Carotid Systolic Blood Pressure Research Articles

Systemic Lupus, Metabolic Syndrome, Cardiac Disease, and Peripheral Artery Disease

Systemic Lupus, Metabolic Syndrome, Cardiac Disease, and Peripheral Artery Disease

Subject-Specific Pressure Normalization of Local Pulse Wave Velocity: Separating Intrinsic From Acute Load-Dependent Stiffening in Hypertensive Patients.

Pulse wave velocity (PWV) is a powerful predictor of cardiovascular events. However, its intrinsic blood pressure (BP)-dependency complicates distinguishing between acute and chronic effects of increased BP on arterial stiffness. Based on the assumption that arteries exhibit a nearly exponential pressure-area (P-A) relationship, this study proposes a method to assess intersubject differences in local PWV independently from BP. The method was then used to analyze differences in local carotid PWV (cPWV) between hypertensive and healthy normotensive people before and after BP-normalization. Pressure (P) and diameter (D) waveforms were simultaneously acquired via tonometer at the left and ultrasound scanning at right common carotid artery (CCA), respectively, in 22 patients with Grade 1 or 2 hypertension and 22 age- and sex-matched controls. cPWV was determined using the D2P-loop method. Then, the exponential modeling of the P-area (A = πD2/4) relationships allowed defining a mathematical formulation to compute subject-specific changes in cPWV associated with BP changes, thus enabling the normalization of cPWV against intersubject differences in BP at the time of measurement. Carotid systolic BP (SBP) and diastolic BP (DBP) were, on average, 17.7 (p < 0.001) and 8.9 mmHg (p < 0.01) higher in hypertensives than controls, respectively. cPWV was 5.56 ± 0.86 m/s in controls and 6.24 ± 1.22 m/s in hypertensives. BP alone accounted for 68% of the cPWV difference between the two groups: 5.80 ± 0.84 vs. 6.03 ± 1.07 m/s after BP-normalization (p = 0.47). The mechanistic normalization of cPWV was in agreement with that estimated by analysis of covariance (ANCOVA). In conclusion, the proposed method, which could be easily implemented in the clinical setting, allows to assess the intersubject differences in PWV independently of BP. Our results suggested that mild hypertension in middle-aged subjects without target organ damage does not significantly alter the stiffness of the CCA wall independently of acute differences in BP. The results warrant further clinical investigations to establish the potential clinical utility of the method.

CAROTID VERSUS BRACHIAL BLOOD PRESSURE IN CHILDREN AND ADOLESCENTS

Objective: To compare carotid and brachial office blood pressure (BP) in terms of their association with 24-hour ambulatory BP and preclinical organ damage in children and adolescents. Design and method: Apparently healthy children and adolescents (age 6–18 yeas) referred for elevated BP were subjected to (i) measurements of office brachial BP measurement (Microlife WatchBP Home N; duplicate measurements), carotid BP and carotid-femoral pulse wave velocity (Complior Analyse device; duplicate measurements), (ii) 24-hour ABP monitoring (Microlife WatchBP O3), (iii) carotid intima-media thickness (cIMT) measurement (high resolution B-mode ultrasonography) at the level of common carotid and bulb bilaterally using automated software, and (iv) echocardiographic determination of left ventricular mass index (LVMI). Results: 64 individuals were included (mean age 12.9 ± 3.2 years, 37 males, BMI 24.5 ± 5.1 kg/m2, 11 with ambulatory hypertension [BP >=95th percentile or >=130/80 mmHg]). Carotid office systolic BP (SBP) was lower than brachial office SBP (120.1 ± 16.7 vs. 125.5 ± 15.1 mmHg, p < 0.01). The brachial minus carotid SBP difference (amplification) did not differ in males vs. females (4.9 ± 6.3 and 5.9 ± 6.2 mmHg respectively, p = NS) or in hypertensives vs. normotensives (7.8 ± 4.4 and 4.8 ± 6.4 mmHg, p = NS) and was not associated with age (r = −0.05) or height (r = −0.13). Carotid and brachial office SBP were correlated to 24-hour ambulatory SBP (r = 0.75 and 0.83 respectively, both p < 0.05) and with each other (r = 0.93). 24-hour ambulatory, carotid and brachial office SBP were associated with all indices of preclinical organ damage (LVMI: r = 0.33, 0.22 and 0.28; cIMT: 0.47, 0.36 and 0.38; PWV: 0.55, 0.50 and 0.58 respectively; p = NS for comparisons of coefficients). Conclusions: These preliminary results suggest that in children and adolescents central BP assessed at the carotid artery with the Complior method is not superior to brachial office or ambulatory BP in terms of their association with preclinical organ damage.

