Brachial Blood Pressure Research Articles

PS-C04-4: ASSOCIATIONS OF OFFICE BRACHIAL BLOOD PRESSURE, OFFICE CENTRAL BLOOD PRESSURE, AND HOME BRACHIAL BLOOD PRESSURE WITH ARTERIAL STIFFNESS

Accurate blood pressure (BP) measurement is necessary for the evaluation and treatment of hypertension to prevent the progression of subclinical vascular disease, including arterial stiffness. We investigated the associations between brachial ankle pulse wave velocity (baPWV), a measure of arterial stiffness, and each of office brachial systolic BP (SBP) with and without an observer present (attended or unattended office brachial SBP), attended or unattended office central SBP, and home brachial SBPs (specifically, the means of morning, evening, or morning and evening home brachial SBP) in patients being treated for hypertension. Measurements were performed among 70 adults (mean age, 67.0 ± 9.4 years; women, 51.4%) with a mean attended office brachial SBP of 127.6 ± 14.5 mmHg and mean baPWV of 16.3 ± 2.8 m/s. Univariate analysis showed that higher attended office brachial SBP, morning home brachial SBP, and morning and evening home brachial SBP were each statistically significantly associated with higher baPWV (r = 0.25, P = 0.04; r = 0.37, P = 0.002; and r = 0.32, P = 0.006, respectively). Multiple linear regression analysis with adjustments for traditional cardiovascular risk factors showed that only morning home brachial SBP was statistically significantly associated with baPWV [beta = 0.06, 95% confidence interval (0.01 to 0.11), P = 0.02). In conclusion, higher morning home brachial SBP, but none of the office measured SBP values, was associated with arterial stiffness.

S-37-6: THE PROMISE OF CUFFLESS BLOOD PRESSURE MONITORING IN MANAGING HYPERTENSION

Although blood pressure measurement is perhaps the most common measurement done in clinical practice, many have started to challenge this procedure and calling for transformation in blood pressure monitoring. This is because blood pressure measurement in primary care has many problems, whether clinic, 24-hour ambulatory or home blood pressures are taken. Cuffless blood pressure measurement technologies have been knocking on the door for years, with the first patents already registered over 20 years ago. With advancements in data science, machine learning, artificial intelligence, and mobile phone technologies, many start-ups and major global tech giants are now presenting to the end-user an array of highly innovative technologies. Cuffless monitoring includes many devices from wrist-worn watch-type devices to mobile phone tech (transdermal optical facial video processing or oscillometric finger pressing), wearable ultrasound patches, temporary graphene electronic tattoos, glasses, and even from a toilet seat. These technologies has a major benefit, namely blood pressure being taken without any user awareness. But it also has the potential to harness long-term prognostic cardiovascular information over and beyond blood pressure that may become particularly useful. Continuous long-term cuffless monitoring will provide for the first time the opportunity to move from averaging snapshot readings to capturing the continuous dynamic fluctuations of blood pressure in a high-definition video recording. There are, however, still several hurdles that need to be overcome before cuffless technologies can be implemented in clinical care. While biomedical engineers may exert their energy on ensuring that a cuffless innovation can accurately reflect brachial blood pressure, this is not the only aspect to consider. Manufacturers of conventional cuff-based devices have to painstakingly follow the ISO 81060–2:2018 Universal Standard to validate the device for accuracy. The rules are different for cuffless devices. Novel cuffless technologies vary substantially and use many techniques such as pulse transit time, pulse wave analyses, and ultrasound. The key question is whether these devices can accurately track the dynamic changes in blood pressure over time. Currently, an ISO 81060–3 standard is being developed to validate cuffless devices but due to the heterogenous technologies used by cuffless manufacturers there are major challenges. For this and other reasons, the European Society of Hypertension has released a consensus statement that due to fundamental questions regarding the accuracy, performance and implementation of cuffless devices in practice, these devices cannot be recommended for clinical use, while recognising the considering potential.

Estimation of Central Systolic Blood Pressure from Peripheral Pressure Waves using a Novel Second Systolic Pressure-Based Method in Normal and Heritable Hypercholesterolemic Rabbits.

