Brachial Brachial Blood Pressure 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.

Brachial and central hypertension in relation to coronary stenosis in patients with coronary angiography.

The clinical significance of central beyond brachial blood pressure (BP) remains unclear. In patients who underwent coronary angiography, the authors explored whether elevated central BP would be associated with coronary arterial disease (CAD) irrespective of the status of brachial hypertension. From March 2021 to April 2022, 335 patients (mean age 64.9 years, 69.9% men) hospitalized for suspected CAD or unstable angina were screened in an ongoing trial. CAD was defined if a coronary stenosis of ≥50%. According to the presence of brachial (non-invasive cuff systolic BP ≥140mmHg or diastolic BP ≥90mmHg) and central (invasive systolic BP ≥130mmHg) hypertension, patients were cross-classified as isolated brachial hypertension (n=23), isolated central hypertension (n=93), and concordant normotension (n=100) or hypertension (n=119). In continuous analyses, both brachial and central systolic BPs were significantly related to CAD with similar standardized odds ratios (OR, 1.47 and 1.45, p<.05). While categorical analyses showed that patients with isolated central hypertension or concordant hypertension had a significantly higher prevalence of CAD and the Gensini score than those with concordant normotension. Multivariate-adjusted OR (95% confidence interval [CI]) for CAD was 2.24 (1.16 to 4.33, p=.009) for isolated central hypertension and 3.02 (1.58 to 5.78, p<.001) for concordant hypertension relative to concordant normotension. The corresponding OR (95% CI) of a high Gensini score was 2.40 (1.26-4.58) and 2.17 (1.19-3.96), respectively. In conclusion, regardless of the presence of brachial hypertension, elevated central BP was associated with the presence and severity of CAD, indicating that central hypertension is an important risk factor for coronary atherosclerosis.

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.

S-37-2: CIRCADIAN RHYTHM OF PERIPHERAL AND CENTRAL ARTERIAL BLOOD PRESSURES IN RELATION TO ALL-CAUSE MORTALITY

Objective: Brachial blood pressure (BP) presents a circadian rhythm. Abnormal rhythms are associated with adverse outcomes. However, it is not clear about the circadian rhythm of central BP and its predictive value. Methods: The study participants were patients referred to the outpatient clinic of Ruijin Hospital for 24-hour ambulatory BP monitoring from the year 2017 to 2020. The 24-hour brachial and central ambulatory BP monitoring were performed with the use of the Mobil-O-Graph (Germany) monitors. Dipping, non-dipping, reverse dipping and extreme dipping were defined as a night-to-day systolic BP ratio of 0.8–0.9, 0.9–1.0, &gt; 1.0, and &lt; 0.8, respectively. In cross-classification analysis of brachial and central dipping status, extreme dipping and reverse dipping were grouped with dipping and non-dipping, respectively. The vital status of patients until Dec 2020 was ascertained according to the vital statistics of the Shanghai Center for Disease Prevention and Control. Results: In 26,023 enrolled patients (men 47.4%, average age 53.0 years) followed up for a median of 1.8 years, 120 deaths occurred. The prevalence of non-dipping (46.7% vs. 43.7%, respectively) and reverse dipping (16.0% vs. 13.1%) was significantly (P &lt; 0.001) higher for central than for brachial BP. The hazard ratios (95% confidence intervals, [CI]) for all-cause mortality were statistically significant for reverse dipping (1.95 [1.18–3.23] and 2.37 [1.43–3.94], respectively), but not other dipping status, versus dipping in brachial and central BP, respectively. In the brachial and central cross-classification analysis, the prevalence of consistent dipping, consistent non-dipping, isolated central non-dipping, and isolated brachial non-dipping was 34.7%, 54.2%, 8.6%, and 2.5%, respectively. Taking the consistent dipping as reference, the hazard ratios (95% CI) for all-cause mortality were 1.83 (0.77–4.31), 1.34 (0.46–3.95), and 1.94 (1.20–3.15) for isolated central, isolated brachial and consistent non-dipping, respectively. Furthermore, cross-classification significantly improved the risk prediction of all-cause mortality with a net reclassification improvement index (95% CI) of 0.193 (0.069–0.304). Conclusions: Non-dipping and reverse dipping were more common for central than for brachial BP, and were associated with a higher mortality risk irrespective of brachial or central BP. Cross-classification of brachial and central dipping status further improved risk stratification.

