Brachial Pulse Pressure Research Articles

Variable association of 24-h peripheral and central hemodynamics and stiffness with hypertension-mediated organ damage: the VASOTENS Registry.

In this analysis of the telehealth-based Vascular health ASsessment Of The hypertENSive patients Registry, we checked how 24-h central and peripheral hemodynamics compare with hypertension-mediated organ damage (HMOD). In 646 hypertensive patients (mean age 52 ± 16 years, 54% males, 65% treated) we obtained ambulatory brachial and central SBP and pulse pressure (PP), SBP, and PP variability, pulse wave velocity and augmentation index with a validated cuff-based technology. HMOD was defined by an increased left ventricular mass index (cardiac damage, evaluated in 482 patients), an increased intima-media thickness (vascular damage, n = 368), or a decreased estimated glomerular filtration rate or increased urine albumin excretion (renal damage, n = 388). Ambulatory SBP and PPs were significantly associated with cardiac damage: the largest odds ratio was observed for 24-h central SBP [1.032 (1.012, 1.051), P = 0.001] and PP [1.042 (1.015, 1.069), P = 0.002], the weakest for brachial estimates. The association was less strong for vascular damage with a trend to the superiority of 24-h central [1.036 (0.997, 1.076), P = 0.070] over brachial PP [1.031 (1.000, 1.062), P = 0.052]. No statistically significant association was observed for renal damage. SBP and PP variabilities, pulse wave velocity and augmentation index were not associated with any form of HMOD. In the multivariate analysis, age was associated with any type of HMOD, whereas central SBP and PP were predictive of an increased risk of cardiac damage. In hypertensive patients a variable association exists between peripheral and central hemodynamics and various types of HMOD, with the most predictive power being observed for central SBP and PP for cardiac damage.

The Relation between Immune Cell Mitochondrial Respiration and Brachial Artery Pulse Pressure in Humans

Elevated pulse pressure (PP) occurs with advancing age due to stiffening of the elastic arteries and is an important risk factor for cardiovascular disease (CVD), even among normotensive adults. Mitochondrial function declines with aging and may contribute to the increase in PP through a mechanism involving oxidative stress and chronic inflammation; two important hallmarks of arterial aging. Emerging evidence indicates that mitochondrial respiration in peripheral blood mononuclear cells (PBMCs) is negatively associated with risk factors for CVD in heart failure; however, the role of impaired mitochondrial function on cardiovascular function in healthy adults is not known. We hypothesized that mitochondrial function would be negatively associated with brachial PP. Twenty‐two healthy adults free of overt CVD (12 M/10 F; age: 56 ± 21 years; age range: 22–78 years; blood pressure, BP: 123 ± 15/72 ± 10 mmHg; PP: 51 ± 11 mmHg) were included in this analysis. PP was determined from brachial artery BP assessed in triplicate in the non‐dominant arm using an automated BP monitor. PBMCs were isolated by density dependent centrifugation and used to assess mitochondrial function by respirometry using an Agilent Seahorse XFp Analyzer. Primary outcome measures included the oxygen consumption rate (OCR) at baseline (basal respiration; BASERESP) and following three serial injections of oligomycin, FCCP and rotenone/antimycin A into the respirometer to determine maximal respiration (MAXRESP). Spare respiratory capacity (SRC), an indicator of how well the cell can respond to an increased energetic demand, ATP‐linked oxygen consumption (ATPO2), and coupling efficiency, which is how well ATPO2 is matched to BASERESP, were also measured. The associations between mitochondrial function and PP were analyzed using multi‐linear regressions correcting for age. PP was not associated with BASERESP (p=0.89, R2=0.10, β=0.01), coupling efficiency (p=0.20, R2=0.18, β= −8.5), or ATPO2 (p=0.33, R2=0.15, β= −0.10). However, PP was inversely associated with MAXRESP (p=0.05, R2=0.28, β= − 0.03) and SRC (PP; p=0.02, R2=0.33, β=−0.04). These data suggest that the impaired mitochondrial respiration may be an important contributor to CVD risk through increases in pulse pressure. Future studies should explore whether these associations are mediated by increases in oxidative stress and inflammatory cytokines.Support or Funding InformationFunding Sources: P20GM113125, K01AG054731

Sex Differences in Education and Cerebrovascular Contributions to Cognitive Aging

