Brachial Systolic Blood Pressure Research Articles

Age and Sex Differences in the Contribution of Mean Arterial Pressure to Pulse Pressure Before Middle Age.

A lower ability to buffer pulse pressure (PP) in the face of increasing mean arterial pressure (MAP) may underlie the disproportionate increase in systolic blood pressure (SBP) in women from young adulthood through middle-aged relative to men. To evaluate the contribution of MAP to the change in PP and pressure wave contour in men and women from young adulthood to middle age. Central pressure waveform was obtained from radial artery applanation tonometry in 312 hypertensive patients between 16 to 49 years (134 women, mean age 35 ± 9 years), 185 of whom were on antihypertensive treatment. Higher MAP levels (≥ 100 mmHg) were significantly associated with higher brachial and central SBP (P < 0.001), PP (P < 0.001), incident wave (P = 0.005), AP (P < 0.001), and PWV (P < 0.001) compared to lower MAP levels. The relationship between MAP and brachial PP (P < 0.001), central PP (P < 0.001), incident wave (P < 0.001), and AP (P < 0.01), but not PWV, strengthens with age. The age-related increase in the contribution of MAP to brachial PP (P < 0.001), central PP (P < 0.001), and incident wave (P < 0.001) was more prominent in women than in men beginning in the fourth decade. In multiple regression analyses, MAP remained a significantly stronger predictor of central PP and incident wave in women than in men, independent of age, heart rate, and antihypertensive treatment. In turn, age remained a significantly stronger predictor of central PP and incident wave in women than in men, independent of MAP, heart rate, and antihypertensive treatment. Women of reproductive age showed a steeper increase in PP with increasing MAP, despite comparable increases in arterial stiffness in both sexes. The difference was driven by a greater contribution of MAP to the forward component of the pressure wave in women.

Relationship between baroreflex sensitivity and orthostatic blood pressure increases in humans

Background: Orthostatic hypertension (OHT) is characterized by an increase in blood pressure (BP) upon standing. Although not a common condition, it is not considered rare. Autonomic dysfunction has been speculated to be a potential cause of OHT as the baroreflex is essential for maintaining homeostasis. However, the exact mechanism responsible for OHT remains unclear. Additionally, the definition of OHT varied among prior reports, and diagnostic criteria have not been firmly established. Thus, this study aims to assess differences in autonomic function in the supine and standing positions in individuals with and without elevated BP upon standing. Hypothesis: Individuals with elevated BP upon standing will have lower cardiovagal baroreflex sensitivity (CBRS) than individuals without elevated BP upon standing. Methods: This study included 90 healthy volunteers (39 ± 14 years; 21 men and 69 women). Brachial BP was measured with a cuff on an upper arm. Beat-by-beat BP with a Finometer and heart rate (HR) with ECG were measured during 10 minutes of supine rest and 10 minutes of standing. Spontaneous CBRS was calculated from the relationship between systolic BP (SBP) and R-R intervals using the sequence method. Heart rate variability (HRV) indices were also calculated. Results: Subjects were sorted into four groups based on the change in brachial SBP upon standing: Control (-5 &lt; ΔSBP &lt; 10 mmHg, n = 53), Mild (10 ≤ ΔSBP &lt; 15 mmHg, n = 22), Moderate (15 ≤ ΔSBP &lt; 20 mmHg, n = 8), and Severe (ΔSBP ≥ 20 mmHg, n = 7). There were no significant differences in age, body mass index, or sex ratio among groups (all P &gt; 0.05). Supine CBRS was significantly lower in the Severe group than in the Control group (9.8 ± 4.1 vs. 16.9 ± 9.0 ms/mmHg, P = 0.003) and the other two groups (all P &lt; 0.05). Additionally, ΔSBP was negatively correlated with supine CBRS in subjects with ΔSBP ≥ 10 mmHg (R = -0.39, P = 0.02, n = 37). Supine high-frequency (HF) power of HRV, an index of vagal activity, was also significantly lower in the Severe group than in the Control group (493 ± 503 vs. 1561 ± 2277 ms2, P = 0.006). Standing induced significant decreases in CBRS and HF power in all groups (all P &lt; 0.05). During standing, CBRS remained significantly lower in the Severe group than in the Control group (P = 0.045), but no other significant differences were observed in CBRS or HRV indices between the groups. Discussion and Conclusion: OHT is associated with adverse cardiovascular events. Our data show that supine baroreflex sensitivity and vagal tone are lower in individuals with higher (ΔSBP ≥ 20 mmHg) elevated BP upon standing. Additionally, a negative relationship was observed between CBRS and elevated SBP (ΔSBP ≥ 10 mmHg) upon standing. These findings suggest that altered or impaired autonomic function may contribute to OHT. In addition, the data support the recent consensus definition of clinical OHT (ΔSBP ≥ 20 mmHg). Further studies are warranted to examine the mechanisms in more detail. This study was supported by NIH R01 HL144781 and R01 HL141198. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Age Comparisons of Cardiac Work During Exercise in Women: Insight from Acute β1 Adrenergic Blockade