Do diurnal changes in blood pressure affect myocardial work indices?

Do diurnal changes in blood pressure affect myocardial work indices?

Inorganic nitrate attenuates endothelial dysfunction consequent to systemic inflammation

Abstract Introduction Chronic cardiovascular diseases are characterised by low-grade systemic inflammation and attenuated nitric oxide (NO) bioavailability resulting in endothelial dysfunction. Inorganic nitrate augments NO bioavailability and improves markers of vascular dysfunction in patients with cardiovascular risk factors. However, the exact mechanism of this effect is uncertain. Purpose To determine whether inorganic nitrate supplementation alters systemic inflammation-induced endothelial dysfunction. Methods 62 healthy male volunteers were randomised 1:1 to receive ∼8–10 mmol of dietary inorganic nitrate in beetroot juice or nitrate-free beetroot juice (placebo) once daily for 6 days. Measures of brachial artery flow-mediated dilatation (FMD), brachial blood pressure (BP), pulse wave analysis and carotid-femoral pulse wave velocity (PWV) by Vicorder were taken prior to and at 8 hours after a typhoid vaccine (to induce mild systemic inflammation). Plasma, urine and saliva samples were also collected. Clinicaltrials.gov: NCT02715635. Results Baseline characteristics were similar between the two groups. Inorganic nitrate significantly elevated plasma nitrite (placebo = Δ0.02±0.5 μM, inorganic nitrate = Δ0.63±1.2 μM; p=0.01) and nitrate levels (p&amp;lt;0.0001) compared to placebo. There were significant increases in urine nitrite (p&amp;lt;0.0001) and nitrate (p&amp;lt;0.0001) in addition to salivary nitrite (p&amp;lt;0.0001) and nitrate (p&amp;lt;0.0001) compared to placebo. After 8 hours, typhoid vaccine induced an increase in circulating white cells (placebo = Δ3.34±3.37x109/L, inorganic nitrate = Δ2.9±2.78x109/L; p=0.58) that was similar in in both arms. However, there was a significant reduction in the FMD response in the placebo group at 8-hours post vaccine; an effect that was absent in volunteers treated with inorganic nitrate (placebo = Δ−1.33±1.53%, inorganic nitrate = Δ−0.07±1.84%, p=0.005). Importantly, there were no statistically significant differences in baseline vessel diameter (p=0.78), time to peak diameter in response to flow (p=0.87) and peak shear rate (p=0.57) between the groups. When comparing change from baseline to 8 hours after the vaccine, there were no significant differences in brachial systolic BP (p=0.12), central systolic BP (p=0.12) and PWV (p=0.60) between groups, but a significant reduction in brachial diastolic BP in the inorganic nitrate group (p=0.048). Conclusions Inflammation-induced endothelial dysfunction was prevented in those receiving dietary inorganic nitrate suggesting that elevating circulating nitrite and delivering NO to the blood vessel wall, through dietary approaches may offer potential therapeutic benefit in those cardiovascular diseases which typically exhibit low grade inflammation and deficiencies in bioavailable NO. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): British Heart Foundation

Total vascular resistance, augmentation index, and augmentation pressure increase in patients with peripheral artery disease.