IntroductionAlzheimer’s disease (AD) manifests through complex interactions of modifiable (blood pressure, education) and non‐modifiable (age, female sex) risk factors. While women are initially protected against cognitive decline, they are diagnosed with AD at more advanced disease states compared with men however, the mechanism by which this occurs remains unclear. Recently, we demonstrated that education attenuates the adverse effects of vascular pulse pressure (PP), a novel risk factor for cerebrovascular dysfunction in AD, on cognitive performance but this relation differed by sex. Cerebrovascular dysfunction uncouples cerebral blood flow (CBF) supply from metabolic demand contributing to acidosis and lower cognition in AD. Therefore, we explored differences in the contribution of education, PP and cerebrovascular dysfunction on cognitive performance in older adults stratified by sex. We hypothesized that 1) education would differentially moderate the relation between PP and global cognition; 2) relations between lower global cognitive performance, CBF dysfunction, cerebral acidosis and amyloid deposition would differ in men and women without AD.MethodsIn the entire cohort, brachial PP and global cognitive performance (RBANS Total Scale Score) were measured in 113 adults (50–84 years, 50% female). In a subset, CBF ([15O]water PET imaging, n=27), amyloid deposition (Pittsburgh Compound‐B, n=24) and cerebral pH (T1rho MRI, n=19) were measured. Global CBF was quantified under basal and memory recall of a learned word list to calculate the absolute change in CBF between memory and basal conditions (ΔCBF). Global cerebrovascular reserve (CVR%) to a pharmacological stimulus (acetazolamide) was measured as an index of cerebrovascular function independent of neuronal activity.ResultsIn the entire cohort, global cognitive performance was one standard deviation lower in men compared with women (p=0.01) despite no differences in education (p=0.11). Education attenuated the detrimental effects of PP (education*PP, B=0.06±0.02, p=0.01, F=11.3, p<0.001, R2=0.53) on global cognitive performance in men only. In the subset, CVR% was higher in women compared with men (50±6 vs. 25±3%, p<0.001); however, basal CBF, ΔCBF, brain pH and amyloid burden did not differ by sex (p>0.39). Higher PP was associated with lower CVR% in men (r= −0.70, p=0.001, covariate: age) but not women (r=0.40, p=0.29). CVR% was correlated with a greater increase in CBF during the memory condition (ΔCBF) in women (r=0.75, p=0.01, age) but not men (r=0.39, p=0.49). A larger reduction in CBF during the memory condition (ΔCBF) was associated with elevated cerebral acidosis in men (r=‐0.80, p=0.01, age) but not women (r= −0.48, p=0.19). Finally, higher RBANs performance was correlated with a greater ΔCBF in response to the memory stimulus in women (r=0.83, p=0.02, education) but not men (r=0.34, p=0.31).ConclusionEducation moderates the effects of PP on cognitive performance in men only. However, greater cerebrovascular responsiveness to a pharmacological or memory stimulus is associated with higher cognitive performance in women only. These data suggest mechanisms contributing to cognitive decline may differ between men and women.Support or Funding InformationNIH1R03AG047306, 1S10OD025025‐01

Brachial pulse pressure is associated with the presence and extent of coronary artery disease in stable angina patients: a cross-sectional study

BackgroundPrevious epidemiological evidence has identified many risk factors for coronary artery disease (CAD). Pulse pressure (PP) was reported to be associated with CAD. However, more attention was paid to aortic PP than to brachial PP. This cross-sectional study aimed to investigate the direct relationship between brachial PP and the presence and extent of CAD in stable angina patients.MethodsWe recruited a total of 1118 consecutive patients with stable chest pain suspected of CAD. After screening with exclusion criteria, 654 patients were finally included in our study. Every patient underwent both blood pressure measurement and selective coronary angiography. Univariate and multivariate analysis were performed to analyze the association between PP and the presence and extent of CAD.ResultsThis study revealed that brachial PP was an independent correlate of multivessel CAD. In multivariate generalized linear regression model, increasing brachial PP (per 1 mmHg) were associated with the increased number of diseased vessels (β = 0.01, SE = 0.00, P < 0.0001). Binary logistic regression analysis further confirmed this association. The risk of multivessel CAD increased significantly in patients with brachial PP ≥ 60 mmHg (OR = 1.69, 95% CI = 1.14–2.48, P = 0.0084) and as per 1 mmHg increased in brachial PP (OR = 1.02, 95% CI = 1.01–1.03, P = 0.0002), independent of age, gender, body mass index (BMI), smoking, diabetes, hypercholesterolemia and creatinine (Cr). This association was still of statistical significance in subgroup analysis of hypertension and diabetes.ConclusionIncreasing brachial PP was significantly and independently associated with increased risk of multivessel coronary disease in stable angina patients. The association of brachial PP with CAD was more pronounced in hypertension group than in non-hypertension one.

Increased Aortic Characteristic Impedance Explains Relations Between Urinary Na+/K+ and Pulse or Systolic Blood Pressure.

