Carotid-femoral Aortic Pulse Wave Velocity Research Articles

Effect of 12-Week Resistance Training with Blood Flow Restriction on Arterial Stiffness in Octogenarian People with Low Gait Speed: A Randomized Controlled Trial

Aim: Aging is associated with loss of muscle mass and strength. Low-Intensity Resistance Exercise with Moderate Blood-Flow Restriction (LIRE-BFR) improves these outcomes, but the long-term effect on arterial stiffness and safety in elderly people with low gait speed is unknown. Methods: This is a parallel, randomized controlled clinical study with 12 older adults (3 men; 9 women; 84.0 [76.0; 87.5] years old) who completed a 12-week training of traditional resistance exercise (TRE; n=6) or LIRE-BFR (n=6). All participants were evaluated at baseline and after 12 weeks by carotid-femoral aortic Pulse Wave Velocity (PWV). Results: After 12 weeks of interventions, PWV decreased in TRE group (-2.9 [-8.1; 2.4] m/s) and increased slightly in LIRE-BFR group (1.1 [-3.2; 5.3] m/s) but no differences were observed between the groups (p=0.21 for group; Hedge’s g: 0.52). Mean blood pressure was similar between TRE (86.2 [81.8; 90.9] to 85.8 [76.5; 96.3] mmHg) and LIRE-BFR (92.4 [82.1; 103.9] to 85.5 [79.2; 92.4] mmHg, p=0.462 for interaction). Gait speed increased significantly after 12 weeks in both groups (p<0.001 for time) with no differences between them (p=0.693 for groups). Conclusions: Compared to TRE, LIRE-BFR increased PWV slightly, while gait speed increased similarly in both training modalities. Larger clinical trials including elderly people with low gait speed are needed to determine the clinical impact of these findings.

IMPACT OF POLYPHARMACY AND COMORBIDITIES TO CLINICAL OUTCOMES IN RESISTANT HYPERTENSION RENAL DENERVATION GROUP

Objective: To analyse impact of polypharmacy to blood pressure control in resistant hypertension renal denervation group. Design and method: This prospective study included 73 selected patients with resistant hypertension and RDN (Sympathetic Renal Denervation) performed. Routine follow up was performed subsequently 1, 3, 6, 12, 24 and 48 months after the RDN. Total numbers of pills, prescibed for all diseases was registered. Two groups of patients were defined: A group- patient whom less than 7 pills prescribed and group B -more than 7 pills. Number of antihypertensive medications was analysed separately Also various characteristics were registered: age, sex, comorbidities, 24h-ABPM, arterial stiffness etc. Statistical analysis was performed using SPSS 23.0 Statistical Software. Results: A total cases of 73 patients were included. 6 patients died, 18 failed to remain in the follow up during 4 years. Remaining 49 patients data were analyzed. Median age was 55 (33–72) years old with 53,1 % (n = 26) patients being male. Two groups were similar, acoording to age, weight, office blood pressure, heart rate (p > 0,05), but there was higher numbers of diabetes melitus and coronary artery disease in group B. Mean prescribed antihypertensive drugs (A- 4,75; B- 6,52; p > 0,05). In A group we observed significantly reduced BP (sABP 162,6mmHg to 149,6mmHg, p < 0,01; dABP 100,8mmHg to 90,24mmHg, p = 0,01) during 48 months. In B group: sABP 163,76 mmHg to 152,1mmHg, p = 0,13; dABP 89,7 mmHg to 85,1 mmHg, p = 0,54). In A group we observed significantly reduced carotid-femoral aortic pulse wave velocity (AoPWV) from 11.2 m/s to 10.0 m/s in 4 years (p = 0,01). In second group AoPWV increased from 11,8 m/s to 12,8 m/s, but not significantly (p = 0.34). Conclusions: Patients with more comorbidities and receiving more pills are at higher cardiovascular risk and their blood pressure is more difficult to control, even after renal denervation procedure.