Bi-Modal Arterial Compliance Probe for Calibration-Free Cuffless Blood Pressure Estimation.

We propose a calibration-free method and system for cuffless blood pressure (BP) measurement from superficial arteries. A prototype device with bi-modal probe arrangement was designed and developed to estimate carotid BP - an indicator of central aortic pressure. Mathematical models relating BP parameters of an arterial segment to its dimensions and local pulse wave velocity (PWV) are introduced. A bi-modal probe utilizing ultrasound and photoplethysmograph sensors was developed and used to measure diameter values and local PWV from the carotid artery. Carotid BP was estimated using the measured physiological parameters without any subject- or population-specific calibration procedures. The proposed cuffless BP estimation method and system were tested for accuracy, usability, and for potential utility in hypertension screening, on a total of 83 subjects. The prototype device demonstrated its capability of detecting beat-by-beat arterial dimensions and local PWV simultaneously. Carotid diastolic BP (DBP) and systolic BP (SBP) were estimated over multiple cardiac cycles in real-time. The absolute error in carotid DBP was <10mmHg in 82% cases, and root-mean-square-error = 8.3mmHg. Consistent with the theory, estimated SBP at the carotid site was lower than the reference brachial SBP. ROC curves obtained for hypertension screening analysis revealed an area under the curve ≥0.8 for both carotid SBP and DBP values, illustrating the potential for using the developed method in hypertension screening. The feasibility of calibration-free, cuffless BP measurement at an arterial site of interest was demonstrated with a level of acceptable accuracy. The study also demonstrated the potential utility of the proposed method and system in hypertension screening and local evaluation of arterial stiffness indices. Novel approach for calibration-free cuffless BP estimation; a potential tool for local BP measurement and hypertension screening.

The Role of Central Blood Pressure Monitoring in the Management of Hypertension.

Central blood pressure is a novel predictor of cardiovascular risk that can be measured in the clinical setting using currently available technology. This paper will review current available methods of central blood pressure monitoring as well as its impact in cardiac and renal disease. Both aortic and carotid systolic blood pressure are independently associated with cardiovascular mortality and serious cardiac events. Furthermore, studies show that systolic aortic blood pressure has been shown to be superior predictor of cardiovascular as compared to brachial blood pressure. Inhibitors of the renin angiotensin axis may have a beneficial effect on central blood pressure; however, long term studies evaluating the impact of lowering central blood pressure on clinical outcomes are lacking. Central blood pressure is a good predictor of cardiovascular risk. As more studies emerge demonstrating the value of central blood pressure as a therapeutic target, it is possible that targeting central blood pressure may become an important part of the armamentarium to lower cardiovascular risk.

Acute Effect of Aerobic Exercise on Carotid Strain in Individuals with Multiple Sclerosis

INTRODUCTIONIndividuals with multiple sclerosis (MS) have increased arterial stiffness, a known risk factor for cardiovascular disease. Acute aerobic exercise is a stressor affecting markers of arterial stiffness, such as carotid strain (CS) and beta stiffness index, which provides insight into aspects of arterial function. Individuals with MS may have different responses to exercise compared to healthy individuals due to arterial dysfunction, which can be evaluated via markers of arterial stiffness.PURPOSETo evaluate the acute effect of aerobic exercise on CS in individuals with MS.METHODSSixteen individuals with MS (42 ± 8 yrs; 27.5 ± 6.9 kg/m2) underwent treadmill walking at 60% of their peak aerobic capacity for 20 min. Images of the carotid artery were obtained in the radial view with ultrasonography at baseline, immediate and 30 min post‐exercise. Speckle tracking software was used to calculate the following variables of arterial function: CS, CS time to peak (TPK), CS rate, CS rate TPK, radial velocity (RV), RV TPK, radial displacement (RD) and RD TPK. Carotid systolic blood pressure (cSBP) was measured via applanation tonometry and longitudinal carotid beta stiffness index via ultrasonography.RESULTSSee Table. CS rate, RV and carotid systolic blood pressure (cSBP) increased immediate post‐exercise (p&lt;0.05). CS TPK and RD TPK decreased immediately post‐exercise and RD TPK remained decreased at 30 min post‐exercise (p&lt;0.05). HR and beta stiffness index increased immediately post‐exercise (p&lt;0.05) and returned to baseline at 30 min (p&gt;0.05).CONCLUSIONThe baseline levels of CS in individuals with MS are lower than values reported for middle‐aged adults in the literature, indicative of baseline arterial dysfunction. Beta stiffness index increased immediately after exercise. While CS rate increased after exercise in individuals with MS similar to beta stiffness index, the difference disappeared after statistically controlling for HR. Our results suggest that individuals with MS do not improve arterial stiffness with acute aerobic exercise, providing more evidence for arterial impairment.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Factors affecting affect cardiovascular health in Indonesian HIV patients beginning ART

