Brachial Systolic Blood Pressure Research Articles

Associations of office brachial blood pressure, office central blood pressure, and home brachial blood pressure with arterial stiffness.

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

Myocardial work and left ventricular mechanical adaptations following isometric exercise training in hypertensive patients.

Hypertension is a major risk factor for cardiovascular disease. Isometric exercise training (IET) reduces resting and ambulatory blood pressure; however, few studies have investigated the myocardial adaptations following IET. We randomly assigned 24 unmedicated hypertensive patients in a cross-over study design to 4-weeks of IET and control period, separated by a 3-week washout period. Speckle tracking echocardiography was used to measure left ventricular (LV) mechanics, and global myocardial work indices were derived from non-invasive LV pressure-strain loops constructed from global longitudinal strain (GLS) indexed to brachial systolic blood pressure. IET significantly improved GLS (- 2.3 ± 2%, p < 0.001) and global work efficiency (2.8 ± 2%, p < 0.001), and significantly reduced global wasted work (- 42.5 ± 30mmHg%, p < 0.001) with no significant change during the control period. This is the first evidence to demonstrate that IET significantly improved cardiac health in a relevant patient population. Our findings have important clinical implications for patients with high blood pressure and support the role of IET as a safe and viable therapeutic and preventative intervention in the treatment of hypertension.

Acute Citrulline Blunts Aortic Systolic Pressure during Exercise and Sympathoactivation in Hypertensive Postmenopausal Women.

Hypertensive postmenopausal women (PMW) have exaggerated exercise systolic blood pressure (SBP) due to impaired functional sympatholysis. l-Citrulline (CIT) supplementation attenuates aortic SBP responses to cold pressor test (CPT)-induced vasoconstriction in young men. We hypothesized that acute CIT ingestion would attenuate aortic SBP and leg hemodynamic responses during exercise and CPT (EX + CPT). Fifteen hypertensive PMW (61 ± 7 yr) were randomly assigned to consume either 6 g of CIT or placebo (PL) separated by a minimum 3-d washout phase. Brachial and aortic blood pressure, femoral artery blood flow (FBF), and vascular conductance (FVC) were measured at rest and during 5 min of unilateral plantarflexion exercise with a CPT applied during minutes 4 and 5. No differences between conditions were found in FBF, FVC, and brachial and aortic blood pressure at rest and during exercise alone. Changes in brachial SBP (CIT vs PL, 29 ± 12 vs 40 ± 10 mm Hg) and mean arterial pressure (CIT vs PL, 21 ± 10 vs 33 ± 11 mm Hg), and aortic SBP (CIT vs PL, 27 ± 11 vs 38 ± 9 mm Hg) and mean arterial pressure (CIT vs PL, 23 ± 9 vs 33 ± 11 mm Hg) to EX + CPT were lower in the CIT versus PL condition (P < 0.05). FBF, FVC, and functional sympatholysis (%ΔFVC) were not significantly different between conditions. Acute CIT ingestion attenuated aortic SBP response to exercise and cold-induced sympathetic activation that may prevent left ventricle overload in hypertensive PMW.

Abstract 12482: Exposure to Greenspace Reduces Blood Pressure and Attenuates the Association With Air Pollution in Tamil Nadu, India

Background: Globally, high systolic blood pressure (SBP) is a major cause for cardiovascular mortality. Air pollution affects SBP and diastolic blood pressure (DBP), but has not been studied in relation to greenness in rapidly urbanizing and polluted areas. Here we assess the association between long-term concentrations of ambient PM 2.5, greenness and blood pressure in the Population study of Urban, Rural, Semi-urban Endovascular disease and Holistic Intervention Study (PURSE-HIS) in Tamil Nadu, India. Methods: The study included 8080 randomly selected participants (mean age 42 years; 58% women). We measured greenness using MODIS satellite derived normalized difference vegetation index (NDVI) at 250 m 2 resolutions. We used modeled estimates of annual average PM 2.5 at 1 km 2 developed for Global Burden of Disease to assign to residences. Brachial SBP and DBP were assessed in the dominant arm and an average of three measurements was used in the analysis. The associations were examined using generalized linear regression models controlling for age, gender, waist circumference, physical activity, sodium intake, smoking, stress, and anxiety. Results: The PM 2.5 exposure estimates ranged from 18μg/m 3 to 35μg/m 3 in the study area. In independent multivariate models IQR increase in PM 2.5 (3.0 μg/m 3 ) was associated with a 5.5 mmHg (95%CI: 4.9, 6.2) change in SBP. Stratification of participants into greenness exposures of high, medium and low, showed markedly higher association of PM 2.5 with SBP when comparing those residing in low greenness areas (5.0 mmHg [95%CI: 3, 6.9]) to those in medium (3.7 mmHg [95%CI: 2.8, 4.6]) and high NDVI areas (1.1 mmHg [95%CI: -0.6, 2.8]). Conclusions: Greenness and PM 2.5 were associated with SBP and DBP independently, with significant modification of this association by greenness. Further studies are required to assess interaction between PM 2.5 and greenness on SBP.