Postmenopausal women exhibit exaggerated increases in blood pressure during activities of daily living and exercise. The decreased size and increased stiffening of postmenopausal women's hearts elevate myocardial oxygen demand when compared to age-matched men and younger cohorts. Together, this poses a risk to the safety of, and capacity for, exercise in postmenopausal women. We recently studied the effects of esmolol, a fast-acting, cardio-selective β1 antagonist, on oxygen transport variables during dynamic exercise in healthy young (Y) and older (O) women to better understand differences in cardiovascular responses to exercise. Objective: Determine the effects of acute cardiac specific blockade on myocardial oxygen demand (rate pressure product, RPP) and cardiac work (CW) in healthy young premenopausal and older postmenopausal women. Methods: Thirteen healthy young (20-32 yr) and older postmenopausal (58-70 yr) women performed moderate (85% of lactate threshold) and heavy (50% between lactate threshold and the respiratory compensation point) recumbent leg cycling exercise during IV infusion of saline or esmolol in randomized order. Whole body oxygen consumption (VO2, indirect calorimetry), brachial systolic blood pressure (SBP, automated cuff), heart rate (HR, ECG), and cardiac output (CO, bioimpedance) were measured continuously. RPP (HR×SBP), CW (CO×SBP), and cardiac effciency (CE, CW/VO2) were calculated. Mixed model repeated measures ANOVAs were used to determine the effect of treatment and age group. Results: Power outputs were lower in O vs. Y at both moderate (45±9W and 72±15W, p&lt;0.001) and heavy (81±21W vs. 117±32W, p&lt;0.001) intensities. During the saline trial CO was lower (p&lt;0.001), and RPP was higher (p&lt;0.001) in the O vs. Y group during both intensities. There was a main effect of treatment on RPP, CW, and CE. Esmolol reduced RPP (4638±775 SD, p&lt;0.001), CW (547±89, p&lt;0.001) and CE (1682±62, p&lt;0.001) in both O and Y. There was a main effect of age group on CE, pairwise comparisons showed CE was lower in O than Y (441±112, p&lt;0.001). Conclusions: Older postmenopausal women experience higher myocardial oxygen demand and perform more cardiac work for a given whole body liter oxygen consumed during dynamic leg exercise compared to younger premenopausal women. Acute β1 adrenergic blockade narrows the gap between central cardiovascular function in young and old women and provides a powerful tool to investigate age-related cardiovascular differences. NIH R21 AG054940. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Sex Differences in Central Hemodynamics of Patients with Untreated Obstructive Sleep Apnea

Patients with obstructive sleep apnea (OSA) have increased risk for cardiovascular diseases. Data from the Atherosclerosis Risk in the Communities and Sleep Heart Health Study suggest that OSA is more deleterious to females versus males, although mechanistic data are lacking. Estimates of central (aortic) blood pressure (BP) are superior in predicting future cardiovascular events than traditional brachial BP measurements. While patients with OSA have altered central hemodynamics (e.g., higher aortic pulse wave velocity; PWV), potential sex differences are unexplored. We tested the hypothesis that females with OSA (n=7, 50±3yrs, 35.1±1.9kg/m2, 22.2±7.6 events/hr) have worse central hemodynamics than males with OSA (n=9, 47±3yrs, 35.0±1.4kg/m2, 31.7±6.2 events/hr). Data collection consisted of an overnight sleep study (polysomnography) to identify the presence, and characterize the severity, of OSA via the apnea-hypopnea index (AHI). Then, duplicate measures of central (aortic) and peripheral (brachial) BP, as well as central artery stiffness (PWV) and wave reflection (AIx), were made in the morning after ≥15min of quiet, supine rest. Additional hemodynamic measurements were made if data differed by ≥2% (AIx) or ≥0.5m/s (PWV). Data that met these criteria were averaged and used for analysis. Comparisons were made using two-tailed, independent samples t-tests or nonparametric Mann-Whitney Rank Sum tests, as indicated. No differences were observed in age (p=0.44), body mass index (p=0.96), nor AHI (p=1.00) between sexes. Similarly, no sex differences were observed in brachial systolic (female vs. male: 129±7 vs. 134±8mmHg, p=0.83), diastolic (77±5 vs. 85±4mmHg, p=0.26), or mean BP (96±6 vs. 101±5mmHg, p=0.45). Similarly, central systolic (122±6 vs. 125±7mmHg, p=0.96), diastolic (78±5 vs. 86±4mmHg, p=0.25), and augmentation (21±2 vs. 15±2mmHg, p=0.07) BP did not differ between sexes. Resting heart rate was also comparable between groups (67±3 vs. 65±2bpm, p=0.64). However, AIx (AIx; 42±3 vs. 35±4%) and AIx normalized to a heart rate of 75bpm (42±3 vs. 30±3%) were higher in females with OSA relative to males with OSA (p&lt;0.05 for both). Interestingly, the forward (30±3 vs. 28±2mmHg, p=0.63) and reflected (20±2 vs. 18±2mmHg, p=0.44) pulse heights, as well as PWV (7.3±0.6 vs. 7.4±0.6m/s, p=0.85), were similar between groups. Our data indicate that despite a trend towards higher BP in males with OSA (~5mmHg) that may be clinically, though not statistically different, females with OSA have a higher AIx. As AIx is positively associated with left ventricular hypertrophy, these data also suggest that altered central (aortic) hemodynamics may contribute to the sex differences in cardiovascular risk with OSA. This work was supported by the National Institutes of Health T32-HL007111 and U54AG044170 (JMB), HL065176 (PS and VKS), and HL134885 (VKS). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Differences between brachial and aortic blood pressure in adolescence and their implications for diagnosis of hypertension.