BackgroundWe present a small longitudinal study of how demographic factors and persistent burdens of HIV and cytomegalovirus (CMV) influence cardiovascular health in young adults beginning ART in an inner-city clinic in Jakarta, Indonesia.MethodsART-naïve HIV patients [n = 67; aged 31 (19 to 48) years] were enrolled in the JakCCANDO Project. Echocardiography and carotid Doppler ultrasonography were performed before ART (V0) and after 3, 6, and 12 months (V3–12). Antibodies reactive with CMV lysate or IE-1 protein were assessed at each timepoint and CMV DNA was identified at V0.ResultsMarkers of adverse cardiovascular prognosis [left ventricular mass index, ejection fraction and carotid intimal media thickness (cIMT)] were similar to healthy controls, but increased at V12. Internal diameters of the carotid arteries and systolic blood pressure correlated with HIV disease severity at V0, but cardiac parameters and cIMT did not. E/A ratios (left ventricular diastolic function) were lower in patients with CMV DNA at V0, but this effect waned by V6. Levels of antibody reactive with CMV IE-1 correlated inversely with CD4 T cell counts at V0, and levels at V6–V12 correlated directly with the right cIMT.ConclusionsOverall the severity of HIV disease and the response to ART have only subtle effects on cardiovascular health in this young Asian population. CMV replication before ART may have a transient effect on cardiac health, whilst antibody reactive with CMV IE-1 may mark a high persistent CMV burden with cumulative effects on the carotid artery.

Impact of glycemic control on aortic stiffness, left ventricular mass and diastolic longitudinal function in type 2 diabetes mellitus

BackgroundPoor glycemic control is associated with impaired left ventricular (LV) diastolic function in patients with type 2 diabetes mellitus (T2DM). Inappropriate LV mass increase and accelerated aortic stiffening were suggested to participate on deterioration of diastolic function. The present study investigated the inter-relationships between glycemic control, early diastolic and systolic longitudinal velocity of mitral annulus, LV mass and aortic stiffness in T2DM patients free of cardiovascular disease and with preserved LV ejection fraction, and compared them with those observed in healthy volunteers of similar age and sex distribution.Methods125 T2DM patients and 101 healthy volunteers underwent noninvasive measurement of systolic (s′) and early diastolic (e′) velocities of mitral annulus, LV mass, carotid-femoral pulse wave velocity (cfPWV) and local carotid blood pressure (BP).ResultsForty-four (35.2%) T2DM patients had e′ velocity lower than that expected for age (against 7.9% in healthy volunteers; P < 0.0001), 34 (27.2%) had cfPWV higher than that expected for age and mean BP (against 5.9% in healthy volunteers; P < 0.0001), and 71 (56.8%) had LV mass higher than that expected for body size and stroke work (against 17.6% in healthy volunteers; P < 0.0001). Carotid systolic BP was higher in T2DM patients (124 ± 14 vs 111 ± 11 mmHg; P < 0.0001). In multivariate analysis, e′ velocity was independently related to age, carotid BP and s′ velocity in healthy volunteers, and to male sex, age, carotid BP, heart rate and LV mass in T2DM. Glycosylated hemoglobin (HbA1c) was independently related to cfPWV and LV mass in T2DM patients. T2DM patients with HbA1c ≥6.5% (N = 85) had higher cfPWV (P < 0.05), central BP (P = 0.01), prevalence of LV hypertrophy (P = 0.01) and lower e′ and s′ velocity (P = 0.001 and <0.05, respectively) as compared to those with HbA1c <6.5%.ConclusionsOne-third of T2DM patients with preserved LV ejection fraction has sign of subclinical LV diastolic dysfunction. HbA1c levels are positively associated with LV mass and aortic stiffness, both of which show a negative independent impact on early diastolic velocity e′, the latter through an increase in afterload. T2DM patients with suboptimal glycemic control (HbA1c ≥ 6.5%) have lower diastolic and systolic LV longitudinal performance, together with increased aortic stiffness and a higher prevalence of LV hypertrophy.