Alterations in sodium (Na+) relative to potassium (K+) intake increase systolic blood pressure, effects in-part attributed to enhanced pulsatile loads (pulse pressure) beyond steady-state pressures (mean arterial pressure). Whether this effect is through reversible changes (increases in blood volume and hence aortic flow [Q] or wave reflection [Pb]), or potentially irreversible structural changes in the proximal aorta, is unknown. In 581 black South Africans, we determined 24-hour urinary Na+ and K+ excretion and aortic function from central aortic pressure (radial pulse wave analysis [SphygmoCor software]), velocity, and diameter measurements. Proximal aortic function was assessed from characteristic impedance (Zc). Beyond mean arterial pressure and additional confounders, urinary Na+/K+ was independently associated with Zc (P<0.005) but not peak aortic Q (P=0.30) or alternative aspects of Q or ejection volume. Although age was strongly associated with proximal aortic diameter, no independent relations between urinary Na+/K+ and aortic diameter were noted (P=0.17). Relations between urinary Na+/K+ and Zc translated into independent relations with early systolic compression wave pressures (QxZc [PQxZc]) and aortic forward wave pressures but not Pb. Moreover, neither reflected wave magnitude (P=0.92) nor aortic pulse wave velocity were independently associated with urinary Na+/K+. In product of coefficient mediation analysis, the independent relations between urinary Na+/K+ and peak aortic or brachial pulse pressure or systolic blood pressure were accounted for by Zc and PQxZc. In conclusion, abnormalities in Na+/K+ intake determine pulse pressure or systolic blood pressure beyond mean arterial pressure mainly through potentially irreversible impacts on proximal aortic impedance rather than readily modifiable increases in aortic flow (blood volume) or wave reflection.

Arterial Stiffness and Blood Pressure in Patients Newly Diagnosed with Graves’ Disease Compared with Euthyroid Controls

Introduction and Objective: The excess cardiovascular morbidity and mortality in hyperthyroidism and Graves’ disease (GD) is inadequately understood. We aimed to elucidate whether well-established cardiovascular risk factors such as arterial stiffness in terms of pulse wave velocity (PWV) and blood pressure differ in GD and controls. Methods: This was a cross-sectional study comparing 55 hyperthyroid patients with newly diagnosed GD and 55 euthyroid, population-based controls matched for age, sex and menopausal status. PWV and blood pressure were measured in office (SphygmoCor Xcel) and 24-h ambulatory settings (Arteriograph). Differences between groups were assessed using adjusted linear regression analysis. Results: Compared to controls, GD patients showed higher PWV in the 24-h but not in the office setting with an adjusted 24-h PWV difference of 1.0 (95% CI: 0.6–1.5) m/s. PWV was higher in GD at both day and night, and nightly PWV dipping was lower (–5.5, 95% CI: –10.4 to –0.6%). Furthermore, central and brachial pulse pressure was significantly higher in both the office and 24-h setting, whereas nightly central pulse pressure dipping was significantly lower in GD (–5.4, 95% CI: –10.5 to –0.2%). Mean arterial pressure did not differ between the groups. Conclusions: Despite comparable blood pressure, GD is associated with a higher 24-h PWV that was not detected in the office setting. Pulse pressure was higher in GD, whereas mean arterial pressure did not differ between the groups. Longitudinal studies should pursue whether higher PWV might be a piece to the puzzle of understanding the increased risk of cardiovascular disease in hyperthyroidism and GD.

Abstract TP485: Aortic Stiffness Detrimental Effect in Brain Blood Flow Autoregulation

Background: Cerebral hemodynamic dysfunction is associated with brain small artery disease and poorer cognition. With aging, systemic arteries stiffen, magnifying the spread of pulsatility to distal organs. The brain is especially susceptible to pulsatility due to low impedance to flow. Increased pulsatility causes abnormal brain arteriolar remodeling in animal models. Therefore, we hypothesize that measures of aortic stiffness relate to poorer cerebral autoregulation, an in-vivo measure of arteriolar function. Methods: We recruited participants in the Washington Heights-Inwood Community Aging Project for this study. For autoregulation, both middle cerebral arteries were insonated at a depth of 50-58 mm. End-tidal CO2 (EtCO2) was measured continuously with a facemask. After ten minutes of baseline recording, a mixture of air enriched with 5% CO2 was administered through the facemask for 2 minutes. Cerebrovascular reactivity was calculated as % change in mean CBFV (mCBFV) per 1 mm increase in mean EtCO2 during CO2 inhalation. We averaged the right and left CO2 reactivity percentage. For aortic stiffness, we acquired carotid-femoral pulse wave velocity (cfPWV) with non-invasive oscillometry using the Vicorder system (Skidmore Medical Limited, Bristol, UK). We used generalized linear model to obtain beta estimates of the association between CO2 reactivity and cfPWV. Results: We included 158 participants (mean age 77±6.4 years, 67% women, 40% non-Hispanic black, 38% non-Hispanic white, and 20% Hispanic). Hypertension was present in 54% of the participants. cfPWV was associated with poorer CO2 reactivity (B=-0.038, P=0.047), independent of age, sex, ethnicity, and hypertension. Brachial pulse pressure (B=0.007, P=0.38) and mean arterial pressure (B=-0.017, P=0.21) were not associated with CO2 reactivity, and adding brachial pulse pressure and mean arterial pressure to the adjusted model did not change the association between cfPWV and poorer CO2 reactivity. Conclusions: Aortic stiffness is associated with poorer CO2 reactivity independent of traditional measures of hypertension, a marker of cerebral autoregulation and arteriolar health. Poorer CO2 reactivity may mediate the reported effects of aortic stiffness on brain outcomes.

