Brachial Blood Pressure Measurements Research Articles

OP.1A.09] ORTHOSTATIC HYPERTENSION PREDICTS MASKED HYPERTENSION IN THE VERY ELDERLY TREATED HYPERTENSIVES

Objective: Masked hypertension (MHT) and isolated nocturnal hypertension are associated with increased risk of target organ damage and cardiovascular events. We investigated prevalence and predictors of those blood pressure phenotypes in very elderly treated hypertensives. Design and method: Office blood pressure evaluation (simultaneous bilateral brachial blood pressure measurements in supine position and then after 2 minutes of standing) and 24-h ambulatory blood pressure monitoring (ABPM) were performed with a validated oscillometric cuff-based device iin 67 treated hypertensive subjects older than 80 years (mean age 84.1 ± 3.1 years, 25.5% male, mean office brachial SBP 134.8 ± 23.2 mm Hg). Patients with left ventricular ejection fraction < 40% and severe comorbidities were not included. Orthostatic hypotension (OH) was defined as a decrease in SBP of at least 20 mm Hg upon standing and orthostatic hypertension (OHT) as a corresponding increase. Results: The prevalence of MHT was 47.7% in the entire study population and 71.1% among patients with office-controlled hypertension (BP < 150/90 mm Hg). 78.2% patients with MHT had isolated nocturnal hypertension. Orthostatic reaction was abnormal in 34.3% subjects: 22.4% participants had OH while incidence of OHT was 11.9%. OHT was significantly associated with MHT (RR = 1.7, 95% CI = 1.14–2.78). Conclusions: OHT is predictive for MHT in the very elderly treated hypertensives. Evaluation of orthostatic reaction in very elderly may help to detect a population that would benefit from ABPM.

PP.03.12] SIGNIFICANT INTER-ARM DIFFERENCE IN BLOOD PRESSURE IS ASSOCIATED WITH INCREASED ARTERIAL STIFFNESS AND ABDOMINAL OBESITY IN VERY ELDERLY HYPERTENSIVES

Objective: Inter-arm difference in blood pressure (BP) and orthostatic BP response have important prognostic significance in hypertensive patients. However, data on prevalence, predictors and clinical associations of those phenomena are controversial. The aim was to investigate inter-arm difference, orthostatic response and to establish their clinical associations in very elderly hypertensives. Design and method: 67 hypertensive subjects older than 80 years (mean age 84,1 ± 3,1 years, 25,5% male, mean clinic brachial SBP 134,8 ± 23,2 mm Hg) were included in cross-sectional study. Simultaneous bilateral brachial BP measurements were performed using oscillometric validated cuff-based device in supine position and then after 2 minutes of standing. Central pulse waveform characteristics and arterial stiffness parameters were estimated by BPLab Vasotens system. Results: The median of inter-arm difference in SBP (IADSBP) was 4,00 (2,5; 9,0) mm Hg. 25,4% participants had IADSBP of 10 mm Hg and more. Compared to others, those with IADSBP of 10 mmHg and more had significantly higher body mass index (31,4 ± 5,7 vs 28,5 ± 4,1 kg/m2, p < 0,05), waist circumference (116,3 ± 13,6 vs 107,7 ± 11,2 cm, p < 0,05) and pulse wave velocity in aorta (11,7 ± 1,5 vs 10,8 ± 1,7 m/s, p < 0,05). Positive correlation between IADSBP and augmentation index was revealed (r = 0,277, p < 0,05). Patients with asymptomatic orthostatic hypotension (OH) (22,4% participants) had higher levels of brachial SBP and pulse pressure (PP) while central BPs and markers of arterial stiffness did not differ from those without OH. Conclusions: Significant IADSBP is associated with increased arterial stiffness and abdominal obesity in very elderly hypertensive patients, whereas there was no evidence of interrelation between orthostatic response and arterial stiffness in such patients

Noninvasive oscillometric cardiac output determination in the intensive care unit \u2013 comparison with invasive transpulmonary thermodilution