Central systolic blood pressure (cSBP) was closely related to hypertension-related organ damage rather than peripheral systolic blood pressure (pSBP). We aimed to estimate cSBP from pSBP without generalized transfer function in normal and Kurosawa and Kusanagi-hypercholesterolemic (KHC) rabbits aged 12 months. Two catheter-tip transducers were advanced into the ascending aorta (AA) and distal end of the right brachial artery (Br) through the right common carotid and right radial arteries, respectively, under pentobarbital anesthesia. Pressure waves in response to the intravenous administration of angiotensin II and sodium nitroprusside were simultaneously recorded in AA and Br under regular cardiac pacing. The first (pSBP) and second peaks (pSBP2) of the brachial blood pressure and their average (pSBPm) were significantly correlated with cSBP, despite Murgo's wave pattern of central pressure waves in both rabbit groups. In Bland-Altman plot and its modification as a function of the peripheral augmentation index (pAI) analyses, the differences between pSBP and cSBP decreased, and those between pSBP2 and cSBP increased significantly in their average- or pAI-dependent manner, with undeniable mean biases in both rabbit groups. When the same analyses for SBPm were performed instead, the mean bias was around zero, with reduced variance in the two rabbit groups. The observed pressure or pAI-dependent systematic biases for pSBP and pSBP2 disappeared, representing the precise feature of pSBPm as a cSBP estimate. We conclude that pSBPm could be more precise than pSBP2 as a cSBP estimate, irrespective of blood pressure levels, pAI, or the presence of atherosclerosis.

PS-BPC02-7: RADIAL-DIGITAL PULSE WAVE VELOCITY: STIFFNESS OF SMALL CONDUIT ARTERIES INCREASES AFTER NITROGLYCERIN ADMINISTRATION

Objective: The alteration of the physiological stiffness gradient within larger vessels would increase the transmission of greater pulsatility to the microcirculation, thus explaining the damage to the pressure-sensitive organs. We aimed to describe the response of small conduit arteries of the hand (radial-digital PWV, rd-PWV) following the pharmacological alteration of the stiffness gradient using nitroglycerin. Design and method: Simultaneous application of piezoelectric sensors (Complior) at the level of the carotid (c), the radial artery (r) and the tip of the index finger (d) was used to calculate the rd-PWV by the following formula (rd-PWV = cd-cr direct distances/cd-cr transit times). Rd-PWV was obtained before and 4 minutes after a sublingual administration of 0.4 mg of NTG, in healthy adults (controls, n = 36) and patients with moderate chronic kidney disease (CKD, n = 30). Changes in arterial stiffness pre-post NTG and comparisons between the two groups were analyzed respectively with paired or independent samples t-tests. Results: Compared to controls, the CKD group was older (69 ± 15 years vs. 41 ± 20 years) and more hypertensive. Despite similar cd-PWV and cr-PWV, rd-PWV was significantly lower in CKD than in controls (3.6 ± 1.4 m/s vs. 4.5 ± 1.8 m/s, p = 0.024), but this difference faded (p = 0.145) after adjustment for age. Post NTG, brachial blood pressure decreased and heart rate increased similarly between groups (see Table 1). Cr-PWV decreased after NTG (both groups p < 0.001) while rd-PWV increased in controls (from 4.62 ± 1.49 m/s to 5.94 ± 2.29 m/s, p < 0.001) and in CKD (from 3.71 ± 1.60 m/s to 5.18 ± 2.12 m/s, p < 0.001), in a similar extent (p = 0.111 for interaction term). Cd-PWV significantly increased post-NTG only in the CKD group (p = 0.009). Conclusions: Again, we observed opposing changes in the regional stiffnesses of two distinct vascular territories following the administration of a vasodilator. Here, the two segments were mid-size and small conduit muscular arteries. This technique, adapted by our team for short peripheral arterial segments, may broaden our understanding of the consequences of the inversion of the stiffness gradient.