Aortic stiffness is not only associated with structural but also functional parameters of retinal microcirculation

ObjectiveThe aim of the study was to test the hypothesis that alterations in large arteries are associated with microvascular remodelling and decreased retinal capillary blood flow. MethodsThe study group comprised of 88 patients with essential hypertension and 32 healthy controls. Retinal microcirculation was evaluated by scanning laser Doppler flowmetry. Macrovascular changes were assessed on the basis of arterial stiffness measurement (carotid-femoral pulse wave velocity), its hemodynamic consequences (central pulse pressure, augmentation pressure, augmentation index) and intima media thickness of common carotid artery. ResultsPulse wave velocity was inversely correlated to mean retinal capillary blood flow in hypertensive patients (R = −0.32, p < 0.01). This relationship remained significant in multivariate regression analysis after adjustment for age, sex, central systolic blood pressure (BP) and body mass index (β = −31.27, p < 0.001). Lumen diameter (LD) of retinal arterioles was significantly smaller in hypertensive then normotensive subjects (79.4 vs. 83.8, p = 0.03). Central and brachial systolic, diastolic and mean BPs were significantly correlated with LD and outer diameter of retinal arterioles. The relationship between LD and central BPs remained significant in multivariate analysis (β = −0.15, p = 0.03 for cSBP; β = −0.22, p = 0.04 for cDBP; β = −0.21, p = 0.03 for cMBP). Moreover, in a subgroup with cardiac damage central and brachial pulse pressure were positively associated with retinal wall thickness, wall cross sectional area, and wall to lumen ratio. ConclusionIn conclusion, the study provides a strong evidence that microcirculation is coupled with macrocirculation not only in terms of structural but also functional parameters.

The Role of Arterial Stiffness and Central Hemodynamics in Heart Failure.

Whereas traditional understanding of left ventricular afterload was focused on a steady-state circulation model with continuous pressures and flow, a more realistic concept is emerging, taking the pulsatile nature of the heart and the arterial system into account. The most simple measure of pulsatility is brachial pulse pressure, representing the pulsatility fluctuating around the mean blood pressure level. Brachial pulse pressure is widely available, fundamentally associated with the development and treatment of heart failure (HF), but its analysis is often confounded in patients with established HF. The next step of analysis consists of arterial stiffness, central (rather than brachial) pressures, and of wave reflections. The latter are closely related to left ventricular late systolic afterload, ventricular remodeling, diastolic dysfunction, exercise capacity, and, in the long term, the risk of new-onset HF. Wave reflection may also evolve as a suitable therapeutic target for HF with preserved and reduced ejection fraction. A full understanding of ventricular-arterial coupling, however, requires dedicated analysis of time-resolved pressure and flow signals. This review provides a summary of current understanding of pulsatile hemodynamics in HF.

P1601 Relationship between aortic distensibility and aortic regurgitation assessed by CMR in bicuspid valve patients

Abstract Funding Acknowledgements Spanish Ministry of Economy and Competitiveness RTC-2016-5152-1, ISCIII PI17/00381, La Marató de TV3 (20151330), Eur FP7/People 267128 and CIBERCV BACKGROUND The severity of aortic regurgitation can be evaluated with cardiac magnetic resonance (CMR) through calculation of regurgitant fraction (RF) in phase contrast sequences acquired at the aortic root (as close as possible to the aortic valve). However, the impact of aortic distensibility in this evaluation remains unkown. PURPOSE The aim of the study was to evaluate the relation between aortic distensibility and RF valve in bicuspid aortic valve patients. METHODS We enrolled bicuspid aortic valve patients without significant aortic stenosis (maximum velocity &amp;lt;2.5 m/s) and connective tissue disease. All patients underwent a CMR study with phase contrast sequences for evaluation of regurgitant fraction at the level of the aortic valve. Aortic regurgitation was considered as mild, moderate or severe depending on RF value (mild &amp;lt;15%; moderate 15-30%; severe &amp;gt;30%). Furthermore we used cine-sequences of aortic root, ascending and proximal descending aorta to estimate aortic diameters and distensibilities, using Art Fun software. Distensibility was calculated as (change in aortic area between systole and diastole/diastolic area)/brachial pulse pressure. RESULTS A total of 98 bicuspid aortic valve patients were included (30% female, 49.7 ± 14.5 years). 75 (76,5%) AR was mild, 17 (17,4%) moderate and 6 (6,1%) severe. RF valvewas significantly correlated with aortic root diameter (r= 0.430 y p &amp;lt; 0.001 )and aortic distensibility at the level of the ascending (r = 0.273 p =0.016) and descending aorta (r = 0.502 and p&amp;lt; 0.001). Aortic distensibility was positively correlated with RFvalve even after adjustment for aortic diameter ( p = 0.002 and p &amp;lt;0.001 respectively) . (Table) (IMG) CONCLUSIONS In our study, aortic regurgitation in bicuspid valve patients, evaluated by CMR using RF valve, is related to aortic distensibility. Thus, aortic distensibility should be included in the evaluation of aortic regurgitation by CMR as additional parameter. However, longitudinal studies are needed to evaluate the impact of including aortic distensibility in the evaluation of AR severity by CMR. AR SEVERITY MILD MODERATE SEVERE Descending aorta distensibility(mean ± std. deviation) 2693,68 ± 997,5 3285,8 ±1952,7 5042,99 ±2873,44 Correlation between AR severity (by RFvalve) and descending aorta distensibility Abstract P1601 Figure.