Blood pressure (BP) is the leading global cause of mortality, and its prevalence is increasing in children and adolescents. Aortic BP is lower than brachial BP in adults. We aimed to assess the extent of this difference and its impact on the diagnosis of hypertension among adolescents. We used data from 3850 participants from a UK cohort of births in the early 1990s in the Southwest of England, who attended their ∼17-year follow-up and had valid measures of brachial and aortic BP at that clinic [mean (SD) age 17.8 (0.4) years, 66% female individuals]. Data are presented as mean differences [95% prediction intervals] for both sexes. Aortic systolic BP (SBP) was lower than brachial SBP [male, -22.3 (-31.2, -13.3) mmHg; female, -17.8 (-25.5, -10.0) mmHg]. Differences between aortic and brachial diastolic BP (DBP) were minimal. Based on brachial BP measurements, 101 male individuals (6%) and 22 female individuals (1%) were classified as hypertensive. In contrast, only nine male individuals (<1%) and 14 female individuals (<1%) met the criteria for hypertension based on aortic BP, and the predictive value of brachial BP for aortic hypertension was poor (positive-predictive value = 13.8%). Participants with aortic hypertension had a higher left ventricular mass index than those with brachial hypertension. Brachial BP substantially overestimates aortic BP in adolescents because of marked aortic-to-brachial pulse pressure amplification. The use of brachial BP measurement may result in an overdiagnosis of hypertension during screening in adolescence.

A Practical Approach for Ischemic Preconditioning Intervention in Sports: A Pilot Study for Cuff Thigh Occlusion Pressure Estimation Based on Systolic Blood Pressure.

For the ischemic preconditioning (IPC) intervention, the accuracy of the protocol is paramount for mediating its possible ergogenic effects. However, the lack of standardization and widespread use of arbitrary cuff pressures (ranging from 130 to >300 mmHg) have been predominantly observed, potentially affecting the results and compromising the reproducibility of findings. Thus, the purpose of this study was to determine an appropriate cuff pressure during IPC. Seventeen healthy male participants were enrolled in the study. Anthropometric measurements were initially conducted, followed by systolic and diastolic blood pressure measurements. Subsequently, we determined the individual thigh occlusion pressure (TOP) for the right leg using a hand-held Doppler device. Based on these findings, we developed an estimation equation for TOP, considering the current brachial systolic blood pressure (SBP) values. We then conducted a retrospective analysis of its capacity to mediate occlusion. We observed the ability to estimate TOP using the equation (p = 0.01; ES: 0.86), presenting ~6% superiority in absolute values for occlusion compared to direct measurement (TOP equation: 169.9 ± 9.1; TOP direct measured: 161.2 ± 11.1). However, TOP estimation was insufficient to produce complete occlusion in two out of 17 subjects (11.8%). In conclusion, the estimation of TOP incorporating SBP values may offer a valid and practical means for cuff administration during IPC protocols with potential to minimize adverse effects and maximize its positive effects.

Endothelial dysfunction influences augmented aortic hemodynamic responses to metaboreflex activation in postmenopausal women.

Postmenopausal women experience augmented aortic hemodynamic responses to isometric handgrip (IHG) exercise and metaboreflex activation post-exercise muscle ischemia (PEMI). Relationships between endothelial function brachial artery flow-mediated dilation (FMD) and aortic stiffness carotid-femoral pulse wave velocity (cfPWV) with aortic pulsatile hemodynamics during IHG and PEMI have not been determined. The relationships between aortic hemodynamic responses to PEMI were evaluated. Aortic blood pressure (BP), wave reflection, and pressure of forward (Pf) and backward (Pb) waves were measured using arterial tonometry at rest, IHG at 30% maximal force, and PEMI in 30 (15/group) postmenopausal women with low (≤ 4.5%) and normal (≥ 5.5%) FMD. Hemodynamic responses were analyzed as the change (Δ) from rest to the last minute of IHG and PEMI. Brachial and aortic systolic BP (SBP) responses to IHG were higher in the low vs normal FMD group (P < 0.05). Aortic SBP (Δ20 ± 8 vs Δ11 ± 7mmHg), pulse pressure (PP) (Δ12 ± 8 vs Δ6 ± 4mmHg), augmented pressure (AP) (Δ5 ± 3 vs Δ2 ± 2mmHg), and Pb (Δ6 ± 4 vs Δ3 ± 2mmHg) responses to PEMI were greater (P < 0.05) in women with low vs. normal FMD. FMD was negatively correlated with aortic SBP, PP, AP, and Pb (P < 0.05) responses to PEMI. cfPWV was not correlated with responses to PEMI. Endothelial dysfunction relates to augmented aortic pulsatile load during metaboreflex activation, which may increase cardiovascular risk in postmenopausal women.