Peripheral arterial disease (PAD) is one of major vascular diseases which frequently coexists with coronary arterial disease and cerebrovascular disease. The patients with PAD have a poor prognosis when it progresses. A new blood pressure testing device enables to simultaneously measure brachial blood pressure (BP), central BP, and several vascular parameters, with easy and non-invasive, in a short time. Here, we aimed to evaluate these arterial stiffness parameters in patients with PAD.In this study, 243 consecutive patients who were suspected of having PAD and referred to our hospital from September 2016 to June 2019, were registered. Several parameters, such as brachial BP, central BP, aortic pulse wave velocity (aPWV), total vascular resistance (TVR), augmentation index (AI) and augmentation pressure (AP), were determined by Mobil-O-Graph. Ankle-brachial pressure index (ABI) was used to define PAD (ABI ≤ 0.9 as PAD). The relationship between PAD and central BP, aPWV, TVR, AI, or AP were investigated.One hundred sixty-two patients (67%) were categorized as the PAD group and 81 patients (33%) as the non-PAD group. In the PAD group, the systolic brachial BP and central systolic BP were significantly higher than those in the non-PAD group (138 ± 24 mmHg vs 131 ± 19 mmHg, P < .05, 125 ± 22 mmHg vs 119 ± 18 mmHg, P < .05, respectively). TVR, AI, and AP were significantly higher in the PAD group (1785 ± 379 dyn s/cm5 vs 1661 ± 317 dyn s/cm5, P < .05, 26.2 ± 13.0% vs 22.2 ± 13.3%, P < .05, 13.5 ± 9.4 mmHg vs 10.7 ± 7.2 mmHg, P < .05, respectively). No significant differences in diastolic BP, central diastolic BP, and aPWV were found between the groups. Multivariate logistic regression analysis revealed that PAD was significantly associated with TVR, AI, and AP (P < .05, respectively).TVR/AP/AI were significantly higher in the PAD group than in the non-PAD group.

Cardiovascular health effects of wearing a particulate-filtering respirator to reduce particulate matter exposure: a randomized crossover trial

This randomized crossover trial sought to determine whether wearing a high-efficiency particulate-filtering respirator (PFR) improves cardiovascular function over 48 h among healthy college students in Tehran. This trial was conducted from February 14th to 23rd, 2019 and twenty-six participants completed two 48-h intervention periods. Brachial blood pressure (BP) measured by 24-h ambulatory monitoring was the primary health outcome. Secondary outcomes included 48-h heart rate variability (HRV) indices, high-sensitive cardiac troponin (hs-TnT) and other biomarkers. The participants wore the PFR between 10.2 and 11.1 h while awake during the interventions. More than 80% of participants reported increased respiratory resistance while wearing the PFR due to a lack of an exhalation valve. There were no significant differences in brachial BP levels between subjects who wore PFR respirator and those did not. Except for high frequency (HF) power and heart rate (HR), no significant differences between interventions were observed for other HRV metrics. Wearing the PFR led to an increase of 66.0 ms2 (95% confidence interval [CI], 9.6-110.5) and 79.6 ms2 (95% CI, 19.0-140.1) in HF power during the first day when the two groups of participants wore the PFR. Night-time HR was significantly increased during the PFR intervention period. Other secondary outcomes were not significantly different between interventions. It is plausible that incomplete exposure reduction due to wearing the PFR less than half of the time or increased respiratory resistance mitigated potential health benefits. Additional trials are warranted to validate the CV protection of wearing PFRs in heavily-polluted cities.

CUFF-BASED AND INTRAARTERIAL BRACHIAL BLOOD PRESSURE MISMATCH AND ITS POTENTIAL IMPACT ON ANTIHYPERTENSIVE TREATMENT AND ESTIMATION OF AORTIC BLOOD PRESSURE