Relationship between Brachial pulse pressure index and subclinical atherosclerosis among susceptible individuals

Background: Atherosclerosis develops gradually with a subclinical change in arterial elasticity. Pulse pressure index (PPI) (i.e. pulse pressure/systolic blood pressure) could be a predictive parameter of decreased arterial compliance. Objective: This study aimed to evaluate whether brachial PPI (BPPI) is an independent predictor for increased Carotid intima-media thickness (CIMT), and additionally, whether BPPI is superior to brachial pulse pressure (BPP) in the prediction of subclinical atherosclerosis. Methods: In this cross-sectional study, 115 patients, aged 40-60 years, who attended Minia University Hospital Medical units, were recruited. Subjects who had a history of coronary heart disease or stroke or were prescribed to drugs that could affect blood pressure on the day of the study were excluded. CIMT at a cut-off value of > 0.9 mm was used as a reference measure. Results: The mean values of BPPI and BPP were 0.37±0.06 and 49.17±12.59, respectively. Subjects with BPPI ≥ 0.36 (median value) had higher CIMT (0.81±0.15 versus 0.72±0.14) compared to those with BPPI 0.9 mm were 0.702 (p <0.001) and 0.598 (p =0.001), respectively. Conclusion: BPPI is a valuable predictive tool for subclinical atherosclerosis with higher predictive accuracy compared to BPP.

Association Between Central Blood Pressure and Subclinical Cerebrovascular Disease in Older Adults.

Elevated blood pressure (BP) level is one of the most consistently identified risk factors for silent brain disease. BP values obtained at the proximal segment of the aorta (central BP) are more directly involved than brachial BP in the pathogenesis of cardiovascular disease. However, the association between central BP and silent cerebrovascular disease has not been clearly established. Participants in the CABL (Cardiovascular Abnormalities and Brain Lesions) study (n=993; mean age, 71.7±9.3 years; 37.9% men) underwent 2-dimensional echocardiography, arterial wave reflection analysis for determination of central BPs, and brain magnetic resonance imaging. Central BPs were calculated from the radial pulse waveform. Subclinical silent cerebrovascular disease was defined as silent brain infarction and white matter hyperintensity volume. Both brachial (P=0.014) and central pulse pressure (P=0.026) were independently associated with silent brain infarctions after adjustment for clinical variables, but not adjusting for each other. None of the brachial BP values was associated with upper quartile of white matter hyperintensity volume in multivariable analysis. Both central systolic BP (P<0.001) and central pulse pressure (P<0.001) were significantly associated with upper quartile of white matter hyperintensity volume in multivariable analysis, even after adjustment for brachial BP. In a predominantly older population-based cohort, both brachial and central pulse pressure were independently associated with silent brain infarction. However, higher central systolic BP and central pulse pressure, but not brachial BP, were significantly associated with white matter hyperintensity volume.

Plasminogen activator inhibitor-1 activity and the 4G/5G polymorphism are prospectively associated with blood pressure and hypertension status.

Plasminogen activator inhibitor-1 (PAI-1) has consistently shown positive associations with blood pressure (BP). Whether elevations in PAI-1 levels precede or result from raised BP is still under debate and data on prospective studies are limited. Hence, we investigated the prospective associations of PAI-1 and the 4G/5G polymorphism with brachial and central BP and pulse pressure (PP) over a 10-year period. Black South Africans aged 30 years and older were included. Baseline data collection commenced in 2005 (n = 2010) with follow-up data collection in 2010 (n = 1288) and 2015 (n = 926). Plasma PAI-1 activity (PAI-1act), 4G/5G polymorphism genotyping, waist circumference and BP measurements were performed and analysed using sequential regression and mixed models. In multivariable adjusted analyses, PAI-1act and the 4G/4G (vs. the 5G/5G) genotype increased the odds of developing hypertension in the total group [1.04 (1.01; 1.08) and 1.82 (1.07; 3.12) respectively]. Furthermore, PAI-1act was prospectively associated with brachial SBP (r = 0.0815) and PP (r = 0.0832) in the total group, and with central PP in women (r = 0.1125; all P < 0.05). Addition of waist circumference to the models either decreased or nullified the contribution of PAI-1act to BP and hypertension development. PAI-1act and the 4G/4G (vs. the 5G/5G) genotype increased the odds of developing hypertension. Furthermore, PAI-1act associated prospectively with both brachial and central BP. These associations were mediated in part by central adiposity. The study supports the hypothesis that PAI-1 also contributes to hypertension development rather than solely being a consequence thereof.

