Central Aortic Pulse Pressure Research Articles

Changes in Parameters of Arterial Stiffness with Posture in 41 Hypertensive Patients on Anti-Hypertensive Treatment

1.1. Objective: To determine changes in parameters of arterial stiffness with posture in 41 hypertensive patients on anti-hypertensive treatment 1.2. Method: Postural variations of parameters of arterial stiffness are measured in hypertensive patients on anti-hypertensive medication (n=41). Operator index, central aortic systolic pressure (ASP), central aortic pulse pressure (APP), Augmentation Index (AI) and brachial systolic pressure (SP) and brachial diastolic pressure (DP) were measured in supine and sitting positions. Parameters of arterial stiffness were obtained through Sphygmo-Cor device between 8am to 10am initially on supine position. After three minutes, values in sitting position were obtained. Ethics approval was taken. Demographics such as age, race, gender, height and BMI were noted. Differences between BP characteristics in supine and sitting were compared using non-parametric paired test of Wilcoxon Signed-rank test. 1.3. Results: A statistically significant decrease in median APP (38(35-54) vs 38(31-48), p=0.0058) and a significant increase in median DP (74(69-83) vs 76(69-87), p=0.023) was observed in hypertensive subjects on medications when moved from supine into sitting position. 1.4. Conclusions: Parameters of arterial stiffness vary with postural changes in hypertensive subjects on anti-hypertensive medications. The parameters of arterial stiffness reduce in sitting position compared to supine position. The significance of these variations is not well known but it may indicate reduction in cardiovascular events when patient is in sitting positon and may be on activity or exertion.

Association between invasively measured central aortic pulse pressure and diameter of ascending aorta

Data on the relationship between arterial pulsatile hemodynamics and aortic root geometry, using invasive hemodynamic measurement, has been scarce. Thus, this study aimed to assess the relationship between invasively measured aortic pulse pressure (aPP) and the diameter of ascending aorta (AoD). We analyzed 665 subjects (64.3 ± 11.0 years; 34.6% female) who underwent elective invasive coronary angiography (ICA) for the evaluation of coronary artery disease. Transthoracic echocardiography was performed on the same day, and AoD was measured at the level of 1 cm above the sinotubular junction at the end-diastole. Body surface area (BSA)-adjusted AoD (AoD/BSA) was used for the analysis. A pig-tail catheter was used to measure aortic pressures at a level approximately 3 cm above the aortic valve just before ICA. aPP was calculated as the difference between systolic and diastolic pressures of the aorta. In multiple linear regression analyses, aPP (β = 0.259; P < 0.001) was found to be significantly correlated with AoD/BSA even after controlling for potential confounders. This correlation power was stronger than aortic systolic pressure (β = 0.189; P < 0.001) and brachial pulse pressure (β = 0.091; P = 0.018) at the same multivariable analyses. In conclusion, our study demonstrated a significant association between invasively measured aPP and AoD/BSA, providing stronger evidence for the link between central aortic pulsatile hemodynamics and aortic root geometry.

Pulse wave analysis measurements: important, underestimated and undervalued parameters in cardiovascular health problems.

Central aortic stiffness is established as a reliable measure of cardiovascular disease. While pulse wave velocity (PWV) analysis measures arterial distensibility, risk profile of cardiovascular diseases can be expanded with following pulse wave analysis measurements: central aortic systolic blood pressure (CABPS), central aortic pulse pressure (CAPP), central aortic reflection magnitude (CARM), central aortic augmented pressure (CAAP) and central aortic augmentation index (CAAIx). The aim of this study is to evaluate the clinical usefulness and importance of pulse wave analysis measurements in specific cardiovascular conditions and diseases, both in term of diagnosis and therapeutic monitoring. One thousand sixty-six subjects were included. According to age bracket, four cohorts were investigated-healthy subjects (NL), hypertensive patients (HP), ischemic heart disease (IHD) and valvular heart disease (VHD) patients. Arterial stiffness was analyzed through Sphygmocor XCEL Central Blood Pressure Measurement System and Sphygmocor XCEL PWV Measurement System. Furthermore we observed the pulse wave analysis measurements of 14 patients with diagnose of ADHD who were referred by a child psychiatrist, in order to investigate the initiation of methylphenidate treatment. Statistically significant differences were found between NL and HP cohorts, across almost all age brackets, regarding pulse wave analysis measurements. In the risk stratification of arterial stiffness hypertension and especially central aortic blood pressure systolic (CABPS) seems a determining factor. Pulse wave analysis measurements for IHD and VHD cohort comparisons with NL counterparts, revealed non- statistically significant variations. Elevated CAAP, CAAIx and CARM within the youngest age group (0-10 years) in attention-deficit-hyperactivity-disorder (ADHD) patients warrant attention. Following such investigations, CABPS appears as a robust predominant factor in problems of arterial stiffness. Pulse wave analysis and PWV are important parameters in the evaluation and monitoring of arterial hypertension and cardiovascular diseases. There is a hypothesis that CAAP could be an important and even decisive parameter in the diagnosis of ADHD. Further investigation needed.

