Brachial Systolic Blood Pressure Research Articles

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.

CARDIAC PROTECTION THERAPY CAN PREVENT THE ELEVATION OF CENTRAL BLOOD PRESSURE IN ADULT PATIENTS WITH CONGENITAL HEART DISEASE

Objective: There is no evidence of beneficial effect of cardiac protection (CP) therapy for heart failure, that is medication of renin-angiotensin system antagonists and beta blockers, in patients with congenital heart disease (CHD). However, these drugs have blood pressure (BP) lowering effect and may prevent future hypertension in CHD patients, who are high risk for hypertension. Therefore, we examine the BP lowering effect of CP in adults with CHD. Design and method: We enrolled 131 consecutive subjects aged > 20 years who visited the Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center. The exclusion criteria were as follows: (1) a history of atrial fibrillation or frequent supra or ventricular premature beats, (2) history of cardiac operation in the past 6 months, (3) medication for hypertension, and (4) NYHA II-IV. We divided the remaining 60 patients into cardiac protection (+) and (-) and compared their brachial and central systolic BP (SBP). We defined a patient whose brachial SBP was higher than 1SD of age and sex matched control (Japanese general population) as high SBP. Moreover, we defined a patient whose central SBP was higher than 1SD of control as high central SBP. Results: Fifteen patients were medicated CP drugs (carvedilol 7, bisoprolol 1, enalapril 11, candesartan 2) (CP+). The mean age was 34.1 ± 13.2 years in CP- and 30.3 ± 11.4 in CP+. The brachial systolic/diastolic BP was 124.4 ± 19.7/74.6 ± 14.0 mmHg in CP- 116.7 ± 12.5/66.2 ± 12.1 mmHg in CP+. There were 14 high SBP patients in CP- and one patient in CP+ (p = 0.0535). The central SBP was 126.8 ± 21.0 mmHg in CP- and 113.2 ± 16.0 mmHg in CP+. There were 16 high central CBP patients in CP- and one patient in CP+ (p = 0.0043). Conclusions: The number of high central SBP in patients with CP+ was smaller than CP-. It may be obvious because the drugs used for CP have BP lowering effect. It is well known that hypertension is popular in patients with CHD. CP drugs for heart failure may prevent future cardiovascular disease in patients with CHD.

NON-INVASIVE CENTRAL BLOOD PRESSURE ESTIMATIONS IN PATIENTS WITH OR WITHOUT CHRONIC KIDNEY DISEASE: A PILOT PROJET

Objective: Central systolic blood pressure (SBP) is a better surrogate for hemodynamic strain on the myocardium, brain and kidneys. In the context of chronic kidney disease (CKD), where the blood flow to the kidneys is reduced and there is a higher degree of aortic stiffness, estimation of central BP through non-invasive methods needs to be validated. The aim of our study is to determine the accuracy of brachial and central SBP, as measured and estimated by two devices, towards the invasively measured aortic BP, in CKD patients compared to patients without CKD. Design and method: This is a multicenter pilot study taking place at the hospitals Hotel-Dieu de Québec and Sacré-Coeur de Montréal. Patients undergoing non-urgent coronary angiograms are undergoing evaluation of non-invasive and invasive BPs simultaneously in supine position. In brief, intraarterial aortic BPs are recorded in the aorta within 3 cm of the aortic valve for every heartbeat for 30 seconds then averaged. Non-invasive central and brachial BP measures are recorded concurrently to the intraarterial aortic BP recordings with WatchBP central and Mobil-o-graph. All measurements are recorded on the contralateral arm used for angiography. Results: In 34 subjects (29% female, mean age 64.2 ± 8.7). In the CKD group (n = 8, eGFR < 30 ml/min/1.73m2) and the control group (n = 26, eGFR> 30 ml/min/1.73m2). Brachial cuff-SBP underestimated aortic SBP in CKD (-10.0 ± 19.6 mmHg) but overestimated aortic SBP (3.9 ± 16.3 mm Hg) in the control group. Mobil-o-graph estimations are more precise than the brachial BP in CKD (0.0 ± 10.1 mmHg) but not in the control group (6.5 ± 14.7 mmHg). WatchBP Central SBP estimations are also more precise than the brachial BP in CKD (1.2 ± 10.8) but overestimated aortic SBP in the control group (13.4 ± 18.9). Conclusions: The preliminary results indicate that brachial SBP underestimates aortic SBP by in CKD as compared to controls, and that estimation of central BP by both devices provide a better estimate of aortic SBP in CKD than in controls. These preliminary results suggest that the use of central BP estimations could be beneficial for the management of hypertension in CKD.