Effect of bisoprolol on central aortic systolic pressure in Chinese hypertensive patients after the initial dose and long-term treatment.

We conducted a prospective open-label cohort study with the aim of examining the effects of the highly β1-selective agent bisoprolol on central aortic systolic pressure (CASP) after the first dose and after 6 weeks’ treatment and whether the CASP response could be predicted from the early response. Chinese patients with primary hypertension (BP ≥140/90 mmHg) on no therapy or background amlodipine were treated with bisoprolol 2.5 mg daily for 6 weeks. Brachial systolic BP (Br-SBP), resting heart rate (HR), and CASP were determined at baseline, 24 hours after the first dose, and pre-dose after treatment for 6 weeks using the BPro® device. In 42 patients (age 54 ± 9 years), the mean reductions in CASP and Br-SBP after 6 weeks of treatment were not significantly different from each other at −14.5 ± 12.7 and −15.4 ± 12.9 mmHg (both p < 0.01), respectively. Changes in CASP and Br-SBP were highly correlated after the first dose (r = 0.964, p < 0.01) and after 6 weeks (r = 0.963, p < 0.01) and the reductions in CASP after 6 weeks were also associated with the reduction in CASP after the first dose (r = 0.577, p < 0.01). Bisoprolol was shown to effectively reduce CASP and this effect was directly proportional to the reduction in Br-SBP and of a similar magnitude. More favorable CASP responses to long-term therapy may be predicted by greater reductions in CASP after the first dose.

Circulating fibroblast growth factor 21 links hemodynamics with kidney function in middle-aged and older adults: A mediation analysis.

Altered hemodynamics are commonly observed in individuals with declining renal function; however, the pathophysiological mechanisms linking renal dysfunction and hemodynamics have not been fully elucidated. Fibroblast growth factor 21 (FGF21), which upregulates sympathetic nerve activity, can alter systemic hemodynamics, and its level can increase as renal function declines. This study aimed to determine the associations among circulating FGF21 levels, hemodynamics, and renal function in middle-aged and older adults. In a total of 272 middle-aged and older adults (age range: 46-83 years), estimated glomerular filtration rate (eGFR), hemodynamics (brachial and aortic blood pressure and aortic pulse wave velocity [PWV]), and serum FGF21 levels were measured. For mediation analysis, hemodynamic parameters were entered as outcomes. eGFR or log-transformed urinary albumin and creatinine ratio (UACR) and log-transformed serum FGF21 levels were set as the predictors and mediator, respectively. According to multivariable regression models after adjusting for potential covariates, serum FGF21 levels were significantly associated with brachial systolic blood pressure (β = 0.140), pulse pressure (β = 0.136), and aortic PWV (β = 0.144). Mediation analyses showed that serum FGF21 levels significantly mediated the relationship of eGFR with brachial systolic blood pressure (indirect effect [95% confidence interval]: -0.032 [-0.071, -0.002]), pulse pressure (-0.019 [-0.041, -0.001]), and aortic PWV (-0.457 [-1.053, -0.021]) and the relationship of UACR with aortic PWV (7.600 [0.011, 21.148]). These findings suggest that elevated circulating FGF21 levels partially mediate the association of elevated blood pressure and/or aortic stiffness with renal dysfunction in middle-aged and older adults.