PS-C03-8: NOVEL STUDY TO SEE ARTERIAL STIFFNESS CHANGES WITH POSTURE IN HYPERTENSIVE SUBJECTS IN ASIAN POPULATION

Aim: To see the effect of postural variation on parameters of arterial stiffness, in Asian population especially in Singapore. Methods: Postural variations and their effects on measures of arterial stiffness were analysed in 2 groups of patients consisting of hypertensive subjects (57 patients) and normotensive subjects (54 patients). Operator index (OI), central pressures such as aortic systolic pressure (ASP), aortic pulse pressure (APP), Aortic Pulse Augmentation (APA), Augmentation Index (AI) and brachial blood pressures (BP) such as brachial systolic pressure (SP) and brachial diastolic pressure (DP) were measured in supine and sitting positions. Differences between BP characteristics in supine and sitting were compared using non parametric paired test of Wilcoxon Signed-rank test. A p-value of p &lt; 0.05 was accepted as statistically significant Results: A statistically significant increase in APP (45(35–54) vs 42(31–48) = 0.0058 and a significant decrease in DP (75(69–83) vs 78(69–87), p = 0.023) was seen in the supine position as compared to in the sitting position. A similar trend of significant increase in APP and decrease in DP (33(28.3–36) vs 30(23.3–33.8), p = 0.00158 and 62(55–67) vs 65(59–71), p = 0.0006 respectively was seen in normotensive subjects. Conclusion: Postural changes has an effect on arterial stiffness. Normotensive subjects and hypertensive patients on treatment behave similarly on postural changes. On the other hand, hypertensive subjects who are not on medications, behave differently with posture. Central aortic pulse pressure is a sensitive marker for postural variation response of arterial stiffness.

THE IMPORTANCE OF THE SYMPTOMS FOR DIAGNOSING AND TREATING OF HYPERTENSION IN CHILDREN, ADOLESCENTS AND YOUNG-AGED, ASSESSED WITH APPLANATION TONOMETRY

Objective: The aim is to know if the presence of symptoms in children, adolescents, and young-aged are important for early diagnosis and therapy of hypertension. Design and method: For this cross-sectional study was entered 180 children, adolescents, and young-aged, female 96 -male 84 (F-M), divided into 3 groups of age: from 5 years to 12, from 13 to 18, and from 19 to 22 years. Principally, patients consulted for the presence of symptoms. During the anamnesis, several symptoms were registered, such as headache, palpitations, thoracic pain, breathlessness, sweating, asthenia, and mental confusion. Was entered the anthropomorphic measures, systolic and diastolic blood pressure (S-DBP), heart rate, central hemodynamics parameters (CHP), and difference of augmentation index (Diff AIx) between observed values and normal levels, evaluated with applanation tonometry (Sphygmocor-PVX AtCor-Medical Australia) according to standards methods. Results: In F-M, S-DBP increased from 1 group (104.3/66.9–109.1/67.7 mmHg) to 2 group (117.5/71.5–120.4/72.0 mmHg). Into the 3 group (117.9/73.0–126.6/77.8 mmHg) a slight increase was observed (normal values according to JHypertens 2019). Similar changes occur in CHP, but central aortic pressure and pulse pressure were higher than normal, both sexes. The Diff-AIx (surrogate value of arterial stiffness), was measured only in the 3 group and results were higher than normal, both sexes. High prevalence of headache was observed among female 69%-76% and male 53%-47% in the 2-3 groups, respectively, and high percentage of palpitations too, among female 66%-64% and male 47%-41% in the 2-3 groups, respectively. Also, was observed thoracic pain, dyspnoea, sweating, and asthenia whose prevalence increases with age. Few cases of mental confusion were more prevalent in females (7%-7%) in the 2-3 group. Patients in therapy with Angiotensin Receptors Blocker were registered female 31%-38% and male 40%-47% into the 2-3 group, respectively. All the patients treated improved the symptoms since the first month. Conclusions: In the diagnosis of Hypertension in children, adolescents, and young-aged it is very important the evaluation of symptoms and assesses them by applanation tonometry to know the optimal time of therapy to more early age with the objective of preventing future complications.

