistical: Student test, ANOVA, Chi2. Design and method: 1595 subjects were recruited (female 47.8%, 70.9 ± 5.2 years); 66.6%(n:1063) hypertensive/33.3%(n:532) normotensives. We identified HCH in 7.9%(n:84), SH in 5.2%(n:55) in hypertensive group, compared with 10.7%(n:57) and 3.4%(n:18) respectively in normotensives. Elevated values of SBP-b were detected in 27.1% normotensives, although 10.7% had normal SBP-c. Table 1 shows the baseline and hemodynamic characteristics of general population according to phenotypes. No differences were found between different classes of antihypertensive drugs, but a higher number of medications was reported in SH. OH was identified in 35%, showing 48% of them SH. Conclusion: Hidden central hypertension was present in almost 5% of elderly people while spurious hypertension in 9%, similar in hypertensives and normotensives. Phenotypically HCH subjects were older, less active, with increase PWV and AIX, but with lower HR than those with SH, who showed higher CI, HR and SVR. As it was expected, our study results suggest that elderly people with HCH could be at risk of being sub-treated and inversely, those with SH could be over-treated. The OH prevalence in SH supports this latter issue. Finally, the measurement of SBP-c seems to be a useful clinical variable that could lead to a better management of blood pressure in the elderly.

Validation of a Non-invasive Inverse Problem-Solving Method for Stroke Volume.

Stroke volume (SV) is a major biomarker of cardiac function, reflecting ventricular-vascular coupling. Despite this, hemodynamic monitoring and management seldomly includes assessments of SV and remains predominantly guided by brachial cuff blood pressure (BP). Recently, we proposed a mathematical inverse-problem solving method for acquiring non-invasive estimates of mean aortic flow and SV using age, weight, height and measurements of brachial BP and carotid-femoral pulse wave velocity (cfPWV). This approach relies on the adjustment of a validated one-dimensional model of the systemic circulation and applies an optimization process for deriving a quasi-personalized profile of an individual’s arterial hemodynamics. Following the promising results of our initial validation, our first aim was to validate our method against measurements of SV derived from magnetic resonance imaging (MRI) in healthy individuals covering a wide range of ages (n = 144; age range 18–85 years). Our second aim was to investigate whether the performance of the inverse problem-solving method for estimating SV is superior to traditional statistical approaches using multilinear regression models. We showed that the inverse method yielded higher agreement between estimated and reference data (r = 0.83, P < 0.001) in comparison to the agreement achieved using a traditional regression model (r = 0.74, P < 0.001) across a wide range of age decades. Our findings further verify the utility of the inverse method in the clinical setting and highlight the importance of physics-based mathematical modeling in improving predictive tools for hemodynamic monitoring.

Abstract 10636: Inter-Arm Difference in Systolic Blood Pressure: Prevalence and Associated Factors in an African Population

Background: Systolic inter-arm blood pressure differences (IABPD) is associated with increased cardiovascular mortality and morbidity. However, almost all data are issued from western countries, and the epidemiology and associated risk factors of IABPD in sub-Saharan Africa is unknown. Objectives: This study aims to determine the descriptive epidemiology of IABPD in a rural community of Benin. Methods: A cross-sectional study was conducted among participants of the TAnve HEalth Study (TAHES), a prospective population-based cohort conducted in Benin since 2015. All inhabitants of two villages (Tanve and Dékanme), aged 25 years and over were included. Pregnant woman and participants unable to answer the questions were excluded from the study. Data were collected from February to March, 2020 using the WHO STEPS adapted questionnaire in a systematic door-to-door survey. Brachial BP were recorded at rest on both arm with an electronic device. Three series of BP measures were collected sequentially. On each arm the average of the two last measurements was used for analysis. High IABPD was defined as the absolute value of the difference in systolic BP between the left and right arms ≥ 10 mmHg. A multivariate logistic regression models identified factors associated with IABPD. Results: A total of 1,505 participants (median age 40 [32-54] years, 59.3% women) were included in this study. The prevalence of systolic IABPD was 19% (95%CI: 17-21). The prevalence was 19.0% (95%CI: 16-22) in men and 20% (95%CI: 17-22) in women. In the final multivariable model, the probability for systolic IABPD ≥ 10 mmHg increased significantly with age (adjusted OR (aOR) = 1.10 (95%CI: 1.02-1.20) per 10-years), hypertension (aOR = 2.21; 95%CI: 1.68- 2.91) and diabetes (aOR = 1.69; 95%CI: 1.09-2.63). Conclusion: Almost one out of 5 native Africans have an IABPD ≥ 10 mmHg, with an increased risk with older age and presence of hypertension and diabetes. The clinical implication of our finding is in the importance of bilateral brachial blood pressure measurement in this setting.