Global Myocardial Work Combined with Treadmill Exercise Stress to Detect Significant Coronary Artery Disease

Myocardial work (MW) derived from the left ventricular pressure-strain loop is a novel and noninvasive method for assessing left ventricular function that accounts for loading conditions. We aimed to explore whether global MW combined with treadmill exercise stress could detect significant coronary artery disease (CAD) in patients with angina pectoris. Eighty-five patients with angina pectoris and no prior CAD history were included. All patients underwent treadmill exercise stress echocardiography and coronary angiography. Global MW was constructed from speckle-tracking echocardiography indexed to the brachial systolic blood pressure. The association between MW parameters and the presence of significant CAD was assessed with logistic regression. The discriminative power of MW parameters to detect CAD was assessed with receiver operative characteristic curve, net reclassification improvement, and integrated discrimination improvement analysis. Twenty-five patients had a positive exercise echocardiogram, while significant coronary artery stenosis (≥70% in one or more major epicardial vessels or ≥50% in the left main coronary artery) was observed in 41 patients. The global wasted work (GWW) and global work efficiency (GWE) were significantly higher or lower, respectively, in patients with significant CAD compared with those of nonsignificant CAD at the peak exercise and during recovery periods (P<.05 for all). Multivariate logistic regression analysis demonstrated that peak GWE and recovery GWW could predict significant CAD. Peak GWE had the highest area under the receiver operating characteristic curve (AUC) among all global MW parameters (AUC=0.836). Furthermore, a model comprising peak GWE and recovery GWW performed better for the identification of significant CAD than peak GWE alone (AUC=0.856). Peak GWE could detect significant CAD. The new model, incorporating peak GWE and recovery GWW, not only identified but also provided additional value for estimating the probability of significant CAD. Global MW parameters combined with exercise stress perform as an accurate noninvasive screening before the invasive diagnostic technique.

Aortic systolic blood pressure predicts periprocedural myocardial injury after transcatheter aortic valve implantation

Abstract Background/Introduction Periprocedural myocardial injury (PPMI) is a complication of transcatheter aortic valve implantation (TAVI) associated with worse outcome. Central (aortic) systolic blood pressure (SBP) is an independent predictor of cardiovascular events. Purpose We sought to investigate the effect of TAVI on peripheral and central hemodynamics, as well as the predictive ability of brachial and aortic SBP for PPMI. Methods We enrolled 70 patients (mean age 79.9±8.7 years, 50% males) with severe symptomatic aortic valve stenosis (AVS) undergoing TAVI. Brachial pressures were measured with an oscillometric device and central pressures were assessed by arterial tonometry at baseline and after the procedure at discharge. PPMI was identified based on Valve Academic Research Consortium (VARC-2) criteria. Biomarkers for MI (cardiac troponin and creatinine kinase MB) were analyzed and signs and symptoms according to VARC-2 criteria were collected from clinical records. Stepwise multivariable regression analysis was performed for the prediction of PPMI. Results According to VARC-2 definition, 38 (54%) patients had PPMI. In stepwise multivariable regression analysis, brachial SBP at baseline was not predictive of PPMI (p=0.07) after adjusting for age, sex and history of coronary artery disease. On the contrary, aortic SBP predicted PPMI even after adjustment for the abovementioned confounders (Odds ratio [OR]=1.032, 95% Confidence Interval [CI] 1.004–1.061, p=0.026). Interestingly, both SBP and aortic SBP were higher at discharge in patients with PPMI compared to patients without PPMI after adjustment (p=0.021 and p=0.006, respectively). On the contrary, the periprocedural changes of aortic SBP and SBP were not different between patients with PPMI and without PPMI. Conclusions Aortic SBP, as assessed by tonometry, is an independent predictor stronger than brachial SBP for PPMI in AVS patients treated with TAVI. This finding suggests the possible clinical role of aortic pressures as a risk stratification tool for PPMI prior to TAVI, as well as, warrants further investigation on their role as therapeutic targets to decrease the incidence of PPMI. Funding Acknowledgement Type of funding sources: None.