Racial Differences in Aortic Stiffness in Children

To investigate racial differences in central blood pressure and vascular structure/function as subclinical markers of atherosclerotic cardiovascular disease in children. This cross-sectional study recruited 54 African American children (18 female, 36 male; age 10.5 ± 0.9 years) and 54 white children (27 female, 26 male; age 10.8 ± 0.9 years) from the Syracuse City community as part of the Environmental Exposures and Child Health Outcomes study. Participants underwent blood lipid and vascular testing on 2 separate days. Carotid artery intima-media thickness and aortic stiffness were measured by ultrasonography and carotid-femoral pulse wave velocity, respectively. Blood pressure was assessed at the brachial artery and estimated in the carotid artery using applanation tonometry. African American children had significantly higher pulse wave velocity (4.8 ± 0.8 m/s) compared with white children (4.2 ± 0.7 m/s; P < .05), which remained significant after adjustment for confounding variables including socioeconomic status. African American children had significantly higher intima-media thickness (African American 0.41 ± 0.06, white 0.39 ± 0.05 mm), and carotid systolic blood pressure (African American 106 ± 11, white 102 ± 8 mm Hg; P < .05) compared with white children, although these racial differences were no longer present after covariate adjustments for height. Racial differences in aortic stiffness are present in childhood. Our findings suggest that racial differences in subclinical cardiovascular disease occur earlier than previously recognized.

Hemodynamic Correlates of Blood Pressure in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

The primary aim of the present study was to identify the hemodynamic correlates of both steady and pulsatile blood pressure (BP) in community-dwelling older adults. In 3762 adults aged 70 to 89 years, significant hemodynamic determinants of both brachial and carotid systolic BP included arterial stiffness as measured by aortic pulse wave velocity, stroke volume (via echocardiography), arterial wave reflection, left ventricular ejection time, and upstroke time. The strongest influence was exerted by arterial stiffness. The steady-state component of blood pressure, mean arterial pressure, was associated with both cardiac index and total peripheral resistance (TPR), but was more strongly associated with TPR. Results were similar when participants taking antihypertensive medications were excluded from analyses. The overall findings suggest that mean arterial pressure is associated strongly with TPR and that significant hemodynamic correlates of systolic BP included arterial stiffness, stroke volume, and arterial wave reflection.

Vascular dysfunction in children and young adults with autosomal dominant polycystic kidney disease.

Adults with autosomal dominant polycystic kidney disease (ADPKD) exhibit vascular dysfunction, as evidenced by impaired endothelium-dependent dilation (EDD) and stiffening of the large elastic arteries. However, it is unknown whether vascular dysfunction begins earlier in the course of ADPKD. The aim of the study was to assess EDD and arterial stiffness in children and young adults with ADPKD. Fifteen children and young adults 6–22 years of age with ADPKD and normal renal function were prospectively recruited for participation in a cross-sectional study. Fifteen healthy controls were enrolled to match cases for age and sex. The primary outcomes were EDD, measured as brachial artery flow-mediated dilation (FMDBA), and arterial stiffness, measured as carotid-femoral pulse wave velocity (CFPWV). ADPKD cases were more likely to be taking an angiotensin-converting enzyme inhibitor, but otherwise did not differ from controls in clinical characteristics, including blood pressure. FMDBA was 25% lower in children and young adults with ADPKD (7.7 ± 0.9%, mean ± SE) when compared with matched controls (10.2 ± 0.8%) (P < 0.05). CFPWV was 14% higher in children and young adults with ADPKD (544 ± 23 cm/s) when compared with matched controls (478 ± 17 cm/s) (P < 0.05). Secondary measures of arterial stiffness, carotid augmentation index and carotid systolic blood pressure were also increased in cases when compared with controls (P < 0.05). Impaired EDD and increased arterial stiffness, important independent predictors of future cardiovascular events and mortality, are evident very early in the course of ADPKD in the presence of normal kidney function. Novel interventions to reduce vascular dysfunction in children and young adults with ADPKD should be evaluated, as childhood and young adulthood may represent a critical therapeutic window to reduce future cardiovascular risk in patients with ADPKD.