Assessment of the cardiac output (CO) is usually performed with invasive techniques requiring specialized equipment in the intensive care unit (ICU). With TEL-O-GRAPH (TG), CO can be derived from the oscillometrically obtained brachial pulse wave during the measurement of brachial blood pressure. CO and stroke volume (SV) determinations with TG were compared with transpulmonary thermodilution measurements with the PICCO system (PICCO) in 38 haemodynamically unstable ICU patients with a total of 84 comparison measurements performed. SV (33.3 ± 9.0 ml/m2 vs. 44.3 ± 14.4 ml/m2, p < 0.001) and CO (2.7 ± 0.5 l/min/m2 vs. 3.8 ± 1.2 l/min/m2, p < 0.001) were underestimated significantly with TG and oscillometric brachial systolic blood pressure (BP) was significantly lower and diastolic BP significantly higher than invasive femoral artery pressure. A linear correlation was found between CO dimension and CO underestimation with TG. Correct tracking of CO changes with a fluid challenge was possible in 69.5% of measurements. Oscillometric noninvasive CO is possible in the ICU, but accuracy and precision of this new method are lacking. Implementation of a correction factor accounting for the linear increase in CO underestimation observed with increasing CO could improve CO assessment with TG in haemodynamically unstable patients.

A Magnetic Plethysmograph Probe for Local Pulse Wave Velocity Measurement.

We present the design and experimental validation of an arterial compliance probe with dual magnetic plethysmograph (MPG) transducers for local pulse wave velocity (PWV) measurement. The MPG transducers (positioned at 23 mm distance apart) utilizes Hall-effect sensors and permanent magnets for arterial blood pulse detection. The MPG probe was initially validated on an arterial flow phantom using a reference method. Further, 20 normotensive subjects (14 males, age = 24 ± 3.5 years) were studied under two different physical conditions: 1) Physically relaxed condition, 2) Postexercise condition. Local PWV was measured from the left carotid artery using the MPG probe. Brachial blood pressure (BP) was measured to investigate the correlation of BP with local PWV. The proposed MPG arterial compliance probe was capable of detecting high-fidelity blood pulse waveforms. Reliable local pulse transit time estimates were assessed by the developed measurement system. Beat-by-beat local PWV was measured from multiple subjects under different physical conditions. A profound increment was observed in the carotid local PWV for all subjects after exercise (average increment = 0.42 ± 0.22 m/s). Local PWV values and brachial BP parameters were significantly correlated (r ≥ 0.72), except for pulse pressure (r = 0.42). MPG arterial compliance probe for local PWV measurement was validated. Carotid local PWV measurement, its variations due to physical exercise and correlation with BP levels were examined during the in vivo study. A novel dual MPG probe for local PWV measurement and potential use in cuffless BP measurement.

P 49 Brachial artery invasive versus non-invasive blood pressure monitoring in women with severe pre-eclampsia

Objective The aim of this study was to compare the accuracy of non-invasive blood pressure measurements in the brachial artery based on systolic occlusion pressures to brachial intra-arterial blood pressure measurements in patients with severe pre-eclampsia. Methods A prospective descriptive cross sectional study was conducted in the Obstetrics Critical Care Unit (OCCU) of Tygerberg Hospital. In this unit when it was not technically possible to cannulate the radial artery for intra-arterial blood pressure monitoring, the clinician cannulised the brachial artery. This study prospectively enrolled 15 women with severe pre-ecalmpsia and an intra-arterial brachial artery cannula in situ. Simultaneous monitoring was performed using both automated oscillometric and manual aneroid sphygmomanometric blood pressures. These two non-invasive methods of blood pressure measurements were compared to brachial intra-arterial blood pressure measurements.The University Ethics Committee approved the study protocol. The paired T-test was used to compare measured values. Results There was weak correlation between manual and intra-arterial SBP ( r = 0.27, p = 0.048) for SBP ⩾ 160 mmHg. The calculated mean difference between manual SBP compared to the intra-arterial SBP in this group was −23.19 mmHg (±19.40). There was moderate correlation between automated and intra-arterial SBP ( r = 0.69, p r = 0.53, p Conclusion When compared to intra-arterial monitoring in the brachial artery, compared to the systolic occlusion pressures in the brachial artery measured with the automated and manual methods it showed poor correlation with systolic severe hypertension values. Intra-arterial blood pressure monitoring is best at detection of systolic peaks in patients with severe-pre-eclampsia.