Impact of cardiac rehabilitation on ventricular-arterial coupling and left ventricular function in patients with acute myocardial infarction.

To maintain efficient myocardial function, optimal coordination between ventricular contraction and the arterial system is required. Exercise-based cardiac rehabilitation (CR) has been demonstrated to improve left ventricular (LV) function. This study aimed to investigate the impact of CR on ventricular-arterial coupling (VAC) and its components, as well as their associations with changes in LV function in patients with acute myocardial infarction (AMI) and preserved or mildly reduced ejection fraction (EF). Effective arterial elastance (EA) and index (EAI) were calculated from the stroke volume and brachial systolic blood pressure. Effective LV end-systolic elastance (ELV) and index (ELVI) were obtained using the single-beat method. The characteristic impedance (Zc) of the aortic root was calculated after Fourier transformation of both aortic pressure and flow waveforms. Pulse wave separation analysis was performed to obtain the reflection magnitude (RM). An exercise-based, outpatient cardiac rehabilitation (CR) program was administered for up to 6 months. Twenty-nine patients were studied. However, eight patients declined to participate in the CR program and were subsequently classified as the non-CR group. At baseline, E' velocity showed significant associations with EAI (beta -0.393; P = 0.027) and VAC (beta -0.375; P = 0.037). There were also significant associations of LV global longitudinal strain (LV GLS) with EAI (beta 0.467; P = 0.011). Follow-up studies after a minimum of 6 months demonstrated a significant increase in E' velocity (P = 0.035), improved EF (P = 0.010), and LV GLS (P = 0.001), and a decreased EAI (P = 0.025) only in the CR group. Changes in E' velocity were significantly associated with changes in EAI (beta -0.424; P = 0.033). Increased aortic afterload and VA mismatch were associated with a negative impact on both LV diastolic and systolic function. The outpatient CR program effectively decreased aortic afterload and improved LV diastolic and systolic dysfunction in patients with AMI and preserved or mildly reduced EF.

24-h central pressure is a valuable predictor for left ventricular hypertrophy in non-dialysis patients with chronic kidney disease.

The current research on the relationship between 24-h central pressure and 24-h brachial pressure with left ventricular hypertrophy (LVH) is characterised by limited sample size and inconsistent findings. Furthermore, the association has never been explored in chronic kidney disease (CKD). A multicentre, cross-sectional study among non-dialysis patients with CKD was conducted. All participants underwent brachial and central ambulatory blood pressure monitoring using MobilO-Graph PWA, while trained cardiologists performed echocardiography. In this study, 2117 non-dialysis patients with CKD were examined. 24-h central systolic blood pressure with c2 calibration (24-h c2SBP) demonstrated a stronger association with left ventricular mass index and LVH compared with 24-h brachial systolic blood pressure (24-h bSBP) in the univariate and multivariate regression analyses. The multivariate net reclassification index (NRI) analysis revealed that 24-h c2SBP exhibited greater discriminatory power over 24-h bSBP (NRI = 0.310, 95% CI [0.192-0.429], P < 0.001). Applying 130/135 mmHg as the threshold for 24-h bSBP/c2SBP to cross-classify, the patients were divided into concordant normotension (1509 individuals), isolated brachial hypertension (155 individuals), isolated central hypertension (11 individuals), and concordant hypertension (442 individuals). With concordant normotension as the reference, the multivariable-adjusted ORs were 0.954 (95% CI, 0.534-1.640; P = 0.870) for isolated brachial hypertension and 2.585 (95%CI, 1.841-3.633; P < 0.001) for concordant hypertension. Among non-dialysis patients with CKD, 24-h c2SBP exhibits greater efficacy in identifying the presence of LVH compared with 24-h bSBP. The presence of LVH was greater in cases of concordant hypertension compared with cases of isolated brachial hypertension and concordant normotension.

Assessing the accuracy of systolic aortic pressure estimation from a brachial cuff alone: a comparison with radial tonometry.