Modification of sympathetic tone by renal artery denervation causes early, significant and sustained arterial de-stiffening

ObjectiveTo examine whether Sympathetic Renal Denervation (RDN) might have an additive value for cardiovascular risk decline beyond lowering blood pressure.Methods73 selected patients with resistant hypertension had RDN performed. Arterial stiffness was measured, using applanation tonometry, before the procedure, 24 to 48 hours following the procedure and subsequently 1, 3 and 6 months after the RDN.ResultsWithin 48 hours RDN significantly reduced carotid-femoral aortic pulse wave velocity (AoPWV) from 11.3 ± 2.7 to 10.3 ± 2.6 m/s (p = 0.001), the reduction was sustained at months 1, 3, and 6. Early changes of AoPWV value did not correlate with office systolic or diastolic BP (p = 0.45; p = 0.33). Furthermore, the higher the initial AoPWV value, the greater the reduction of AoPWV was observed after 6 months: Q1 8.4 ± 1, Δ 0.05 ± 1.6/Q2 10.1 ± 0.4, Δ 1.1 ± 1.4/Q3 12.2±0.8, Δ 1.8 ± 1.7/Q4 15.3 ± 1.7, Δ 2.8 ± 2.1, (p = 0.002).ConclusionA sustainable effect on AoPWV, observed in our study as early as within 24–48 hours following the procedure and up to 6 months, suggests an additional RDN effect on reducing arterial stiffness and cardiovascular risk. The de-stiffening effect was greater in patients with high initial AoPWV.

Vascular inflammation and aortic stiffness: potential mechanisms of increased vascular risk in chronic obstructive pulmonary disease

BackgroundChronic obstructive pulmonary disease (COPD) is a complex inflammatory condition in which an important extra-pulmonary manifestation is cardiovascular disease. We hypothesized that COPD patients would have increased aortic inflammation and stiffness, as candidate mechanisms mediating increased cardiovascular risk, compared to two negative control groups: healthy never-smokers and smokers without COPD. We also studied patients with COPD due to alpha− 1 antitrypsin deficiency (α1ATD) as a comparator lung disease group.MethodsParticipants underwent 18F-Fluorodeoxyglucose (FDG) positron emission tomography imaging to quantify aortic inflammation as the tissue-to-blood-ratio (TBR) of FDG uptake. Aortic stiffness was measured by carotid-femoral aortic pulse wave velocity (aPWV).ResultsEighty-five usual COPD (COPD due to smoking), 12 α1ATD-COPD patients and 12 each smokers and never-smokers were studied. There was no difference in pack years smoked between COPD patients and smokers (45 ± 25 vs 37 ± 19, p = 0.36), but α1ATD patients smoked significantly less (19 ± 11, p < 0.001 for both). By design, spirometry measures were lower in COPD and α1ATD-COPD patients compared to smokers and never-smokers. Aortic inflammation and stiffness were increased in COPD (TBR: 1.90 ± 0.38, aPWV: 9.9 ± 2.6 m/s) and α1ATD patients (TBR: 1.94 ± 0.43, aPWV: 9.5 ± 1.8 m/s) compared with smokers (TBR: 1.74 ± 0.30, aPWV: 7.8 ± 1.8 m/s, p < 0.05 all) and never-smokers (TBR: 1.71 ± 0.34, aPWV: 7.9 ± 1.7 m/s, p ≤ 0.05 all).ConclusionsIn this cross-sectional prospective study, novel findings were that both usual COPD and α1ATD-COPD patients have increased aortic inflammation and stiffness compared to smoking and never-smoking controls, regardless of smoking history. These findings suggest that the presence of COPD lung disease per se may be associated with adverse aortic wall changes, and aortic inflammation and stiffening are potential mechanisms mediating increased vascular risk observed in COPD patients.