Brachial pulse pressure in acute heart failure. Results of the Heart Failure Registry.

AimsTo investigate the still uncertain independent prognostic impact of pulse pressure (PP) in acute heart failure (HF), in particular across the left ventricular ejection fraction (EF) phenotypes, and the potential contribution of PP in outlining the individual phenotypes.Methods and resultsWe prospectively evaluated 1‐year death and rehospitalization in 4314 patients admitted for acute HF grouped by EF and stratified by their PP level on admission. In HF with reduced (< 40%) EF (HFrEF), the highest quartiles of PP had the lowest unadjusted [hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.61–0.98] and adjusted (HR 0.64 0.50–0.82) risk of 1 year all cause death compared to the lowest quartile. Its prognostic impact was partially mediated by systolic blood pressure (SBP). In HF with preserved (≥ 50%) EF (HFpEF), the intermediate quartile of PP showed the lowest 1 year all cause mortality in unadjusted (HR 0.598, CI 0.416–0.858) and adjusted (HR 0.55, 95% CI 0.388‐0.801) models with no relationship with SBP. In a receiver operating characteristic analysis, a combination of PP > 60 mmHg and SBP > 140 mmHg was associated to a preserved EF with a high performance value. No prognostic significance of PP was found in the HF with mid‐range EF subgroup.ConclusionsIn acute HFrEF, there is an almost linear inverse relation between mortality and PP, partly mediated by SBP. In HFpEF, a J‐shaped relationship between mortality and PP was present with a better prognosis at the nadir. A combination of PP > 60 mmHg with SBP > 140 mmHg may be clinically helpful as marker of a preserved left ventricular EF.

6070Association of blood pressure measures with brain structure and function: the Southall and Brent REvisited (SABRE) study

Abstract Background In our rapidly ageing society, dementia and neurocognitive decline are significant global public health problems. Blood pressure (BP), an established cardiovascular risk factor, has been extensively studied with respect to brain structure and function; however, findings across the literature differ depending on the BP component in consideration, and the use of brachial rather than central BP. Purpose We set out to assess associations between detailed measures of brain structure and function with comprehensive measures of central and peripheral BP. Furthermore, we performed comprehensive mediation analyses on the associations to investigate potential micro and macro vascular mediatory pathways. Methods A community-based sample of 1438 individuals (69.7±6.2 years) from a tri-ethnic cohort. underwent vascular, cognitive and MRI based structural brain measures. BP measures included central (cSBP (Pulsecor)) and peripheral systolic BP (pSBP), diastolic BP (DBP), brachial (bPP) and central pulse pressure (cPP), and mean arterial pressure (MAP). Cognitive assessments comprised tests which explored global/overall function (CSID), executive function and memory. For brain structure, hippocampal brain volume was our key measure. Potential macro- and microvascular mediators included: arterial stiffness (cfPWV), carotid intima-media thickness, retinopathy, white matter hyperintensities and infarcts. Multivariable regression analyses were used to assess associations of BP components with cognitive function scores and brain volumes, adjusted for age, sex and ethnicity as well as macro- and microvascular risk factors. Multiple imputation was performed to account for missing data. Results After adjusting for age, sex and ethnicity, both cSBP and pSBP were negatively associated with memory (data are β±SE (z-score) −0.014±0.006, p=0.04), while DBP was positively associated with hippocampal volume (0.006±0.003, p=0.03). cPP was negatively associated with memory (−0.020±0.009, p=0.03), executive function (−0.018±0.006, p=0.002) and hippocampal volume (−0.007±0.003, p=0.005), while bPP was negatively associated with CSID (−0.008±0.004, p=0.04), memory (−0.020±0.008, p=0.02), executive function (−0.016±0.005, p=0.002) and hippocampal volume (−0.006±0.002, p=0.007). There was a stronger association between both PP measures and brain structure and function than with the other BP components, especially MAP. There was little difference in association between cPP and bPP measures with brain structure and function. Furthermore, these associations do not appear to be mediated by either macro- or microvascular disease. Conclusion These results suggest that there is a direct association between increased PP and a decline in brain structure and function. This implies that older patients with suboptimal PP control may be at increased risk of developing cognitive impairment and that measuring PP offers mechanistic information above and beyond conventional BP measures. Acknowledgement/Funding Wellcome Trust, British Heart Foundation

Deterioration of sexual function is associated with central hemodynamics in adult Japanese men.