Head-down Posture in Glaucoma Suspects Induces Changes in IOP, Systemic Pressure, and PERG That Predict Future Loss of Optic Nerve Tissue.

To obtain pilot data on posture-induced changes of intraocular pressure (IOP), systemic pressure, and pattern electroretinogram (PERG) predictive of future optic nerve tissue loss glaucoma suspects (GSs). Mean peripapillary retinal fiber layer thickness (RNFLT) was measured with optical coherence tomography 2 times/year in 28 GS aged 58±8.9 years over 5.0±0.73 years. All patients had a baseline PERG, IOP, and brachial blood pressure measurements in the seated and -10 degrees head-down-body-tilt (HDT) position. Outcome measures were seated/HDT PERG amplitude and phase, IOP, mean arterial blood pressure, and estimated ocular perfusion pressure. An additional group of 11 similarly aged controls aged 56.9±13 years was tested for comparison. Although all GS had initial RNFLT in the normal range, 9/28 of them developed significant (P<0.05) loss of mean RNFLT [thinners (T)] over the follow-up period as opposed to 19/28 who did not [nonthinners (NT)]. Significant (P<0.05) differences between similarly aged controls, NT, and T were found in PERG amplitude, PERG phase, mean arterial blood pressure, IOP, and ocular perfusion pressure. A nominal logistic regression using baseline PERG and hemodynamic variables was able to distinguish T from NT with an area under receiving operator characteristic of 0.89 (SE, 0.07). Baseline PERG, IOP, and systemic blood pressure, together with their changes upon HDT, may have predictive value for future loss of optic nerve tissue in GS. This study supports the rationale for a full-scale clinical trial to identify patients at high risk of development of glaucoma.

The DanCavas Pilot Study of Multifaceted Screening for Subclinical Cardiovascular Disease in Men and Women Aged 65–74 Years

This pilot study of a large population based randomised screening trial investigated feasibility, acceptability, and relevance (prevalence of clinical and subclinical cardiovascular disease [CVD] and proportion receiving insufficient prevention) of a multifaceted screening for CVD. In total, 2060 randomly selected Danish men and women aged 65–74 years were offered (i) low dose non-contrast computed tomography to detect coronary artery calcification (CAC) and aortic/iliac aneurysms; (ii) detection of atrial fibrillation (AF); (iii) brachial and ankle blood pressure measurements; and (iv) blood levels of cholesterol and hemoglobin A1c. Web based self booking and data management was used to reduce the administrative burden. Attendance rates were 64.9% (n = 678) and 63.0% (n = 640) for men and women, respectively. In total, 39.7% received a recommendation for medical preventive actions. Prevalence of aneurysms was 12.4% (95% confidence interval [CI] 9.9–14.9) in men and 1.1% (95% CI 0.3–1.9) in women, respectively (p < .001). A CAC score > 400 was found in 37.8% of men and 11.3% of women (p < .001), along with a significant increase in median CAC score with age (p = .03). Peripheral arterial disease was more prevalent in men (18.8%, 95% CI 15.8–21.8) than in women (11.2%, 95% CI 8.7–13.6). No significant differences between the sexes were found with regard to newly discovered AF (men 1.3%, women 0.5%), potential hypertension (men 9.7%, women 11.5%), hypercholesterolemia (men 0.9%, women 1.1%) or diabetes mellitus (men 2.1%, women 1.3%). Owing to the higher prevalence of severe conditions, such as aneurysms and CAC ≥ 400, screening for CVD seemed more prudent in men than women. The attendance rates were acceptable compared with other screening programs and the logistical structure of the screening program proved successful.

Invasive validation of a novel brachial cuff-based oscillometric device (SphygmoCor XCEL) for measuring central blood pressure.