Association of arterial hemodynamics with left ventricular systolic function in hypertensive patients: A longitudinal study

BACKGROUND Left ventricular (LV) systolic impairment, particularly in the longitudinal direction, is considered an early and sensitive marker of hypertensive heart disease and increased cardiovascular risk. The evidence indicates that aortic stiffness and central hemodynamic factors are important determinants of LV performance, mediating the interaction between the heart and vascular load. Despite the existence of cross-sectional analyses linking central blood pressure (BP) parameters with LV mechanics, no longitudinal data are available which include serial measurements in the course of antihypertensive treatment. OBJECTIVES To investigate the associations between changes in LV longitudinal and circumferential function with alterations in arterial hemodynamics and ventricular-arterial coupling (VAC) in patients with uncomplicated hypertension during a 12-month follow-up. MATERIAL AND METHODS In this retrospective study, 216 patients (age 64.3 ±7.6 years) underwent echocardiography including left ventricular longitudinal (GLS) and circumferential strain (GCS) analysis, brachial BP measurements, VAC (combining echocardiography and brachial BP), and arterial hemodynamics using radial tonometry at baseline and after 12 months of antihypertensive therapy. Patients were grouped into 2 subsets: with improvement in GLS (n = 103) and with deterioration in GLS (n = 113). RESULTS No significant differences were observed in the majority of cardiovascular, demographic or clinical characteristics between the groups. The subset with improvement in GLS demonstrated more favorable changes over follow-up in pulse wave velocity (p = 0.03), central augmentation pressure (p = 0.01) and ventricular-arterial coupling (p = 0.04) compared to patients showing deterioration in GLS. In the multivariable analysis, independent determinants of changes in GLS were: GLS at baseline (-0.48; p < 0.001), changes from baseline to follow-up in central augmentation pressure (-0.29; p = 0.002) and ventricular-arterial coupling (-0.25; p = 0.004). Independent determinants of analogous changes in GCS were: GCS at baseline (-0.46; p < 0.001) and changes in central augmentation pressure (-0.22; p = 0.02). CONCLUSIONS Left ventricular longitudinal and circumferential functional remodeling over time in hypertensive patients is associated with arterial hemodynamics and ventricular-arterial coupling.

Abstract P150: Sex Differences In Augmentation Index And Aortic Pulse Pressure Among Patients Diagnosed With Acute Primary Intracerebral Hemorrhage

Introduction: Intracerebral hemorrhage (ICH) is the second most common subtype of stroke. Hypertension is a major cause of primary spontaneous ICH. However, sex difference in blood pressure (BP) and arterial stiffness among ICH patients is not well characterized. Methods: A prospective pilot study to investigate the feasibility of measuring arterial stiffness in acute primary ICH patients was approved by the institutional research board at Wake Forest Baptist Health. Eligible subjects with primary ICH were enrolled in the study within 7 days of onset. Non-invasive measurements of brachial BP, aortic BP, augmentation index at heart rate of 75 beats per minute (AIx75), and carotid-femoral pulse wave velocity (cf-PWV) were measured at the patient’s bedside, using the SphygmoCor XCEL System v1 (AtCor Medical Pty Ltd., Sydney, Australia). Results: A total of 20 patients have been enrolled in the study over 5 months. Over half the patients enrolled were female (55%, n = 11), including 82% (n = 9) White, 9% (n = 1) Asian and 9% (n = 1) Hispanic. There was increased diversity in the male patients (45%, n = 9) including 44% (n = 4) Black, 22% (n = 2) White, 22% (n = 2) Hispanic, and 11% (n = 1) Asian. Men were significantly younger than women (57 ± 5 years vs 74 ± 3 years, respectively, P = 0.009). There were no significant differences in BMI or ICH score. At the time of measurement, there were no significant sex differences in brachial or aortic blood pressures (systolic and diastolic), however, females had significantly higher AIx75 (35 ± 4 vs 20 ± 6, P = 0.036) and aortic PP (53 ± 2 mm Hg vs 42 ± 4 mm Hg, P = 0.020) than males. Sex difference in cf-PWV was not statistically significant (p = 0.054). Conclusion: In the current feasibility pilot study, preliminary data show that females had higher arterial stiffness measured as AIx75 and aortic PP than males in the acute setting of ICH. Further study will be required to ascertain whether this is related to higher age at presentation in females. Whether sex differences in arterial stiffness predict differences in the outcome among ICH patients is not well characterized; thus, assessment of 30-day functional and neurological outcomes will be performed with NIHSS and modified Rankin Scores.