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

Effect ofglucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors and their combination on left atrial strain and arterial function

Abstract Background We investigated the effects of insulin, glucagon-like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and their combination on left atrial function of patients with type 2 diabetes mellitus and we searched for a relation with arterial function. Methods A total of 213 patients (59,5±9,1 year old, 161 male) with type 2 diabetes mellitus treated with metformin were randomized to insulin (n=46 served as controls), liraglutide (n=40), empagliflozin (n=46) or their combination (GLP-1RA + SGLT-2i) (n=50) as add-on. We measured at baseline and 6 months posttreatment: (a) perfused boundary region of the sublingual arterial microvessels (marker of endothelial glycocalyx thickness), (b) pulse wave velocity (PWV) and central systolic blood pressure, (c) global left ventricular Longitudinal strain, (d) left atrial strain. Results Six months after intervention, all patients improved left atrial reservoir strain (GLP1RA 30,7±9,3 vs 33,9±9,7%, p=0,011 / SGLT2i 30±8,3 vs 32,3±7,3%, p=0,04 / GLP1 &amp; SGLT2i 29,1±8,7 vs 31,3±8,2, p=0,007) in comparison with controls (33±8,3% vs 32,8±7,4, p=0,829). Also, patients treated with GLP1RA and their combination improved left atrial conduction strain (p&amp;lt;0.05). GLP-1RA or GLP-1RA + SGLT-2i provided a greater improvement in GLS compared with insulin or SGLT-2i (controls −18,5±3,9% vs −19,1±3%, p=0,202 / GLP1RA −18,2±4,1% vs −19,1±3,5%, p=0,03 / SGLT2i −19±4,1% vs −19,1±3,8%, p=0,764 / GLP1 &amp; SGLT2i −16,7±3,9% vs −17,5±4,3%, p=0,026). SGLT-2i or GLP-1RA and SGLT-2i showed a greater decrease of PWV (Controls 12,06±3,02 vs 11,62±2,79 m/sec, p=0,142 / GLP1 11,54±2,91 vs 11,45±2,52 m/sec, p=0,822 / SGLT2 11,86±2,51 vs 11,33±2,28 m/sec, p=0,047 / GLP1 &amp; SGLT2 12,01±2,46 vs 10,85±1,79 m/sec, p=0,021) and central and brachial systolic blood pressure than insulin or GLP-1RA. At baseline, there was a correlation of LA reservoir strain with PWV (r=−0,209, p=0,008), central SBP (r=−0,151, p=0,030), EF (r=0,214, p=0,004), GLS (r=−0,279, p=0,009). At 6 months follow up, there was a correlation of LA reservoir strain with PWV (r=0,217, p=0,003), central SBP (r=0,214, p=0,004), EF (r=−0,221, p=0,049), GLS (r=0,275, p=0,014). Conclusions Treatment with GLP-1RA, SGLT-2i, and their combination for 6 months showed a greater improvement of left atrial function compared to insulin treatment in parallel with improvement arterial and myocardial function. Funding Acknowledgement Type of funding sources: None.

The association between central ambulatory blood pressure and end-organ damage

Abstract Background/Introduction Central blood pressure (BP) measured in the clinic relates more strongly to end-organ damage and may be superior to brachial BP in predicting cardiovascular events. Measurement of central ambulatory BP (ABP) is now possible and emerging data suggest that central ABP is better correlated with left ventricular mass index (LVMI) than brachial ABP.1,2 However, the association between central ABP and other measures of end-organ damage remains unclear. Purpose We investigated the association between brachial or central ABP and end-organ damage, in a large community-based population of untreated individuals. Method 1091 participants (mean age 45±18 years; 589 females) had simultaneous measurements of brachial and central ABP over 24 hours, using the Mobil-O-Graph device. Central ABP was derived using two waveform calibration methods (1: mean/diastolic BP; 2: systolic/diastolic BP). Participants also underwent measurement of aortic pulse wave velocity (aPWV; SphygmoCor device) in the clinic. In a subset of 675 individuals, LVMI was assessed by echocardiography and in 610 individuals, carotid intima-media thickness (CIMT) was measured, using ultrasound. 24-hour and daytime brachial and central ambulatory systolic BP (ASBP) and pulse pressure (APP) were considered. Results The Pearson's coefficient for each correlation is listed in Table 1. LVMI was most strongly correlated with 24-hour central ASBP, using calibration method 1 (MAP/DBP; r=0.403, P&amp;lt;0.001). CIMT was most strongly correlated with daytime central ASBP, again derived from calibration method 1 (r=0.341, p&amp;lt;0.001), whereas aPWV measured in the clinic, was most strongly correlated with 24-hour central ASBP, derived from calibration method 2 (SBP/DBP; r=0.441, P&amp;lt;0.001). Based on z statistics, all correlations reported above were significantly stronger than equivalent correlations using brachial ASBP (P&amp;lt;0.001 for all three comparisons of correlation coefficients). Conclusion Measurement of central ABP relates more closely to end-organ damage than equivalent measures based on brachial ABP. Central ABP may provide valuable additional information concerning cardiovascular risk above and beyond brachial ABP. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): British Heart Foundation