Abstract P082: Arterial Stiffness and Pressure Amplification are Associated with Lower Cognition Among Older Caucasian Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Accelerated cognitive decline is influenced by vascular aging. Arterial stiffness and pressure amplification, measures of vascular aging, are associated with lower cognitive performance though their association with cognitive domains has been understudied. Hypothesis: Arterial stiffness and pressure amplification are associated with lower global and domain-specific cognition among a sample of Caucasian and African American (AA) older adults. Methods: In a cross-sectional study of 4618 members from visit 5 (2011-2013) of ARIC (mean age: 75 years, 41% men, 20% AA), we measured arterial stiffness (carotid-femoral pulse wave velocity (cfPWV)) and pressure amplification (pulse pressure amplification (PPA), central pulse pressure (cPP) and carotid systolic blood pressure (cSBP)) using the Omron VP-1000 Plus device. Race-specific 25th percentile cut points were estimated for each measure. Domain-specific cognitive function was examined using the Delayed Word Recall Test (memory), Digit Symbol Substitution Test (executive function/processing speed), and Word Fluency Test (language). Test-specific z scores were calculated from sample means and standard deviations. A global cognition z score was generated by averaging the test-specific z scores. Linear regression was used to estimate the associations between race-specific 25th percentile dichotomies for arterial stiffness and pressure amplification measures with test-specific and global cognition z scores, adjusted for age, sex, education, ApoE4, heart rate, smoking and body mass index. Results: Among AAs, there was no significant association between measures of arterial stiffness and pressure amplification with either global or the domain-specific measures of cognition. Among Caucasians, all measures of arterial stiffness and pressure amplification were associated with lower global cognitive z scores (cfPWV: Beta (β) =-0.11, 95% Confidence Interval (CI): -0.19, -0.04; PPA: β=-0.11, 95% CI: -0.19, -0.03; cPP: β=-0.11, 95% CI: -0.18, -0.04; cSBP: β=-0.12, 95% CI: -0.20, -0.05). All measures of arterial stiffness and pressure amplification also were associated with lower executive function/processing speed (cfPWV: β=-0.09, 95% CI: -0.16, -0.03; PPA: β=-0.15, 95% CI: -0.22, -0.08; cPP: β=-0.14, 95% CI: -0.21, -0.07; cSBP: β=-0.13, 95% CI: -0.20, -0.07). High cfPWV was associated with lower memory (β=-0.12, 95% CI: -0.20, -0.04); and high cSBP was associated with lower language (β=-0.12, 95% CI: -0.20, -0.04). Conclusions: Arterial stiffness and measures of pressure amplification are inversely associated with global and domain-specific cognition in Caucasian older adults, but not in a smaller sample of AAs. Further study of the role of modifiable components of arterial aging on the preservation of cognition, particularly executive function/psychomotor speed, in older adulthood is warranted.

Night-time electromechanical activation time, pulsatile hemodynamics, and discharge outcomes in patients with acute heart failure.

AimsBoth electromechanical activation time (EMAT) and pulsatile hemodynamics measured during the hospitalization course are useful in the prediction of cardiovascular outcomes in patients with acute heart failure syndrome (AHFS). We investigated whether night‐time monitoring of EMAT with the ambulatory acoustic cardiography is superior to the measures of pulsatile hemodynamics for prediction of AHFS post‐discharge outcomes.Methods and resultsA total of 97 patients (71.1 ± 15.4 years old, 81% male, and 73.8% systolic heart failure) hospitalized for AHFS were included. Before discharge, 24 h ambulatory acoustic cardiography and a comprehensive echocardiographic and pulsatile hemodynamic study were performed to assess the mean 24 h, daytime, and night‐time EMAT, carotid systolic blood pressure (SBP) and pulse pressure (PP), amplitude of the reflected pressure wave from a decomposed carotid pressure wave (Pb), and carotid–femoral pulse wave velocity (cfPWV), in addition to measurement of N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) levels. During a mean follow‐up of 389 ± 281 days, 49 patients (50.5%) experienced events including re‐hospitalization for heart failure, myocardial infarction, stroke, or death. Pulsatile hemodynamics, including carotid SBP and PP and Pb, but not cfPWV, and night‐time EMAT, but not daytime EMAT, significantly predicted post‐discharge events when age and NT‐proBNP were accounted for (all P < 0.05). In a final model with adjustment for age and NT‐proBNP, night‐time EMAT, but not Pb, significantly predicted post‐discharge events [hazard ratio per 1 SD and 95% confidence intervals: 1.33 (1.05–1.69), P < 0.05].ConclusionPre‐discharge night‐time EMAT may be a better predictor for post‐discharge adverse events than the measures of the pulsatile hemodynamics in patients with AHFS.