PS-C08-1: ACCURACY OF CUFF BLOOD PRESSURE AND SYSTOLIC BLOOD PRESSURE AMPLIFICATION

Objective: Automated cuff measured blood pressure (BP) is the global standard used for diagnosing hypertension, but there are concerns regarding the accuracy of the method. Individual variability in systolic BP (SBP) amplification from central (aorta) to peripheral (brachial) arteries could be related to the accuracy of cuff BP, but this has never been determined and was the aim of this study. Methods: Cuff BP and invasive brachial BP were recorded in 755 participants (73% male, aged 64 ± 11 years) receiving coronary angiography at six independent research sites (using seven different automated cuff BP devices). SBP amplification was recorded invasively by catheter and defined as brachial SBP minus aortic SBP. Results: Compared with invasive brachial SBP, cuff SBP was significantly underestimated (130 ± 18 mmHg vs. 138 ± 22 mmHg, p < 0.001). The level of SBP amplification varied significantly among individuals (mean ± SD, 7.3 ± 9.1 mmHg; interquartile range, -2.4 to 12.3 mmHg) and was similar to level of difference between cuff and invasive brachial SBP (mean difference -7.6 ± 11.9 mmHg). SBP amplification explained most of the variance in accuracy of cuff SBP (R2 = 19%). The accuracy of cuff SBP was greatest among those participants in the lowest SBP amplification quintiles (ptrend< 0.001). After cuff BP values were corrected for SBP amplification, there was a significant improvement in the mean difference from the intra-arterial standard (p < 0.0001) and in the accuracy of hypertension classification according to 2017 ACC/AHA guideline thresholds (p = 0.005). Conclusions: The accuracy of automated cuff BP is markedly influenced by individual variability in SBP amplification. This knowledge can help improve the accuracy of cuff BP.

Central and brachial pulse pressure predicts cardiovascular and renal events in treated hypertensive patients

Purposes Central blood pressure is a stronger predictor of cardiovascular prognosis rather than brachial blood pressure. The reflection wave reaches the abdominal aorta sooner than ascending aorta. Thus, the contribution of central pulse pressure (cPP) to renal events may differ from that of cardiovascular events. Methods The subanalysis of the ABC-J II study was performed. Subjects were 3434 treated hypertensive patients with a mean follow-up of 4.7 years. Left ventricular hypertrophy, an index of cardiovascular risk, correlated with cPP better than central systolic blood pressure in this cohort. The contribution of brachial pulse pressure (bPP) and cPP to cardiovascular and renal events was analysed. Results Cox proportional-hazard analysis revealed that sex (p < 0.001), height (p < 0.05), history of cardiovascular diseases (p < 0.001), number of antihypertensive drugs (p < 0.05), and cPP (p < 0.05) contributed to cardiovascular events. However, Cox proportional-hazard analysis disclosed that baseline serum creatinine (p < 0.001) and bPP (p < 0.05) predicted renal events. After adjusting for the history of cardiovascular diseases, Cox regression demonstrated only sex as a significant predictor of cardiovascular events. After adjusting for baseline serum creatinine, no parameters were shown to predict renal events. Conclusions The present findings support our previous data that the absence of cardiovascular or renal diseases is an important determinant for event-free survival, and suggest that cPP and bPP contribute to cardiovascular and renal events in treated hypertensive patients.

Extremity tourniquets raise blood pressure and maintain heart rate

BackgroundTourniquets have been modified and used for centuries to occlude blood flow to control hemorrhage. More recently, the occlusion of peripheral vessels has been linked to resultant increases in blood pressure, which may provide additional therapeutic potential, particularly during states of low cardiac output. ObjectiveThe objective of this study was to investigate a causal relationship between tourniquet application and blood pressure in healthy adults. MethodsHealthy adult volunteers were recruited to participate in this IRB-approved study. Each participant met inclusion criteria and demonstrated baseline normotension. Brachial cuff blood pressure and heart rate were recorded pre- and post-tourniquet application to the bilateral legs. ResultsTwenty-seven adults aged 22 to 35 years participated and were included in analysis. The average systolic blood pressure was 122 ± 7 mmHg, diastolic blood pressure was 72 ± 9 mmHg, and heart rate was 70 ± 13 bpm. Following bilateral tourniquet application over the femoral vasculature, we observed a statistically significant increase in systolic (7 mmHg, p < 0.001) and diastolic (4 mmHg, p = 0.05) blood pressures with no significant change in heart rate (2 bpm, p > 0.05). ConclusionsThe elevations in systolic and diastolic blood pressures establish a dependent relationship between tourniquet application to the lower extremities and blood pressure elevation. These results may support new indications for tourniquet-use or extremity vessel occlusion in settings of hemodynamic instability.