Feasibility of waveform separation of central aortic pressure pulse based on lognormal flow wave approximation

Wave reflections affect the aortic pressure and flow waves and may yield effective indices for monitoring cardiovascular health and disease. More accurate measures of wave reflection are obtainable after separation of aortic pressure waveform into its forward and backwards components. This paper presents a novel method for waveform separation of aortic pressure using a single pressure pulse measurement together with a lognormal flow wave approximation. The separated forward and backward waves were used to calculate the wave reflection parameters including reflection amplitude (RM) and reflection index (RI), and derive the aortic pulse transit time (PTT). The feasibility of the proposed method was verified using the central aortic pressure estimated from a measured radial pressure pulse by an aortic pulse analyzer and aortic flow waveform (39 data sets). Wave separation analysis (WSA) was assessed using the pressure and approximated flow waveforms based on two methods respectively, the proposed lognormal flow wave and the existing triangular flow wave. The results were compared with that of the measured flow wave. In time domain, for RM, RI, and PTT, the relations between the values calculated from the estimated flow and that from the measured flows can be characterized accurately by the linear regression models with the following coefficients of determination: R2 = 0.87 (RM), 0.86 (RI), 0.79 (PTT) using the lognormal flow; R2 = 0.84 (RM), 0.83 (RI), 0.77 (PTT) using the triangular flow. Agreement between reference and approximated values was increased when the approximated flow waveform was obtained using lognormal approximation rather than triangular estimation. The lognormal flow wave, a more physiological waveform, for approximating the flow improved the results of WSA in both time and frequency domains.

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.

Aortic diameter, pulse wave velocity, central aortic pulse pressure, left ventricular parameters, and diastolic dysfunction in patients with aortic aneurysm

Abstract Background The enlargement of aortic aneurysm can alters pulse wave propagation and reflection, which may influence to left ventricular (LV) afterload changes. The relevance of pulse wave velocity (PWV) and central blood pressure depending on the locus of the aneurysm for LV structure and diastolic function (DF) are not clearly unknown. Purpose Assess the relationship between central pulse pressure (CPP), PWV and LV structure and DF in patients with ascending aortic aneurysm (AA) and abdominal aortic aneurysm (AAA). Methods 121 patients (95 male, 63±12 years) with aortic aneurysms and preserved LV systolic function were enrolled before aortic repair. 51 patients (37 male, 54±13 years) had AA and 70 patients (58 male, 69±7 years) had AAA. CPP and PWV were measured using applanation tonometry. A echocardiographic exam was performed with a Vivid 7 GE (USA). LV mass index (LVMI) and relative wall thickness (RWT) were calculated according to standard formulas. LV filling pressure (E/Em) was estimated by Doppler-derived ratio of mitral inflow velocity (E) to septal (Em) by tissue Doppler. Transmitral flow patterns (E/A ratio of E to late (A) ventricular filling velocities) were measured with the pulsed doppler method. Results Concentric LV hypertrophy (LVH) was observed in 51 (42%), eccentric LVH – in 35 (29%) patients. CPP was positively related with LVMI (r=0.362, P=0.001), but PWV was inversely associated with LVMI (r=−0.244, P=0.029). CPP was not associated with RWT (P≥0.5), whereas PWV was positively related (r=0.223, P=0.004). PWV decreased with increasing aortic diameter in AA and AAA (r=−0.360, P=0.029 and r=−0.315, P=0.019, respectively). 12 (23%) patients with AA and 36 (56%) patients with AAA had grade I diastolic dysfunction, 20 (40%) patients with AA and 12 (18%) patients with AAA had grade II diastolic dysfunction (P&amp;lt;0.001). Consequently, the E/A ratio was higher in patients with AA than in patients with AAA (1.21±0.39 vs 0.83±0.33; P=0.007). CPP and PWV was inversely associated with LV DF (E/A: r=−0.352 and −0.238; E/Em: r=−0.292 and −0.279, respectively; both P&amp;lt;0.05). E/A and E/Em increased with the expansion of the maximum aortic diameter at the level of the AA and AAA (E/A: r=0.612 and 0.416; E/Em: r=0.719 and 0.339, respectively; both P&amp;lt;0.005). RWT and LVMI were correlated with the aortic diameter at the level of the AA (r=−0.439, P=0.008 and r=0.286, P=0.05, respectively), but bore no relation with the aortic diameter at the level of the AAA. Conclusions In patients with aortic aneurysm CPP and PWV were conjointly but differently related to LV structure. Eccentric LV hypertrophy was accompanied by a significant decrease of PWV. Reduced PWV and decreased CPP exhibited association with more severe LV diastolic dysfunction, possibly due to the apparent effect of increased aortic aneurysm diameter. LV DF was severely reduced in the patients with AA compared by patients with AAA. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Almazov National Medical Research Centre