A novel method for estimating central systolic aortic pressure (cSAP) has emerged, relying solely on peripheral mean (MBP) and diastolic (DBP) blood pressures. We aimed to assess the accuracy of this Direct Central Blood Pressure estimation using cuff alone (DCBPcuff=MBP²/DBP) in comparison to the use of generalized transfer function to derive cSAP from radial tonometry (cSAPtono). This retrospective analysis involved International Database of Central Arterial properties for Risk Stratification (IDCARS) data (Aparicio et al., Am J Hypertens 2022). The dataset encompassed 10,930 subjects from 13 longitudinal cohort studies worldwide (54.8%women; median age 46.0 years; office hypertension: 40.1%; treated: 61.0%), documenting cSAPtono via SphygmoCor calibrated against brachial systolic BP (SBP) and DBP. Our analysis focused on aggregate group data from 12/13 studies (89%patients) where full BP dataset was available. A 35% form factor was used to estimate MBP = (DBP+(0.35×(SBP-DBP)), from which DCBPcuff was derived. The predefined acceptable error for cSAPtono estimation was set at ≤5mmHg. The cSAPtono values ranged 103.8-127.0 mmHg (n=12). The error between DCBPcuff and cSAPtono was 0.2 ± 1.4 mmHg, with no influence of the mean. Errors ranged from -1.8 to 2.9 mmHg across studies. No significant difference in errors was observed between BP measurements obtained via oscillometry (n=9) vs auscultation (n=3) (p=0.50). Using published aggregate group data and a 35% form factor, DCBPcuff demonstrated remarkable accuracy in estimating cSAPtono, regardless of the BP measurement technique. However, given that individual BP values were unavailable, further documentation is required to establish DCBPcuff's precision.

Association of Blood Pressure With Brain White Matter Microstructural Integrity Assessed With MRI Diffusion Tensor Imaging in Healthy Young Adults.

High blood pressure (BP) in middle-aged and older adults is associated with a brain white matter (WM) microstructural abnormality. However, little evidence is available in healthy young adults. We investigated the associations between high BP and WM microstructural integrity in young adults. This study included 1015 healthy young adults (542 women, 22-37 years) from the Human Connectome Project. Brachial systolic and diastolic BP were measured using a semiautomatic or manual sphygmomanometer. Diffusion-weighted magnetic resonance imaging was acquired to obtain diffusion tensor imaging metrics of free water (FW) content, FW-corrected WM fractional anisotropy, axial diffusivity, radial diffusivity, and mean diffusivity. Using whole-brain voxel-wise linear regression models and ANCOVA, we examined associations of BP and hypertension stage with diffusion tensor imaging metrics after adjusting for age, sex, education, body mass index, smoking status, alcohol consumption history, and differences in the b value used for diffusion magnetic resonance imaging. Systolic and diastolic BP of the sample (mean±SD) were 122.8±13.0 and 76.0±9.9 mm Hg, respectively. Associations of BP with diffusion tensor imaging metrics revealed regional heterogeneity for FW-corrected fractional anisotropy. High BP and high hypertension stage were associated with higher FW and lower FW-corrected axial diffusivity, FW-corrected radial diffusivity, and FW-corrected mean diffusivity. Moreover, associations of high diastolic BP and hypertension stage with high FW were found only in men not in women. High BP in young adults is associated with altered brain WM microstructural integrity, suggesting that high BP may have damaging effects on brain WM microstructural integrity in early adulthood, particularly in men.

Aortic calcification is associated with the difference between invasive central and cuff-measured brachial blood pressure in chronic kidney disease.

Chronic kidney disease (CKD) is associated with accelerated vascular calcification and increased central systolic blood pressure when measured invasively (invCSBP) relative to cuff-based brachial systolic blood pressure (cuffSBP). The contribution of aortic wall calcification to this phenomenon has not been clarified. We therefore examined the effects of aortic calcification on cuffSBP and invCSBP in a cohort of patients representing all stages of CKD. During elective coronary angiography, invCSBP was measured in the ascending aorta with a fluid-filled catheter with simultaneous recording of cuffSBP using an oscillometric device. Furthermore, participants underwent a non-contrast computed tomography scan of the entire aorta with observer blinded calcification scoring of the aortic wall ad modum Agatston. We included 168 patients (mean age 67.0±10.5, 38 females) of whom 38 had normal kidney function, while 30, 40, 28, and 32 had CKD stage 3a, 3b, 4, and 5, respectively. Agatston scores adjusted for body surface area ranged from 48 to 40,165. We found that invCSBP increased 3.6 (95% confidence interval 1.4-5.7) mmHg relative to cuffSBP for every 10,000-increment in aortic Agatston score. This association remained significant after adjustment for age, diabetes, antihypertensive treatment, smoking, eGFR and BP level. No such association was found for diastolic BP. Patients with advanced aortic calcification have relatively higher invCSBP for the same cuffSBP as compared to patients with less calcification. Advanced aortic calcification in CKD may therefore result in hidden central hypertension despite apparently well-controlled cuffSBP.