Renal biomarkers reflect overall hypertensive organ damage: “one organ to rule them all”

Abstract Background/Introduction Hypertension is associated with higher cardiovascular risk as well as several markers of subclinical target organ damage (TOD). Albumin to creatinine ratio (ACR) in urine has been recognized as an independent risk factor for cardiovascular events. Purpose We hypothesized that there is a relationship between ACR and markers of TOD in never-treated hypertensives. Methods We enrolled 924 consecutive essential hypertensives (mean age 53±12 years, 486 males) without known cardiovascular disease (CVD). Markers of subclinical TOD [left ventricular mass index (LVMI), pulse wave velocity (PWV), ankle-brachial index (ABI) and estimated glomerular filtration rate (eGFR)] were evaluated in all patients. LVMI was assessed echocardiographically using the Devereux formula. Carotid-femoral PWV was estimated with the Complior device. eGFR was calculated by the Cockcroft-Gault formula. ABI was calculated by dividing the highest ankle systolic blood pressure by the highest brachial systolic blood pressure. Results ACR exhibited significant association with LVMI (r=0.277, p&amp;lt;0.001, Figure), PWV (r=0.277, p&amp;lt;0.001) ABI (r=−0.078, p=0.018) and eGFR (r=−0.100, p=0.002). In further analysis, ACR was associated with TOD as suggested by the 2018 European Guidelines for Hypertension [left ventricular hypertrophy (LVMI&amp;gt;115 g/m2 in men and &amp;gt;95 g/m2 in women), increased PWV (PWV&amp;gt;10m/s), decreased ABI (ABI&amp;lt;0.9) and decreased renal function (eGFR&amp;lt;60ml/min)]. Specifically, ACR exhibited significant association with the number of TOD and this association was independent of age and gender (p&amp;lt;0.05). Conclusions Our findings support the close relationship between ACR and TOD in hypertension, as well as, the predictive ability of ACR for TOD. Funding Acknowledgement Type of funding sources: None. Association between LVMI and ACR

Hemodynamic response and pulse wave analysis after upper- and lower-body resistance exercise with and without blood flow restriction

ABSTRACT Resistance exercise (RE) has been shown to elevate hemodynamics and pulse wave reflection. However, the effects of acute RE with blood flow restriction (BFR) on hemodynamics and pulse wave reflection are unclear. The purpose of this study was to evaluate the differences between upper- and lower-body RE with and without BFR on hemodynamics and pulse wave reflection. Twenty-three young resistance-trained individuals volunteered for the study. Hemodynamics and pulse wave reflection were assessed at rest, 10, 25, 40, and 55 min after either upper- or lower-body with or without BFR. The upper-body RE (URE) consisted of the latissimus dorsi pulldown and chest press; the lower-body RE (LRE) consisted of knee extension and knee flexion. The BFR condition consisted of four sets of 30, 15, 15, and 15 repetitions at 30% 1-repetition maximum (1RM) while the without BFR condition consisted of four sets of 8 repetitions at 70% 1RM. Heart rate, rate pressure product, and subendocardial viability ratio significantly (p < 0.05) increased after all exercises. Brachial and aortic systolic blood pressure (BP) significantly (p < 0.05) elevated after LRE while brachial and aortic diastolic BP significantly (p < 0.05) reduced after URE. Augmentation pressure, augmentation index (AIx), AIx normalized at 75 bpm, and wasted left ventricular pressure energy significantly (p < 0.05) increased after URE while transit time of reflected wave significantly (p < 0.05) decreased after LRE. URE places greater stress on pulse wave reflection while LRE results in greater responses in BP. Regardless of URE or LRE, the cardiovascular responses between BFR and without BFR are similar. HIGHLIGHTS High-load resistance exercise and low-load resistance exercise with blood flow restriction may produce similar cardiovascular responses. Upper-body resistance exercise generates greater changes on pulse wave reflections while lower-body resistance exercise induces greater elevations in systolic blood pressure.

