Central Aortic Systolic Blood Pressure Research Articles

Intrafamilial aggregation and heritability of left ventricular geometric remodeling is independent of cardiac mass in families of African ancestry.

Whether left ventricular (LV) geometric remodeling, as indexed by relative wall thickness (RWT), aggregates in families and is inherited independent of LV mass (LVM) and additional confounders is uncertain. We determined whether RWT as assessed from 2D targeted M-mode echocardiography shows intrafamilial aggregation and heritability independent of LVM in 181 nuclear families (73 spouse pairs, 403 parent-child pairs, and 177 sibling-sibling pairs) with 16 families including 3 generations from an urban developing community of black Africans. Intrafamilial aggregation and heritability estimates (S.A.G.E. software) were assessed independent of confounders, including central aortic systolic blood pressure (SBPc) (radial applanation tonometry and SphygmoCor software). Independent of confounders including SBPc, LV RWT was correlated in parent-child (r = 0.32, P < 0.0001) and sibling-sibling (r = 0.29, P < 0.0001), but not in spouse (r = 0.11, P = 0.33) pairs. The relationships between parent-child (r = 0.28, P < 0.0001) and sibling-sibling (r = 0.24, P < 0.001) pairs persisted with further adjustments for LVM or LVM indexed to height(2.7) (LVMI). Similarly, independent of confounders, LV RWT showed significant heritability (h(2) ± SEM = 0.56 ± 0.09, P < 0.0001) and this persisted with further adjustments for LVM (h(2) ± SEM = 0.48 ± 0.09, P < 0.0001) or LVMI (h(2) ± SEM = 0.49 ± 0.09, P < 0.0001). In a group of African ancestry, independent of LVM, LV geometric remodeling shows significant intrafamilial aggregation and heritability. Genetic factors may in-part determine the LV geometric remodeling process independent of the extent of cardiac hypertrophy.

Effects of acute aerobic exercise and resistance training on central aortic pressure

Objective To explore the effects of aerobic exercise and resistance training on center arterial blood pressure.Methods Fifteen healthy men who had not practiced aerobic exercise or resistance training within the previous 6 months were enrolled in this study.A self-matched pairs design was adopted.All of the subjects performed moderate intensity aerobic exercise,for 30 min initially,and after 2 weeks,performed resistance training at 60％ of their l-repeat maximum effort (1-RM).Their central aortic systolic blood pressure (CSBP) before and after aerobic exercise and resistance training were measured and compared,respectively.The changes in CSBP and an augmentation index (AI) of radial artery and relative blood pressure were compared between the two interventions.Results CSBP decreased significantly after both sorts of training.The two types of training showed no significant difference in their effects on CSBP.However,after a 20 min recovery,systolic blood pressure and pulse pressure were significantly lower after aerobic exercise than after resistance training.The significant difference persisted after 20 min and 40 min of re-covery.The AI of the radial artery was also significantly lower 5 min after aerobic exercise than after resistance train-ing.Conclusions After moderate aerobic exercise and resistance training,CBSP,AI and systolic pressure all display favorable changes.However,moderate intensity aerobic exercise provides the better effect in improving blood pressure. Key words: Central arterial pressure; Aerobic exercise; Resistance exercise

Hemodiafiltration Does Not Have Additional Benefits over Hemodialysis on Arterial Stiffness, Wave Reflections and Central Aortic Pressures

Background/Aims: The hypothesis that dialytic modality affects arterial stiffness was never investigated. This study includes comparative evaluation of hemodiafiltration versus hemodialysis on arterial function during first and second weekly dialysis sessions. Methods: 24 patients receiving hemodiafiltration and another 24 age- and sex-matched controls receiving hemodialysis were included. Patients were evaluated before and after first and second weekly dialysis sessions. Applanation tonometry of peripheral arteries was applied to determine aortic and brachial pulse wave velocity and heart rate-adjusted augmentation index (AIx(75)). Results: Hemodiafiltration and hemodialysis reduced AIx(75), but not aortic and brachial pulse wave velocity. Intradialytic reductions in AIx(75) did not differ between hemodiafiltration and hemodialysis in first and mid-week dialysis. In multivariate linear regression, predictors of intradialytic reduction in AIx(75) were changes in body weight and central aortic systolic blood pressure, but not dialytic modality. Conclusion: This study showed that hemodiafiltration has similar effects with hemodialysis on wave reflections and stiffness.