Association Between Augmentation Index and Total Sleep Time in Night Shift Workers.

Augmentation index and pulse wave velocity are markers of vascular compromise and independent predictors of cardiovascular risk and mortality. While the link between shift work and heightened cardiovascular risk is established, the intricate genesis of early cardiovascular outcomes in shift workers remains incompletely understood. However, there is evidence that sleep duration plays a role in this regard. Here we evaluate the association of total sleep time with pulse wave velocity, augmentation index, and central blood pressure in night shift workers. This study cross-sectionally evaluated the association of total sleep time evaluated by 10-day monitoring actigraphy with augmentation index, pulse wave velocity, and brachial and central blood pressure evaluated by oscillometry in nursing professionals, 63 shift workers (89% women; age = 45.0 ± 10.5 years), and 17 (100% women; age = 41.8 ± 15.6) day workers. There were no differences in the studied variables between shift workers and day workers. Results of correlation analysis demonstrated that pulse wave velocity, central systolic blood pressure, central diastolic blood pressure, brachial systolic blood pressure, and brachial diastolic blood pressure tended to have significant correlation with each other, while these measures did not have a significant relationship with augmentation index in both groups. However, results of adjusted restricted cubic spline analysis showed a U-shaped-curve association between total sleep time and augmentation index (p < 0.001 for trend) with a nadir at 300-360 min of total sleep time in shift workers. The present study showed that total sleep time, assessed by actigraphy, had a U-shaped association with augmentation index in shift workers, which indicated better characteristics of vascular functionality when sleep time was 5-6 h in the workers studied.

Central blood pressure and arterial stiffness in patients admitted with acute decompensated heart failure

Objective. To evaluate central systolic blood pressure (cSBP) and arterial stiffness (AS) in patients admitted with acute decompensated heart failure (ADHF) according to different phenotypes of ejection fraction (EF) and to assess their changes after 6 months of stable guideline-directed medical therapy. Design and methods. In 54 patients (61% males, median age 69,5 (62; 77) years, median EF 51% (interquartile range (IQR) 38; 55%), median N-terminal pro-B-type natriuretic peptide (NTproBNP) 623 (500; 1842) pg/ml; heart failure (HF) with reduced EF in 37%, HF with mildly reduced EF in 13%, HF with preserved EF in 50%), apart from routine tests, we assessed cSBP and AS with applanation tonometry (SphygmoCor). cSBP above individual reference values, central pulse pressure (PP) ≥ 50 mmHg, carotid-femoral pulse wave velocity (cfPWV) &gt; 10 m/s, cfPWV above individual reference values, and aortic-brachial stiffness mismatch (stiffness gradient as cfPWV/carotid-radial (cr)PWV) ≥ 1) were considered abnormal. The statistical analysis was performed in the groups with EF ≥ 50% and &lt; 50% р &lt; 0,05 was considered significant. Results. Brachial systolic blood pressure (bSBP) in the whole group was 117 (106; 130) mmHg; cSBP 109,5 (96; 120) mmHg. Uncontrolled blood pressure was observed in 40%, hypotension — in 3%. There were no differences between groups according to EF. cSBP elevation was observed in 33% (28,5% in EF ≥ 50% and 38,4% in EF &lt; 50%; р &gt; 0,05), and in 27,1% with normal bSBP. There were no significant differences in AS parameters between groups according to EF. Elevation of at least 1 marker of AS was present in 78,5%, cfPWV &gt; 10 ms — in 50%, cfPWV above individual reference values— in 55,5%, central PP ≥ 50 mmHg — in 16,6%, high AS gradient — in 70,3%. Abnormal AS gradient was observed in 48,1% of patients with normal cfPWV. Patients with more severe congestion according to bioimpedance vector analysis (BIVA) had lower cfPWV compared to less severe congestion: 9 (6,7; 10,2) vs 11,6 (6,9; 15,1) m/s, р = 0,04. There was significant correlation between the amount of extracellular fluid by BIVA and cfPWV (r = –0,36, p &lt; 0,05). There was significant increase in cSBP, PP, cfPWV and augmentation index and decrease in PP amplification in the whole group after 6 months. Conclusions. Patients admitted with ADHF have high frequency of cSBP elevation regardless of EF and blood pressure control. The most common marker of AS increase was cfPWV elevation above individual reference values and abnormal stiffness gradient. Patients with less congestion by BIVA had higher cfPWV. After 6 months there was increase in cSBP and parameters of AS.

Association of cardiorespiratory fitness level with vascular function and subclinical atherosclerosis in the elderly.