HEART-TO-ANKLE PULSE WAVE VELOCITY AS USED IN CARDIO-ANKLE VASCULAR INDEX (CAVI) AND CAVI_0 IS A NEARLY DIASTOLIC WAVE SPEED METRIC

Objective: Cardio-ankle vascular index (CAVI) and CAVI_0 are arterial stiffness indices based on the heart-to-ankle pulse wave velocity (haPWV). haPWV is derived from the heart-to-ankle transit time (haTT = tb+tba) as haPWV = L/haTT, with L an estimated transit distance. tb is the time difference between aortic valve closure (causing the aortic dicrotic notch) and the dicrotic notch in the brachial pressure waveform; tba is the time difference between the diastolic feet in the brachial and ankle pressure waveforms. CAVI and CAVI_0 aim to normalise haPWV for blood pressure at the time of measurement. As tb and tba are determined at different pressures — tb at dicrotic notch pressure (P_notch); tba at diastolic blood pressure (DBP; Fig. C) — determining the pressure that governs haPWV (P_haPWV) and hence should ideally be used for normalisation of haPWV is not trivial. CAVI uses P_m = (SBP+DBP)/2 to normalise haPWV, whereas CAVI_0 uses DBP (SBP: brachial systolic blood pressure). We aim to analytically estimate P_haPWV and compare this to the normalisation pressures used in CAVI and CAVI_0. Design and method: Consistent with CAVI/CAVI_0 assumptions, the arterial tree was assumed to consist of tubes with exponential pressure-diameter relationship and uniform stiffness index beta_0, allowing us to calculate PWV at P_notch (PWV_notch) and at DBP (PWV_DBP; Fig. A). P_notch was calculated as 0.55DBP+0.45SBP [Adji et al.,J Hypertens 2012;30:1540–1551]. The resulting PWVs, together with heart-to-ankle (L_ha=170 cm) and heart-to-brachial (L_hb=38 cm) path lengths [Alastruey et al.,11th Int Conf Press Surges 2012;401–442] (Fig. B), allowed analytically estimating tb and tba: tb=L_hb/PWV_notch and tba=(L_ha-L_hb)/PWV_DBP. P_haPWV was finally estimated as the weighted average of P_notch and DBP using tb and tba as weights. Results: Choosing SBP/DBP=120/80 mmHg (and hence P_m=100 mmHg) and beta_0 = 10 yielded tb = 0.048 s and tba = 0.187 s, giving P_haPWV = 84 mmHg. This implies that P_haPWV was much closer to DBP (as used in CAVI_0) than to P_m (as used in CAVI). This result was only marginally influenced by blood pressure: e.g., SBP/DBP = 160/90 mmHg (P_m = 125 mmHg) yielded P_haPWV = 96 mmHg. Conclusions: DBP offers a more accurate estimate of P_haPWV than Pm, supporting the utility of CAVI_0 as an enhancement of CAVI.

HYPERTENSION IN CAMEROONIAN RURAL AND URBAN PYGMIES AND BANTUS OF THE SOUTHERN REGION

Objective: To determine the prevalence of hypertension and associated risk factors among rural and urban pygmy and Bantu dwellers of southern Cameroon Design and method: In this cross-sectional cluster sampling survey, we examined 100 traditional pygmies (TP) living in equatorial forest in Kavabousse village under hunter-gatherer subsistence mode, 100 traditional Bantus (TB) living in Bidjouka village closed to Kavabousse (rural area); and 100 contemporary pygmies (CP) and 100 contemporary Bantus (CB) both living in the same urban environment in Kribi city. Trained observers recorded in each participant lifestyle and socio-demographic data, and clinical parameters. Brachial systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured in triplicate using an automatic sphygmomanometer (Omron 705 CP). Hypertension was defined as SBP/DBP > or = 140/90 mmHg. Results: As compared to Bantus, Pygmies were younger (38 ± 16 vs 45 ± 17 years, p = 0.0001), with lower body mass index (22.7 ± 3.3 vs 24.9 ± 4.6, p < 0.0001). Age-adjusted SBP and DBP were lower in Pygmies than in Bantus (p < 0.0001), however within group SBP and DBP were similar among rural and urban individuals. Age-adjusted prevalence of hypertension was lower in pygmies than Bantus globally (7.5% vs 21.5% p = 0.0001), and in rural and urban areas: 4% vs 19% and 11% vs 24 %, respectively, both p < 0.01). In pygmies taken separately, the age-adjusted prevalence of hypertension was lower in TP than in CP (4% vs 11%). In the whole study population, multivariate logistic regression analysis revealed that hypertension was independently associated with urban area (OR = 2.15, 95%CI: 1.14–4.05), Bantu status (OR = 2.17, 95%CI: 1.09–4.34), age >or = 50 years (OR = 2.15, 95%CI: 1.14–4.05), and abdominal obesity (OR = 0.20 95%CI: 0.09–0.46) (all p < 0.05). In pygmies taken separately, multivariate logistic regression analysis shown that age >or = 50 years (OR = 3.83, CI95%: 1.33–11.36) and urban area (OR = 3.33, CI95%: 1.04–11.11) (both p < 0.05) were independent determinants of hypertension. Conclusions: This study reveals that hunter-gatherer lifestyle is associated with lower prevalence of hypertension as illustrated in TP. Hypertension is more common in Bantus and CP, and is largely attributable to their westernized lifestyle and the growing urbanization of rural area.