Myocardial Work: a Systematic Review of Novel Echocardiography Method and Clinical Applications

Background: Myocardial work (MW) is a novel imaging modality that has emerged as a potential left ventricular (LV) function assessment in various clinical settings. MW calculates speckle-tracking echocardiography strain curves with an estimated LV pressure curve by non-invasively utilizing standard brachial blood pressure curves. Objective: This study aimed to provide a summary of current knowledge of non-invasive MW and its clinical applications, including in heart failure, coronary artery disease, cardiomyopathy, and hypertension. In addition, the limitations, and recommendations of MW in clinical practice are discussed. Methods: We searched the PubMed database using the following keywords: (myocardial constructive work) OR (wasted septal work) OR (global myocardial work) OR (myocardial work) OR (myocardial constructive work) OR (novel echocardiography). We further subjected 12 studies to full-text review and included them in this systematic review. Results: While MW indices, particularly global work index and global constructed work, have shown good correlations with ejection fraction (EF) and strain parameters, the opportunity of offering incremental information that is unaffected by loading conditions has made MW application particularly useful in a variety of clinical settings. Conclusion: Compared to EF and global longitudinal strain, MW is a promising test with higher sensitivity and accuracy for identifying individuals with cardiovascular disease. Clinicians should also evaluate symptoms and electrocardiographic findings until extensive multicenter studies validating this strategy are performed to establish the incremental value of MW in daily echocardiographic assessments.

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.

Acute influences of tennis services on cardiac output and brachial hemodynamics in young male tennis players.

This study aimed to examine the influences of tennis service exercise on cardiac output (CO) and bilateral brachial hemodynamics in young tennis players. Experimental study. Ten young male tennis players (21 ± 2 years of age) participated. Each performed 100 tennis services without a return shot for experimental tennis exercise. Cardiovascular hemodynamic variables, including bilateral brachial blood flow (BF), shear rate (SR), blood pressure, and CO, were collected under three conditions: 1) baseline, 2) immediately after the tennis services (post), and 3) 1 h after the tennis services (1-hour). The positive incremental area under the curve (iAUC) for brachial hemodynamic variables was calculated. Immediately after the 100 tennis services, CO, brachial BF, SR, and brachial vascular conductance (VC) in the dominant and non-dominant arms increased (p < 0.05). At the 1-hour condition, CO returned to baseline; the brachial BF, SR, and VC in the non-dominant arm returned to baseline levels, whereas the same variables in the dominant arm remained increased. The iAUC for brachial BF and VC in the dominant arm was higher than that in the non-dominant arm. Furthermore, the brachial BF/CO ratio index in the dominant arm increased at the post and 1-hour conditions, whereas that in the non-dominant arm was unchanged. Tennis service exercise specifically increases brachial BF, SR, and VC in the dominant arm, independent of increased CO. Our findings contribute to unveiling the underlying mechanisms of brachial artery adaptations in tennis players.

Enhancing central blood pressure accuracy through statistical modeling: A proof-of-concept study.

Non-invasive estimation of central blood pressure (BP) may have better prognostic value than brachial BP. The accuracy of central BP is limited in certain populations, such as in females and the elderly. This study aims to examine whether statistical modeling of central BP for clinical and hemodynamic parameters results in enhanced accuracy. This study is a cross-sectional analysis of 500 patients who underwent cardiac catheterization. Non-invasive brachial cuff and central BP were measured simultaneously to invasive aortic systolic BP (AoSBP). Central BP was calibrated for brachial systolic (SBP) and diastolic BP (Type I calibration; C1SBP) or brachial mean and diastolic BP (Type II calibration; C2SBP). Differences between central SBP and the corresponding AoSBP were assessed with linear regression models using clinical and hemodynamic parameters. These parameters were then added to C1SBP and C2SBP in adjusted models to predict AoSBP. Accuracy and precision were computed in the overall population and per age or sex strata. C1SBP underestimated AoSBP by 11.2 mmHg (±13.5) and C2SBP overestimated it by 6.2 mmHg (±14.8). Estimated SBP amplification and heart rate were the greatest predictors of C1- and C2-AoSBP accuracies, respectively. Statistical modeling improved both accuracy (0.0 mmHg) and precision (±11.4) but more importantly, eliminated the differences of accuracy seen in different sex and age groups. Statistical modeling greatly enhances the accuracy of central BP measurements and abolishes sex- and age-based differences. Such factors could easily be implemented in central BP devices to improve their accuracy.