Studies have established the prognostic value of central SBP and pulse pressure (PP). The SphygmoCor XCEL (AtCor Medical, Sydney, Australia) device provides practical central blood pressure (BP) measurement for daily clinical use with its easy-to-use, operator-independent procedure. However, this device has not been validated against invasive measurement. Simultaneous oscillometric and high-fidelity invasive measurements of central SBP and PP were compared for 36 patients who underwent coronary arteriography. Invasive measurement of brachial BP was also performed. Oscillometrically measured brachial SBP and DBP were used for calibration. The differences between the invasive and the oscillometric measurements were -4.6 ± 9.9 mmHg for central SBP and -18.5 ± 10.6 mmHg for central PP (mean ± SD). We found strong correlation between the invasive and oscillometric measurements (central SBP and central PP, respectively: r = 0.91 and 0.89; slope, 1.28 and 1.38; both P < 0.001). Although the large slopes of the regression lines indicated a systemic bias toward lower values when measuring in high pressure ranges, the bias was mainly due to calibration error rather than device-specific error because errors of the central measurements correlated well with those of brachial measurements (SBP and PP, respectively: r = 0.80 and 0.77; both P < 0.001). The impaired accuracy of central BP measurement was mainly due to calibration-derived, but not device-dependent, bias. Strong correlation between oscillometric and invasive measurements indicates that SphygmoCor XCEL warrants future investigations to determine the clinical validity of this device.

The DanCavas Pilot Study of Multifaceted Screening for Subclinical Cardiovascular Disease in Men and Women Aged 65–74 Years

This pilot study of a large population based randomised screening trial investigated feasibility, acceptability, and relevance (prevalence of clinical and subclinical cardiovascular disease [CVD] and proportion receiving insufficient prevention) of a multifaceted screening for CVD. In total, 2060 randomly selected Danish men and women aged 65-74 years were offered (i) low dose non-contrast computed tomography to detect coronary artery calcification (CAC) and aortic/iliac aneurysms; (ii) detection of atrial fibrillation (AF); (iii) brachial and ankle blood pressure measurements; and (iv) blood levels of cholesterol and hemoglobin A1c. Web based self booking and data management was used to reduce the administrative burden. Attendance rates were 64.9% (n=678) and 63.0% (n=640) for men and women, respectively. In total, 39.7% received a recommendation for medical preventive actions. Prevalence of aneurysms was 12.4% (95% confidence interval [CI] 9.9-14.9) in men and 1.1% (95% CI 0.3-1.9) in women, respectively (p<.001). A CAC score > 400 was found in 37.8% of men and 11.3% of women (p<.001), along with a significant increase in median CAC score with age (p=.03). Peripheral arterial disease was more prevalent in men (18.8%, 95% CI 15.8-21.8) than in women (11.2%, 95% CI 8.7-13.6). No significant differences between the sexes were found with regard to newly discovered AF (men 1.3%, women 0.5%), potential hypertension (men 9.7%, women 11.5%), hypercholesterolemia (men 0.9%, women 1.1%) or diabetes mellitus (men 2.1%, women 1.3%). Owing to the higher prevalence of severe conditions, such as aneurysms and CAC≥400, screening for CVD seemed more prudent in men than women. The attendance rates were acceptable compared with other screening programs and the logistical structure of the screening program proved successful.

PP.27.21] CLINIC BASED MEASUREMENT OF CENTRAL AORTIC SYSTOLIC PRESSURE – PRACTICAL UTILITY AND ADVANTAGES

Objective: 1. To measure CASP across a cross-section of our patient (pt) population and assess the demographic profile using A-Pulse CASP device. 2. To compare and analyse CASP measurements vs brachial blood pressure (BBP) measurements in pts with Hypertension (HTN) and CKD. Design and method: BBP was measured by oscillometric method using A-Pulse device. CASP was then measured by applanation tonometry and radial transfer function technique by placing the sensor of the A-Pulse CASP device over the ipsilateral radial artery. Results: 90 consecutive pts (males-60;females-30) were included. Subgroups: Group (Gp) A- Normal subjects (n = 25); Gp B – pts with HTN (n = 16); Gp C – pts with CKD, not on dialysis (n = 27) & Gp D –pts with CKD on dialysis (n = 22). In Gp A,mean CASP (114.92 ± 10.8) values across all age gps corresponded to the worldwide reference range. In this gp,subjects (n = 14) with BMI > 25 kg/m2 had significantly higher CASP (119.14 ± 8.66 vs 109 ± 11.21) as compared to subjects (n = 11) with BMI < 25 kg/m2. In Gps B, C & D (n = 65), the mean BASP was 143.09 ± 17.35 and mean CASP was 132.78 ± 16.53 which was higher than the corresponding readings in Gp A. Amongst these pts, the younger sub-gp (n = 29; age < 50 years) had significantly higher CASP (131.76 ± 16.68) comparable with the older sub gp (133.9 ± 16.57) (n = 36; age >50 years) even as the two groups had similar & “within target” BASP readings (142 ± 17.85 vs 144.10 ± 17.02). Mean difference between CASP and BASP was similar in both these subgroups,thus emphasizing that younger pts with HTN & CKD exhibit accelerated vascular ageing <ST>Conclusions:</ST> In healthy individuals,CASP & not BBP, can predict cardiovascular risk much earlier in those with higher BMI. In younger pts with HTN & CKD, Cardiovascular risk is better predicted by CASP and not by BBP measurements. Office based measurement of CASP is a necessary additional tool for thorough cardiovascular risk assessment,especially in pts with CKD.