Vasoprotective effects hypotensive therapy in patients with coronary heart disease combined with chronic kidney disease stage 2-3 after coronary stenting

Aim To study the condition of coronary vasculature by data of coronarography (CG) in patients with chronic ischemic heart disease (IHD) and arterial hypertension (AH) associated with stage 2-4 chronic kidney disease (CKD) and to evaluate the effect of a 12-week complex treatment with perindopril or with a combination of perindopril/amlodipine on changes in vascular wall stiffness, endothelial function, and structure and function parameters in this patient category after coronary stenting.Material and methodsr This study included 87 patients with chronic IHD and AH associated with stage 2-3 CKD for whom CG was performed due to ineffectiveness of the antianginal therapy. The patients were divided into three subgroups: subgroup 1 included 28 patients who received a conservative treatment with perindopril 10 mg/day; subgroup 2 consisted of 25 patients who underwent coronary stenting and were prescribed perindopril; subgroup 3 consisted of 34 patients who underwent stenting and were prescribed the perindopril/amlodipine combination. The reference group included 47 patients with IHD and AH with preserved kidney function. Anatomic and functional parameters of the heart, arterial stiffness, pulse wave velocity, cardio-ankle vascular index, augmentation index, central aortic systolic and pulse pressure, endothelium-dependent vasodilation, plasma concentration of endothelin-1 (ET-1), and plasma concentration of nitric oxide metabolites were evaluated at baseline and after 12 weeks of treatment.Results In patients with IHD, AH, and stage 2-3 CKD, arterial stiffness was more pronounced than in patients with preserved kidney function. Concentrations of ET-1 were significantly higher and levels of nitric oxide were lower in CKD. Supplementing the complex therapy with perindopril resulted in a considerable hypotensive effect in all subgroups, improvement of the kidney function, and positive dynamics of arterial stiffness and endothelial function. Changes in these parameters were more pronounced in patients after coronary stenting than in patients receiving only a conservative treatment. The use of perindopril/amlodipine following stenting exerted the most significant angioprotective and cardioprotective effect.Conclusion Patients with IHD and AH in combination with early CKD have pronounced impairment of the condition of arterial blood vessels and the heart. Addition of perindopril to the treatment not only exerted a hypotensive effect but also beneficially influenced mechanisms of progression of this combined pathology.

Evaluating daily profile of central aortic pressure and reflected pulse wave parameters in climacteric women

IntroductionStructural and functional changes of the vascular wall in women occur already at the very early stages of reproductive aging. An emergence of applanation tonometry made it possible to evaluate arterial stiffness and central hemodynamic parameters non-invasively, which considerably expanded the information that had been provided previously by invasive methods used for studying these parameters during cardiac catheterization. Whereas a few studies have assessed central aortic pressure (CAP) parameters and reflected pulse wave in women at different phases of their reproductive aging, none investigated the daily profile of CAP and reflected pulse wave parameters in women undergoing different stages of the menopause. Background: assessment of the daily variability in CAP and daily profile of amplification and augmentation of pulse blood pressure (PBP) in women at different menopause phases.MethodsThe study involved 384 climacteric women. The first group included 168 women undergoing perimenopause, the second group comprised of 216 women in their early postmenopausal stage. A 24-h blood pressure (BP) monitoring in the brachial artery and aorta (BPLab® Vasotens® system, Petr Telegin LLC, Russia) was performed via the measurements of the following indicators: systolic blood pressure (SBP), pulse blood pressure (PBP), central aortic systolic pressure (CASP), central aortic pulse pressure (CAPP), aortic augmentation index (AIxao), and pulse pressure amplification (PPA).ResultsWhen investigating PPA values in the brachial artery and aorta, we detected smaller amplification and higher aortic augmentation index at night than in daytime, which reflected a disproportionately higher CAP level during night hours. This pattern was more pronounced in postmenopausal women. We calculated the logistic regression equation (adjusted R2 = 0.49, log-likelihood = − 50.3, chi-square (19) = 97.6, p < 0.001), in which dependent variable was represented by the menopausal status, whereas body mass index with all indicators of a 24-h BP monitoring represented independent variables. In this model, two indicators (body mass index and AIxao) were, independently of each other, associated significantly with the menopause phases. Differences among women at various climacteric phases in terms of remaining indicators of a 24-h BP monitoring, apparently, matched the differences in their body mass index values.ConclusionRising CAP, in combination with declining PPA and augmenting reflected pulse wave amplitude, may be associated with an increased risk of cardiovascular complications.