IMPACT OF POSTURAL POSITION ON DETERMINATION OF AORTIC STIFFNESS AND CENTRAL BLOOD PRESSURE

Objective: Aortic stiffness is associated with increased central pulse pressure and cardiovascular disease and mortality. It is generally performed by determination of carotid-femoral pulse wave velocity (PWV) in a supine position. Two alternative approaches have been developed to estimate aortic stiffness, namely brachial pulse waveform analysis (Mobil-O-Graph) and finger-to-toe PWV by photoplethysmography (pOpmeter). These devices make it possible to assess and estimate aortic stiffness conveniently in different positions. However, it remains unclear if the values obtained are independent of the position at the time of measurement. Therefore, the aim of the present study is to determine the extent of postural changes on pulse wave velocity and central blood pressure estimation using pOpmetre and Mobil-O-Graph devices in a group of healthy controls. Design and method: Central blood pressure and PWV were assessed in 20 healthy subjects using both Mobil-O-Graph (PWV-M) and pOpmetre (PWV-pop) in three positions: supine position in bed, supine position in medical sampling chair and a sitting position. Central systolic blood pressure (SBP) was determined by calibration of brachial systolic and diastolic blood pressures (C1 calibration) by both methods (SBP-M and SBP-pop). Results: In the supine position in bed, PWV-M and PWV-pop were similar (5.5 ± 1.0 vs 5.4 ± 1.3 m/s, P = NS). In the supine position in a sampling chair, PWV-M decreased slightly (5.3 ± 1.0 m/s, P = 0.04 vs supine in bed), while PWV-pop increased significantly (5.9 ± 1.5 m/s, P = 0.04 vs supine in bed). However, in the sitting position, while PWV-M was not statistically different from the supine position (5.5 ± 1.0 m/s, P = NS), PWV-pop increased very significantly (9.2 ± 1.7 m/s, P < 0.001). Central blood pressure estimation remained similar for SBP-M (110.2 ± 10.3 vs 106.9 ± 10.5 vs 108.8 ± 11.1 mmHg, P = NS) and for SBP-pop (107.7 ± 10.4 vs 110.3 ± 9.6 vs 109.5 ± 9.9 mmHg, P = NS). Conclusions: These preliminary results tell us that postural position has little impact on the determination of aortic stiffness by the approach using brachial pulse wave analysis. However, finger-to-toe PWV increases remarkably with changes in position, possibly offering to explore the relationship between hydrostatic pressure and arterial stiffness as a dynamic test.

CAN IMPARED SYSTOLIC FUNCTION BE DETECTED FROM PRESSURE WAVEFORMS?

Objective: Heart failure with reduced ejection fraction (HFrEF) is a significant health problem. Early diagnosis, using widely available, cheap methods, remains an important goal. Therefore, we investigated whether individuals with normal left ventricular ejection fraction (EF) can be discriminated from patients with reduced EF with contemporary, automated analysis of pressure pulse waveforms. Design and method: Left ventricular EF was measured prospectively in 78 patients with HFrEF (15 females) with echocardiography (apical 4 chamber view, Simpson`s method, on a Philips EPIQ system). The control group was matched for age, sex, height, weight, and brachial blood pressure. Pressure waveforms were acquired from the radial artery (SphygmoCor system, AtCor medical) and processed with ARCSolver algorithms to derive Wave Intensity Analysis (WIA) parameters S and D and their ratio (SDR). Additionally, left ventricular ejection time index (iLVET) was calculated using a method based on numerical derivatives. Clinical characteristics between patients and controls were compared, using t-tests or Mann Whitney U test, as appropriate. Receiver-operating-curves (ROC) analysis was performed to investigate the discriminative ability of the pulse waveform parameters. Results: Patients with HFrEF (mean EF░=░28%) and controls (mean EF░=░66%) were well matched, according to age (56 vs. 56░years, p░=░0.597), sex, height (1.74 vs. 1.73 m, p░=░0.576), weight (86 vs. 83░kg, p░=░0.590), brachial systolic (127 vs. 129░mmHg, p░=░0.359) and diastolic (79 vs.79░mmHg, p░=░0.763) blood pressure, and the presence of hypertension (51 vs. 51%) respectively. Mean heart rate of patients and controls differed slightly (65 vs. 61 BPM, p░=░0.040). Diabetes, coronary artery disease, and the use of ACE-inhibitors/Angiotensin Receptor Blockers/Angiotensin Receptor Neprilysin Inhibitors were more prevalent in patients, as compared to controls. SDR (2.4 vs. 5.7 %, p░<░0.001) and iLVET (0.39 vs. 0.42, p░<░0.001) were significantly lower in HFrEF patients, as compared to controls. Moreover, SDR (AUC░=░0.93, 95% CI░=░[0.96, 0.88]) and iLVET (AUC░=░0.90, 95% CI░=░[0.94, 0.83]) were highly discriminative between HFrEF patients and controls – fx30. Conclusions: Parameters derived from pressure pulse waveforms, obtained non-invasively and processed automatically, may be suitable for early diagnosis of severely impaired EF.