Methodology and technology for peripheral and central blood pressure and blood pressure variability measurement: current status and future directions - Position statement of the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability.

Office blood pressure measurement has been the basis for hypertension evaluation for almost a century. However, the evaluation of blood pressure out of the office using ambulatory or self-home monitoring is now strongly recommended for the accurate diagnosis in many, if not all, cases with suspected hypertension. Moreover, there is evidence that the variability of blood pressure might offer prognostic information that is independent of the average blood pressure level. Recently, advancement in technology has provided noninvasive evaluation of central (aortic) blood pressure, which might have attributes that are additive to the conventional brachial blood pressure measurement. This position statement, developed by international experts, deals with key research and practical issues in regard to peripheral blood pressure measurement (office, home, and ambulatory), blood pressure variability, and central blood pressure measurement. The objective is to present current achievements, identify gaps in knowledge and issues concerning clinical application, and present relevant research questions and directions to investigators and manufacturers for future research and development (primary goal).

Post-exercise effects on aortic wave reflection derived from wave separation analysis in young-to middle-aged pre-hypertensives and hypertensives.

Decreases in brachial blood pressure (BP) may occur for several hours following a bout of exercise. Although aortic backward waves predict cardiovascular damage independent of brachial BP, whether decreases in aortic backward waves also occur post-exercise in young-to-middle-aged hypertensives, the extent to which these changes exceed brachial BP changes, and the best method of identifying these changes is uncertain. We examined aortic function at baseline and 15-min post-exercise in 20 pre-hypertensive or hypertensive men and women (age 45±7years). Central aortic pressure, forward (Pf) and backward (Pb) wave pressures, the reflection index (RI) and augmentation pressure (AP) and index (AIx) were determined using applanation tonometry, and SphygmoCor software. Decreases in central aortic (p<0.001) but not brachial systolic BP and pulse pressure (PP) occurred post-exercise. In addition, decreases in post-exercise (baseline versus post-exercise) Pb (19±4 vs 13±3mm Hg p<0.0001), RI (72.9±22.1 vs 47.6±12.8%, p<0.0001), AIx (26.3±10.8 vs 7.8±11.6%, p<0.0001) and AP (9.9±3.9 vs 2.8±3.9mm Hg, p<0.0001), but not Pf, were noted. However, decreases in AIx were not correlated with decreases in Pb, and whilst decreases in aortic PP correlated with decreases in Pb (p<0.0001), no correlations were noted with decreases in AP or AIx. In young-to-middle-aged pre-hypertensive and hypertensive individuals, aortic backward waves decrease post-exercise; this change is not reflected in brachial BP measurements and is poorly indexed by measures of pressure augmentation.

