Brachial Systolic Blood Pressure Research Articles

Central hemodynamics and the discrepancy between central blood pressure and brachial blood pressure.

Despite similar brachial blood pressure, central hemodynamics could be different. The objective of the present study was to investigate the factors, which could influence the discrepancy between central BP (cBP) and brachial blood pressure. Six hundred forty-seven patients (364 males, 48 ± 12 years old) were enrolled. Using applanation tonometry, cBP was noninvasively derived. The median difference between brachial systolic BP (bSBP) and central systolic BP (cSBP) was 8 mm Hg. We defined the discrepancy between bSBP and cSBP as differences >8 mm Hg. For adjustment of cBP, population was divided into 3 groups according to the cBP: group 1, <140 mm Hg of cSBP; group 2, 140 > cSBP < 160 mm Hg; group 3, =160 mm Hg of cSBP. All the central hemodynamic parameters of the patients, including augmentation pressure, augmentation index (AI), heart rate (75 bpm) adjusted augmentation index (AI@HR75), and subendocardial viability ratio, were measured. Using multivariate logistic regression analysis, we evaluated the factors which could influence the discrepancy between bSBP and cSBP. Age, gender, augmentation pressure, AI, and AI@HR75 were correlated with the discrepancy between bSBP and cSBP. AI@HR75 was significantly correlated with the discrepancy between bSBP and cSBP (β-coefficient = −0.376, P < .001 in group 1; β-coefficient = −0.297, P < .001 in group 2; and β-coefficient = −0.545, P < .001 in group 3). In groups 1 and 2, male gender was significantly correlated with the discrepancy between bSBP and cSBP (β-coefficient = −0.857, P = .035 in group 1; β-coefficient = −1.422, P = .039 in group 2). In present study, arterial stiffness might affect the discrepancy between bSBP and cSBP. Also, male gender was closely related to the discrepancy between bSBP and cSBP especially with cSBP <160 mm Hg. Not only cSBP, the discrepancy between cSBP and bSBP should be considered for understanding the central hemodynamics.

Global constructive myocardial work predicts reduction of ejection fraction in patients with heart failure with preserved ejection fraction

Abstract Background Despite advances in treatment of heart failure with preserved ejection fraction (HFpEF) its management remains challenging. SGLT2 inhibitors benefits across the full range of ejection fraction, and sacubitril/valsartan benefits up to the lower end of preserved EF &amp;lt;57% implies that in some patients with HFpEF some pathophysiological mechanisms of HFrEF might co-exist, and some subset of HFpEF patients might benefit from proven treatment of HFrEF, particularly those with EF deterioration over time. We aimed to found out predictors of EF deterioration in HFpEF patients assuming that we can start treating them earlier with therapies of HFrEF, preventing further deterioration. Methods We studied 215 patients (63% women) 73±8 years with HFpEF. All patients had records of comorbidity Charlson index (CI), glomerular filtration rate (GFR). Echocardiography (EchoCG) was performed with offline analysis, including calculations of myocardial work (MW), global longitudinal (LS), radial (RS), circumferential (SS) and area strain (AS) by one experienced specialist. GW index was obtained from pressure-strain loops derived from speckle tracking analysis multiplied by brachial systolic blood pressure. Global constructive work (GCW) as the sum of positive work due to myocardial shortening during systole and negative work due to lengthening during isovolumic relaxation, global wasted work as energy loss by myocardial lengthening in systole and shortening in isovolumic relaxation, and GW efficiency as the percentage ratio of constructive work to the sum of constructive work and wasted work were obtained. RS, SS and AS were calculated in 3D by dedicated software. Patients followed up for 3 years. Results 5 patients developed myocardial infarction and were excluded from the study. Baseline EF was higher in women (61,2±3,1 vs 56,4±2,7; P&amp;lt;0.002), in patients &amp;gt;70 years (62,4±2,1 vs 57,1±2,3; p&amp;lt;0.005), and with end-diastolic volume index &amp;lt;60 ml/m2 (56,1±3,2 vs 63,4±2,3; p&amp;lt;0.001). Overall decline in EF compare to baseline was −7.3±1.6%, p&amp;lt;0.01. Reduction in EF was more prominent in patients &amp;gt;70 years (−6,9±1,8 vs −5,7±1,7; P&amp;lt;0,002), and in patients with coronary artery disease (CAD) (−7,2±1,9 vs −5,8±1,6; P&amp;lt;0,001) and did not relate to sex, LV size, CI, and GFR. During follow up 58 (27%) patients had EF &amp;lt;50%. We observed significant worsening in AS (−27.9±8.5% vs −24.7±5.3%, p&amp;lt;0.003), LS (−19.7±2.4% vs −17.1±1.6%, p&amp;lt;0.005), and GCW (GCW 2378±117 vs 2107±102 mmHg%, p&amp;lt;0.002). Patients with EF &amp;lt;50% at the end of the study had significantly less AS and GCW baseline values compared with patients with EF&amp;gt;50% (22.4±7.2% vs −27.6±8.1%, p&amp;lt;0.002; 2081±92 vs 2489±127 mmHg%, p&amp;lt;0.001). GCW was the predictor of EF deterioration (area under curve 0,875). Conclusion GCW predicts reduction of EF in patients with HFpEF which may help earlier identify the subset of HFpEF patients who may benefit from proven therapies for HFrEF and prevent upcoming deterioration. Funding Acknowledgement Type of funding sources: None.