Objective: Cuff-based brachial blood pressure (BP) is universally used as a guide to treat hypertension, although it can differ from the intraarterial BP. In this study, we examine the potential impact of cuff-to-intraarterial brachial systolic BP (bSBP) mismatch phenotypes on BP treatment and its impact on determination of central BP. Design and method: In 379 hypertensive subjects undergoing cardiac catheterization through the radial artery, non-invasive brachial cuff and central BPs were measured using the Mobil-o-Graph device simultaneously to intraarterial brachial and aortic BP. According to the difference between cuff-based bSBP (CUFF-bSBP) and intraarterial bSBP (IA-bSBP), we identified three phenotypes: Underestimation Mismatch group (CUFF-bSBP &lt; IA-bSBP by more than 10 mmHg); No Mismatch group (CUFF-bSBP within 10 mmHg of IA-bSBP); Overestimation Mismatch group (CUFF-bSBP &gt; IA-bSBP by more than 10 mmHg). Influence on ACC/AHA BP categories was evaluated and accuracy was determined following ARTERY society recommendations (mean difference &lt;=5 ± 8 mmHg). Results: The Underestimation (n = 190), No Mismatch (n = 155) and Overestimation (n = 34) groups, despite overall similar clinical characteristics, showed only minor differences in CUFF-bSBP (127 ± 17, 123 ± 15, 126 ± 19 mmHg) despite highly different IA-bSBP (147 ± 18, 126 ± 16 vs 108 ± 18 mmHg, p &lt; 0.001) and aortic SBP (136 ± 20, 122 ± 16, 109 ± 18 mmHg, p &lt; 0.001). ACC/AHA BP categories were concordant in 33%, 68% and 44% of the Underestimation, No Mismatch and Overestimation groups. The Underestimation Mismatch group had 64% of individuals at risk of undertreatment compared to 16% in the No Mismatch Group, while in the Overestimation Mismatch Group 50% were at risk of overtreatment compared to 17% in the No Mismatch group. Cuff bSBP accurately estimated the aortic SBP only in the No Mismatch Group (mean difference 1.7 ± 8.2 mmHg) whereas central BP with the Mobil-o-Graph device did not reach the strict ARTERY criteria for accuracy in any groups. Conclusions: Our study shows that the brachial cuff underestimates and overestimates intraarterial brachial BP in a significant proportion of hypertensive subjects, potentially leading to an increased risk of BP mismanagement, and inaccurate non-invasive estimation of central BPs. This underlines the importance of improving the accuracy of cuff-based brachial and central BP monitors, ideally taking into consideration invasive BP phenotypes.

WHAT DOES THE FINDING OF MINIMAL MITRAL REGURGITATION MEAN?

Objective: bjective: Leonardo da Vinci intuited that the cardiac valves were key to the functioning of the heart. Minimal mitral regurgitation in young's is often interpreted as haemodynamically insignificant. Morphological changes in the arterial wall can lead to mitral regurgitation, left atrial enlargement, and atrial fibrillation (AF). The aim is to know the measures of the central haemodynamic parameters (CHPs), brachial blood pressure (BP) values, and the prevalence of headache and AF, in both genders with minimal mitral regurgitation. Design and method: Design and Methods: For this cross-sectional retrospective study, data were collected from 323 patients: Female/Male 189/134, from 20 to 89 years old, divided and analyzed in each one of the 7 decades. Some patients were unaware of having hypertension, others with and without antihypertensive therapy. The finding of AF was confirmed with the presence of brief phases in the 24hs-Holter monitoring. The CHPs were measured with a SphygmoCor System PVX (AtCor-Medical Australia), a validated device employing the high-fidelity technique of applanation tonometry according to established protocols. Also, the difference of Augmentation Index (Diff-AIx) between the normal levels and the observed values was assessed according to normal range by age. Results: Results: Average BP was higher than normal: Female- Male 141/83–137/82 mmHg. CHPs and BP values increased in each one of the 7 decades, both genders. Frequently, the patients were symptomatic, among the female/male the headache was found in 61%/25%, with a high prevalence of up to 69 years old in 85%/88% of them. Also, they presented symptoms such as sweating, asthenia, thoracalgia, palpitations. Hypertension would not be silent chronic disease. AF was found in 49 patients (15%), female/male 22/ 27 (12%/20%), increasing the prevalence with age, after 50/60 years old was observed in 68/78%. Conclusions: Conclusions: Minimal mitral regurgitation would not be a bystander, it can be the consequence of the higher values of the brachial BP, the central haemodynamic parameters and the Diff-AIx. The appearance of minimal mitral regurgitation principally among younger can indicate that the brachial BP found is higher than normal and the optimal levels should be reassessed.

Prediction of Cardiovascular Events by Type I Central Systolic Blood Pressure: A Prospective Study.