Editorial: Do We Have Effective Means to Treat Arterial Stiffness and High Central Aortic Blood Pressure in Patients with and without Hypertension?

The reduction or loss of arterial elasticity or distensibility leads to arterial stiffness (AS), which has a substantial predictive value for all-cause and cardiovascular disease (CVD) mortality, as well as for non-fatal CVD events [1]. A plethora of evidence consistently showed the prognostic value of aortic stiffness for fatal and nonfatal CVD events in various populations at different levels of CVD risk, including the general population, elderly subjects and patients with hypertension, type 2 diabetes mellitus (T2DM) and end-stage renal disease (ESRD) [2]. It has been reported that 1-SD increase in pulse wave velocity (PWV) is associated with a 47% increase in the risk for total mortality [95% confidence interval (CI), 1.31-1.64] and a similar 47% increase in the risk for CVD mortality (95% CI, 1.29-1.66) [2].

Central Aortic Blood Pressure and Management of Hypertension

See related article, pp 1138–1145 Hypertension, a condition of elevated arterial blood pressure (BP) conventionally diagnosed by brachial cuff sphygmomanometry, is associated with increased risk of cardiovascular mortality and morbidity and end-organ damage. However, the marked differences in pulse pressure between the central aorta and peripheral limbs1 suggest that effects of peak values of arterial BP (eg, systolic BP) on centrally located organs (heart, brain, kidney) may not be accurately assessed using peripheral measurements. Our early studies2 showed substantial difference in the effects of sublingual nitroglycerin on peripheral and central (carotid) pulse pressures: in some cases, central systolic BP decreasing ≤20 mm Hg with little or no effect on brachial or radial systolic BP. There were, however, marked changes in the pulse wave form.2 The relationship between central aortic and radial pressure waves, quantified in terms of a mathematical transfer function, has been validated to be applicable across a large range of physiological pressures.3 The use of this noninvasive technique (and other variations, including other forms of analysis of the radial pulse or direct registration of the carotid pulse) has facilitated a large number of studies highlighting the differential effects of antihypertensive therapy on central aortic systolic BP for similar values of brachial cuff systolic BP.4 A seminal study by McEniery et al5 in >10 000 subjects demonstrated a substantial overlap of central and brachial BP between categories of hypertension. Approximately 32% of men and 10% of women who would be considered to have normal brachial systolic BP (and therefore, not treated) would be classified as having stage 1 hypertension based on equivalent central aortic systolic BP. Indeed, the implications of these findings suggested a possible sign of a paradigm shift in the management and treatment of hypertension as a significant cardiovascular risk.6 Subsequent studies …

Effects of the DPP-4 inhibitor saxagliptin on early vascular changes in the retinal and systemic circulation

In type-2 diabetes early vascular changes (among others) are hyperperfusion in the retinal circulation (like in the kidney) and increased pulse wave reflection leading to increased aortic pressure. We analyzed whether the DPP4-inhibitor saxagliptin reverses early vascular and haemodynamic changes in type-2 diabetes. In this double-blind randomized controlled clinical cross-over trial 42 patients with type-2 diabetes (age 60.3, 13 were females, BMI 30.6 kg/m2, mean duration of diabetes 4 years, HbA1c 7.0%, blood pressure 132/79 mmHg) were consecutively [PB1] included and randomized to placebo or saxagliptin 5 mg for 6 weeks each. Retinal capillary flow (RCF) was assessed at baseline and after flickerlight exposure (as a vasodilatory test) by scanning laser Doppler flowmetry. Central (aortic) systolic blood pressure (SBP), central pulse pressure (PP), augmentation index and pulse wave velocity were determined with the SphygmoCor device. Following treatment with saxagliptin (as opposed to placebo) saxagliptin effected a better glycemic control, a reduced retinal capillary flow (p=0.033) and, in parallel, reduced central systolic augmentation and pulse pressure (see table). In accordance, Flicker light induced increment of RCF (indicative of vasodilatory capacity of the retinal circulation) was numerically 2-fold greater, although not significant. View this table: Table 1 Our data suggest that treatment with saxagliptin for 6 weeks normalizes retinal capillary flow and improves central haemodynamics in type 2 diabetes.