HIDDEN CENTRAL HYPERTENSION AND SPURIOUS HYPERTENSION IN ELDERLY PEOPLE

Objective: Determination of brachial systolic blood pressure (SBP-b) and central systolic blood pressure (SBP-c) in the elderly could contribute to their better management by the identification of hidden central hypertension (HCH) and spurious hypertension (SH). Objectives: a) to analyse SBP-b and SBP-c relationship, b) to determine prevalence and phenotypes of HCH and SH, c) to evaluate antihypertensive treatment; d) to identify risk of orthostatic hypotension (OH). Methods: We included patients older than 65 years old who consecutively consulted to the participating sites (2014–2019) retrospectively and accordingly to their previous hypertension diagnosis were classified as hypertensives or normotensives. Brachial and central blood pressure measurements allow us to identify four phenotypes: 1) normal SBP-b with high SBP-c, 2) high SBP-b with normal SBP-c, 3) both normal, 4) both high. Statistical: Student test, ANOVA, Chi2. Design and method: 1595 subjects were recruited (female 47.8%, 70.9 ± 5.2 years); 66.6%(n:1063) hypertensive/33.3%(n:532) normotensives. We identified HCH in 7.9%(n:84), SH in 5.2%(n:55) in hypertensive group, compared with 10.7%(n:57) and 3.4%(n:18) respectively in normotensives. Elevated values of SBP-b were detected in 27.1% normotensives, although 10.7% had normal SBP-c. Table 1 shows the baseline and hemodynamic characteristics of general population according to phenotypes. No differences were found between different classes of antihypertensive drugs, but a higher number of medications was reported in SH. OH was identified in 35%, showing 48% of them SH. Conclusion: Hidden central hypertension was present in almost 5% of elderly people while spurious hypertension in 9%, similar in hypertensives and normotensives. Phenotypically HCH subjects were older, less active, with increase PWV and AIX, but with lower HR than those with SH, who showed higher CI, HR and SVR. As it was expected, our study results suggest that elderly people with HCH could be at risk of being sub-treated and inversely, those with SH could be over-treated. The OH prevalence in SH supports this latter issue. Finally, the measurement of SBP-c seems to be a useful clinical variable that could lead to a better management of blood pressure in the elderly.

ARM BASED ON LEG BLOOD PRESSURES (ABLE-BP): CAN SYSTOLIC LEG BLOOD PRESSURE MEASUREMENTS PREDICT BRACHIAL BLOOD PRESSURE? AN INDIVIDUAL PARTICIPANT DATA META-ANALYSIS

Objective: Hypertension is diagnosed and managed using brachial blood pressures; accurate measurement can be impeded by several temporary or permanent factors, including fractures, presence of vascular access devices, limb deformities and altered muscle tone after stroke. Leg (ankle) blood pressure measurement is a practical alternative, but limited data exist to guide clinicians’ interpretation of leg blood pressure values for hypertension diagnosis and treatment. Design and method: Individual participant data meta-analyses were undertaken, using data from 14 studies within the international inter-arm blood pressure difference individual participant data (INTERPRESS-IPD) Collaboration, to 1) determine the relationship between arm and leg systolic blood pressure, 2) develop and validate a multivariable model predicting arm from leg systolic blood pressure, and 3) investigate the prognostic association between leg systolic blood pressure and cardiovascular disease and mortality. Results: Arm and leg systolic blood pressure data existed for 33,710 individuals (mean age: 58 years, mean arm systolic/diastolic blood pressure at baseline: 138/80 mmHg, 45% female). Mean leg systolic blood pressure was 12.0 (95% CI, 8.8 to 15.2) mmHg higher than arm systolic blood pressure. The multivariable model derived to predict highest arm from highest leg systolic blood pressure demonstrated excellent performance (area under receiver operating characteristic curves, sensitivity and specificity remained above 0.89, 0.80 and 0.81, respectively, across blood pressure thresholds from 160 to 130 mmHg). Lowest leg systolic blood pressure was a predictor of all-cause mortality and cardiovascular events over a 10-year period. Cardiovascular risk scores were similar for observed arm systolic blood pressure and the highest arm systolic blood pressure predicted from lowest leg systolic blood pressure [Atherosclerotic Cardiovascular Disease Score: 16.73% (12.65) vs 17.17% (12.61), Framingham Score: 19.33% (15.05) vs 19.91% (15.06)]. Conclusions: These results provide a robust evidence-based method for describing the arm-leg systolic blood pressure relationship and estimating individual brachial systolic blood pressure and cardiovascular risk from leg blood pressure measurements using individual participant data. A freely available and easy-to-use web-based calculator has been created to support patients and clinicians in estimating equivalent arm blood pressure when only leg blood pressure measurements and patient characteristics are available.

AORTIC CALCIFICATION INCREASES CENTRAL BLOOD PRESSURE RELATIVE TO BRACHIAL BLOOD PRESSURE IN CKD PATIENTS – A STUDY IN PATIENTS UNDERGOING ELECTIVE CORONARY ANGIOGRAPHY