The effect of propofol-sufentanil intravenous anesthesia on systemic and cerebral circulation, cerebral autoregulation and CO2 reactivity: a case series

Background and objectivesThe aim of our study was to assess systemic and cerebral hemodynamic changes as well as cerebral CO2-reactivity during propofol anesthesia. Methods27 patients undergoing general anesthesia were enrolled. Anesthesia was maintained using the Target-Controlled Infusion (TCI) method according to the Schnider model, effect site propofol concentration of 4 μg.mL-1. Ventilatory settings (respiratory rate and tidal volume) were adjusted to reach and maintain 40, 35, and 30 mmHg EtCO2 for 5 minutes, respectively. At the end of each period, transcranial Doppler and hemodynamic parameters using applanation tonometry were recorded. ResultsSystemic mean arterial pressure significantly decreased during anesthetic induction and remained unchanged during the entire study period. Central aortic and peripherial pulse pressure did not change significantly during anesthetic induction and maintenance, whereas augmentation index as marker of arterial stiffness significantly decreased during the anesthetic induction and remained stable at the time points when target CO2 levels were reached. Both cerebral autoregulation and cerebral CO2-reactivity was maintained during propofol anesthesia. ConclusionsPropofol at clinically administered doses using the Total Intravenous Anesthesia (TIVA/TCI) technique decreases systemic blood pressure, but does not affect static cerebral autoregulation, flow-metabolism coupling and cerebrovascular CO2 reactivity. According to our measurements, propofol may exert its systemic hemodynamic effect through venodilation. Trial registrationThe study was registered at http://www.clinicaltrials.gov, identifier: NCT02203097, registration date: July 29, 2014.

CAROTID-FEMORAL PULSE WAVE VELOCITY, PULSE WAVE ANALYSIS AND 24-HOUR AMBULATORY BLOOD PRESSURE MEASUREMENT IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Objective: Increased arterial stiffness and arterial hypertension are known risk factors for vascular damage and are an independent predictor of cardiovascular events. Pulse wave analysis of the radial artery (PWA) is a simple method for assessing various hemodynamic parameters in the central aorta. The aim of our study was to investigate the relationship between arterial stiffness measured by carotid femoral pulse wave velocity (cfPWV), PWA parameters and 24-hour ambulatory blood pressure measurement (ABPM) in patients with chronic kidney disease (CKD). Design and method: We conducted a cross-sectional study in a cohort of 87 non-dialysed CKD patients. cfPWV and PWA were investigated non-invasively using applanation tonometry (SphygmoCor®,Atcor, Australia). ABPM was measured with the monitor BR -102 (Schiller, Switzerland). Cardiovascular (CV) risk factors (urinary albumin/creatinine ratio, NT -pro-BNP, troponin I, cystatin C, cholesterol, LDL, HDL, triglycerides, lipoprotein Lp(a)) were measured. The patients were divided into two groups according to the median cfPWV: lower cfPWV group (cfPWV &lt; 11.58m/s, n = 44), higher cfPWV group (cfPWV &gt; 11.58m/s, n = 43). Results: The mean age of the patients was 60 ± 13.4 years, 65.5% were men, 24.1% had diabetes, 43.7% were smokers. Further descriptive data for all patients and both groups are presented in Table 1. With the t-test we found a significant difference between both groups regarding age (P &lt; 0.0001), but not regarding the biochemical CV risk factors. Patients with higher cfPWV had statistically significant higher central aortic systolic pressure (P &lt; 0.0001) and pulse pressure (P &lt; 0.0001), lower subendocardial viability ratio (P = 0.003), higher 24 h systolic ABPM (P &lt; 0.0001) and 24 h pulse pressure (P &lt; 0.0001). Conclusions: The results of our study show that non-dialysis CKD patients with higher cfPWV levels also have higher systolic and pulse pressure (central aorta and 24 h ABPM).

Plasma renin activity, serum aldosterone concentration and selected organ damage indices in essential arterial hypertension.