Diverse effects of interdialytic intervals on central wave augmentation in haemodialysis patients

Increased arterial stiffness is a common finding and independent predictor of mortality in end-stage renal disease (ESRD) patients. A long interdialytic interval was associated with increased risk of cardiovascular death in patients receiving conventional haemodialysis (HD). This is the first study to examine the effects of a long (3-day) versus short (2-day) interdialytic period on arterial elasticity in HD patients. Seventy ESRD patients receiving standard HD three times per week were studied at the start and end of a 3-day and a 2-day interdialytic interval. At each time point, applanation tonometry of peripheral arteries was performed to assess arterial stiffness and wave reflection parameters. Aortic and brachial pulse wave velocities (PWV) were recorded as measures of arterial stiffness and augmentation index (AIx) as a measure of wave reflections. AIx, heart-rate-adjusted AIx and augmentation pressure were significantly increased during both interdialytic intervals, whereas aortic and brachial PWVs remained unchanged. The interdialytic increases in all the three AIx parameters were significantly higher during the 3-day interval in comparison to the 2-day interval (P < 0.001 for all comparisons). In contrast, no significant differences in interdialytic changes of aortic (P = 0.355) and brachial (P = 0.319) PWVs were noted between the two intervals. Mixed linear model analysis revealed that central aortic systolic blood pressure (SBP) and body weight, but not aortic or brachial PWV, were independent determinants of the change in heart-rate-adjusted AIx throughout the study. AIx is increased between HD sessions, whereas arterial elasticity is not. This interdialytic increase in central wave augmentation is more pronounced during the 3-day interval, suggesting a mechanism possibly involved in the elevated cardiovascular risk of HD patients at this time point.

A randomized trial of fish oil omega-3 fatty acids on arterial health, inflammation, and metabolic syndrome in a young healthy population

BackgroundLong chain omega-3 fatty acids from fish oils (O3) are known to have beneficial effects on a number of vascular risk factors in at-risk populations. The effects of a highly bioavailable emulsified preparation on an overweight young adult population are less well known.MethodsYoung adults, age 18–30, with body mass indices (BMIs) greater than 23 (average = 28.1) were administered 1.7 g of O3 per day (N = 30) or safflower oil placebo (N = 27) in an emulsified preparation (Coromega, Inc.) for 4 weeks in a double-blind randomized design. Blood was drawn and anthropometric measurements taken before and after dosing. Hemodynamic measures (central pulse wave velocity, augmentation index, and aortic systolic blood pressure), inflammatory cytokines (IL-6, IL-8, IL-10, and tumor necrosis factor-α), red blood cell and plasma phospholipid fatty acid profiles, fasting serum lipids, glucose, and C-reactive protein were measured.ResultsRed cell and plasma phospholipid eicosapentaenoic acid and docosahexaenoic acid concentrations increased over the four weeks of dosing in the O3 group. Dosing with O3 did not affect central pulse wave velocity, augmentation index, or aortic systolic blood pressure. None of the five American Heart Association metabolic syndrome components improved over the dosing period. None of the inflammatory cytokines, C-reactive protein, or lipids (total or LDL cholesterol) improved over the dosing period.ConclusionsNo salutary effects of O3 were observed in hemodynamic, metabolic syndrome criteria or inflammatory markers as a result of this relatively short period of administration in this relatively overweight, but healthy young adult cohort.

Effects of Low-Dose Atorvastatin on Arterial Stiffness and Central Aortic Pressure Augmentation in Patients With Hypertension and Hypercholesterolemia