Standalone sauna vs exercise followed by sauna on cardiovascular function in non-naïve sauna users: A comparison of acute effects.

Background and aimsSauna bathing and aerobic exercise have each been shown to affect cardiovascular function. However, direct comparisons between standalone sauna bathing and a combination of exercise and sauna on vascular indices remain limited. Therefore, we conducted a cross‐over study using matched durations to explore the hemodynamic changes of sauna exposure when compared to a combination of aerobic exercise and sauna exposure.MethodsParticipants (N = 72) with at least one cardiovascular risk factor underwent, on two separate occasions: (a) a 30‐minute sauna at 75°C (SAUNA) and (b) the combination of a 15‐minute cycling exercise at 75% maximum heart rate followed by 15‐minute sauna exposure (EX+SAUNA). Relative changes to arterial stiffness (PWV), augmentation index (Alx), brachial systolic and diastolic blood pressure (SBP and DBP), central SBP (cSBP), mean arterial pressure (MAP), and heart rate (HR) were compared PRE‐POST and pre‐ to 30‐minutes post‐intervention (PRE‐POST30).ResultsBaseline SBP and DBP were 143 (SD 18) mmHg and 86 (SD 10) mmHg, respectively. From PRE‐POST, SAUNA had lower DBP (mean difference [95% CI] 2.5 [1.0, 4.1], P = .002) and MAP (2.5 [0.6, 4.3], P = .01). However, EX+SAUNA had lower SBP (−2.7 [−4.8, −0.5], P = .02), DBP (−1.8 [−3.3, −0.4], P = .01), and MAP (−2.0 [−3.5, −0.5], P = .009) PRE‐POST30. There were no statistically significant differences between SAUNA and EX+SAUNA for other measured parameters.ConclusionThis study demonstrated that when matched for duration, EX+SAUNA and SAUNA elicit comparable acute hemodynamic alterations in middle‐aged participants with cardiovascular risk factors. The sauna is a suitable option for acute blood pressure reductions in those who are unable to perform aerobic exercise, and may be a viable lifestyle treatment option to improve blood pressure control.

Accuracy of Ankle-Brachial Index, Toe-Brachial Index, and Risk Classification Score in Discriminating Peripheral Artery Disease in Patients With Chronic Kidney Disease

The accuracy of ankle-brachial index (ABI) and toe-brachial index (TBI) in discriminating lower extremity peripheral artery disease (PAD) has not been evaluated in patients with chronic kidney disease (CKD). We measured ABI, TBI, and Doppler ultrasound in 100 predialysis patients with CKD without revascularization or amputation. Leg-specific ABI was calculated using higher systolic blood pressure (SBP) in posterior tibial or dorsalis pedis artery divided by higher brachial SBP; alternative ABI was calculated using lower SBP in posterior tibial or dorsalis pedis artery. PAD was defined as ≥50% stenosis detected by Doppler ultrasound. PAD risk classification score was calculated using cardiovascular disease risk factors. The area under the curve (AUC, 95% confidence interval [CI]) for discriminating ultrasound-diagnosed PAD was 0.78 (0.69 to 0.87) by ABI, 0.80 (0.71 to 0.89) by alternative ABI, and 0.74 (0.63 to 0.86) by TBI. Sensitivity and specificity were 25% and 97% for ABI ≤0.9, 41% and 95% for alternative ABI ≤0.9, and 45% and 93% for TBI ≤0.7, respectively. AUC (95% CI) of PAD risk classification score was 0.86 (0.78 to 0.94) with sensitivity and specificity of 95% and 60% for risk score ≥0.10, 76% and 76% for risk score ≥0.25, and 43% and 95% for risk score ≥0.55. Combining risk score with ABI, alternative ABI, and TBI increased AUC (95% CI) to 0.89 (0.82 to 0.96), 0.89 (0.80 to 0.98), and 0.87 (0.78 to 0.96), respectively. In conclusion, current ABI and TBI diagnostic criteria have high specificity but low sensitivity for classifying PAD in patients with CKD. PAD classification risk score based on cardiovascular disease risk factors improves the accuracy of PAD classification.

Sleep Efficiency is Inversely Associated with Brachial Artery Diameter and Morning Blood Pressure in Midlife Adults, with a Potential Sex-Effect.