The Effects of Resistance Training on Carotid Stiffness in Patients with the Metabolic Syndrome: A Pilot Study

Individuals with metabolic syndrome (MetS) have an increased arterial stiffness which is a strong independent risk factor for cardiovascular disease. Therapeutic interventions aimed at decreasing arterial stiffness is critical. However, resistance training has been shown to increase arterial stiffness in young healthy individuals. Thus, would resistance training exacerbate the arterial stiffness in individuals with MetS? We hypothesized individuals with MetS who participated in progressive resistance training of moderate intensity will not experience an increase in carotid arterial stiffness. A total of 18 individuals (8 MetS and 10 healthy control) performed resistance training exercises for 8 weeks. Resting measurements of carotid pulse wave analysis, systolic pressures, and carotid ultrasounds were taken before and after the intervention. No changes in systolic carotid diameter were found in the MetS (pre 0.65 ±0.02; post 0.66 ±0.02, p&gt;0.5) or control (pre 0.61 ±0.01; post 0.61 ±0.01, p&gt;0.5) group. Carotid systolic blood pressure did not significantly change in the MetS (pre 123±6; post 120±4 mmHg p&gt;0.5) or control (pre 112 ±3; post 111±4 p&gt;0.5) group. Regardless of group, a non‐significant (p=0.08) 16% decrease in carotid β‐stiffness was found following resistance training. In summary, individuals with MetS may safely participate in progressive hypertrophic resistance training.

Clinical Significance of Arterial Stiffness and Thickness Biomarkers in Type 2 Diabetes Mellitus: An Up-To-Date Meta-Analysis.

BackgroundType 2 Diabetes mellitus (T2DM) is associated with increased risk of cardiovascular disease (CVD). Previous studies explored the association of T2DM with arterial stiffness and thickness biomarkers including the augmentation index (AIX), aortic pulse wave velocity (aPWV), brachial-ankle PWV (baPWV), carotid intima-media wall thickness (IMT) as well as blood pressure (BP), low density lipoprotein cholesterol (LDL-C); however the conclusions are either inconsistent or incomprehensive.Material/MethodsThe average differences of each included trial were expressed as the standardized mean difference (SMD) with 95% confidence interval (CI). Analyses of carotid IMT, aPWV, baPWV and AIX Systolic BP (SBP), diastolic BP (DBP), LDL-C and HDL-C were independently performed. Furthermore, subgroup analyses by ethnicity (Caucasian or Asian) were conducted. Begg’s and Egger’s tests were performed for potential publication biases detection.ResultsA total of 14 case-control eligible studies with 1222 T2DM patients and 1094 control subjects were included. In the overall analysis, significant associations were observed between the carotid IMT, aPWV, baPWV, LDL-C, HDL-C, SBP, and DBP with T2DM (IMT: p=1.1*10−12; aPWV: p=1.1*10−7; baPWV: p=1.8*10−33; LDL-C: p=3.1*10−8; HDL-C: p=6.1*10−18; SBP: p=3.9*10−21; DBP: p=4.8*10−5). No association was detected for AIX (p=0.09). Subgroup analyses indicated that aPWV, baPWV, SBP, LDL-C, and HDL-C were associated with T2DM in both white and Asian populations (p<0.05). The significant associations of IMT, AIX and DBP with T2DM were only observed in the Asian subgroup.ConclusionsCarotid IMT, aPWV, baPWV, as well as LDL-C, HDL-C, SBP, and DBP but not AIX were useful noninvasive early markers for T2DM vascular dysfunction detection.