Experimental and clinical data suggest that statins exert anti-inflammatory and antiproliferative actions on vasculature beyond their lipid-lowering properties. Whether these pleiotropic effects of statins translate into a beneficial effect on arterial stiffness is not clear. This study aimed to evaluate the potential effects of low-dose atorvastatin treatment on arterial stiffness and central arterial pressure waveforms in patients with mild hypertension and hypercholesterolemia. In a double-blind, randomized, placebo-controlled fashion, 50 hypertensive and hypercholesterolemic patients were allocated to receive 10 mg of atorvastatin or placebo for 26 weeks. Arterial stiffness was assessed by aortic pulse-wave velocity (PWV) using a Sphygmocor device. Central arterial pressure waveform parameters were estimated by radial artery applanation tonometry. Heart rate-adjusted augmentation index (AIx(75)) was used as measure of wave reflections. At study end, aortic PWV (9.0 ± 1.5 vs. 10.9 ± 2.6 m/sec; P < 0.001) and AIx(75) (24.9% ± 9.7% vs 28.8% ± 11.8%; P < 0.001) were significantly lower in the atorvastatin group than that placebo group. Furthermore, decreases in central aortic systolic blood pressure and pulse pressure were evident at study-end with atorvastatin but not with placebo (130 ± 8 vs. 138 ± 6 mm Hg, P < 0.001; 48 ± 7 vs. 53 ± 6 mm Hg, P < 0.05, respectively). Atorvastatin-induced reductions in aortic PWV during follow-up showed significant associations with changes in AIx(75) and central aortic systolic blood pressure and pulse pressure. This study shows that low-dose atorvastatin treatment improves arterial stiffness and exerts a reduction on central aortic pressures. These effects may represent a potential mechanism of cardiovascular risk reduction observed with statin use. ClinicalTrials.gov Database Identifier Number: NCT01126684.

Measurement Accuracy of a Stand-Alone Oscillometric Central Blood Pressure Monitor: A Validation Report for Microlife WatchBP Office Central

The superiority of prognostic value of blood pressure (BP) measured at central aorta (CBP) over conventional brachial BP measured by cuff-based BP monitors has reignited the development of new noninvasive techniques for estimating CBP. The present study validated the accuracy of CBP measured by a newly developed stand-alone CBP monitor. The CBP monitor provided readings of brachial systolic BP (SBP), brachial diastolic BP (DBP), central SBP, and central pulse pressure (PP). Brachial PP and central DBP were calculated from the relevant readings. The accuracy of the brachial and central SBP, PP, and DBP was validated against the simultaneously recorded invasively measured central aortic SBP, PP, and DBP, according to the invasive standard requirements for the noninvasive brachial BP monitors from the Association for the Advancement of Medical Instrumentation (AAMI) in 85 subjects (255 measurements; age range, 30-93 years). The mean differences of cuff BP with reference to the invasively measured central SBP, PP, and DBP were -2.6 ± 9.0, -8.6 ± 11.2, and 6.1 ± 7.0 mm Hg, respectively, with the former two being obviously underestimated at high CBP and overestimated at low CBP. In contrast, the corresponding differences for the central SBP, PP, and DBP measured by the CBP monitor were -0.6 ± 5.5, -0.4 ± 7.0, and -0.2 ± 6.5 mm Hg, respectively, without obvious systematic bias. The distribution of measurement errors for central SBP, PP, and DBP surpassed the AAMI criteria. Central SBP, PP, and DBP can be measured accurately by a stand-alone automatic BP monitor.

Central Hemodynamics in Prehypertension: Effect of the β‐Adrenergic Antagonist Nebivolol

The aim of the current study was to characterize the effects of the novel β-adrenergic antagonist nebivolol on central aortic blood pressures, arterial properties, and nitroxidergic activity in individuals with prehypertension. Prehypertension is emerging as a major risk factor for several adverse cardiovascular consequences. Increased pulse wave velocity, aortic augmentation index, and aortic blood pressures have been linked with augmented risk of cardiovascular disease and mortality. While the effects of antihypertensive drugs on these parameters in hypertensive patients have been studied, there are limited data so far in prehypertension. Fifty individuals with prehypertension were randomized to either nebivolol (5 mg per day) or placebo in a double-blind clinical trial. Patients underwent measurement of pulse wave velocity as well as aortic blood pressure and aortic augmentation index via pulse wave analysis at baseline and 8 weeks. Patients also had blood and urine biochemistries done at each visit. Nebivolol achieved significant reductions in central aortic systolic (P=.011), diastolic (P=.009), and mean arterial blood pressure (P=.002). Pulse wave velocity trended toward improvement but did not achieve significance (P=.088). Nitric oxide production, measured as urinary nitrite/nitrite excretion, also rose substantially in the nebivolol group (by approximately 60%, P=.030). Central blood pressures can be effectively lowered by β-blockade while patients are still in the prehypertension phase, and the effects may be coupled to improve nitric oxide release by the drug.