Objective: Chronic kidney disease (CKD) and arterial stiffness are associated with increased central (aortic) systolic blood pressure (cSBP) relative to brachial systolic blood pressure (bSBP). This study examined the impact of aortic calcification on cSBP relative to bSBP in patients with CKD. Design and method: Patients with or without CKD undergoing elective coronary angiography (CAG) at Aarhus University Hospital were considered for inclusion in this cross-sectional study. During CAG, cSBP was measured in the ascending aorta with a fluid-filled catheter while bSBP was measured simultaneously with an oscillometric device using a cuff. Furthermore, patients underwent a non-contrast computed tomography (CT) scan of the entire aorta with subsequent blinded Agatston-scoring of the aorta from (but excluding) the aortic valve to the aortic bifurcation. Carotid-femoral pulse wave velocity was measured in duplicate using a Sphygmocor device. Data are presented as mean ± standard deviation unless stated otherwise. Statistical comparisons were made using Wilcoxon rank sum test for differences between 2 groups and Bonferroni-adjusted Kruskal-Wallis test when testing for differences between > 2 groups. Results: 149 patients were included in the study. Of these, 134 patients had a CT-scan of sufficient quality to allow analysis. Patient characteristics and measurements of BP and pulse wave velocity are presented in Table 1. Agatston-score was higher in CKD patients as compared to patients with normal kidney function (table 1, P < 0.001). bSBP was 6.5 ± 13.1 mmHg higher than cSBP in patients categorized into the first tertile of Agatston-scores. This difference was reduced to 3.3 ± 11.0 mmHg in the second tertile (p = 0.31, compared to first tertile) and -2.6 ± 16.8 mmHg in the third tertile (p < 0.01, compared to first tertile). Conclusions: Patients with CKD have a higher degree of aortic calcification. Furthermore, patients with a high degree of aortic calcification have a higher invasively measured cSBP as compared to the bSBP measured with an ordinary oscillometric BP device.

Blood Pressure and Arterial Stiffness after a Maximal Aerobic Exercise in Young Adult Binge Drinkers and Moderate Drinkers

Exaggerated systolic blood pressure (SBP) response to exercise predicts the development of hypertension. In normotensive young adults, alcohol consumption is associated with increased arterial stiffness, which potentially influence exercise SBP response. Young adults who have alcohol drinking habits usually exercise regularly, but their exercise SBP response has received little attention. Whether alcoholic drinking pattern influences exercise SBP response remains to be determined. The purpose of this study is two‐fold: 1) to investigate SBP and arterial stiffness in response to maximal aerobic exercise; and 2) to examine if alcoholic drinking pattern influences the response. Twenty healthy young adults (9 women; age: 27±3 years; BMI: 24.1±2.1 kg/m2; mean±SD) with a history of alcohol consumption over the past year were included in this study. Based on the self‐reported alcoholic drinking pattern, participants were categorized as binge drinkers (n=10; BD) or moderate drinkers (n=10; MOD). Brachial SBP and central SBP and arterial stiffness (carotid to femoral pulse wave velocity; cfPWV) were measured before and after a maximal graded exercise test on a cycle ergometer. At the end of maximal exercise, brachial SBP increased (BD: 110±13 vs. 172±15 mmHg; pre‐ vs. post‐ex; P<0.0005 and MOD: 110±9 vs. 158±22 mmHg; P<0.0005), regardless of drinking pattern (P=0.1 for BD vs. MOD). Central systolic BP (BD: 101±10 vs. 113±7 mmHg and MOD: 102±8 vs. 112±8 mmHg; P≤0.01 for both groups) increased in all participants after exercise (obtained ~ 4min post‐ex), regardless of drinking pattern (P=0.5 for BD vs. MOD). After exercise (~15 min), cfPWV did not increase in MOD (5.6±0.8 vs. 5.7±1.1 m/s; P=0.8), while cfPWV increased in BD (5.5±0.5 vs. 6.3±0.9 m/s; P=0.02). In conclusion, our study found that SBP response to maximal aerobic exercise was similar between BD and MOD. However, arterial stiffness was higher following maximal aerobic exercise in BD, suggesting a negative adaptation in vasculature associated with binge drinking. Future studies with larger sample sizes and a group of alcohol abstainers are needed to confirm our findings.

A Practical Application of Blood Flow Restriction Exercise

Exercise with blood flow restriction (BFR) is emerging as an effective training option to increase muscle size and strength, in healthy, clinical, and athletic populations. However, the need for specialized equipment and associated costs present a major barrier to its accessibility. The purpose of this study was to develop a practical method to implement BFR in the lower body using a thigh sphygmomanometer. Specifically, we aimed to 1) explore what factors should be accounted for when setting pressures with this type of restrictive cuff and 2) generate both a lab‐based and field‐based prediction equation to estimate arterial occlusion pressure (AOP). We hypothesized that measures of limb size and blood pressure would constitute significant predictors of lower body AOP. We also hypothesized that a multiple linear regression model including significant predictors would explain approximately 50% of the variance in AOP. Thirty‐eight normotensive healthy adults (age: 24±5 yrs, BMI: 25±4) visited the laboratory for one testing session. Brachial and femoral systolic (SBP) and diastolic (DBP) blood pressures were taken in the seated position. Next, thigh circumference, muscle thickness of the anterior thigh, and maximal isometric knee extension strength was assessed. Lean thigh volume was estimated using anthropometric measures. Lastly, lower body AOP was assessed in the seated position using an 18cm wide thigh sphygmomanometer and Doppler ultrasound (156±12 mmHg). A multiple linear regression analysis including brachial and femoral SBP and DBP, thigh circumference, muscle thickness, lean thigh volume, and maximal isometric knee extension strength was performed to assess which variables constituted significant predictors of AOP. Regression analysis was then repeated with only significant variables to generate both a lab‐based and field‐based prediction equation for AOP. Thigh circumference (β = 0.322, part = 0.876), brachial SBP (β = 0.362, part = 0.463) and isometric knee extension strength (β = 0.421, part = 0.076) constituted significant predictors of AOP. A lab‐based model including thigh circumference (β=0.278, part = 0.754), brachial SBP (β=0.492, part = 0.549), and isometric knee extension strength (β=0.306, part = 0.055) explained 56% of the variance in AOP. A field‐based model including only thigh circumference (β=0.316, part = 0.857) and brachial SBP (β=0.515, part = 0.658) explained 47% of the variance in AOP. Our results indicate that thigh circumference, brachial SBP, and isometric knee extension strength serve as predictors of AOP in the lower body when utilizing an 18cm wide sphygmomanometer as a restrictive cuff. Further, a field‐based prediction equation including thigh circumference and brachial SBP offers a practical way to estimate AOP. Future work will build upon this prediction equation by utilizing subjective measures of cuff tightness, effort, and muscle pain to further adjust exercising cuff pressures to an appropriate level. Results will help to provide researchers and practitioners with a practical way to implement BFR without the need for specialized equipment.