IntroductionThe aim of this study was to assess the relations between plasma renin activity (PRA), serum aldosterone concentration (ALDO) and selected asymptomatic organ damage (AOD) indices in mild primary arterial hypertension (AH).Material and methodsWe measured PRA, ALDO, and selected AOD indices (carotid-femoral pulse wave velocity (cfPWV), central aortic pulse pressure (cPP), estimated glomerular filtration rate (eGFR)) in 122 patients with untreated AH.ResultsPatients with high PRA (≥ 0.65 ng/ml/h) were characterized by lower plasma sodium and aldosterone to renin ratio (ARR), higher ALDO, but a similar level of AOD indices compared to patients with low PRA. cfPWV (p = 0.04) and cPP (p = 0.019) increased with ARR, while eGFR decreased with ALDO (p = 0.008). Only eGFR was independently correlated with ALDO. In subjects with simultaneously high PRA and ARR values, we found significantly higher cfPWV (p = 0.02) and cPP (p = 0.04) and lower eGFR (p = 0.02) than in those with high PRA but low ARR values.ConclusionsAssessment of the influence of the renin-angiotensin-aldosterone system (RAAS) on AOD should include the relationship between renin and aldosterone. The PRA itself has no predictive value for AOD. More advanced arterial stiffness and renal impairment are associated with increased PRA and ARR. The RAAS activity might be useful in AOD prediction and hypertension severity assessment.

Determinants of central aortic pressure and pulse pressure amplification changes in patients with aortic aneurysm: the role of aortic diameter and aortic aneurysm location level

Abstract Background The presence of aortic aneurysm can alters pulse wave propagation and reflection, causing changes in central aortic pressure and pulse pressure amplification (PPA) between the aorta and the brachial artery that might be associated with unfavorable hemodynamic effects for the central arteries and the heart. However, the impact of the location of the aneurysm and increase of the aortic diameter on central blood pressure (CBP) is not fully understood. Objective To investigate central aortic pressure and PPA regarding to association with arterial stiffness and aortic diameter in patients with ascending aortic aneurysm (AA), descending thoracic and abdominal aortic aneurysm (TAA and AAA). Methods 122 patients (96 males, 65±11 years) with aortic aneurysm were enrolled before aortic repair. The parameters of the aorta were evaluated by MSCT angiography: 44 patients (30 males, 55±13 years) had AA (the maximum diameter: 59.9±14.2 mm), 13 patients (11 males, 62±11 years) had TAA (the maximum diameter: 62.8±8.0 mm) and 65 patients (54 males, 69±8 years) had AAA (the maximum diameter: 52.3±17.2 mm). Brachial blood pressure (BBP) was measured by OMRON. CBP, augmentation index (AIx), carotid-femoral pulse wave velocity (PWV) were assessed by SphygmoCor. PPA was calculated as a difference between the values of central and brachial pulse pressure (CPP and BPP). Results Patients of the three groups did not differ in BPP (AA: 59.2±17.6; TAA 56.8±12.8; AAA: 59.3±11.4 mm Hg; P=0.5). Intergroup comparison revealed a difference in CPP between the three patients groups: CPP was higher in patients with AA and AAA, lower in patients with TAA (AA: 50.3±16.2; TAA 43.8±10.8; AAA: 50.0±11.2 mm Hg; P=0.05). PPA was lower in patients with AA and AAA than in patients with TAA (9.6±6.7 and 9.3±4.2 vs. 13.0±6.5 mm Hg; P=0.05 and P=0.04, respectively). IAx was higher in patients with AA and AAA than in patients with TAA (25.2±8.1 and 27.6±8.2 vs. 17.2±8.2 mm Hg; P=0.008 and P=0.001, respectively). A decrease of PPA across all patients correlated with an increase of IAx (r = - 0.268; P=0.003). CPP decreased with an increase of the aortic diameter for each level of the aneurysm (AA: r = - 0.460, P=0.016; TAA: r = - 0.833, P=0.003; AAA: r = - 0.275, P=0.05). PWV decreased with the expansion of the maximum aortic diameter at the level of the AA, TAA and AAA: (r = - 0.389, P=0.03; r = - 0.827, P=0.02 and r = - 0.350, P=0.01, respectively). Conclusion In patients with aortic aneurysm measurements of lower central pulse pressure and reduced PWV indicate an association with increased diameter of the aneurysm. An increase in augmentation index, early return of reflected waves, thus smaller PP amplification and higher CPP were identified in patients with ascending and abdominal aortic aneurysm compared by patients with descending thoracic aortic aneurysm. Funding Acknowledgement Type of funding source: None

Relation between central aortic pulse pressure and coronary artery disease: a coronary angiographic study in a tertiary care center