0504 : Ultrasonic evaluation of aortic wall biomechanic properties of sporadic BAV patient and first relative

Bicuspid aortic valve (BAV) disease is associated with an increased risk of aneurysms and dissections of the ascending aorta. The aim of this study was to evaluate the biomechanical properties of the ascending aorta in sporadic BAV patients which could potentially explain their aortic fragility. A prospective monocentric study of BAV patients and their non-BAV relatives was conducted. Systolic and diastolic Valsava sinuses and tubular aortas were measured by transthoracic echocardiography, associated to the brachial blood pressure measurement with an oscillometric method. Distensibility and stiffness index calculations used aortic diameters variation over the cardiac cycle. 93 patients were tested for this study. 43 unoperated BAV patients (30 men, mean age 51±17 years with no significant valve dysfunction) were compared to 50 non-BAV relatives (26 male, mean age 42±18 years). BAV patients had a lower distensibility of the Valsalva sinus (2.28±1.74 vs. 3.72±3.04, p=0.005 and p=0.044 after adjustment for age and hypertension) and tubular aorta (2.30±1.74 vs. 3.34±2,74, p=0.055). Valsalva sinus stiffness index was higher in BAV patients (18,41±18,37 vs. 11,89±12,38, p=0,046) but this was not the case at the tubular aortic level (16,45±13,03 vs. 13,28±12,35, p=0,307). However Figure shows that tubular aortic stiffness index increases significantly with the aortic dilation (R 2 =0,334) in BAV patients which was not the case in non-BAV relatives (p=NS). Ascending aorta of BAV demonstrated different biomechanics properties than non BAV relative with lower distensibility and increase of stiffness index at the level of Valsalva sinuses independently of age and blood pressure. We hope that aortic distensibility could be used to predict aortic dilation in BAV patient. The author hereby declares no conflict of interest Figure

Experiences from the Pilot Study of the Danish Cardiovascular Screening (DANCAVAS) Study

Objective: To assess the feasibility, organization, and attendance experience of men and women, aged 65e74, who underwent a combination cardiovascular screening for aortic aneurysms, coronary calcium scores, atrial fibrillation, hypertension, peripheral arterial disease, hypercholesterolemia and diabetes mellitus. Methods: Attenders were booked via a web-based program with 10 minute sessions, covering four issues: 1) Informed consent and an interview, including family history, medication, history of smoking, prior cardiovascular disease and quality of life. 2) Bilateral brachial and ankle blood pressure measurements. 3) Electroocardiogram gated non-contrast computed tomography and, 4) Blood sampling. Data were then entered into a database, supplemented with a weekly running program to identify positive findings for recommended additional prevention. Results: Web-based solutions for booking and data-management worked remarkably well with no major issues. There were 1044 men and 1016 women invited, of which 678 (63%) men and 640 (63%) women attended screening. No exclusion criteria were applied. Compared to the American MESA group, a more rapid increase in CAC by age was registered in Danish males and women. Apart from these findings and isolated hypercholesterolaemia, men had an increased risk of all other positive findings, especially concerning ascending aortic-, abdominal aortic-, and iliac aneurysm. In all, men accounted for 90.9% of all detected aneurysms. In 7.8% of these aneurysms, criteria for surgery were fulfilled. Conclusion: The offer of this combination screening proved feasible, while acceptable attendance rates were observed, and it appears potentially most cost-effective for men. Consequently, the offer of this combination screening will be extended to other sites with randomization of 45.000 men aged 65e74 years.

Adverse effect of diabetes and hyperglycaemia on arterial stiffness in Europeans, South Asians, and African Caribbeans in the SABRE study.

Ethnic minority groups in the U.K. experience marked differences in cardiovascular disease risk. We investigated differences in arterial central haemodynamics, stiffness, and load in a tri-ethnic population-based cohort. A total of 1312 participants (70 ± 6 years) underwent echocardiography and measurement of brachial and central blood pressure to assess central arterial haemodynamics including central pulse pressure (cPP), arterial stiffness [cPP/stroke volume (SV)], systemic vascular resistance (SVR), and load (Ea). Brachial and central SBPs were similar in all ethnic groups. Compared with Europeans, cPP, cPP/SV, and Ea were higher in South Asians. In contrast, cPP/SV was lower in African Caribbeans despite higher mean arterial pressure, higher SVR, and higher diabetes prevalence. cPP/SV and Ea remained significantly higher in South Asians and significantly lower in African Caribbeans after multivariate adjustment. Diabetes and higher HbA1c were more strongly associated with higher cPP/SV in South Asians than in Europeans (Pinteraction = 0.045 and 0.005, respectively); higher HbA1c was also more strongly associated with increased Ea in South Asians than Europeans (Pinteraction = 0.01). There was no evidence of an interaction between glycaemia and cPP/SV in African Caribbeans. Compared with Europeans, South Asians have unfavorable arterial function. Diabetes and hyperglycaemia have a more deleterious effect on cPP/SV and Ea in South Asians. In contrast, African Caribbeans have more favourable arterial function than Europeans and South Asians. These differences may contribute to the differential ethnic rates of cardiovascular disease.