Abstract 12457: Carotid Intima-Media Thickness and Aortic Stiffness are Elevated in Chronic Obstructive Pulmonary Disease (COPD) Subjects Compared to Controls and Not Associated With Systemic Inflammation

Introduction: COPD is associated with increased cardiovascular risk, independent of established risk factors. Carotid intima thickness (CIMT) and carotid-femoral aortic pulse wave velocity (aPWV) are surrogate measures of cardiovascular risk and small studies have suggested elevated CIMT and aPWV in COPD are associated with systemic inflammation. We investigated this further as part of the ERICA (Evaluation of Role of Inflammation in Chronic Airways disease) multi-centre UK study: the largest cohort study focussing on cardiovascular manifestations in COPD. Hypothesis: COPD subjects have increased CIMT and aPWV compared to controls and CIMT and aPWV are associated with systemic inflammation in COPD. Methods: Spirometry, cardiovascular history and assessment, CIMT and haemodynamic measures including aPWV were performed in 432 COPD patients recruited from Cambridge and Cardiff study centres only. Age and gender matched healthy controls (n=324) were evaluated for comparison. Possible determinants for CIMT and aPWV in COPD subjects were assessed by linear regression analysis. Results: Mean age of COPD and control subjects was 67 years (SEM±0.41), 61% were male. COPD subjects, when compared to controls had increased CIMT (0.85±0.01mm vs 0.70 ±0.08mm, p=0.0001) and aPWV (10.35±0.12m/s vs 8.22 ±0.1m/s, p=0.0001), which were maintained after adjustment for mean arterial pressure (MAP) and heart rate (HR). COPD subjects also had higher brachial systolic BP (Δ 12±0.2mmHg, p=0.0001), and central systolic BP (Δ 12±0.2mmHg, p=0.0001). COPD was an independent determinant of CIMT and aPWV in pooled analysis of COPD and controls (p=0.0001 respectively). In COPD, age and systolic BP were independently associated with CIMT; and age, MAP and HR were determinants of aPWV. Inflammatory markers (fibrinogen, CRP, WCC), smoking status and pack years smoked were not associated with CIMT or aPWV. Conclusions: These data support the theory of accelerated ageing in COPD subjects compared to matched controls, which may partly explain the excess cardiovascular risk seen. As systemic inflammatory biomarkers did not relate to CIMT or aPWV, consideration of novel therapeutic targets to ameliorate premature arterial stiffening in COPD, merits further investigation.

The effects of significant coronary stenosis and percutaneous coronary intervention on aortic stiffness

Although aortic stiffness (AS) is a strong predictor of cardiovascular events, its value is unknown in patients who have coronary stenosis and undergo percutaneous coronary intervention (PCI). Our hypothesis was that AS might provide additional information about coronary hemodynamic status. In this context, we investigated the effects of coronary stenosis and PCI on AS. The study included 107 patients undergoing coronary angiography. The patients were divided into three groups based on the angiographic results: 39 patients with significant lesions (≥50%) formed the 'critical group' and 38 patients with nonsignificant lesions (<50%) formed the 'noncritical group'. The control group (30 patients) had normal angiograms. Aortic stiffness was determined using the carotid-femoral aortic pulse wave velocity (PWV) method. All patients in the critical group underwent successful PCI and repeat PWV measurements. All baseline characteristics were similar in the three groups except for the mean PWV, which was significantly higher (9.4±2.2 m/sec) in the critical group compared to the control group (5.7±1.1 m/sec) and the noncritical group (5.8±1.1 m/sec) (p<0.0001). The latter two groups had similar PWV values (p=0.6). After PCI, the mean PWV decreased significantly by 24.4% to 7.1±2.0 m/sec (p=0.002); however, it was still significantly higher than that of the control group (p<0.0001). In correlation analysis, PWV showed significant correlations with age (r=0.412, p=0.01), systolic blood pressure (r=0.342, p<0.01), and hemoglobin (r=-0.370, p=0.02). Multiple logistic regression analysis showed that PWV was a predictor for significant stenosis [Exp(B) 3.960, 95% CI 2.014-7.786]. Our findings suggest that significant coronary stenosis is associated with significantly increased AS and successful PCI improves AS to some extent.