PurposeSleep efficiency is inversely associated with cardiovascular risk. Brachial artery diameter and flow-mediated dilation (FMD) are noninvasive cardiovascular disease markers. We assessed the associations between sleep efficiency and these vascular markers in midlife adults, including people with sleep apnea.Patients and MethodsThirty (18 males) participants completed an in-laboratory 8-hour sleep opportunity beginning at their habitual bedtimes. Polysomnography was used to assess sleep patterns and sleep efficiency (time asleep/time in bed). We measured systolic and diastolic blood pressure, heart rate, and baseline diameter, and FMD immediately upon awakening in the morning. Mixed model analyses, adjusting for apnea-hypopnea and body mass indices, were used to assess the relationship between overnight sleep efficiency and cardiovascular markers. We also explored sex differences.ResultsSleep efficiency was negatively associated with baseline brachial artery diameter (p = 0.005), systolic BP (p = 0.01), and diastolic BP (p = 0.02), but not flow-mediated dilation or heart rate (p > 0.05). These relationships were confirmed with correlations between sleep efficiency and baseline diameter (r = −0.52, p = 0.004), systolic BP (r = −0.43, p = 0.017), and diastolic BP (r = −0.43, p = 0.019). There was a sex-specific interaction trend for sleep efficiency and arterial diameter (p = 0.07) and a significant sex-specific interaction (p < 0.05) for BP, such that the relationships between sleep efficiency and cardiovascular markers were significant in women but not in men.ConclusionIn midlife adults, poor sleep efficiency is associated with increased brachial artery diameter and blood pressure, effects that were primarily driven by significant associations in women. These associations could underlie the observed increase in cardiovascular risk in adults with poor sleep and cardiovascular disease.

Central Haemodynamics Are Associated With Pulmonary Function in Postmenopausal Women

Increased arterial stiffness predicts cardiovascular disease, which is associated with deteriorated pulmonary function and worsened chronic obstructive pulmonary disease. The present study examined whether arterial function was associated with pulmonary function in postmenopausal women. This study evaluated 41 postmenopausal women (age range: 59-85 years). Arterial function was measured as central systolic blood pressure (cSBP), central pulse pressure (cPP), brachial systolic BP (bSBP), brachial diastolic BP (bDBP), brachial PP (bPP), brachial mean arterial pressure (bMAP) and the augmentation index (AIx). AIx was adjusted for a heart rate of 75 beats per minute (bpm) (AIx@75) and served as the index of arterial stiffness determined by the reflected wave at the central artery. Pulmonary function was measured as forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and the FEV1/FVC ratio. Univariate regression analysis demonstrated that cPP, bDBP and bPP were correlated with FVC and FEV1 (p<0.05, respectively), while AI@75 was correlated with FVC, FEV1 and FEV1/FVC ratio (p<0.01, respectively). A stepwise multivariate regression analysis revealed that bDBP was independently associated with FVC (p=0.032), while AI@75 was independently associated with FVC, FEV1 and FEV1/FVC ratio (p=0.001, p=0.003 and p=0.017, respectively). The FVC, FEV1 and FEV1/FVC ratio were lower in participants with a high AIx versus with a low AIx (p=0.0001, p=0.001 and p=0.044, respectively). These results suggest that increased AIx is associated with lower pulmonary function in postmenopausal women.

Effects of indoor and outdoor temperatures on blood pressure and central hemodynamics in a wintertime panel of peri-urban Chinese adults

BACKGROUND AND AIM: Excess wintertime cardiovascular mortality has been observed in populations globally and is partly attributed to cold-induced elevated blood pressure (BP). An inverse relationship between outdoor temperature and BP is well documented. The influence of indoor environmental conditions (e.g., heating, insulation) and indoor temperature on BP is less clear. We examined the effects of indoor and outdoor temperature on wintertime BP and central hemodynamics among older adults in peri-urban Beijing, China. METHODS: We enrolled 1,285 older adults into a panel study conducted in two winter seasons (2018-19 and 2019-2020). Staff traveled to participant homes to administer a questionnaire and measure their brachial and central systolic and diastolic BPs, pulse pressures, and pulse pressure amplification. Indoor temperature was measured within the 5-minutes prior to BP measurements for all participants and 12-month indoor temperature measurements were obtained in a 37% (1st season) and 32% (2nd season) random subsample. Village-level outdoor temperature was estimated from regional meteorological stations. Multivariable mixed-effects regression models were used to estimate the within- and between-individual effects of indoor and outdoor temperature on BP, allowing for effect measure modification. RESULTS:Indoor and outdoor winter temperatures ranged from 0.0 to 28.0˚C and -14.3 to 6.4˚C, respectively. Those in colder homes had a lower wealth score and less home insulation. We observed an inverse linear relationship between indoor temperature and BP (mmHg per 1˚C increase in temperature: −0.4 to −0.5 systolic, −0.3 diastolic, and −0.2 pulse pressure). We found little evidence of any effect of outdoor temperature with BP, or that outdoor temperature modified the effect of indoor temperature. CONCLUSIONS:We found an inverse association between indoor temperature and BP, but no relationship of BP with outdoor temperature. This suggests a stronger effect on BP of indoor compared to outdoor temperature. Improving insulation and household heating may help lower BP and prevent excess winter mortality. KEYWORDS: Cardiovascular diseases, Epidemiology, Socio-economic factors, Temperature