Correlation between central aortic stiffness indices and cardiac mechanics in hypertensive patients: new insights from speckle tracking echocardiography imaging

Abstract Background Left ventricular (LV) and left atrial (LA) mechanics are altered in hypertensive patients. Recent evidence suggests that central aortic pressure, rather than brachial pressure is strongly related to future cardiovascular events. Currently, oscillometric non-invasive devices are considered a reliable method for estimation of central aortic pressure and stiffness indices. Purpose To evaluate the relation between central aortic pressure measured using oscillometric non-invasive device and cardiac mechanics assessed by speckle tracking echocardiography (STE). Methods Fifty hypertensive patients with apparently structural normal heart were consecutively enrolled. A new oscillometric device was programmed to measure blood pressure over a period of 30 minutes (total of 15 sequential readings) and then data was transferred to a computer-based software where the central aortic pressure and stiffness indices (Augmentation index {AIx} and Pulse wave velocity {PWV}) were automatically calculated. All patients underwent conventional transthoracic echocardiography and STE. STE analysis of LV and LA functions was done using a specific software. LV systolic (global longitudinal strain {GLS}) as well as diastolic (measured at peak mitral filling {E} and at isovolumetric relaxation time {IVRT}) strain/strain rate were measured. LA strain was measured during reservoir (LASr), conduit (LAScd) and contraction (LASct) phases. Results The mean age was 45.9±10.6 years and 38% of patients were males. Most of the population was overweight with mean BMI 28±1.9 kg/m2. About 2/3 of population has uncontrolled hypertension (mean brachial systolic and diastolic blood pressure was 139.8±17.5 and 88.4±11.3 mmHg, respectively). The mean central systolic (cSBP) and diastolic blood pressures (cDBP) were elevated (122.2±13.3 and 84.6±10.8 mmHg, respectively). cSBP and cDBP showed significant weak negative correlation with LV diastolic strain rate (Dsr) at peak E (cSBP: r=−0.33, p=0.02; cDBP: r=−0.28, p=0.04). There was no significant correlation between LV GLS and central stiffness indices (p&amp;gt;0.05). cDBP was significantly negatively correlated with LASct (r=−0.3, p=0.03), with no other significant correlation between central stiffness indices and other LA functions (LASr and LAScd) (p&amp;gt;0.05). Conclusions Changes in LV diastolic strain/strain rate parameters assessed by STE are related to central aortic pressure particularly cSBP and cDBP in patients with hypertension. This relation was also observed with LA strain parameters namely LASct. Funding Acknowledgement Type of funding sources: None.

Impact of Cardiovascular Risk Factors on Arterial Stiffness in a Countryside Area of Switzerland: Insights from the Swiss Longitudinal Cohort Study.

Cardiovascular disease is the leading cause of morbidity and mortality. Besides traditional cardiovascular risk factors, arterial stiffness is a recognized predictor of cardiovascular risk. We investigated the relationship between traditional cardiovascular risk factors, sex, and aortic pulse wave velocity in subjects living in a countryside area of Southern Switzerland. For this aim, we performed a cross-sectional analysis of data from adult participants of the Swiss Longitudinal Cohort Study, which, initiated in 2015, follows health status and disease risk factors in a Swiss countryside cohort at least 6years of age. A total of 387 people (205 women and 182 men) were included. Hyperlipidemia, overweight, and obesity were more common (p ≤ 0.001) and LDL-cholesterol, triglycerides, and hemoglobin A1c were higher (p < 0.03) in men than women. Systolic and diastolic brachial and aortic blood pressures were higher in men (p < 0.02), whereas aortic pulse wave velocity and aortic pulse pressure were higher in women (p < 0.05). The aortic pulse wave velocity was significantly higher in subjects with hypertension, hyperlipidemia, diabetes, and obesity, and significantly increased with age (p < 0.0001). Multiple linear regression analysis showed a significant correlation between pulse wave velocity and age, female sex, brachial systolic blood pressure, and heart rate (p < 0.005). Also in a countryside area, the aortic pulse wave velocity is higher in subjects with hypertension, hyperlipidemia, diabetes and obesity, and significantly increases with age. Furthermore, with advancing age, aortic pulse wave velocity is higher in women than men. ClinicalTrials.gov identifier, NCT02282748.