Race, Psychosocial Factors, and Aortic Pulse Wave Velocity: The Health, Aging, and Body Composition Study

Increasingly, researchers have begun to explore pathways through which psychosocial factors might influence cardiovascular disease, with some emphasis on early markers. The current study examined the cross-sectional association between psychosocial factors and aortic pulse wave velocity (an early marker of cardiovascular disease) in a biracial cohort of older adults. We were particularly interested in determining whether the association between psychosocial factors and aortic pulse wave velocity differed for older blacks compared with whites. Participants were 2,488 (40% black and 52% female) older adults from the Health, Aging, and Body Composition Study. Carotid-femoral aortic pulse wave velocity was assessed using standard methodologies. Depressive symptoms, anxiety symptoms, negative life events, and inadequate emotional support were assessed, and a summary psychosocial risk index was created. In multivariable linear regression models, psychosocial risk was not associated with aortic pulse wave velocity (Estimate [Est] = .00, p = .83), but there was a significant Race × Psychosocial risk interaction (Est = .07, p = .01), after adjusting for age, race, sex, and education. Further analyses revealed that this association was driven by the inadequate emotional support component of psychosocial risk (Race × Inadequate emotional support, p = .005). In race-stratified analyses, inadequate emotional support was associated with higher levels of arterial stiffness in older blacks (Est = .05, p = .04) but not whites (Est = -.04, p = .13). This association persisted after adjusting for demographics, cardiovascular risk factors, and social network characteristics. Findings suggest that older blacks may be particularly vulnerable to the effects of inadequate emotional support on vascular health. Interventions aimed at increasing social support among this population might be beneficial in reducing cardiovascular disease risk.

Perindopril: an updated review of its use in hypertension.

Perindopril erbumine (perindopril) is a prodrug ester of perindoprilat, an angiotensin converting enzyme (ACE) inhibitor. Perindopril 4 to 8 mg once daily significantly reduces supine systolic blood pressure (SBP) and diastolic blood pressure (DBP) from baseline values in hypertensive patients. These reductions are maintained for at least 24 hours, as evidenced by trough/peak ratios of >50%. Vascular abnormalities associated with hypertension were improved or normalised during perindopril treatment. Perindopril 4 to 8 mg once daily significantly decreased carotid-femoral aortic pulse wave velocity (PWV), improved arterial compliance, reduced left ventricular mass index and, in patients with recent cerebral ischaemia and/or stroke, preserved cerebral blood flow despite significantly reducing SBP and DBP. Further research is needed to establish the significance of promising results showing that reductions in aortic PWV were associated with reduced mortality in patients with end-stage renal failure, a third of whom received perindopril. Response rates (numbers of patients with supine DBP < or = 90 mm Hg) were significantly higher with perindopril 4 to 8 mg once daily (67 to 80%) than with captopril 25 to 50 mg twice daily (44 to 57%) in 3 randomised double-blind trials. In other clinical trials, the antihypertensive effects of perindopril were similar to those of other ACE inhibitors (including enalapril) and calcium-channel antagonists. Combination treatment with perindopril and an antihypertensive agent from another treatment class provided additional benefits, either as first-line treatment or in patients failing to respond to monotherapy. Perindopril monotherapy was also effective in the elderly and in patients with hypertension and concomitant disease. Perindopril has a similar adverse event profile to that of other ACE inhibitors; cough is the most common event reported during treatment, and is also the most common adverse event responsible for treatment withdrawal. Perindopril is a well tolerated ACE inhibitor that is significantly better than captopril (in terms of response rates) in the treatment of hypertension, and as effective as other ACE inhibitors. Perindopril appears to reverse some of the vascular abnormalities associated with hypertension, including arterial stiffness and left ventricular hypertrophy, although further research is needed to confirm promising results regarding its ability to decrease associated cardiovascular morbidity and mortality. Results from ongoing studies will help confirm the place of perindopril in the treatment of hypertension; currently, it is an effective and well tolerated treatment for patients with mild to moderate essential hypertension.