Compared with brachial blood pressure (BP), central systolic BP (SBP) can provide a better indication of the hemodynamic strain inflicted on target organs, but it is unclear whether this translates into improved cardiovascular risk stratification. We aimed to assess which of central or brachial BP best predicts cardiovascular risk and to identify the central SBP threshold associated with increased risk of future cardiovascular events. This study included 13 461 participants of CARTaGENE with available central BP and follow-up data from administrative databases but without cardiovascular disease or antihypertensive medication. Central BP was estimated by radial artery tonometry, calibrated for brachial SBP and diastolic BP (type I), and a generalized transfer function (SphygmoCor). The outcome was major adverse cardiovascular events. Cox proportional-hazards models, differences in areas under the curves, net reclassification indices, and integrated discrimination indices were calculated. Youden index was used to identify SBP thresholds. Over a median follow-up of 8.75 years, 1327 major adverse cardiovascular events occurred. The differences in areas under the curves, net reclassification indices, and integrated discrimination indices were of 0.2% ([95% CI, 0.1-0.3] P<0.01), 0.11 ([95% CI, 0.03-0.20] P=0.01), and 0.0004 ([95% CI, -0.0001 to 0.0014] P=0.3), all likely not clinically significant. Central and brachial SBPs of 112 mm Hg (95% CI, 111.2-114.1) and 121 mm Hg (95% CI, 120.2-121.9) were identified as optimal BP thresholds. In conclusion, central BP measured with a type I device is statistically but likely not clinically superior to brachial BP in a general population without prior cardiovascular disease. Based on the risk of major adverse cardiovascular events, the optimal type I central SBP appears to be 112 mm Hg.

Determinants and clinical significance of aortic stiffness in patients with moderate or severe aortic stenosis

BackgroundPatients with degenerative aortic stenosis (AS) are often older and have systemic hypertension and atherosclerosis, which all lead to increased aortic stiffness. We aimed to assess the determinants of carotid-femoral pulse wave velocity (cf-PWV), a direct measure of aortic stiffness, and its association with revealed symptoms and clinical outcome in patients with AS. MethodsWe included 103 asymptomatic patients aged 66.6 ± 13.2 years (range 27–85 years, 69% males) with moderate (n = 50) and severe (n = 53) AS. All underwent a comprehensive echocardiography, exercise treadmill test (ETT) and assessment of aortic stiffness derived from cf-PWV by applanation tonometry. ResultsThe mean cf-PWV was 10.6 ± 3.1 m/s and resting brachial blood pressure (BP) 139 ± 20/79 ± 11 mmHg. Increased cf-PWV (≥10 m/s) was found in 44% (n = 45) patients. Patients with moderate and severe AS had a similar degree of aortic stiffness (cf-PWV 10.7 ± 3.3 vs. 10.5 ± 3.0 m/s, p = 0.698). In a univariate logistic regression analysis, higher cf-PWV was not associated with revealed symptoms (odds ratio [OR] for 1SD higher cf-PWV 1.12; 95% CI 0.62–2.04, p = 0.706). In a multivariable linear regression analysis, age, resting brachial systolic BP and diabetes were associated with higher cf-PWV independent of antihypertensive treatment and left ventricular ejection fraction. The event-free survival was significantly lower in patients with cf-PWV ≥10 m/s compared to those with cf-PWV <10 m/s (p = 0.015). ConclusionIncreased cf-PWV was common in patients with moderate or severe AS, and was associated with higher cardiovascular disease burden and impaired prognosis. cf-PWV did not correlate with the severity of AS or the frequencies of revealed symptoms by ETT.

Feasibility of 24-h central blood pressure monitoring: experience from multinational clinical trial assessing the efficacy of perindopril/indapamide/amlodipine.

Brachial blood pressure (BP) is a predictor of cardiovascular events. Evidence suggests that central BP (CBP) provides additional information for cardiovascular risk assessment. Methods to assess 24-h CBP are now available. Our objective was to assess the feasibility of 24-h CBP monitoring in clinical trials and its ability for drug evaluation. Data are issued from an international phase 3 randomized clinical trial comparing the efficacy of perindopril/indapamide/amlodipine vs. perindopril/indapamide (Per/Ind), in uncontrolled hypertensive patients treated with Per/Ind. 24-h ambulatory BP monitoring (ABPM) was performed at baseline and after 1-month treatment using the Mobil-O-Graph device which provide brachial BP and CBP and arterial parameters. From the 345 patients included in the ABPM substudy, 276 had two valid ABPM (M0 and M1) for brachial BP assessment (80%). After applying device/software built-in and expert quality control criteria on these recordings, 210 (76%) had valid data at M0 and M1 for the assessment of CBP. After 1 month, superior ambulatory central SBP reductions were observed in the perindopril/indapamide/amlodipine (n = 101) vs. Per/Ind group (n = 109) for 24-h/daytime/night-time periods (-4.5 mmHg, P = 0.002/-5.0, P < 0001/-4.1 mmHg, P = 0.016, respectively). Similar trends were observed for pulse wave velocity and other central parameters. Recording 24-h central ABPM and its derived arterial parameters needs a strict expert quality control and must consider a loss of up to 39% of the population included in the ABPM substudy. This method can be used to assess drug effect.