Physical exercise is crucial for healthy aging and plays a decisive role in the prevention of atherosclerotic cardiovascular disease (ASCVD). A higher level of cardiorespiratory fitness (CRF) in the elderly is associated with lower cardiovascular and all-cause mortality. This study investigated the association of CRF level with vascular function and cardiovascular risk factors in the elderly. We examined 79 apparently healthy and physically active subjects aged > 55years (64 ± 4years). Cardiovascular functional parameters assessed included brachial and central blood pressure (BP), pulse wave velocity (PWV), augmentation index (Aix), and ankle-brachial index. Sonography of the common carotid artery was performed. CRF level was determined by a cardiopulmonary exercise test, and everyday activity was quantified with an accelerometer. All participants had a higher CRF level than the reported age-specific normative values. Twenty-nine subjects had subclinical atherosclerosis of the common carotid artery. Compared with participants without atherosclerosis, they were older (p = 0.007), displayed higher brachial systolic BP (p = 0.006), and higher central systolic BP (p = 0.014). Lower brachial (p = 0.036) and central (p = 0.003) systolic BP, lower PWV (p = 0.004), lower Aix (p < 0.001), lower body fat percentage (< 0.001), and lower LDL cholesterol (p = 0.005) were associated with a higher CRF level. In this cohort of healthy and physically active individuals, subjects with subclinical atherosclerosis displayed higher systolic brachial and central BP. A higher CRF level was associated with enhanced vascular function, consistent with an influence of CRF on both BP and vascular function in the elderly.

Reduction of Outdoor and Indoor PM2.5 Source Contributions via Portable Air Filtration Systems in a Senior Residential Facility in Detroit, Michigan.

Background: The Reducing Air Pollution in Detroit Intervention Study (RAPIDS) was designed to evaluate cardiovascular health benefits and personal fine particulate matter (particulate matter < 2.5 μm in diameter, PM2.5) exposure reductions via portable air filtration units (PAFs) among older adults in Detroit, Michigan. This double-blind randomized crossover intervention study has shown that, compared to sham, air filtration for 3 days decreased 3-day average brachial systolic blood pressure by 3.2 mmHg. The results also showed that commercially available HEPA-type and true HEPA PAFs mitigated median indoor PM2.5 concentrations by 58% and 65%, respectively. However, to our knowledge, no health intervention study in which a significant positive health effect was observed has also evaluated how outdoor and indoor PM2.5 sources impacted the subjects. With that in mind, detailed characterization of outdoor and indoor PM2.5 samples collected during this study and a source apportionment analysis of those samples using a positive matrix factorization model were completed. The aims of this most recent work were to characterize the indoor and outdoor sources of the PM2.5 this community was exposed to and to assess how effectively commercially available HEPA-type and true HEPA PAFs were able to reduce indoor and outdoor PM2.5 source contributions. Methods: Approximately 24 h daily indoor and outdoor PM2.5 samples were collected on Teflon and Quartz filters from the apartments of 40 study subjects during each 3-day intervention period. These filters were analyzed for mass, carbon, and trace elements. Environmental Protection Agency Positive Matrix Factorization (PMF) 5.0 was utilized to determine major emission sources that contributed to the outdoor and indoor PM2.5 levels during this study. Results: The major sources of outdoor PM2.5 were secondary aerosols (28%), traffic/urban dust (24%), iron/steel industries (15%), sewage/municipal incineration (10%), and oil combustion/refinery (6%). The major sources of indoor PM2.5 were organic compounds (45%), traffic + sewage/municipal incineration (14%), secondary aerosols (13%), smoking (7%), and urban dust (2%). Infiltration of outdoor PM2.5 for sham, HEPA-type, and true HEPA air filtration was 79 ± 24%, 61 ± 32%, and 51 ± 34%, respectively. Conclusions: The results from our study showed that intervention with PAFs was able to significantly decrease indoor PM2.5 derived from outdoor and indoor PM2.5 sources. The PAFs were also able to significantly reduce the infiltration of outdoor PM2.5. The results of this study provide insights into what types of major PM2.5 sources this community is exposed to and what degree of air quality and systolic blood pressure improvements are possible through the use of commercially available PAFs in a real-world setting.

Influence of acute dietary nitrate supplementation timing on nitrate metabolism, central and peripheral blood pressure and exercise tolerance in young men

PurposeDietary nitrate (NO3−) supplementation can lower systolic blood pressure (SBP) and improve exercise performance. Salivary flow rate (SFR) and pH are key determinants of oral NO3− reduction and purported to peak in the afternoon. We tested the hypotheses that NO3−-rich beetroot juice (BR) would increase plasma [nitrite] ([NO2−]), lower SBP and improve exercise performance to a greater extent in the afternoon (AFT) compared to the morning (MORN) and evening (EVE).MethodTwelve males completed six experimental visits in a repeated-measures, crossover design. NO3−-depleted beetroot juice (PL) or BR (~ 13 mmol NO3−) were ingested in the MORN, AFT and EVE. SFR and pH, salivary and plasma [NO3−] and [NO2−], brachial SBP and central SBP were measured pre and post supplementation. A severe-intensity exercise tolerance test was completed to determine cycling time to exhaustion (TTE).ResultsThere were no between-condition differences in mean SFR or salivary pH. The elevation in plasma [NO2−] after BR ingestion was not different between BR-MORN, BR-AFT and BR-EVE. Brachial SBP was unchanged following BR supplementation in all conditions. Central SBP was reduced in BR-MORN (− 3 ± 4 mmHg), BR-AFT (− 4 ± 3 mmHg), and BR-EVE (− 2 ± 3 mmHg), with no differences between timepoints. TTE was not different between BR and PL at any timepoint.ConclusionAcute BR supplementation was ineffective at improving TTE and brachial SBP and similarly effective at increasing plasma [NO2−] and lowering central SBP across the day, which may have implications for informing NO3− supplementation strategies.