Central blood pressure: a powerful predictor of the development of hypertension

We examined whether the central aortic systolic blood pressure, a marker of the function of the systemic arterial tree, might be a more powerful predictor of the development of hypertension than the brachial-ankle pulse wave velocity, a marker of the stiffness of the large- to middle-sized arteries, independent of the conventional risk factors for the development of hypertension. In 1268 Japanese men without hypertension (43±8 years old), the relationships between three variables (the second peak of the radial pressure waveform (SP2), brachial-ankle pulse wave velocity and conventional risk factors measured at the first examination) with the presence of hypertension at the second examination (after 3 years' follow-up) were examined. Hypertension was detected at the second examination in 154 men. The best cutoff points of the brachial-ankle pulse wave velocity and SP2, for predicting the development of hypertension, were 12.7 m/s and 109 mm Hg, respectively. The results of a logistic regression analysis confirmed that an SP2 of ≥109 mm Hg (odds ratio=8.493, P<0.001) was a more powerful predictor of the development of hypertension than a brachial-ankle pulse wave velocity of ≥12.7 m/s, independent of the conventional risk factors. The net reclassification index of SP2 (at the best cutoff point) to brachial-ankle pulse wave velocity was 0.211 (P<0.001), indicating that SP2 is a better predictor of the development of hypertension than brachial-ankle pulse wave velocity. In middle-aged Japanese men without hypertension, SP2 may be a more powerful predictor of the development of hypertension than the assessment of stiffness in large to middle-sized arteries independent of the conventional risk factors.

Maternal Hemodynamics in Normal Pregnancies at 11–13 Weeks’ Gestation

Objective: In women with established pre-eclampsia and gestational diabetes there is an increase in central aortic systolic blood pressure (SBP_Ao), pulse wave velocity (PWV) and augmentation index (AIx), which are measures of arterial stiffness. The aim of this study was to establish normal ranges for PWV, AIx and SBP_Ao at 11–13 weeks’ gestation and to examine the maternal characteristics which affect these parameters. Methods: This was a prospective study in singleton pregnancies at 11⁺⁰–13⁺⁶ weeks’ gestation. Maternal history and characteristics were recorded and PWV, AIx and SBP_Ao were measured. Multiple regression analysis was used to examine which of the maternal characteristics provided a significant contribution in the prediction of Alx-75, PWV and SBP_Ao. Results: In normal pregnancies PWV, AIx-75 and SBP_Ao were related to certain maternal characteristics, including increase with maternal age for AIx-75 and PWV, decrease with maternal height for AIx-75 and increase with maternal weight for PWV and SBP_Ao and decrease for AIx (p < 0.0001). The median, 5th, 10th, 90th and 95th percentiles for AIx-75 MoM (multiple of the unaffected median), PWV MoM and SBP_Ao MoM were 1.00, 0.72, 0.79, 1.34 and 1.48; 1.00, 0.77, 0.82, 1.24 and 1.33; and 1.00, 0.86, 0.88, 1.15 and 1.20, respectively. Conclusions: This study provides normal ranges for PWV, AIx and SBP_Ao at 11–13 weeks’ gestation and defines the maternal characteristics which affect these vascular parameters.

Maternal hemodynamics at 11–13 weeks' gestation and risk of pre‐eclampsia

Women who develop pre-eclampsia are at increased risk of cardiovascular disease and stroke in the subsequent decades. Individuals with cardiovascular disorders have increased central aortic systolic blood pressure (SBP(Ao) ) and arterial stiffness, as assessed by pulse wave velocity (PWV) and augmentation index (AIx). The aim of this study was to examine the potential value of assessment of SBP(Ao) , PWV and AIx at 11-13 weeks' gestation in identifying women who subsequently develop pre-eclampsia. This was a screening study for pre-eclampsia in singleton pregnancies at 11 + 0 to 13 + 6 weeks' gestation. Maternal history and characteristics were recorded and PWV, AIx (adjusted to a heart rate of 75 beats per min (AIx-75)) and SBP(Ao) measured. We compared these parameters in women who developed pre-eclampsia (n = 181) with those in unaffected controls (n = 6766) and examined their performance in screening for pre-eclampsia. In the pre-eclampsia group, compared to unaffected controls, there was an increase in AIx-75 (1.13 vs. 1.00 multiples of the median (MoM); P < 0.0001), PWV (1.06 vs. 1.00 MoM; P < 0.0001) and SBP(Ao) (1.09 vs. 1.00 MoM; P < 0.0001). In screening for pre-eclampsia by a combination of maternal variables and log(10) AIx-75 MoM, log(10) PWV MoM and log(10) SBP(Ao) MoM, the estimated detection rate was 56.9% at a false-positive rate of 10%. Compared with women who remain normotensive, women who develop pre-eclampsia have higher SBP(Ao) and arterial stiffness, which is apparent from the first trimester of pregnancy.