Vascular Health in Adults Born After Using Assisted Reproductive Technologies

An increasing number of children are conceived by assisted reproductive technologies (ART). Several studies indicated vascular alterations in ART children. However, limited data is available within the adult ART population. Therefore, this study investigated the overall vascular health of young ART adults in comparison to spontaneously conceived peers. In total, 16 ART subjects and 22 spontaneously conceived peers (22.06 ± 2.21 years vs. 22.00 ± 2.14 years, p = 0.194) were enrolled for the assessment of endothelial function, brachial blood pressure, central blood pressure, pulse wave velocity, carotid intima-media thickness, and blood lipids. No significant differences in vascular function were detected between the in vitro fertilization subgroup (n = 9), the intracytoplasmic sperm injection subgroup (n = 7) and spontaneously conceived peers. This pilot study suggests an unimpaired vascular function in young ART adults. In the future, multi-centric studies with a greater sample size are required to confirm the results of the current study and enable precise cardiovascular risk stratification of the adult ART population.

Acute circulatory and femoral hemodynamic responses induced by standing core exercise at different rotational cadence: a crossover study

BackgroundCore exercise is often adopted as an adjunct in maintaining musculoskeletal health in rehabilitation; we previously showed that standing core rotational exercise improves femoral blood flow after training. This study aimed to investigate the effects of different rotational cadences on circulatory and hemodynamic responses after acute standing core exercise.MethodsSixteen healthy male adults (22 ± 1 yrs) were randomly assigned to participate in two 30-min standing core exercises of fast (75 rpm, FC) and slow cadence (20 rpm, SC) sessions after completing an acute bout of seated knee extension exercise session (KE) (80% of 1 repetition maximum × 12 repetitions × 3 sets). Impedance cardiography-derived circulatory responses and femoral hemodynamics by ultrasound imaging were measured pre- and 30, and 60 min post-exercise.ResultsKE acutely increased post-exercise cardiac output at 30 min (p = 0.008) and heart rate at 30 min (p = 0.04) and 60 min (p = 0.01), yet brachial blood pressure did not change. Systemic vascular resistance was significantly lower after FC and KE at 30 min (p = 0.008) and 60 (p = 0.04) min, respectively, compared with the baseline. In addition, KE acutely decreased post-exercise arterial stiffness (p = 0.05) at 30 min, increased femoral conductance (p = 0.03, p < 0.001), and blood flow (p = 0.009, p < 0.001) at 30 and 60 min. No significant changes were observed in absolute femoral blood flow after FC and SC, except that FC significantly increased relative femoral blood flow (p = 0.007) and conductance (p = 0.005). Post-exercise femoral diameter significantly increased in KE at 30 (p = 0.03) and 60 min (p = 0.01), but not in core exercise.ConclusionOur results suggest that standing core exercise elicits circulatory and hemodynamic changes only when the rotational cadence is set at a faster cadence, which provides preliminary scientific evidence for its use in exercise programs.

Arterial Stiffness Response to Acute Combined Training with Different Volumes in Coronary Artery Disease and Heart Failure Patients.

Resistance training has been shown to acutely increase arterial stiffness (AS), while endurance training appears to decrease AS. However, the findings are from studies in apparently healthy subjects and have limited applicability to patients at low and high cardiovascular risk, for whom combined exercise is recommended. We compared the time course of changes in local and regional indices of AS in response to high-volume combined endurance training (CET) and high-volume combined resistance training (CRT) in patients with coronary artery disease (CAD) and heart failure (HF). We studied 20 men with CAD and HF (10 each) aged 68.3 ± 9.6 years. AS was measured by pulse wave velocity (PWV), and brachial and central blood pressure (BP) were determined after 15 min of rest and 5 and 15 min after the exercise session. All patients completed two sessions on nonconsecutive days. A protocol by time interaction effect was observed for carotid (η2 = 0.21, p = 0.02), aortic (η2 = 0.60, p &lt; 0.001), and femoral (η2 = 0.46, p = 0.01) PWV after CET and CRT, suggesting that PWV decreased after CET and increased after CRT. Decreases in the brachial and central variables of BP across time points were observed in both protocols. CET decreased whereas CRT increased carotid, aortic, and femoral PWV at 15 min after exercise in patients with CAD and HF.

Subjects Conceived through Assisted Reproductive Technologies Display Normal Arterial Stiffness.