Finger Systolic Blood Pressure Index Measurement: A Useful Tool for the Evaluation of Arterial Disease in Patients With Systemic Sclerosis.

To evaluate the prevalence and clinical correlates of peripheral arterial disease of the upper limbs in patients with systemic sclerosis (SSc), as detected with finger brachial pressure index (FBPI) measurements. This work is based on the baseline data of the SCLEROCAP multicenter cohort of SSc patients. Finger systolic blood pressure was measured with laser Doppler flowmetry, and the FBPI was obtained as its ratio over the ipsilateral brachial systolic blood pressure. An FBPI of <0.70 was used as the diagnostic criterion for occlusive arterial disease of the upper limbs. Thus, the prevalence of defined arterial disease as well as its clinical, biologic, and capillaroscopic correlates were evaluated. Among 326 enrolled patients, 177 (54.3%) met the criterion for arterial disease (FBPI <0.70). No association was found with the type of SSc nor with the type of associated antinuclear antibodies, but a significant association was found with the duration of the disease (P < 0.001), the capillaroscopic pattern (P < 0.001), and most strikingly with the presence of digital ulcers (42.9% versus 13.4%; P < 0.001). A quantitative relationship was found between the FBPI and the prevalence of digital ulcers and was shown to be independent from the capillaroscopic pattern. This cross-sectional study shows a high prevalence of arterial disease of the upper limbs in patients with SSc. FBPI appears to be a strong and independent predictor of digital ulcers. This study suggests that both macro- and microangiopathy are contributing to the ischemic damage of the fingertips.

Postexercise Hypotension Is Delayed in Men With Obesity and Hypertension.

BackgroundPostexercise hypotension (PEH) can play a major role in the daily blood pressure management among individuals with hypertension. However, there are limited data on PEH in persons with obesity and hypertension, and no PEH data in this population beyond 90 min postexercise.PurposeThe purpose of this study was to determine if PEH could be elicited in men with obesity and hypertension during a 4-h postexercise measurement period.MethodsSeven men [age = 28 ± 4 years; body mass index = 34.6 ± 4.8 kg/m2; brachial systolic blood pressure (SBP): 138 ± 4 mmHg; brachial diastolic BP (DBP): 80 ± 5 mmHg; central SBP: 125 ± 4 mmHg; central DBP: 81 ± 8 mmHg] performed two exercise sessions on a cycle ergometer, each on a separate day, for 45 min at ∼65% VO2max. One exercise session was performed at a cadence of 45 RPM and one at 90 RPM. Blood pressure was monitored with a SunTech Oscar2 ambulatory blood pressure monitor for 4 h after both exercise sessions, and during a time-matched control condition.ResultsBoth brachial and central SBP were not changed during the first h postexercise but were reduced by ∼5–11 mmHg between 2 and 4 h postexercise (p < 0.05) after both exercise sessions. Brachial and central DBP were elevated by ∼5 mmHg at 1 h postexercise (p < 0.05) but were ∼2–3 mmHg lower compared to control at 4 h postexercise, and ∼2–4 mmHg lower at 3 h postexercise compared to baseline. Mean arterial pressure (MAP) was elevated compared to control at 1 h postexercise after both exercise sessions, but was ∼2–3 mmHg lower compared to control at 2, 3, and 4 h postexercise, and ∼4–7 mmHg lower at 3 h postexercise compared to baseline.ConclusionDespite the small sample size and preliminary nature of our results, we conclude that PEH is delayed in men with obesity and hypertension, but the magnitude and duration of PEH up to 4 h postexercise is similar to that reported in the literature for men without obesity and hypertension. The PEH is most pronounced for brachial and central SBP and MAP. The virtually identical pattern of PEH after both exercise trials indicates that the delayed PEH is a reproducible finding in men with obesity and hypertension.

Arterial stiffness and blood pressure are similar in naturally menstruating and oral contraceptive pill-using women during the higher hormone phases.