Supporting Physical Health Of Black Male Faculty Through A Wellness-integrated Professional Development Program: FIT Leaders

PURPOSE: An intervention strategy examining the integration of professional development and wellness for black male faculty at an R1 university was conducted. The intervention was directed at supporting the retention and academic promotion of black male faculty through minimizing the impact of culturally relevant physical (i.e., hypertension, obesity) and cognitive (i.e. John-Henryism, social isolation, discrimination, etc.) challenges. The implications on the physical health of the participants are presented here. METHOD: A 24-week intervention brought together black male faculty of differing ranks at a university fitness center twice per week. Each session included a 45 min trainer lead exercise session followed by a 30 min semi-guided discussion on culturally relevant professional development topics. A series of assessments implemented in a pre-/post-structure around the intervention included cardiovascular measures including central aortic pressure, brachial blood pressure (BP) and carotid-femoral pulse wave velocity (cf-pwv) measured via the Sphygmocor Xcel Device, body composition via BodPod, strength and cardiorespiratory fitness via graded exercise treadmill test. Pre-post analyses using paired T-tests were performed using STATA 13.4. RESULTS: Among 9 participants the mean age was 40.4 +/- 4.1 years. Cardiovascular measures improved including Aortic Systolic Pressure 123+/-11 vs 117+/-12 mmHg, p=0.007; Brachial systolic BP 136+/-10 vs 128+/-12mmHg, p=0.002; Brachial diastolic BP 87+/-10 vs. 84+/-10, p=0.057; and Cf-pwv 8.3+/-1.4 vs. 6.9=+/-0.6 m/s (n=6, p=0.007). Adiposity measures improved including body mass index 29.6+/-5.0 vs. 29.0+/-4.9 kg/m2, p=0.014; waist circumference 96.6+/-11.8 vs. 93.4+/-12 cm, p<0.001; and body fat percentage 26.9+/-7.7 vs. 23.4+/-7.6%, p=0.005. Max chest press improved from 174.4+/-52.1 vs. 191.4+/-45.9 lbs, p=0.008. There were no improvements in cardiorespiratory fitness, highest VO2max 37.1+/-7.4 vs. 37.5+/-6.9 ml/kg/min (n=7), p=0.801. CONCLUSION: Changes in the physical health of participants indicate that this intervention shows promise for supporting the physical wellness of black male faculty in parallel with culturally relevant leadership support.

A Double-Blind Placebo-Controlled Crossover Study of the Effect of Beetroot Juice Containing Dietary Nitrate on Aortic and Brachial Blood Pressure Over 24 h.

Dietary inorganic nitrate in beetroot can act as a source of nitric oxide and has been reported to lower brachial blood pressure (BP). This study examined the effect of inorganic nitrate in beetroot juice on aortic (central) BP acutely and over the subsequent 24-h period. A double blind, randomized, placebo-controlled crossover trial was performed in fifteen healthy, normotensive men and women (age 22–40 years). Participants were randomized to receive beetroot juice containing nitrate (6.5–7.3 mmol) or placebo beetroot juice from which nitrate had been removed (<0.06 mmol nitrate). Effects on aortic systolic BP were measured at 30 min (primary endpoint), 60 min and over a subsequent 24 h period using an ambulatory BP monitor. Carotid-femoral pulse wave velocity (cfPWV) was also measured at 30 min. Following a washout period, the procedure was repeated within 7 days with crossover to the opposite arm of the trial. Compared with placebo, ingestion of beetroot juice containing nitrate lowered aortic systolic BP at 30 min by 5.2 (1.9–8.5) mmHg [mean (95% confidence interval); p < 0.01]. A smaller effect on aortic systolic BP was observed at 60 min. There were minimal effects on brachial BP or cfPWV. Effects on aortic systolic BP were not sustained over the subsequent 24 h and there were no effects on other hemodynamic parameters during ambulatory monitoring. A single dose of beetroot juice containing nitrate lowers aortic BP more effectively than brachial BP in the short term, but the effects are comparatively short-lived and do not persist over the course of the same day.