Multiple studies reported signs of vascular dysfunction in subjects conceived through assisted reproductive technologies (ART). The assessment of arterial stiffness in this cohort seems beneficial for risk stratification. Regional arterial stiffness of the abdominal aorta (AAO) and the common carotid arteries (CCA) was evaluated sonographically using two-dimensional speckle tracking in subjects conceived through ART and spontaneously conceived peers. Global arterial stiffness was assessed utilizing an oscillometric blood pressure device. The cohorts of 67 ART subjects and 86 spontaneously conceived peers (11.31 (8.10-18.20) years vs. 11.85 (8.72-18.27) years, p = 0.43) did not differ significantly in parameters of regional and global arterial stiffness. In the sub-analysis of study participants ≥10 years of age, markers of arterial stiffness did not display significant differences between both groups. However, a higher tendency of brachial systolic blood pressure was demonstrated in the ART cohort compared to the control group (120.18 ± 9.57 mmHg vs. 116.55 ± 8.05 mmHg, p = 0.050). The present study displayed no significant differences in arterial stiffness between ART subjects and spontaneously conceived peers. Moreover, this study suggests that arterial stiffness does not elevate more profoundly in ART subjects with increasing age. Further studies are required for a more detailed cardiovascular risk stratification of the ART cohort.

Habituation attenuates the sex-specific associations between ischemic pain, blood pressure, and arterial stiffness in young adults.

Cardiovascular reactivity (CVR) during physical stress is prognostic for incident cardiovascular disease. CVR is influenced by perceived pain. However, there is limited data on the effect of sex differences and repeated exposures to painful stimuli on CVR. We measured blood pressure (BP) and carotid-femoral pulse wave velocity (cf-PWV; an index of arterial stiffness) at rest, during isometric handgrip (HG) exercise at 30% of maximum voluntary contraction, and during postexercise circulatory occlusion (PECO) during two identical trials in 39 adults (20M/19F; 18-39 yr). We assessed participants' perceived pain using a visual analog scale after the first minute of each stimulus. We collected BP during minute 2 of each stimulus and cf-PWV during minute 3 of each stimulus. In male participants, we observed moderate associations (Ps ≤ 0.023) between perceived pain and changes in brachial diastolic (ρ = 0.620) and mean BP (ρ = 0.597); central diastolic, mean, and systolic BP (ρs = 0.519-0.654); and cf-PWV (ρ = 0.680) during PECO in trial 1, but not trial 2 (Ps ≥ 0.162). However, in female participants, there were no associations between pain and CVR indices during either trial (Ps ≥ 0.137). Irrespective of sex, reductions in perceived pain during trial 2 relative to trial 1 were weakly to moderately associated (Ps ≤ 0.038) with reductions in brachial diastolic (ρ = 0.346), mean (ρ = 0.379), and systolic BP (ρ = 0.333); central mean (ρ = 0.400) and systolic BP (ρ = 0.369); and cf-PWV (ρ = 0.526). These findings suggest that 1) there are sex differences in pain modulation of CVR in young adults and 2) habituation blunts pain and CVR during PECO, irrespective of sex.NEW & NOTEWORTHY We demonstrate sex differences in the association between pain perception and cardiovascular reactivity (CVR) during ischemic pain. We also demonstrate habituation to pain and reduced CVR during repeated exposure in a sex-independent manner. Accounting for sex differences and habituation may improve the prognostic utility of CVR.

Abstract 14102: The Joint Effect of Arterial Stiffness and High Central Blood Pressure on Risk of Stroke Among Hypertensive Adults

Introduction: The increases in arterial stiffness and central blood pressure (cBP) suggest significant status of vascular damages with different physio-pathological progress. However, the joint effect of them on risk of first stroke have remained uncertain. And the predictive value of CAP over peripheral blood pressure (bBP) is controversial. Hypothesis: This study aims to test the hypothesis that the combination of elevated arterial stiffness and central systolic blood pressure (cSBP) can predict first stroke and is associated with highest risks among hypertensive adults. Methods: A total of 7531 hypertensive adults without prior history of stroke were analyzed. cSBP was measured noninvasively using A-Pulse CASPro device. Arterial stiffness was measured by carotid-femoral pulse wave velocity using the noninvasive PulsePen device (WPP001-ET, DiaTecne s.r.l). Whole data was collected from July 2016 to December 2019. Increased arterial stiffness was defined as cfPWV ≥10 m/s. The primary outcome was first all-cause stroke. Results: Of the 7531 participants, mean age was 61.3 ± 9.3 years, 37.2% were male, the mean brachial blood pressure is the mean cfPWV was 9.4 ± 2.2 m/s, the mean cSBP is 131.3 ± 12.8 mmHg. During a mean follow-up time of 3.3 years, 432 (5.2%) participants developed stroke, of which 380 were ischemic strokes. Compared with the reference group (low cfPWV and cSBP), only the group with both high cfPWV and cSBP was significantly associated with risk of stroke after adjusted for covariates (HR: 1.51, 95% CI 1.10, 2.07). Similar result was found in Kaplan Meier Curve. Such association appears robust in different sub-group analysis. Conclusion: The combination of higher arterial stiffness and central systolic blood pressure is associated with highest risk of first stroke compared to other groups. The combined control of arterial stiffness and central blood pressure serves the purpose of primary prevention of first all-cause stroke among hypertensive population.