Acute Cardiovascular Responses to Self-selected Intensity Exercise in Parkinson's Disease.

Parkinson's disease patients frequently present cardiovascular dysfunction. Exercise with a self-selected intensity has emerged as a new strategy for exercise prescription aiming to increase exercise adherence. Thus, the current study evaluated the acute cardiovascular responses after a session of aerobic exercise at a traditional intensity and at a self-selected intensity in Parkinson's disease patients. Twenty patients (≥ 50 years old, Hoehn & Yahr 1-3 stages) performed 3 experimental sessions in random order: Traditional session (cycle ergometer, 25 min, 50 rpm, 60-80% maximum heart rate); Self-selected intensity: (cycle ergometer, 25 min, 50 rpm with self-selected intensity); and Control session (resting for 25 min). Before and after 30 min of intervention, brachial and central blood pressure (auscultatory method and pulse wave analysis, respectively), cardiac autonomic modulation (heart rate variability), and arterial stiffness (pulse wave analysis) were evaluated. Brachial and central systolic and diastolic blood pressure, heart rate, and the augmentation index increased after the control session, whereas no changes were observed after the exercise sessions (P<0.01). Pulse wave velocity and cardiac autonomic modulation parameters did not change after the three interventions. In conclusion, a single session of traditional intensity or self-selected intensity exercises similarly blunted the increase in brachial and central blood pressure and the augmentation index compared to a non-exercise control session in Parkinson's disease patients.

Female Gender Is Associated with Higher Susceptibility of Weight Induced Arterial Stiffening and Rise in Blood Pressure.

Arterial stiffness is an important predictor of cardiovascular events, independent of traditional risk factors. Stiffening of arteries, though an adaptive process to hemodynamic load, results in substantial increase in the pulsatile hemodynamic forces that detrimentally affects the microcirculation perfusing the vital organs such as the brain, heart and kidneys. Studies have proposed that arterial stiffness precedes and may contribute to the development of hypertension in individuals with obesity. Our study sought to determine the gender-based effects on arterial stiffening in obesity which may predispose to the development of hypertension. We found female sex is associated with higher susceptibility of weight-related arterial stiffening and rise in blood pressure in obesity. Women had significantly higher carotid-femoral pulse wave velocity (CF-PWV) with higher body mass index (BMI) status (normal: 7.9 ± 2 m/s; overweight: 9.1 ± 2 m/s; obese: 9 ± 2 m/s, p < 0.001), whereas it was similar in males across all BMI categories. The linear association between arterial stiffness and BMI following adjustment for age and brachial systolic and diastolic blood pressure (BP), remained significant in females (β = 0.06; 95% CI 0.01 to 0.1; p < 0.05) but not in males (β = 0.04; 95% CI −0.01 to 0.1; p > 0.05). The mean CF-PWV values increased by 0.1 m/s for every 1 kg/m2 increase in BMI in the female subjects in the age adjusted linear model, while such effect was not seen in the male subjects. In line with arterial stiffening, the overweight and obese females demonstrated significantly higher systolic brachial BP. (BP difference: ΔBP 9−11 mmHg, p < 0.01) and central systolic pressure (ΔBP 8−10 mmHg, p < 0.05) compared to their lean counterparts, unlike the male subjects. Our results suggest that female gender is associated with higher susceptibility of weight-related arterial stiffening and rise in blood pressure.