Background: Aortic pulse pressure is a significant marker of cardiovascular morbidity independently of mean blood pressure and pulse pressure of 60 mm Hg should be considered as the threshold at risk both in normotensives and hypertensives. Coronary perfusion is dependent on diastolic blood pressure and patients with CAD may be susceptible to the adverse effects of low diastolic blood pressure. This study conducted to examine the relation between central aortic pulse pressure and the prevalence and extent of CAD.Methods: A cross sectional, hospital-based study conducted in Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, among patients undergoing diagnostic coronary angiography.Results: Risk factors like Diabetes, Hypertension, Dyslipidemia and smoking rates were significantly higher in patients with PP of &gt;60 mmHg (p&lt;0.01). In the first group, the ratio of having normal coronaries is higher 61.9% vs 38% and diseased coronaries was lower when compared to the other group 38% vs 98%. In patients with aortic pulse pressure &gt;60 mmHg, 4 patients had left main coronary artery (LMCA) disease, 20 patients had single vessel disease, 11 patients had two vessel disease and 20 patients had triple vessel disease.Conclusions: In this study it was demonstrated aortic pulse pressure of more than 60 mm Hg is associated with significant CAD.

STRUCTURAL AND FUNCTIONAL VASCULAR CHANGES IN HIGH NORMAL ARTERIAL PRESSURE

The PURPUSE of the present study is changes in function and structure of large arteries in individuals with High Normal Arterial Pressure (HNAP) to be established. MATERIAL and METHODS: Structural and functional changes in the large arteries were investigated in 80 individuals with HNAP and in 45 with optimal arterial pressure (OAP). In terms of arterial stiffness, pulse wave velocity (PWV), augmentation index (AI), central aortic pressure (CAP), pulse pressure (PP) were followed up in HNAP group. Intima media thickness (IMT), flow-induced vasodilatation (FMD), ankle-brachial index (ABI) were also studied. RESULTS: Significantly increased values of pulse wave velocity, augmentation index, central aortic pressure, pulse pressure are reported in the HNAP group. In terms of IMT and ABI, being in the reference interval, there is no significant difference between HNAP and OAP groups. The calculated cardiovascular risk (CVR) in both groups is low. CONCLUSION: Significantly higher values of pulse wave velocity, augmentation index, central aortic pressure and pulse pressure in the HNAP group are reported.

Effect of sevoflurane on systemic and cerebral circulation, cerebral autoregulation and CO2 reactivity

BackgroundSevoflurane is one of the most frequently used inhaled anesthetics for general anesthesia. Previously it has been reported that at clinically used doses of sevoflurane, cerebral vasoreactivity is maintained. However, there are no data how sevoflurane influences systemic and cerebral circulation in parallel. The aim of our study was to assess systemic and cerebral hemodynamic changes as well as cerebral CO2-reactivity during sevoflurane anesthesia.MethodsTwenty nine patients undergoing general anesthesia were enrolled. Anesthesia was maintained with 1 MAC sevoflurane in 40% oxygen. Ventilatory settings (respiratory rate and tidal volume) were adjusted to reach and maintain 40, 35 and 30 mmHg EtCO2 for 5 min respectively. At the end of each period, transcranial Doppler and hemodynamic parameters using applanation tonometry were recorded.ResultsSystemic mean arterial pressure significantly decreased during anesthetic induction and remained unchanged during the entire study period. Central aortic and peripherial pulse pressure and augmentation index as markers of arterial stiffness significantly increased during the anesthetic induction and remained stable at the time points when target CO2 levels were reached. Both cerebral autoregulation and cerebral CO2-reactivity was maintained at 1 MAC sevoflurane.DiscussionCerebral autoregulation and CO2-reactivity is preserved at 1 MAC sevoflurane. Cerebrovascular effects of anesthetic compounds have to be assessed together with systemic circulatory effects.Trial registrationThe study was registered at http://www.clinicaltrials.gov, identifier: NCT02054143, retrospectively registered. Date of registration: February 4, 2014.

A17747 Changes in Parameters of Arterial Stiffness with Posture in Hypertensive patients with and without Anti-Hypertensive treatment

Objectives: To determine and compare differences in postural variation for arterial stiffness between hypertensive patients with and without medication Methods: Postural variations of parameters of arterial stiffness are measured in hypertensive patients with medication (41 subjects) and without medication (15 subjects). Operator index, central aortic systolic pressure (ASP), central aortic pulse pressure (APP), Augmentation Index (AI) and brachial systolic pressure (SP) and brachial diastolic pressure (DP) were measured in supine and sitting positions. Hypertensive subjects were chosen based on their ambulatory blood pressure monitoring and had brachial blood pressure above 140/90 mmHg on at least two separate occasions in clinic. The BP characteristics were obtained through SphygmoCor device between 8am to 10am on supine position. After three minutes, values in sitting position were obtained. Informed verbal consent was obtained from all participants and ethics approval was taken before the start of the study. Differences between BP characteristics in supine and sitting were compared using non-parametric paired test of Wilcoxon Signed-rank test. Differences in BP characteristics amongst the different groups of subjects were analysed using Man Whitney U test. A p < 0.05 was accepted as statistically significant in both tests Results: Statistically significant decrement in APP (38 (35–54 vs 38 (31–48), p = 0.0058) and significant increment in DP (74 (69–83) vs 76 (69–87), p = 0.023) was observed in hypertensive subjects. (Table 1) Conclusion: Postural variation had an effect on APP and DP in hypertensive subjects on anti-hypertensive medications but no effect in subjects off medications. While a postural variations of AI were noted on medications compared to subjects off medication, this was not statistically significant