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.

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.

Effect of the administration of different forms of vitamin D on central blood pressure and aortic stiffness, and its implication in the reduction of albuminuria in chronic kidney disease

Background and objectivesVitamin D (vitD) participates in phospho-calcium metabolism and exerts multiple pleiotropic effects. There is tissue 1-α (OH)ase that converts 25-OH cholecalciferol (25 (OH) D) in calcitriol that exerts autocrine and paracrine effects. 25 (OH)D deficiency could limit these tissue effects of vitD. The administration of nutritional vitD and the activator of the vitD receptor, paricalcitol, may promote beneficial effects on vascular and renal function. The objective of this work was to study in subjects with chronic kidney disease (CKD) the effect that the administration of different forms of vitD has on arterial function and albuminuria, and the possible relationship between the modifications of these variables. Patients and methodsWe studied in 97 patients with CKD stages 3–4 the effect of the administration of cholecalciferol (group 2; n: 35) and paricalcitol (n: 31; group 3) on parameters derived from brachial blood pressure, aortic blood pressure and on aortic stiffness studied using carotid-femoral pulse velocity (Vpc-f), and on albuminuria. A group of patients with stages 3–4 CKD who did not receive vitD therapy served as a control group (n: 31; group 1). All parameters were studied at baseline and after the follow-up period which was 7±2 months. ResultsIn the baseline phase, no differences were observed between the groups in brachial systolic blood pressure (bSBP), central systolic blood pressure (SBP), brachial pulse pressure (bPP), and central pulse pressure (pCP) or in aortic stiffness that was increased in all groups with a baseline Vpc-f value of 10.5 (9.2–12.1) m/sec. The baseline albuminuria value in the grouped patients was 229 (43–876) mg/g (median (interquartile range)), with no differences between the groups.Serum calcium and phosphorus increased significantly in those treated with cholecal-ciferol (native vitD) and paricalcitol (active vitD). Parathormone (PTH) values ​​decreased in those treated with paricalcitol. bPP and cPP decreased in all groups treated with native and active vitD. No significant changes in bPP and cPP were observed in the control group.Vpc-f did not change significantly in any of the groups, although the variation was quantitatively greater in group 3 (11.2±2 vs. 10.7±1.6 (p:0.06)). No differences were observed in the changes in Vpc-f between the groups when adjusted to the baseline values ​​of estimated glomerular filtration rate (eGFR), albuminuria, PTH, vitD, brachial and central blood pressure parameters, and their changes with treatment.Those who received treatment with native and active vitD presented a significant decrease in albuminuria of 17% (group 2) and 21% (group 3) compared to a 16% increase in the untreated group (group 1) (p:0 .01). A decrease in albuminuria ≥30% was observed more frequently in the groups treated with some form of vitD (group 2: 23%; group 3: 45%) than in the control group (13%) (p:0.03). The decrease in albuminuria observed in the groups treated with any of the forms of vitD did not vary when the baseline values ​​of the biochemical parameters of phosphorus-calcium metabolism, those of arterial function (PPb, PPc, Vpc-f) or its modifications were introduced as covariates. There was no significant correlation between changes in Vpc-f and albuminuria. In logistic regression, changes in arterial function parameters were also not explanatory for the ≥30% decrease in albuminuria. ConclusionsIn patients with CKD stages 3–4, treated with RAS blockers and with residual albuminuria, the administration of or paricalcitol reduces brachial and aortic pulse pressures, and albuminuria. The decrease in albuminuria does not seem to be mediated, at least not decisively, by changes in central hemodynamics or aortic stiffness.