Aortic pressure-only wave separation analysis in adolescents: accuracy and associations with left ventricular mass index.

Early-life exposure to high blood pressure (BP) is associated with cardiovascular target organ damage but not all BP-related risk is attributable to systolic and diastolic BP alone. In adolescence, aortic wave separation (WS) parameters are associated with increased left ventricular mass index (LVMI) but this approach is limited by the requirement for aortic flow measurements. Several methods for estimating the aortic flow waveform from pressure waveforms have emerged, but their accuracy and associations with LVMI have never been tested in adolescents, which was the aim of our study. Carotid pressure waveforms were acquired by tonometry from 58 adolescents (age 16 ± 1.5 years, 59% female). Measured (aortic) flow and LVMI were acquired via 2D echocardiography. Three pressure-only approximations of aortic flow were synthesized, including triangular, excess, and individualized-physiologic flow. A 4th aortic flow (average flow) was approximated from the average of all 58 measured flow waveforms. Forward (Pf) and backward (Pb) pressure and reflection magnitude (Rm) were derived from WS analysis. The individualized-physiologic flow produced the best approximations of Pf (mean difference ± SD, -0.15 ± 2.38 mmHg), Pb (0.14 ± 0.25 mmHg), and Rm (0.01 ± 0.02 mmHg). Pf derived using measured, individualized-physiologic, and average flow, was similarly associated with LVMI adjusting for age, brachial systolic BP, cardiac output, and BMI (P ≤ 0.03 all). Pb derived using all flow waveforms was associated with LVMI and all associations yielded similar effect estimates. Of the estimated flow waveforms, individualized-physiologic flow yielded the best approximation of WS parameters and may provide important physiological and clinical insight among adolescents.

Randomized Pilot Study on the Effects of Sarcocornia as a Salt Substitute in Arterial Blood Pressure and Vascular Function in Healthy Young Adults.

Previous studies have shown that excessive salt intake is strongly associated with high blood pressure (HT), vascular dysfunction, and the overall risk of cardiovascular diseases. The aim of this study was to evaluate Sarcocornia effectiveness as a salt substitute, addressing its effect on cardiovascular function in healthy young individuals. Thirty healthy participants, aged 18 to 26 years, were randomized into two groups: the control group (CG) and the intervention group (IG). The IG used Sarcocornia powder as a salt substitute for cooking, and the CG used regular salt, during a period of 1 month. A baseline evaluation was performed before the participants started the intervention phase, and was repeated after a 30-day intervention period. Each evaluation included blood pressure (BP) measurement, carotid-femoral pulse wave velocity (PWV), and carotid pulse wave analysis (PWA), and blood samples were also collected for analysis. Sodium excretion was measured at baseline and after intervention through spot urine collection and analysis, a method suitable for this population but with known limitations. Baseline parameters were similar between groups and were within the normal range. Sodium excretion remained unchanged in the two evaluations in the CG, but significantly decreased after intervention in the IG. The reduction in sodium excretion in the IG was followed by a significant reduction in brachial and aortic systolic (SBP) and diastolic blood pressure (DBP), and also in PWV. No significant changes were observed in the CG in terms of cardiovascular parameters. This preliminary study conveys positive results in favor of Sarcocornia as a dietary substitute for regular salt, providing added evidence of the negative cardiovascular effects of high salt intake in young and healthy adults.

Impact Of Age On Aortic Pressure And Pressure Waves Responses To Metaboreflex Activation In Women