Comparsion of central aortic pressure to brachial artery pressure in hypertensive patients on drug treatment: An observational study

BackgroundHigh brachial blood pressure (BP) is an important cardiovascular risk factor. However major differences in central systolic BP can occur among people with similar brachial systolic BP. It is known that central aortic pressure responses to antihypertensive therapy can differ substantially from brachial BP responses, such that true treatment effects cannot be gauged from conventional brachial BP. ObjectiveThe purpose of this study was to examine if adequate control of brachial BP was concordant with central BP control in treated hypertensive subjects. MethodsNon-invasive acquisition of brachial and central pressures and wave forms was obtained from 100 subjects with systemic arterial hypertension on drug therapy and 50 healthy individuals. After all necessary precautions according to the guidelines, brachial and central pressures and wave forms were measured 3 times at 5 min intervals using an upper arm cuff (AGEDIO K900 HDP Stolberg, Germany). The mean of the last two measurements of each was recorded as representative of brachial and central aortic pressures and wave forms. ResultsIn 45 of 50 healthy subjects with normotension (41 male, 9 female, mean age 38 years), central systolic BP was <120 mmHg. Five healthy subjects (10%) had falsely normal brachial systolic BP, but raised central systolic BP. Out of 100 patients with known hypertension and on various anti-hypertensive drug combinations, 9 had uncontrolled hypertension (defined as brachial BP of >140/90 mmHg and central systolic BP > 120 mmHg). Ninety-one patients had controlled hypertension as estimated by brachial BP of whom, 37 patients had uncontrolled central BP (systolic BP > 120 mmHg). Thus, brachial BP estimation over-estimated control of hypertension in 41% patients (p < 0.01). Central systolic BP control was inadequate in 9 out of 41 patients (22%) on angiotensin receptor blocking therapy versus 27 out of 31 (87%) patients on beta-blocking therapy (p < 0.05). Thus, there was a marked mismatch with regard to control of hypertension between central and peripheral measurements. ConclusionCentral BP measurement provides important information on true prevalence of uncontrolled hypertension in the outpatient setting which is higher than current estimates from brachial BP measurement. Optimal BP control by central BP is far less than observed from peripheral pressure measurement. Residual cardiovascular risk despite adequate control of brachial BP can also be explained by the substantial frequency of uncontrolled hypertension as determined by the central BP in patients with apparently controlled hypertension. Both these conclusions have significant impact on prevalence of uncontrolled hypertension and its proper management. Further studies are required to confirm the current data and to provide evidence that treatment decisions based on measurements of central BP result in better outcomes.

Carotid Local Pulse Wave Velocity Measurement using Dual- Element Accelerometric Patch Probe.

In this work, we demonstrate an accelerometric patch probe with two microelectromechanical accelerometer sensors for local pulse wave velocity (PWV) measurement from the carotid artery. Dual acceleration plethysmogram (APG) signals were acquired from a small section of the artery by keeping the sensors at 32 mm apart. A custom analog front-end circuit (inter-channel delay $< 0.15$ ms) was used for reliable signal acquisition. Simultaneously acquired dual APG signals were processed in real-time and local PWV was evaluated in a beat-by-beat manner. A transversal study on a cohort of 15 volunteers (4 males, 11 females, mean age = $25.6 \pm 1.92$ years) was conducted to validate the developed prototype system. During the study, carotid local PWV and brachial blood pressure (BP) parameters were recorded from both sitting and standing posture. The absolute values of measured carotid local PWV were in the range of 3 m/s - 4.2 m/s (beat-to-beat variation $=$ 2.61% - 13.07%). Measured local PWV values significantly correlated with brachial systolic BP ($\textbf{R}^{\mathbf {2}} =$ 0.87) and diastolic BP ($\textbf{R}_{\mathbf {\, }}^{\mathbf {2}} \quad =$ 0.79). Logarithmic functions provided the best monotonic model for carotid local PWV versus brachial BP parameters for the recorded data points. The developed population-specific mathematical models were then used for cuffless evaluation of BP parameters from carotid local PWV. The root-mean-square error in the estimated systolic and diastolic pressure was 7.53 mmHg and 6.0 mmHg respectively. Study results illustrate the potential application of the developed dual-accelerometric system in non-invasive, continuous cuffless BP measurement techniques.