Sublingual nitroglycerin in patients with heart failure and preserved ejection fraction: Impact on central and regional carotid and radial input impedance and hemodynamics

Background: The systolic blood pressure lowering effect of sublingual nitroglycerin (NTG) administration is generally thought to primarily arise from its action on wave reflection, although recent invasive data indicate that at least part of the blood pressure reduction can be ascribed to an effect on left ventricular dynamics. Methods: Carotid and radial pressure waveforms and aortic, carotid and radial flow were measured in 19 HFpEF patients using applanation tonometry and pulsed Doppler ultrasound, respectively. Signals were time-aligned and global systemic as well as regional impedance and wave reflection analysis was applied. Results: NTG lowered carotid systolic (130.8±26 at baseline vs. 110.4±18.4mmHg after NTG, P<0.01) and mean (92.5±18.4 vs.85.4±14.3) blood pressure. Global systemic effects included a decrease in systemic vascular resistance (1.00±0.32 vs. 0.88±0.28 mmHg.ml-1.s, P<0.05), characteristic impedance (0.133±0.089 vs. 0.089±0.034 mmHg.ml-1.s, P<0.05) and an increase in total arterial compliance (1.20±0.58 vs. 1.52±0.53 ml.mmHg-1, P<0.01).NTG had a major impact on the amplitude of the forward pressure wave (58±24.3 vs. 40.6±13.3 mmHg, P<0.01), with no significant change in reflection magnitude. Regional analysis demonstrated a large effect of NTG on carotid input impedance, lowering impedance over the entire frequency spectrum, with radial artery input impedance did not demonstrate any significant changes (despite large effects on pressure and flow waveform morphology). Conclusions: Our data in HFpEF confirm the absence of impact of NTG on reflection magnitude, and demonstrate large effects of NTG on the input impedance of the cerebral vascular district, with little effect on the distal forearm circulation.

Singular and combined effects of nebivolol and lifestyle modification on large artery stiffness in hypertensive adults (LB567)

Background: We hypothesized that the combination of nebivolol and lifestyle modification would reduce large artery stiffness in middle‐aged and older hypertensive adults more than either intervention alone.Methods: To address this, 45 men and women (age 40‐75 years) with stage I hypertension were randomized to receive either nebivolol (NB; forced titration to 10 mg OD; n = 15; age 57.2 ± 11.4 years; body mass index [BMI] 30.8 ± 5.8 kg/m2), lifestyle modification (LM; 5‐10% weight loss via calorie restriction and physical activity; n = 15; age 52.7 ± 8.5 years; BMI 33.9 ± 7.2 kg/m2) or nebivolol plus lifestyle modification (NBLM; n = 15; age 58.9 ± 9.4 years; BMI 32.5 ± 4.9 kg/m2) for 12 weeks. β‐stiffness index, a blood‐pressure‐independent measure of arterial stiffness, and arterial compliance were measured via high‐resolution ultrasound and tonometry at baseline and after the 12‐week intervention. There was no difference between groups in age, body weight or composition, blood pressure, or in β‐stiffness index or arterial compliance at baseline (all p &gt; 0.05).Results: Following the 12‐week intervention, body weight decreased ~5% (p &lt; 0.05) in the LM and NBLM groups but did not change from baseline in the NB group (p &gt; 0.05). Supine brachial and carotid systolic and diastolic blood pressure declined following treatment in each of the groups (p &lt; 0.05). However, the magnitude of reduction was not different (p &lt; 0.05) between groups. β‐stiffness index declined (‐2.03 ± 0.60, ‐1.87 ± 0.83 and −2.51 ± 0.90 U) and arterial compliance increased similarly (both p &gt; 0.05) in the NB, LM and NBLM groups, respectively.Conclusion: In summary, our findings indicate that the combination of nebivolol and lifestyle modification reduced large artery stiffness to a similar degree as either intervention alone in middle‐aged and older hypertensive adults.Grant Funding Source: Supported by Forest Laboratories, Inc

The addition of non‐fat dairy products to the regular diet reduces central blood pressure and improves vascular function (272.5)