INTRODUCTION: Aging and hypertension are related to exaggerated peripheral blood pressure (BP) responses to exercise and metaboreflex activation (post-exercise muscle ischemia, PEMI). Postmenopausal (POST) women have greater risk of heart failure with preserved ejection fraction due to increased aortic pulsatile load on the left ventricle induced by increased systolic BP (SBP) and decreased diastolic BP (DBP) at rest. Age-related aortic stiffening augments pressures of the forward (Pf) and the reflected wave (Pb) traveling from peripheral arteries to the aorta. Increases in Pf and Pb contribute to elevated aortic SBP and pulse pressure (PP) responses to exercise, increasing the risk for cardiovascular events. However, the influence of Pf and Pb on aortic pulsatile load during isometric handgrip (IHG) and PEMI in normotensive premenopausal (PRE) and POST women have not been examined. PURPOSE: To investigate the effect of age on aortic BP, Pf, and Pb during IHG and PEMI in normotensive PRE and POST women. METHODS: Fifteen PRE (age: 24 ± 1 years) and 16 POST women (age: 59 ± 1 years) participated in this study. Brachial BP was obtained using an automated device and radial arterial tonometry was used to capture aortic waveforms to estimate aortic BP and pressure waves at rest, during a 2-min IHG at 30% of maximal force, and during a 3-min PEMI. RESULTS: BP responses to IHG were similar in both groups. Brachial PP (POST: Δ9 ± 1 mmHg vs PRE: Δ0 ± 2 mmHg, P < 0.01), aortic PP (POST: Δ8 ± 1 mmHg vs PRE: Δ3 ± 2 mmHg, P = 0.03), Pf (POST: Δ6 ± 1 mmHg vs PRE: Δ0 ± 1 mmHg, P < 0.01), and Pb (POST: Δ5 ± 1 mmHg vs PRE: Δ2 ± 1 mmHg, P = 0.02) responses to PEMI were significantly increased in POST compared to PRE women. Aortic DBP (POST: Δ6 ± 1 mmHg vs PRE: Δ11 ± 2 mmHg, P = 0.04) responses to PEMI was significantly lower in POST than PRE women. Brachial and aortic SBP significantly (P < 0.001) increased during PEMI in both PRE and POST women, but there was no difference (P > 0.05) between groups. CONCLUSION: Normotensive POST women have augmented aortic PP response to PEMI compared to PRE women due to increases in pressure of the forward and backward waves and a decrease in DBP. Our findings suggest that the age-related increase in muscle metaboreflex activation does not induce a systolic overload and the increase in aortic PP is attributed to reduced DBP in normotensive POST women.

Abstract 081: Pulse Wave Velocity And Blood Pressure Variability As Prognostic Indicators In Very Elderly Patients With Advanced Chronic Conditions

The prognostic value of BP elevation in very old patients with other chronic comorbidities is uncertain. We aimed to assess the prognostic impact of 24-hour BP (both brachial and central), BP variability, and pulse wave velocity (PWV) in very elderly patients hospitalized due to a chronic disease decompensation. We included 249 patients older than 80 years, admitted to the hospital due to decompensation of congestive heart failure (149), chronic obstructive pulmonary disease (60), chronic kidney disease with acute kidney injury (26), or other decompensated chronic conditions (14). During hospital stay, 24-h BP monitoring was performed (Mobil-O-Graph PWV). Mean values of brachial and central BP, aortic PWV, and BP variability (24-hour SD) were obtained in all participants. After discharge, patients were followed-up for one year. The primary outcome was total mortality. Hazard ratio (HR) of BP estimates (for 1 SD increase) were obtained through Cox models, adjusted for clinical confounders. During follow-up 72 patients (29%) died. Progression of heart failure (58%) was the most frequent cause of death. No differences were observed in 24-h BP between those who died or remained alive. Systolic BP-SD, and PWV were higher in patients who subsequently died, while 24-hour HR- SD was lower (Table). In fully adjusted models, PWV (HR: 3.54; 95%CI: 2.37-5.28), SD of 24-h brachial systolic BP (1.29; 1.00-1.67) and SD of 24-h heart rate (0.65; 0.46-0.91) were associated with the risk of mortality. We conclude that PWV, SBP and heart rate variabilities, but not the level of BP are associated with mortality in very old patients with advanced chronic conditions

Twenty-Four-Hour Central Hemodynamic Load in Adults With and Without a History of COVID-19.

BACKGROUNDAlthough hypertension is an established risk factor for severe COVID-19 illness, little is known about the effects of COVID-19 on blood pressure (BP). Central BP measures taken over a 24-hour period using ambulatory blood pressure monitoring (ABPM) adds prognostic value in assessing cardiovascular disease (CVD) risk compared to brachial BP measures taken at a single time point. We assessed CVD risk between adults with and without a history of COVID-19 via appraisal of 24-hour brachial and central hemodynamic load from ABPM.METHODSCross-sectional analysis was performed on 32 adults who tested positive for COVID-19 (29±13 years, 22 females) and 43 adults without a history of COVID-19 (28±12 years, 26 females). Measures of 24-hour hemodynamic load included brachial and central systolic and diastolic BP, pulse pressure, augmentation index (AIx), pulse wave velocity (PWV), nocturnal BP dipping, the ambulatory arterial stiffness index (AASI), and the blood pressure variability ratio (BPVR).RESULTSParticipants who tested positive for COVID-19 experienced 6±4 COVID-19 symptoms, were studied 122±123 days after testing positive, and had mild-to-moderate COVID-19 illness. The results from independent samples t-tests showed no significant differences in any of our 24-hour, daytime, or nighttime measures of central or peripheral hemodynamic load across those with and without a history of COVID-19 (p > 0.05 for all).CONCLUSIONSNo differences in 24-hour brachial or central ABPM measures were detected between adults recovering from mild-to-moderate COVID-19 and controls without a history of COVID-19. Adults recovering from mild-to-moderate COVID-19 do not have increased 24-hour central hemodynamic load.