Central and cerebral haemodynamic changes after antihypertensive therapy in ischaemic stroke patients: A double-blind randomised trial

Central and cerebral haemodynamic parameters can vary under similar brachial blood pressure (BP). We aimed to investigate the effects of antihypertensive agents on central and cerebral haemodynamic parameters in hypertensive patients with ischaemic stroke. The Fimasartan, Atenolol, and Valsartan On haemodynamic paRameters (FAVOR) study was conducted in a prospective, double-blinded manner. One hundred five patients were randomly administered atenolol, valsartan, or fimasartan during 12 weeks. We measured brachial, central, cerebral haemodynamic parameters and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels at baseline and after 12-week. Baseline haemodynamic parameters were balanced among the three groups. Even with similar brachial BP reduction, significantly lower central systolic BP (atenolol; 146.5 ± 18.8 vs. valsartan; 133.5 ± 20.7 vs. fimasartan; 133.6 ± 19.8 mmHg, p = 0.017) and augmentation index values (89.8 ± 13.2 vs. 80.6 ± 9.2 vs. 79.2 ± 11.6%; p = 0.001) were seen in the angiotensin receptor blockers (ARBs) groups. The pulsatility index on transcranial Doppler was significantly reduced in valsartan (p = 0.002) and fimasartan group (p = 0.008). Plasma NT-proBNP level was also significantly decreased in ARB groups, especially for the fimasartan group (37.8 ± 50.6 vs. 29.2 ± 36.9 vs.19.2 ± 27.8 pg/mL; p = 0.006). These findings suggest that short-term ARB administration would be favourable for ischaemic stroke patients with hypertension, permitting effective reduction of central pressure and dampening of cerebral pulsatility.

Acupuncture therapy improves vascular hemodynamics and stiffness in middle-age hypertensive individuals

Acupuncture (ACU) is becoming a more common practice among hypertensive individuals. However, the reported therapeutic effects of ACU in lowering brachial blood pressure (BP) are ambiguous. Therefore, evaluating more sensitive markers of arterial functioning might unveil the protective effects of ACU on hypertension. We examined the effects of an 8-week ACU therapy intervention on vascular hemodynamics and stiffness in middle-age hypertensive individuals. Participants were randomly assigned to either ACU (n = 23) or a control group (n = 22). Brachial and aortic BP, wave reflection (AIx) and arterial stiffness (SI) were measured before and after 8 weeks. There was a significant group x time interaction (P < 0.05) for brachial and aortic BP, AIx and SI which significantly decreased (P < 0.05) following ACU but not after control. ACU led to reductions in brachial and aortic BP, wave reflection and arterial stiffness in middle-age hypertensive individuals. ACU might be effective in the prevention and treatment of hypertension.

Hypertensive target organ damage is better associated with central than brachial blood pressure: The Northern Shanghai Study.

To compare central and brachial blood pressure (BP) in the association of target organ damage (TOD) in a community-based elderly population, 1599 (aged 71.4±6.1years) participants in northern Shanghai were recruited. TOD included left ventricular hypertrophy (n=1556), left ventricular diastolic dysfunction (n=1524), carotid plaque (n=1558), arteriosclerosis (n=1485), and microalbuminuria (n=1516). Both central and brachial BP significantly correlated with TOD. In full-model regression, central BP was significantly associated with all TOD (P≤.04), whereas brachial BP was only significantly associated with left ventricular hypertrophy and arteriosclerosis (P≤.01). Similarly, in stepwise regression, central BP was significantly associated with left ventricular hypertrophy, left ventricular diastolic dysfunction, arteriosclerosis, and microalbuminuria (P≤.04), while brachial BP was not associated with any TOD. Receiver operating characteristic analyses indicated that central BP identified arteriosclerosis and microalbuminuria better than brachial BP (P≤.01). In conclusion, central BP showed superiority over brachial BP in the association of hypertensive TOD in a community-based elderly population.