What is the central question of this study? Are there differences in blood pressure, arterial stiffness and indices of pressure waveforms between young oral contraceptive pill-using and naturally menstruating women during lower and higher hormone phases of their cycles? What is the main finding and its importance? Blood pressure, arterial stiffness and indices of pressure waveforms are influenced similarly by exogenous and endogenous hormones. However, lower levels of exogenous hormones moderately increase blood pressure among oral contraceptive pill-using women. Elevations in blood pressure (BP) are understood as having a bidirectional relationship with stiffening of central and peripheral arteries. Arterial stiffness is mitigated by oestrogen, which aides in arterial vasorelaxation. To evaluate whether BP, stiffness, and pressure waveforms were different between young healthy naturally menstruating (non-OCP) and oral contraceptive pill (OCP)-using women, we measured brachial and aortic BPs, carotid-to-femoral pulse wave velocity, carotid β-stiffness, elastic modulus, central augmentation index and augmentation index normalized to a heart rate of 75bpm, and forward and backward pressure waveforms in 22 women (22 (1) years, OCP: n=12). To assess phasic differences, women were studied during the early follicular (≤5days of menstruation onset) and early luteal (4 (2)days post-ovulation) phases of non-OCP and compared to the placebo pill (≤5days of onset) and active pill (≤5days of highest-dose active pill) phases of OCP. During the lower hormone phases, OCP users had significantly higher brachial systolic blood pressure (SBP) (119.3 (8.3) vs. 110.2 (8.3) mmHg, P=0.02) and aortic SBP (104.10 (7.44) vs. 96.80 (6.39) mmHg, P=0.03) as compared to non-OCP users; however, during the higher hormone phases, there were no differences in measures of brachial or aortic BP, arterial stiffness, or indices of BP waveforms between OCP and non-OCP users (P≥0.05). In conclusion, exogenous and endogenous hormones have similar influences on BP and arterial stiffness; however, lower levels of exogenous hormones augment both central and peripheral BPs.

Risk Stratification by Cross-Classification of Central and Brachial Systolic Blood Pressure.

Background:Whether cardiovascular risk is more tightly associated with central (cSBP) than brachial (bSBP) systolic pressure remains debated, because of their close correlation and uncertain thresholds to differentiate cSBP into normotension versus hypertension.Methods:In a person-level meta-analysis of the International Database of Central Arterial Properties for Risk Stratification (n=5576; 54.1% women; mean age 54.2 years), outcome-driven thresholds for cSBP were determined and whether the cross-classification of cSBP and bSBP improved risk stratification was explored. cSBP was tonometrically estimated from the radial pulse wave using SphygmoCor software.Results:Over 4.1 years (median), 255 composite cardiovascular end points occurred. In multivariable bootstrapped analyses, cSBP thresholds (in mm Hg) of 110.5 (95% CI, 109.1–111.8), 120.2 (119.4–121.0), 130.0 (129.6–130.3), and 149.5 (148.4–150.5) generated 5-year cardiovascular risks equivalent to the American College of Cardiology/American Heart Association bSBP thresholds of 120, 130, 140, and 160. Applying 120/130 mm Hg as cSBP/bSBP thresholds delineated concordant central and brachial normotension (43.1%) and hypertension (48.2%) versus isolated brachial hypertension (5.0%) and isolated central hypertension (3.7%). With concordant normotension as reference, the multivariable hazard ratios for the cardiovascular end point were 1.30 (95% CI, 0.58–2.94) for isolated brachial hypertension, 2.28 (1.21–4.30) for isolated central hypertension, and 2.02 (1.41–2.91) for concordant hypertension. The increased cardiovascular risk associated with isolated central and concordant hypertension was paralleled by cerebrovascular end points with hazard ratios of 3.71 (1.37–10.06) and 2.60 (1.35–5.00), respectively.Conclusions:Irrespective of the brachial blood pressure status, central hypertension increased cardiovascular and cerebrovascular risk indicating the importance of controlling central hypertension.

L-Citrulline supplementation attenuates aortic pulse pressure and wave reflection responses to cold stress in older adults

Augmented aortic systolic blood pressure (SBP) and wave reflection via sympathetic-mediated vasoconstriction elevates the risk for adverse cardiovascular events in older adults. L-citrulline (L-CIT) supplementation has shown to reduce aortic SBP and pulse pressure (PP) responses to cold pressor test (CPT) induced sympathoactivation in young men. The aim of this study was to elucidate the efficacy of L-CIT supplementation to attenuate aortic hemodynamic responses to CPT in older adults. Sixteen older adults were randomly assigned to placebo or L-CIT (6g/day) for 14-days in a crossover, double-blind, placebo-controlled design. Brachial SBP and aortic SBP, PP, augmented pressure (AP), augmentation index standardized at 75bpm (AIx@75), and pressure of the forward (Pf) and reflected (Pb) waves were evaluated at rest and during CPT pre- and post-intervention. Although no hemodynamic changes at rest, brachial SBP (Δ-12±18 vs. Δ4±14mmHg; P=0.008) and aortic SBP (Δ-10±14 vs. Δ4±12mmHg; P=0.005), PP (Δ-10±12 vs. Δ4±11mmHg; P=0.002), AP (Δ-4±4 vs. Δ2±7mmHg; P=0.004), AIx@75 (Δ-3.2±7.2 vs. Δ2.2±6.9%; P=0.038), Pf (Δ-6±10 vs. Δ3±9mmHg; P=0.019), and Pb (Δ-4±6 vs. Δ2±6mmHg; P=0.008) responses to the CPT were significantly attenuated following L-CIT supplementation vs. placebo. L-CIT supplementation attenuated aortic pulsatile pressure and pressure wave reflection responses to CPT in older adults, providing possible cardioprotection during cold-induced sympathoactivation in older adults.