Comparison between cuff-based and invasive systolic blood pressure amplification.

Accurate measurement of central blood pressure (BP) using upper arm cuff-based methods is associated with several factors, including determining the level of systolic BP (SBP) amplification. This study aimed to determine the agreement between cuff-based and invasively measured SBP amplification. Patients undergoing coronary angiography had invasive SBP amplification (brachial SBP - central SBP) measured simultaneously with cuff-based SBP amplification using a commercially available central BP device (device 1: Sphygmocor Xcel; n = 171, 70% men, 60 ± 10 years) and a now superseded model of a central BP device (device 2: Uscom BP+; n = 52, 83% men, 62 ± 10 years). Mean difference (±2SD, limits of agreement) between cuff-based and invasive SBP amplification was 4 mmHg (-12, +20 mmHg, P < 0.001) for device 1 and -2 mmHg (-14, +10 mmHg, P = 0.10) for device 2. Both devices systematically overestimated SBP amplification at lower levels and underestimated at higher levels of invasive SBP amplification, but with stronger bias for device 1 (r = -0.68 vs. r = -0.52; Z = 2.72; P = 0.008). Concordance of cuff-based and invasive SBP amplification across quartiles of invasive SBP amplification was low, particularly in the lowest and highest quartiles. The root mean square errors from regression between cuff-based central SBP and brachial SBP were significantly lower (indicating less variability) than from invasive regression models (P < 0.001). Irrespective of the difference from invasive measurements, cuff-based estimates of SBP amplification showed evidence of proportional systematic bias and had less individual variability. These observations could provide insights on how to improve the performance of cuff-based central BP.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Impact of the MTHFR C677T polymorphism on blood pressure and related central haemodynamic parameters in healthy adults.

BackgroundThe C677T polymorphism in the gene‐encoding methylenetetrahydrofolate reductase (MTHFR) is associated with an increased risk of hypertension and cardiovascular disease. Riboflavin, the MTHFR cofactor, is an important modulator of blood pressure (BP) in adults homozygous for this polymorphism (TT genotype). The effect of this genetic variant on BP and related central haemodynamic parameters in healthy adults has not been previously investigated and was examined in this study.MethodsBrachial BP, central BP and pulse wave velocity (PWV, SphygmoCor XCEL) were measured in adults aged 18–65 years prescreened for MTHFR genotype. Riboflavin status was assessed using the erythrocyte glutathione reductase activation coefficient assay.ResultsTwo hundred and forty‐two adults with the MTHFR 677TT genotype and age‐matched non‐TT (CC/CT) genotype controls were identified from a total cohort of 2546 adults prescreened for MTHFR genotype. The TT genotype was found to be an independent determinant of hypertension (p = 0.010), along with low‐riboflavin status (p = 0.002). Brachial systolic and diastolic BP were higher in TT versus non‐TT adults by 5.5 ± 1.2 and 2.4 ± 0.9 mmHg, respectively (both p < 0.001). A stronger phenotype was observed in women, with an almost 10 mmHg difference in mean systolic BP in TT versus non‐TT genotype groups: 134.9 (95% confidence interval [CI] 132.1–137.6) versus 125.2 (95% CI 122.3–128.0) mmHg; p < 0.001. In addition, PWV was faster in women with the TT genotype (p = 0.043).ConclusionThis study provides the first evidence that brachial and central BP are significantly higher in adults with the variant MTHFR 677TT genotype and that the BP phenotype is more pronounced in women.

Sleep duration irregularity is associated with elevated blood pressure in young adults

ABSTRACT Sleep irregularity (i.e., highly variable sleep patterns) is an emerging risk factor for cardiometabolic disease. Though irregular sleep patterns are common among young adults, the cardiometabolic health (CMH) repercussions of sleep irregularity in this population are unclear. We examined associations between sleep duration and irregularity with measures of CMH in 44 (24 M/20 F, 23 ± 5y, BMI 26 ± 4 kg/m2, blood pressure (BP): 125/71 ± 14/9 mmHg) young adults. Participants wore actigraphy monitors for seven-days and sleep duration irregularity was operationalized as the standard deviation of nightly sleep duration (sleep SD). CMH variables of interest included brachial and aortic BP, arterial stiffness (cf-PWV), augmentation index (AIx75), and fasting blood glucose and lipids. Associations between sleep duration and sleep SD with CMH variables were assessed via correlations adjusted for sex and BMI. Sleep duration generally was not associated with CMH indices. However, sleep SD was associated with brachial systolic (r = 0.433, p = .027) and diastolic BP (r = 0.415, p = .035). Similarly, sleep duration SD was associated with aortic systolic BP (r = 0.447, p = .022). Our findings show that sleep irregularity, but not duration, is associated with higher brachial and central BP in young adults. Abbreviations: AIx75: augmentation index at a heart rate of 75 beats per minute; BP: blood pressure; CMH: cardiometabolic health; cf-PWV: carotid-femoral pulse wave velocity; DXA: dual x-ray absorptiometry; mg/dl: milligrams per deciliter; PWA: pulse wave analysis; PWV: pulse wave velocity; sleep duration SD: standard deviation of nightly sleep duration