Cardiac MR modelling of systolic and diastolic blood pressure

AimsBlood pressure (BP) is a crucial factor in cardiovascular health and can affect cardiac imaging assessments. However, standard outpatient cardiovascular MR (CMR) imaging procedures do not typically include BP measurements...

Association of Central Blood Pressure and Carotid Intima Media Thickness with New-Onset Hypertension in People with High Normal Blood Pressure.

People with high normal blood pressure (BP) have a higher risk of cardiovascular events than those with normal BP; therefore, progression to hypertension (HT) should be prevented. We aimed to assess the HT risk using central BP and carotid intima media thickness (CIMT) in people with high normal BP. This prospective cohort study used the Tohoku Medical Megabank Community-Based Project Cohort Study (conducted from 2013 in Miyagi Prefecture in Japan). The participants had a high normal BP, defined as a systolic BP of 120-139 mmHg and diastolic BP ＜90 mmHg using brachial BP measurement during the baseline survey. The outcome was new-onset HT during the secondary survey, conducted four years after the baseline survey. Overall, 4,021 participants with high normal BP during the baseline survey, with an average age of 58.7 years, were included; 1,030 (26%) were diagnosed with new-onset HT during the secondary survey, 3.5±0.7 years after the baseline survey. The multivariable odds ratio (95% confidence interval) for HT in the highest versus lowest quartile of central BP was 1.7 (1.2-2.4, p=0.0030), and that of CIMT was 1.8 (1.4-2.4, p＜0.001). Subgroup analysis according to age (＜60 and ≥ 60 years) and sex revealed that the central BP was influential in groups with younger age and female individuals; CIMT was influential in all groups. Higher central BP and thicker CIMT at the baseline were correlated with new-onset HT in individuals with high normal BP, independent of brachial systolic BP and other cardiovascular risk factors.

Effect of sodium-glucose co-transporter inhibitors on arterial stiffness in patients with type 2 diabetes mellitus

Abstract Introduction Selective sodium-glucose co-transporter 2 inhibitors (SGLT2i) reduce cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). In addition to glucose homeostasis the impaired arterial stiffness may participate in this morbidity and mortality. Purpose The aim of this study was to investigate the effect of administration of SGLT2i therapy on arterial stiffness parameters, including aortic pulse wave velocity (PWV) and central systolic blood pressure (SBPao), which have significant prognostic value for predicting cardiovascular events. Methods Our prospective, observational study included 40 patients with T2DM (mean age: 60.3±9.9 years, 24 males). Biochemical and arterial stiffness parameters were analysed before starting SGLT2i therapy (14 patients on dapagliflozin, 25 patients on empagliflozin, 1 patient on ertugliflozin), at 3, 6 months and an average of 3.3±1.3 years follow-up period. Arterial stiffness parameters were determined using an invasively validated oscillometric based Arteriograph (AG) method. Changes in the variables and their interrelation was analysed by repeated data ANOVA and multivariate linear regression. Results Significant decrease in PWV and HgbA1c were observed 3 months after the initiation of SGLT2i therapy (PWV: 10.68±1.35 m/s vs. 10.05±1.40 m/s and HgbA1c: 7.86±0.55 vs. 6.83±0.66 %, p&amp;lt;0,05) and this long-term effect continued during the 3.3-years follow-up period (PWV: 9.96±1.25 m/s and HgbA1c: 7.19±0.81 %, p&amp;lt;0,005, Figure 1). Pearson's correlation analysis and multivariate linear regression analysis showed no association between decreased PWV and BMI, brachial diastolic blood pressure (DBPb) while significant, but weak correlation was observed with HgbA1c and brachial systolic blood pressure (SBPb) (r=0.22-0.26, p&amp;lt;0.05, Figure 2). SBPao results showed non-significant decrease and a subsequent non-significant long-term increase comparing to baseline during the 3.3 years follow-up. Conclusion Short and long-term SGLT2i therapy in T2DM significantly improved PWV values and this effect is independent of changes in SBPao. All these findings emphasize the clinical relevance of arterial stiffness as a biomarker in the SGLT2i induced beneficial effect on the vasculature, however further clarification, long-term evaluation needed to define the role of PWV in the prediction of cardiovascular events.Figure 1Figure 2