Importance of central BP assessment in ISH of the young. Which devices are best suited for practical use?

Isolated systolic hypertension (ISH), defined as brachial systolic blood pressure (bSBP) ≥140 mmHg and diastolic blood pressure (DBP) <90 mmHg, is highly prevalent among young subjects and in the elderly. The prognostic significance of ISH in young individuals remains the object of large debate which might be solved, at least in part, if considering the prognostic role of central BP. For any given value of pBP, the cardiovascular (CV) risk is better defined by central BP (cBP). Young individuals with ISH have long been considered at low CV risk, given the assumption that a "spurious hypertension" phenotype characterized by elevated peripheral (brachial) BP (pBP), normal cBP, and elevated BP amplification was often found in this population. However, this remains to be proven, because many other studies found no differences in BP amplification between ISH and sisto-diastolic hypertension. Despite numerous attempts, methodologies for cBP assessment by non-invasive devices are currently not standardized. As a result, different devices could provide different cBP values despite using the same biological signals. Devices providing accurate estimates of BP amplification as a dimensionless ratio between amplitudes of central and peripheral arterial waveforms might be well suited for clinical purposes in young individuals with ISH. There is urgent need of well-designed prospective studies aiming at longitudinally evaluating the amount of CV risk associated with elevated cBP in young subjects with ISH and their related incremental prognostic value.

Glucose Metabolic Disorders Enhance Vascular Dysfunction Triggered by Particulate Air Pollution: a Panel Study.

Vascular dysfunction is a biological pathway whereby particulate matter (PM) exerts deleterious cardiovascular effects. The effects of ambient PM on vascular function in prediabetic individuals are unclear. A panel study recruited 112 Beijing residents with and without prediabetes. Multiple vascular function indices were measured up to 7 times. The associations between vascular function indices and short-term exposure to ambient PM, including fine particulate matter (PM2.5), ultrafine particles, accumulation mode particles, and black carbon, and the modification of these associations by glucose metabolic status were examined using linear mixed-effects models. Increases in brachial artery pulse pressure, central aortic pulse pressure, and ejection duration, and decreases in subendocardial viability ratio and reactive hyperemia index were significantly associated with at least one PM pollutant in all participants, indicating increased vascular dysfunction. For example, for an interquartile range increment in 5-day moving average ultrafine particles, brachial artery pulse pressure, and central aortic pulse pressure increased 5.4% (0.8%-10.4%) and 6.2% (1.2%-11.5%), respectively. Additionally, PM-associated changes in vascular function differed according to glucose metabolic status. Among participants with high fasting blood glucose levels (≥6.1 mmol/L), PM exposure was significantly associated with increased brachial artery systolic blood pressure, central aortic systolic blood pressure, brachial artery pulse pressure, central aortic pulse pressure, and augmentation pressure normalized to a heart rate of 75 bpm and decreased subendocardial viability ratio and reactive hyperemia index. Weaker or null associations were observed in the low-fasting blood glucose group. Glucose metabolic disorders may exacerbate vascular dysfunction associated with short-term ambient PM exposure.

Posture-Related Differences in Cardiovascular Function Between Young Men and Women: Study of Noninvasive Hemodynamics in Rural Malawi.

BackgroundCardiovascular risk is higher in men than in women, but little information exists about sex‐related differences in cardiovascular function from low‐income countries. We compared hemodynamics between sexes in rural Malawi in a cohort followed up since their birth.Methods and ResultsSupine, seated, and standing hemodynamics were recorded from 251 women and 168 men (mean age, 21 years; body mass index, 21 kg/m2) using oscillometric brachial waveform analyses (Mobil‐O‐Graph). The results were adjusted for estimated glomerular filtration rate, and plasma potassium, lipids, and glucose. Men had higher brachial and aortic systolic blood pressure and stroke index regardless of posture (P<0.001), and higher upright but similar supine diastolic blood pressure than women. Regardless of posture, heart rate was lower in men (P<0.001), whereas cardiac index did not differ between sexes. Women presented with lower supine and standing systemic vascular resistance index (P<0.001), whereas supine‐to‐standing increase in vascular resistance (P=0.012) and decrease in cardiac index (P=0.010) were higher in women. Supine left cardiac work index was similar in both sexes, whereas standing and seated left cardiac work index was higher in men than in women (P<0.001).ConclusionsIn young Malawian adults, men had higher systolic blood pressure, systemic vascular resistance, and upright cardiac workload, whereas women presented with higher posture‐related changes in systemic vascular resistance and cardiac output. These findings show systematic sex‐related differences in cardiovascular function in a cohort from a low‐income country with high exposure to prenatal and postnatal malnutrition and infectious diseases.