Efecto de la administración de diferentes formas de vitamina D en la presión arterial y rigidez aórticas, y su implicación en la reducción de la albuminuria en la enfermedad renal crónica

Background and objectivesVitamin D(vitD) participates in phospho-calcium metabolism and exerts multiple pleiotropic effects. There is tissue 1-α (OH)ase that converts 25-OH cholecalciferol (25 (OH) D) in calcitriol that exerts autocrine and paracrine effects. 25 (OH)D deficiency could limit these tissue effects of vitD. The administration of nutritional vitD and the activator of the vitD receptor, paricalcitol, may promote beneficial effects on vascular and renal function. The objective of this work was to study in subjects with chronic kidney disease (CKD) the effect that the administration of different forms of vitD has on arterial function and albuminuria, and the possible relationship between the modifications of these variables. Patients and methodsWe studied in 97 patients with CKD stages 3-4 the effect of the administration of cholecalciferol (group 2; n: 35) and paricalcitol (n: 31; group 3) on parameters derived from brachial blood pressure, aortic blood pressure and on aortic stiffness studied using carotid-femoral pulse velocity (Vpc-f), and on albuminuria. A group of patients with stages 3-4 CKD who did not receive vitD therapy served as a control group (n: 31; group 1). All parameters were studied at baseline and after the follow-up period which was 7 ± 2 months. ResultsIn the baseline phase, no differences were observed between the groups in brachial systolic blood pressure (bSBP), central systolic blood pressure (SBP), brachial pulse pressure (bPP), and central pulse pressure (pCP) or in aortic stiffness that was increased in all groups with a baseline Vpc-f value of 10.5 (9.2-12.1) m/sec. The baseline albuminuria value in the grouped patients was 229 (43-876) mg / g (median (interquartile range)), with no differences between the groups.Serum calcium and phosphorus increased significantly in those treated with cholecal-ciferol (native vitD) and paricalcitol (active vitD). Parathormone (PTH) values decreased in those treated with paricalcitol.bPP and cPP decreased in all groups treated with native and active vitD. No significant changes in bPP and cPP were observed in the control group.Vpc-f did not change significantly in any of the groups, although the variation was quantitatively greater in group 3 (11.2±2 vs. 10.7±1.6 (P=.06)). No differences were observed in the changes in Vpc-f between the groups when adjusted to the baseline values of estimated glomerular filtration rate (eGFR), albuminuria, PTH, vitD, brachial and central blood pressure parameters, and their changes with treatment.Those who received treatment with native and active vitD presented a significant decrease in albuminuria of 17% (group 2) and 21% (group 3) compared to a 16% increase in the untreated group (group 1) (P=.01). A decrease in albuminuria ≥30% was observed more frequently in the groups treated with some form of vitD (group 2: 23%; group 3: 45%) than in the control group (13%) (P=.03). The decrease in albuminuria observed in the groups treated with any of the forms of vitD did not vary when the baseline values of the biochemical parameters of phosphorus-calcium metabolism, those of arterial function (PPb, PPc, Vpc-f) or its modifications were introduced as covariates. There was no significant correlation between changes in Vpc-f and albuminuria. In logistic regression, changes in arterial function parameters were also not explanatory for the ≥30% decrease in albuminuria. ConclusionsIn patients with CKD stages 3-4, treated with RAS blockers and with residual albuminuria, the administration of or paricalcitol reduces brachial and aortic pulse pressures, and albuminuria. The decrease in albuminuria does not seem to be mediated, at least not decisively, by changes in central hemodynamics or aortic stiffness.

The effect of acute high-intensity interval exercise on post-exercise blood pressure in post coronary artery bypass graft surgery patients: a pilot study

Coronary artery disease is the main cause of death worldwide. Coronary artery bypass graft (CABG) is a preferred treatment option for multi-vessel disease and left main disease patients. Physical training (recovery) enhances exercise tolerance, an activity of daily living, and quality of life in this patient. For this, the aim of the current study was to investigate the effect of acute high-intensity interval exercise on post-exercise blood pressure in CABG patients. In this study, all patients underwent open-heart surgery at least 1 month before involvement in the study. All Subjects were included after Medical rigorous screening. Participants carried out two experimental sessions of high-intensity interval exercise (HIIE) and mild continuous exercise (MCE) with a minimum of 72 h intervals: This study employed a randomized, cross-over design, Brachial systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate (HR) were measured Immediately before (pre) and after (post) and approximately15 min(post-15) and 30 min (post-30) after each exercise bout. The Split-Plot Analysis of Variance with repeated measures (group × time) was used to analyze the data. Significant post-exercise increases in SBP, and HR were seen following each protocol (p&amp;lt;0.05). Following two bouts, SBP decreased at 15- and 30-min post-exercise in two groups but this decline was more in the HIIE group than MCE. Based on the findings of this study, both high-intensity intermittent and continuous exercise can improve heart function in CABG patients by diminishing BP.