Elevated central systolic blood pressure and vascular dysfunction increase the risk of cardiovascular disease. Using a randomized, crossover study design, we tested the hypothesis that the addition of non‐fat dairy products to the regular diet would reduce carotid systolic blood pressure (cSBP) and improve vascular function. Forty‐four adults with elevated brachial blood pressure (52±2 yr, 133±1/80±1 mmHg) underwent a high dairy condition (+4 servings/day non‐fat dairy products) and isocaloric non‐dairy condition (+4 servings/day fruit products) in which all dairy products were removed. Both dietary conditions lasted four weeks with a 2‐week washout before crossing over. After the high dairy condition, cSBP decreased, brachial flow‐mediated dilation (FMD) increased, and carotid‐femoral pulse wave velocity (cfPWV) decreased (‐3±1mmHg, +1.1±0.5%, ‐66±18 cm/sec, respectively; p&lt;0.05). After the non‐dairy condition, cSBP or cfPWV did not change, but FMD was reduced (‐1.0±0.5%, p&lt;0.05). ∆cSBP was positively related to ∆cfPWV (r=0.59). In conclusion, the addition of non‐fat dairy products to the regular diet reduced central systolic blood pressure and improved vascular function. Additionally, the hypotensive effects of non‐fat dairy products may in part be mediated by reductions in central arterial stiffness.Grant Funding Source: Supported by Dairy Research Institute

Singular and combined effects of nebivolol and lifestyle modification on large artery stiffness in hypertensive adults

We hypothesized that the combination of nebivolol and lifestyle modification would reduce large artery stiffness in middle-aged and older hypertensive adults more than either intervention alone. To address this, 45 men and women (age 40-75 years) with stage I hypertension were randomized to receive either nebivolol (NB; forced titration to 10 mg OD; n = 15; age 57.2 ± 11.4 years; body mass index [BMI] 30.8 ± 5.8 kg/m(2)), lifestyle modification (LM; 5-10% weight loss via calorie restriction and physical activity; n = 15; age 52.7 ± 8.5 years; BMI 33.9 ± 7.2 kg/m(2)) or nebivolol plus lifestyle modification (NBLM; n = 15; age 58.9 ± 9.4 years; BMI 32.5 ± 4.9 kg/m(2)) for 12 weeks. β-stiffness index, a blood-pressure-independent measure of arterial stiffness, and arterial compliance were measured via high-resolution ultrasound and tonometry at baseline and after the 12-week intervention. There was no difference between groups in age, body weight or composition, blood pressure, or in β-stiffness index or arterial compliance at baseline (all p > 0.05). Following the 12-week intervention, body weight decreased ~5% (p < 0.05) in the LM and NBLM groups but did not change from baseline in the NB group (p > 0.05). Supine brachial and carotid systolic and diastolic blood pressure declined following treatment in each of the groups (p < 0.05). However, the magnitude of reduction was not different (p < 0.05) between groups. β-stiffness index declined (-2.03 ± 0.60, -1.87 ± 0.83 and -2.51 ± 0.90 U) and arterial compliance increased similarly (both p > 0.05) in the NB, LM and NBLM groups, respectively. In summary, our findings indicate that the combination of nebivolol and lifestyle modification reduced large artery stiffness to a similar degree as either intervention alone in middle-aged and older hypertensive adults.

Cardiovascular effects of abduction shoulder sling in elderly patients; is it really safe?

The purpose of the prospective study is to investigate the cardiovascular effects of abduction shoulder sling (ASS) in elderly patients who underwent rotator cuff surgery. The study included 49 consecutive patients older than 50 years (mean 59.3 ± 8.2 years) who underwent arthroscopic rotator cuff repair surgery and used ASS in postoperative period. All cases underwent Holter electrocardiographic monitoring before (24 h) and after (48 h) the operation. The Holter findings were read by an experienced cardiologist and a pause of longer than 3 s and heart rate of <40 bpm was evaluated as significant bradycardia. One patient (61-year-old male) described feeling faint (presyncope) which was confirmed with the Holter finding of a pause more than 3 s which occurred in the day time. Two other patients (52-year-old male, and 62-year-old female) reported severe dizziness (hypotensive attack) which required admission to a general practitioner. However, Holter findings were normal in these patients. These three cases were referred to cardiology department for evaluation of carotid hypersensitivity syndrome (CSH). CSH was confirmed with tests made with provocative maneuvers in a sitting position. CSH was defined as at least 3 s of asystole (cardio-inhibitor type) during carotid massage or systolic blood pressure falling below 50 mmHg (vaso-depressor type). All three patients were obese patients and BMI was higher than 30. ASS may trigger CSH in short necked and obese patients by exerting mechanical stimulation to the carotid sinus. These patients should be informed about symptoms and signs of CSH and educated on the proper use of ASS and correct positioning of shoulder strap. CSH should be kept in mind in patients who present with dizziness, presyncope and palpitation during the postoperative period.