Effects of blood pressure and sex on heart-vessel coupling in essential hypertension.

This study aimed to investigate the impact of blood pressure and sex on heart-vessel coupling in patients with essential hypertension via ultrasound. We studied 76 patients with essential hypertension (48 males and 28 females) and 65 healthy controls (33 males and 32 females). Coupling parameters were obtained using ultrasound technology combined with brachial artery blood pressure measurement. The Ea and Ees were higher in the hypertension group than in the control group (P < 0.01), with no statistically significant difference in Ea/Ees between the two groups (P >0.05). After subjects were classified by sex, the Ea and Ees of males and females in the hypertension group were higher than those in the control group (P < 0.05 or P < 0.01), while the Ea/Ees was lower in hypertensive females than in control females (P < 0.05). In female patients with essential hypertension, heart-vessel coupling was easily damaged, and systolic blood pressure was associated with heart-vessel coupling damage to some extent.

Inter-arm difference and orthostatic changes of brachial blood pressure in the very elderly patients under antihypertensive treatment

Background. Inter-arm difference in blood pressure (BP) and orthostatic BP response are significant prognostic factors in hypertensive patients, especially in the elderly ones. However, data on their prevalence, predictors and clinical associations remain contradictory. The aim of our study was to investigate inter-arm difference and orthostatic response and to establish their clinical associations in the very elderly hypertensive patients. Design and methods. We enrolled 67 hypertensive subjects older than 80 years (mean age 84,1 ± 3,1 years, 25,5 % male, mean clinic brachial systolic BP (SBP) 134,8 ± 23,2 mm Hg) in a cross-sectional study. Simultaneous bilateral brachial BP measurements were performed using oscillometric validated cuffbased device in sitting position and then 2 minutes after standing up. Central pulse waveform characteristics and arterial stiffness parameters were estimated by BPLab Vasotens system (Petr Telegin, Russia). Results. The median of inter-arm difference in SBP (IADSBP) was 4,00 (2,50, 9,00) mm Hg. IADSBP was ≥ 10 mm Hg in 25,4 % participants. Compared to others, those with IADSBP ≥ 10 mmHg had significantly higher body mass index (31,39 ± 5,73 vs 28,48 ± 4,1 kg/m2 , p < 0,05), waist circumference (116,3 ± 13,6 vs 107,7 ± 11,2 cm, p < 0,05) and pulse wave velocity in aorta (11,65 ± 1,46 vs 10,75 ± 1,71 m/s, p < 0,05). A positive correlation between IADSBP and augmentation index was revealed (r = 0,277, p < 0,05). Patients with asymptomatic orthostatic hypotension (22,4 % participants) had higher levels of brachial SBP and pulse pressure while central BP and markers of arterial stiffness did not differ from those without orthostatic hypotension. Conclusions. Significant IADSBP is associated with increased arterial stiffness and abdominal obesity in the very elderly hypertensive patients, whereas there is no evidence of interrelation between orthostatic response and arterial stiffness in these patients.

Advances in photoplethysmography: beyond arterial oxygen saturation.

Photoplethysmography permits continuous measurement of heart rate and peripheral oxygen saturation and has been widely used to inform clinical decisions. Recently, a myriad of noninvasive hemodynamic monitoring devices using this same technology have been increasingly available. This narrative review aims to summarize the principles that form the basis for the function of these devices as well as to comment on trials evaluating their accuracy and clinical application. Advanced monitoring devices extend photoplethysmography technology beyond measuring oxygen concentration and heart rate. Quantification of respiratory variation of the photoplethysmographic waveform reflects respiratory variation of the arterial pressure waveform and can be used to gauge volume responsiveness. Both the volume-clamp and physiocal techniques are extensions of conventional photoplethysmography and permit continuous measurement of finger arterial blood pressure. Finger arterial pressure waveforms can subsequently inform estimations of cardiac output. Although respiratory variations of the plethysmographic waveform correlate only modestly with the arterial blood pressure waveform, fluid responsiveness can be relatively consistently assessed using both approaches. Continuous blood pressure measurements obtained using the volume-clamp technique may be as accurate as conventional brachial noninvasive blood pressure measurements. Most importantly, clinical comparative effectiveness studies are still needed in order to determine if these technologies can be translated into improvement of relevant patient outcomes.