Correlation of the Second Derivative of Digital Pulse Wave (DPW) with Central Obesity in Women

Background: Obesity, as measured by body mass index (BMI) or measures of central obesity, including waist-to-hip ratio (WHR) and waist circumference, is related to higher total and cardiovascular mortality. Four systolic waves (a, b, c, and d) and one diastolic wave (e) make up the second derivative of the digital pulse wave (SDPTG), which is obtained by two mathematical differentiation of the original PTG. Objective: To find out whether the (SDDPW) is correlated with central obesity in women. Methods: 55 healthy female subjects with Body Mass Index (31.5±7.3) were included in the current study. A fingertip pulse wave transducer was used to record digital pulse waves. For automatic detection and measurement of A, B, C, D, and E waves and amplitude of the second derivative digital pulse wave, Lab Chart Pro version 7.2 was used. Height and weight were measured. Waist and hip circumference were measured. Brachial systolic and diastolic blood pressures (SBP &amp; DBP) were measured. Results: The results showed that B/A ratio is positively and significantly affected by central obesity in terms of waist circumference (r = 0.3, P&lt;0.037), and waist/height ratio (r = 0.31, P&lt;0.031). Conclusion: B/A ratio is positively and significantly affected by central obesity. Keywords: Digital pulse wave (DPW), Central obesity, women

Color Doppler and Ankle-brachial Index in the Diagnosis of Peripheral Artery Disease in Type II Diabetic Subject

Objective: To determine the association of color doppler and ankle-brachial index (ABI) in the diagnosis of peripheral artery disease in type ii diabetic subject.&#x0D; Methods: The study was carried out at ultrasound department of Advanced Radiology Clinic (ARC), Karachi, from January 2020 to December 2020. Patients of diagnosed diabetes mellitus for at least 4 years of either gender between 30-70 years of age were included. All patients were instructed to avoid heavy exercise, smoking and caffeinated beverages before the examination for at the minimum of two hours. All the cases underwent Standard Doppler examination of lower limb peripheral arteries performed by radiologist having experience of more than 10 years. Spectral waveform analysis was evaluated and presence of Biphasic flow or monophasic flow on color Doppler was labelled as peripheral artery disease. The ABI was computed for each patient by measuring the systolic blood pressure in supine position starting with the right arm then proceeding towards right leg, left leg, and finally for the left arm. ABI is a ratio obtained from dividing the higher of the ankle blood pressures for each leg by the highest of the right and left arm’s brachial systolic blood pressures. It was labelled as peripheral artery disease if the value was &lt;0.9. This information along with the demographics was entered in the Performa by the researcher. Data was analyzed by using SPSS Version 26.&#x0D; Result: Mean age of enrolled participants was 58.21±6.74 year. There were 78.6% were males and 21.4% were females; mean duration of diabetes was 11.24±5.62 years. Out of all 121 cases were diagnosed color doppler and 118 cases found positive on ABI. Although ankle-brachial index shows almost similar diagnosis like color doppler ultrasound in the assessment of peripheral arterial disease (P-0.649).&#x0D; Conclusion: This study concludes that ankle-brachial index is a feasible, non-invasive technique almost similar to color Doppler ultrasound method for the detection of peripheral arterial disease. The ankle-brachial index technique is most important in periphery areas where color Doppler ultrasound is not available.

Arterial stiffness and contralateral differences in blood pressure: The Atherosclerosis Risk in Communities (ARIC) study.

A large interarm difference in brachial systolic blood pressure (SBP) (≥10 or ≥15 mmHg) is strongly associated with elevated cardiovascular events and mortality. Evidence demonstrating whether such contralateral differences in SBP occur in ankle blood pressure and its association with arterial stiffness is scarce. The aims of this study were to characterize arm and ankle contralateral SBP differences in a sample of community‐dwelling older adults (5077), and to determine whether this difference is associated with arterial stiffness assessed by pulse wave velocity (PWV) between the heart and ankle (haPWV), femoral artery and ankle (faPWV), and brachial artery and ankle (baPWV) in the right and left sides. Prevalence of interarm SBP differences ≥10 and ≥15 mmHg was 5.1% and .7%, respectively; the corresponding prevalence for interankle SBP was 24.9% and 12.0%. Higher BMI and lower ankle‐brachial index (ABI) were significantly correlated with greater interarm SBP differences. Increased age, higher BMI, lower ABI, and greater contralateral differences in haPWV, faPWV, and baPWV were significantly correlated to greater interankle SBP differences. Interankle SBP difference ≥15 mmHg was significantly associated with contralateral differences of >80 cm/s in haPWV (OR = 1.94 [95% CI = 1.52–2.49]), >165 cm/s in faPWV (OR = 1.64 [95% CI = 1.27–2.12]), and >240 cm/s in baPWV (OR = 2.43 [95% CI = 1.94–3.05]). The associations remained significant after adjustment for age, sex, race, BMI, smoking status, and ABI. Compared with interarm differences, interankle differences in SBP are common in older adults. The magnitude of interankle, but not interarm, differences in SBP is associated with various measures of arterial stiffness.