Elevated aortic blood pressure is more strongly related to the onset of cardiovascular disease (CVD) than elevated brachial blood pressure. On the other hand, erectile dysfunction (ED) is a peripheral vascular disfunction and is also associated with CVD; however, the association between aortic blood pressure and ED has not yet been clarified. Therefore, we aimed to investigate the association between ED severity and aortic blood pressure in adult men. In 253 Japanese adult men (59 ± 16 years), aortic (estimated using a generalized transfer function) and peripheral hemodynamics were measured. Erectile function was assessed with a questionnaire (the International Index of Erectile Function 5: IIEF5), and participants were stratified into three groups based on the IIEF5 score (no ED, mild-to-moderate ED, and moderate-to-severe ED). Aortic systolic blood pressure (SBP) and pulse pressure (PP) were significantly higher in subjects with moderate-to-severe ED than in subjects with no ED or mild-to-moderate ED. In addition, the severity of ED was significantly associated with the time to reflection, augmentation pressure, and augmentation index. Multivariate linear regression analyses suggested that moderate-to-severe ED was significantly associated with aortic SBP and PP (β = 0.129; p = 0.047, β = 0.165; p = 0.013, respectively) but not brachial SBP or PP, after confounding factors were considered. These results suggest that moderate-to-severe ED is associated with elevated aortic blood pressure due to an earlier arrival of the reflected wave and is an independent predictor of elevated aortic blood pressure in Japanese men.

Electrocardiographic left ventricular hypertrophy in relation to peripheral and central blood pressure indices in a Nigerian population

Purpose: Previous studies that addressed whether left ventricular hypertrophy is more closely associated with central than peripheral blood pressure (BP) have been inconsistent. Radial artery wave generated by applanation tonometry and calibrated with brachial BP in 162 adult Nigerians were analysed by using generalized transfer function to derive central BP.Materials and methods: We compared the associations of ECG voltages and left ventricular hypertrophy (ECG-LVH) as continuous and binary variables respectively with central and brachial BP indices.Results: In a multivariable adjusted analysis, 1 standard deviation (SD) increase in brachial systolic, diastolic, pulse and mean arterial pressures increased the Sokolow–Lyon QRS voltage by 0.34 (CI, 0.21–0.48; p < 0.0001), 0.21 (CI, 0.07–0.36; p < 0.05); 0.22 (CI, 0.9–0.34; p < 0.001) and 0.29 (CI, 0.14–0.43) similar to (p > 0.05) corresponding Sokolow–Lyon QRS increase of 0.26 (0.12–0.40, p < 0.001); 0.14 (0.00–0.28, p < 0.05); 0.24 (0.11–0.39; p < 0.001) and 0.19 (0.05–0.34, p < 0.05) respectively observed for 1 SD increment in central pressures. The odds ratio (OR) relating ECG-LVH to 1 SD increase in brachial systolic, pulse, and mean arterial pressures were 2.62 (CI, 1.49–4.65, p < 0.001); 1.88 (CI, 1.19–2.95, p < 0.01) and 2.16 (CI, 1.22–3.82, p < 0.01) was similar to (p > 0.05) corresponding OR of 2.41 (1.33–4.36, p < 0.01); 2.04 (1.23–3.37, p < 0.01); 2.00 (1.11–3.63, p < 0.001) observed for I SD increment in central pressures.Conclusion: Central and peripheral BP are similarly associated with Sokolow–Lyon ECG voltage and hypertrophy.

AORTIC STIFFNESS IS NOT ONLY ASSOCIATED WITH STRUCTURAL BUT ALSO WITH FUNCTIONAL PARAMETERS OF MICROCIRCULATION

Objective: The aim of the study was to test the hypothesis if arterial stiffness is linked to reduction of retinal capillary blood flow and development of retinal microvascular remodelling. Design and method: The study group comprised of 88 patients with essential hypertension (n = 88, 54.3 ± 8.3 years, 44.3% were female) and 32 healthy controls. Inclusion criteria were: essential hypertension, age of 40–70 years old. Exclusion criteria were: secondary hypertension, any cardiovascular disease including heart failure, coronary artery disease, arrhythmia, moderate or severe valve disease, history of stroke or transient ischemic attack, chronic kidney disease with eGFR < 60 mml/min/1.73 m2, diabetes mellitus, eye disease, pregnancy. Retinal microcirculation was evaluated by scanning laser Doppler flowmetry. Macrovascular changes were assessed on the basis of measurement of arterial stiffness (by carotid-femoral pulse wave velocity, central pulse pressure, augmentation pressure and augmentation index) and intima media thickness of common carotid artery. Diastolic dysfunction and left ventricular hypertrophy were analysed by echocardiography. Results: Pulse wave velocity was inversely correlated with mean retinal capillary blood flow in a group of hypertensive patients (R = −0.32, p < 0.01). This relationship remained significant in multivariate regression analysis even after adjustment for age, systolic blood pressure and waist to hip ratio (β = −40.275, p < 0.001). Central pulse pressure was positively correlated with retinal wall thickness (R = 0.44, p < 0.05), wall cross sectional area (R = 0.44, p < 0.05) and wall to lumen ratio (R = 0.43, p < 0.05). Brachial pulse pressure was positively correlated with wall thickness (R = 0.43, p < 0.05), wall cross sectional area (R = 0.41, p < 0.05) and wall to lumen ratio (R = 0.47, p < 0.05). In contrast, the relationship between augmentation pressure or augmentation index and structural indicators of retinal remodelling was not observed. Conclusions: In conclusion, the study provides an evidence that microcirculation is coupled with macrocirculation not only in terms of structural but also functional parameters. Pulse wave velocity was independently associated with retinal capilary flow. Central and brachial pulse pressure were significantly related to retinal wall thickness, wall cross sectional area and wall to lumen ratio.