PP.06.20

Objective: Pulse pressure amplification (PPA) is important novel marker of cardiovascular risk. Purpose of our study was to identify its independent determinants in uncomplicated hypertension (UH) patients (pts) < 75 years of age. Design and method: In 91 consecutively recruited pts with newly diagnosed or treated but uncontrolled UH (BP < 200/120mmHg) aged 35–75 years, 37 (40,7 %) males with sinus rhythm and resting heart rate (HR) of 50–100 bpm office brachial blood pressure (BP) measurement with Microlife BPW200 and pulse wave analysis with SphygmoCor were performed. Based on results of linear correlation analysis of PPA with anthropometric data, traditional risk factors, UH characteristics, resting HR, left ventricular hypertrophy by ECHO, glomerular filtration rate, ROC-analysis for estimate critical values and odds ratio were performed. Results: Mean (M ± SD) age was 56.04 ± 10,3 years, brachial BP -153.2 ± 18,7/94.3 ± 10,3 mmHg, HR – 72.07 ± 11,6 bpm, 8 (8,8%) had diabetes. PPA correlated with age (r = -0,26), height (r = 0,36), waist circumference (r = 0,34), weight (r = 0,21, p < 0,05) and HR (r = 0,58, all p < 0,01). Independent determinants for PPA < 130% (mediana) were female sex – OR = 3,3 (95%CI:1,4–7,9), p = 0,007), height 170 cm or less (AUC = 0,68, p = 0,018); OR = 4,6 (95%CI:1,8–11,3), p = 0,0008) and HR 73bpm or less (AUC = 0,78, p = 0,0002); OR = 9,2 (95%CI:3,4–25,1), p < 0,0001). Conclusions: Independent predictors of PPA < 130% in UH pts < 75 years are female sex, height 170 cm or less and HR 73bpm or less.

Relation Between Exercise Central Hemodynamic Load and Resting Cardiac Structure and Function in Young Men

Left ventricular (LV) structure and function are predictors of cardiovascular mortality and related to resting peripheral hemodynamic load in older adults. The central hemodynamic response to exercise may reveal associations with LV structure and function not detected by traditional peripheral (brachial) measures in a younger population. PURPOSE: Examine correlations between acute exercise-induced changes in brachial blood pressure (BP), arterial stiffness and wave reflections and measures of resting LV structure and function. METHODS: 16 healthy men (age 26 ± 6 yr; BMI 25.3 ± 2.7 kg·m-2) had measures of central hemodynamic load measured pre/post a 30 second Wingate anaerobic test (WAT). Brachial systolic BP and carotid systolic BP were assessed using an automated cuff and applanation tonometry, respectively. Carotid artery stiffness and reflected wave intensity were assessed as the elastic modulus (Ep) and negative area (NA) from Doppler-ultrasound and wave intensity analysis. Resting LV structure (LV mass) and function (fractional shortening, FS) were assessed using M-mode echocardiography in the parasternal short-axis view. RESULTS: There were significant inverse associations between resting FS and WAT-induced increase in: carotid systolic BP (r = -0.54, p = 0.04), logNA (r = -0.53, p = 0.02) and Ep (r = -0.45, p = 0.04). There were no significant associations between resting FS and increases in brachial systolic BP (r = -0.38, p > 0.05) or between resting LV mass and increases in any hemodynamic variable (p > 0.05). CONCLUSION: Exercise-induced increases in central hemodynamic load reveal associations with resting LV function undetected by traditional peripheral hemodynamics. Changes in LV function may precede changes in LV structure offering insight into lack of associations between central hemodynamic load and LV mass in young healthy men.