Accuracy Difference of Noninvasive Blood Pressure Measurements by Sex and Height

Women are at higher risk of cardiovascular events than men with similar blood pressure (BP). Whether this discrepancy in risk is associated with the accuracy of brachial cuff BP measurements is unknown. To examine the difference in brachial cuff BP accuracy in men and women compared with invasively measured aortic BP and to evaluate whether noninvasive central BP estimation varies with sex. This cross-sectional study enrolled 500 participants without severe aortic stenosis or atrial fibrillation from January 1 to December 31, 2019, who were undergoing nonurgent coronary angiography at a tertiary care academic hospital. Simultaneous measurements of invasive aortic BP and noninvasive BP. Sex differences in accuracy were determined by calculating the mean difference between the noninvasive measurements (brachial and noninvasive central BP) and the invasive aortic BP (reference). Linear regression and mediation analyses were performed to identify mediators between sex and brachial cuff accuracy. This study included 500 participants (145 female [29%] and 355 male [71%]; 471 [94%] White; mean [SD] age, 66 [10] years). Baseline characteristics were similar for both sexes apart from body habitus. Despite similar brachial cuff systolic BP (SBP) (mean [SD], 124.5 [17.7] mm Hg in women vs 124.4 [16.4] in men; P = .97), invasive aortic SBP was higher in women (mean [SD], 130.9 [21.7] in women vs 124.7 [20.1] mm Hg in men; P < .001). The brachial cuff was relatively accurate compared with invasive aortic SBP estimation in men (mean [SD] difference, -0.3 [11.7] mm Hg) but not in women (mean [SD] difference, -6.5 [12.1] mm Hg). Noninvasive central SBP (calibrated for mean and diastolic BP) was more accurate in women (mean [SD] difference, 0.6 [15.3] mm Hg) than in men (mean [SD] difference, 8.3 [14.2] mm Hg). This association of sex with accuracy was mostly mediated by height (3.4 mm Hg; 95% CI, 1.1-5.6 mm Hg; 55% mediation). In this cross-sectional study, women had higher true aortic SBP than men with similar brachial cuff SBP, an association that was mostly mediated by a shorter stature. This difference in BP measurement may lead to unrecognized undertreatment of women and could partly explain why women are at greater risk for cardiovascular diseases for a given brachial cuff BP than men. These findings may justify the need to study sex-specific BP targets or integration of sex-specific parameters in BP estimation algorithms.

Disparity in association of obesity measures with ankle and brachial systolic blood pressures in Europeans and South Asians

Obesity causes increases in brachial systolic-blood-pressures (SBP), risks of type 2 diabetes (T2DM) and cardiovascular diseases (CVD). Brachial and ankle SBPs have differential relationship with T2DM and CVD. Our objective was to study the relationship of obesity measures with brachial and ankle SBPs. A population of 1098 adults (South Asians n = 699; 41.70% male and 58.3% female) were recruited over 5 years from primary care practices in England. Their four limbs SBPs were measured using Doppler machine and body-mass-index (BMI) and waist-to-height-ratio (WHtR) calculated. Linear regressions were performed between SBPs and obesity measures, after adjustments for sex, age, ethnicity, T2DM and CVD. The mean age of all participants was 51.3 (SD = 17.2), European was 57.7 (SD 17.2) and South Asian was 47.8 (SD = 16.1). The left posterior tibial [Beta = 1.179, P = 4.559 × 10−15] and the right posterior tibial SBP [Beta = 1.178, P = 1.114 × 10−13] most significantly associated with the BMI. In South Asians, although the left brachial [Beta = 25.775, P = 0.032] and right brachial SBP [Beta = 22.792, P = 0.045] were associated to the WHtR, the left posterior tibial SBP [Beta = 39.894, P = 0.023], association was the strongest. For the first time, we have demonstrated that ankle SBPs had significant association with generalised obesity than brachial systolic blood pressures (SBP), irrespective of ethnicity. However, with respect to visceral obesity, the association with ankle SBP was more significant in South Asians compared to Europeans.