INCREASED PULSE PRESSURE ASSOCIATED WITH A DECLINE IN BRAIN STRUCTURE AND FUNCTION

Objective: Blood pressure (BP) has been extensively studied with respect to brain structure and function; however, findings differ depending on the BP component in consideration, and whether brachial or central BP is used. We assessed associations between detailed measures of brain structure and function with comprehensive central and peripheral BP measures. Furthermore, mediation analyses investigated potential macro- and microvascular mechanistic pathways. Design and method: 1438 individuals (69.7 ± 6.2 years) from a community-based, tri-ethnic cohort underwent vascular, cognitive and MRI-based structural brain measures. BP measures included central (cSBP (Pulsecor)), peripheral systolic BP (pSBP), diastolic BP (DBP), brachial (bPP) and central pulse pressure (cPP), and mean arterial pressure. Cognitive assessments included global function (CSID), executive function and memory. For brain structure, hippocampal volume was our key measure. Potential macro- and microvascular mediators included: pulse wave velocity (cfPWV), carotid intima-media thickness, retinopathy, white matter hyperintensities, infarcts and estimated glomerular filtration rate (eGFR). Multivariable regression analyses assessed associations of BP components with cognitive function scores and brain volumes, adjusted for age, sex and ethnicity as well as macro- and microvascular risk factors. Results: Table 1 shows associations between vascular measures and measures of brain structure and function (data are β±SE (z-score)). After adjusting for age, sex and ethnicity, cSBP and pSBP were negatively associated with memory, while DBP was positively associated with hippocampal volume. cPP was negatively associated with memory, executive function and hippocampal volume, while bPP was negatively associated with all outcome variables. The strongest association was observed between cPP/bPP and brain structure/function. Associations between cPP and bPP measures with brain structure and function were similar. cfPWV was negatively associated with hippocampal volume. Stroke, large infarct and eGFR were associated with all cognitive outcome variables. Stroke and eGFR were positively associated with hippocampal volume. Furthermore, these associations were not mediated by macro- or microvascular disease.Conclusions: These results suggest a direct association between increased PP and decline in brain structure and function, implying that older individuals with suboptimal PP control may be at increased risk of developing cognitive impairment. Measuring PP offers mechanistic information above and beyond conventional BP measures.

ISOLATED SYSTOLIC HYPERTENSION IN ADOLESCENTS AND YOUNG ADULTS

Objective: Isolated systolic hypertension in youth (ISH) is regarded as having different underlying mechanisms than in the elderly, yet the underlying pathogenetic sequel remains controversial. This study assessed the hemodynamic and vascular profile of ISH in young individuals compared to normotension and diastolic or systolic-diastolic hypertension (DH). Design and method: Apparently healthy adolescents and young adults aged 12–25 years referred for elevated blood pressure (BP) and healthy volunteers were subjected to 24-hour ambulatory monitoring of peripheral (brachial) BP (pABP), central (aortic) systolic BP (cABP), hemodynamic parameters [cardiac output (CO), stroke volume (SV), peripheral vascular resistance (PVR)] and pulse wave velocity (PWV), using a noninvasive cuff-based brachial oscillometric device (Mobil-O-Graph 24 h PWA). Pulse pressure (PP) amplification was expressed either as difference (dPPA) or ratio (rPPA) between brachial and aortic PP. Subjects were classified into BP phenotypes according to current ESH guidelines with ISH defined as 24-hour ABP >=95th/<90th percentile (or >=130/<80 mmHg) for individuals <16 years or 24-hour ABP >=130/<80 mmHg for those >=16 years. Results: 131 untreated individuals were analyzed (age 18.1 ± 4.5 years, 100 males, BMI 25.1 ± 4.9 kg/m2). Based on pABP, 22 subjects had ISH, 21 had DH and 88 were normotensives, with no differences among groups in age, gender, height and BMI. Compared with normotensives, ISH subjects had higher 24-hour systolic/diastolic pABP, mean ABP, cABP, dPPA, CO and PWV (all p<0.05), whereas there were no differences in SV, rPPA, PVR and heart rate (Table). Compared with DH subgroup, individuals with ISH had lower 24-hour systolic/diastolic pABP, mean ABP, cABP and PVR and higher dPPA (all p < 0.05), with no difference in rPPA, heart rate, CO, SV and PWV (Table).Conclusions: These data suggest that untreated ISH in young individuals seems to be associated with exaggerated amplification of an already elevated cABP together with increased arterial stiffness and hyperkinetic circulation. A clear differentiation between ISH and DH regarding the underlying mechanisms was the increased PVR in the latter.