Aortic Pulse Pressure Does Not Adequately Index Cardiovascular Risk Factor-Related Changes in Aortic Stiffness and Forward Wave Pressure.

Through the impact of conventional risk factors on arteries, several changes in aortic function contribute to cardiovascular events. It is nevertheless uncertain whether these effects are accurately reflected by changes in central aortic pulse pressure (PPc). We, therefore, aimed to determine the extent to which relations between modifiable risk factors and aortic function translate into increases in PPc. In 1,232 black South Africans from the South West Township (SOWETO) of Johannesburg, we determined risk factors and aortic function from carotid-femoral pulse wave velocity (PWV), aortic PPc, forward wave pressures (Pf), and reflected (backward) wave pressures (Pb) (applanation tonometry and SphygmoCor software). With adjustments for alternative risk factors and distending pressure (mean arterial pressure (MAP)), diabetes mellitus (treatment or HbA1c > 6.5%, n = 151) was associated with an increased PWV (7.10 ± 2.09 vs. 6.17 ± 2.00 m/s, P < 0.0001), and Pf (26 ± 8 vs. 24 ± 8 mm Hg, P < 0.005), but neither brachial PP (46 ± 14 vs. 45 ± 13, P = 0.19), PPc (36 ± 12 vs. 35 ± 11 mm Hg, P = 0.48), nor Pb (17 ± 6 vs. 17 ± 6 mm Hg, P = 0.83). Moreover, independent of alternative risk factors and MAP, uncontrolled hypertension (office blood pressure > 140/90 mm Hg, n = 433) was associated with an increased Pf (26 ± 12 vs. 24 ± 10 mm Hg, P < 0.01), but not with changes in brachial PP (45 ± 19 vs. 44 ± 17, P = 0.75), PPc (35 ± 16 vs. 35 ± 15 mm Hg, P = 0.93), or Pb (18 ± 8 vs. 17 ± 8 mm Hg, P = 0.46). Neither brachial nor aortic PP are adequate indexes of relations between the modifiable conventional risk factors, uncontrolled hypertension or diabetes mellitus, and risk-related aortic functional changes.

The Sacubitril/Valsartan, a First-in-Class, Angiotensin Receptor Neprilysin Inhibitor (ARNI): Potential Uses in Hypertension, Heart Failure, and Beyond.

Sacubitril/valsartan (LCZ696) is a first-in-class, novel-acting, angiotensin receptor neprilysin inhibitor (ARNI) that provides inhibition of neprilysin and the angiotensin (AT1) receptor. A recent clinical trial PRARDIGM-HF demonstrated that this drug is superior to angiotensin-converting enzyme (ACE) inhibitors for improving the prognosis in the patients with heart failure, and this has resulted in the drug being included in clinical practice guidelines for the management of heart failure with reduced ejection fraction (EF). In addition, sacubitril/valsartan has been developed for the management of hypertension, because it has unique anti-aging properties. However, the clinical evidence of mechanism has not been well validated. A recent mechanistic study PARAMETER demonstrated that sacubitril/valsartan (LCZ696) is superior to angiotensin receptor blocker (ARB) monotherapy for reducing central aortic systolic pressure (primary endpoint) as well as for central aortic pulse pressure (secondary endpoint) and nocturnal BP preferentially. Considering these results, sacubitril/valsartan may be an attractive therapeutic agent to treat the elderly with age-related hypertension phenotypes, such as drug-uncontrolled (resistant) hypertension characterized as systolic (central) hypertension (structural hypertension) and/or nocturnal hypertension (salt-sensitive hypertension). These are the high-risk hypertension phenotypes which are prone to develop heart failure with preserved EF and chronic kidney disease. Sacubitril/valsartan may be effective to suppress the age-related continuum from hypertension to heart failure, and it could be clinically useful not only for secondary prevention, but also as primary prevention of heart failure in uncontrolled elderly hypertensive patients.