Maternal hemodynamics at 11–13 weeks of gestation and preterm birth

Women who experience preterm birth (PTB) are at increased risk of cardiovascular morbidity and mortality in the subsequent decades. Individuals with cardiovascular disorders have increased central aortic systolic blood pressure (SBP(Ao)) and arterial stiffness, assessed by pulse wave velocity (PWV) and augmentation index (AIx). The aim of this screening study was to evaluate SBP(Ao), PWV and AIx at 11-13 weeks' gestation in women who delivered preterm. This was a prospective study in singleton pregnancies at 11 + 0 to 13 + 6 weeks' gestation. Maternal history and characteristics were recorded, and PWV, AIx and SBP(Ao) were measured. We compared these parameters in women who had spontaneous (n = 244) or iatrogenic (n = 110) PTB before 37 weeks' gestation and before 34 weeks with those in women who had term delivery (n = 7489). Compared with women who had term delivery, women who had iatrogenic PTB had significantly higher AIx (1.08 (interquartile range (IQR), 0.91-1.27) multiples of the median (MoM), vs. 1.00 (IQR, 0.86-1.16) MoM) and SBP(Ao) (1.06 (IQR, 0.98-1.15) MoM vs. 1.00 (IQR, 0.93-1.07) MoM). However, there was no significant difference in AIx, PWV or SBP(Ao) between those who had spontaneous PTB and those who had term delivery. These findings were similar for those who had PTB at < 34 and < 37 weeks' gestation. Women who had iatrogenic PTB, but not those who had spontaneous PTB, have increased SBP(Ao) and arterial stiffness that is apparent from as early as the first trimester of pregnancy.

OS084. Maternal haemodynamics at 11–13 weeks of gestation and adverse pregnancy outcomes

Women who develop adverse pregnancy outcomes are at increased risk of cardiovascular disease. In individuals with cardiovascular disorders there is increased central aortic systolic blood pressure (SBPAo) and arterial stiffness. The hypothesis is that increased SBPAo and arterial stiffness are apparent before the clinical onset of adverse pregnancy outcomes. This was a prospective study in singleton pregnancies at 11(+0)-13(+6) weeks' gestation. Pulse wave velocity (PWV), augmentation index (AIx) and SBPAo were measured. At the same visit, we recorded maternal characteristics and medical history and performed combined screening for aneuploidies. We also measured the uterine artery Doppler pulsatility index (PI). The study outcomes included preeclampsia (PE), gestational hypertension (GH), gestational diabetes (GDM), small for gestational age (SGA) and preterm delivery (PTD). The diagnosis of PE and GH was made according to the guidelines of the International Society for the Study of Hypertension in Pregnancy. The neonate was considered SGA if the birth weight was less than the 5th percentile for gestation at delivery. The diagnosis of GDM was made if the fasting plasma glucose level was at least 6 mmol/L or the plasma glucose level 2 h after oral administration of 75 g glucose was 7.8 mmol/L or more (WHO). We compared these parameters in those that developed PE (n=181), GDM (n=105), GH (n=137), SGA (n=337), PTD prior to 37 weeks' gestation (n=354) with unaffected controls (n=6,766). Multiple regression analysis was used to examine which maternal characteristics provided a significant contribution in the prediction of AIx-75, PWV and SBPAo. Each value was expressed as a multiple of the median (MoM) after adjustment for those characteristics. Pearson correlation analysis was used to examine the association between log10AIx-75 MoM, log10PWV MoM, log10 SBPAo MoM, log10uterine artery PI MoM and log10PAPP-A MoM with gestational age at delivery. In the PE group there was an increase in AIx-75 (1.13, IQR 0.96-1.33 MoM vs 1.00, IQR 0.87-1.16 MoM, p<0.0001), PWV (1.11, IQR 0.97-1.17 MoM vs 1.00, IQR 0.90-1.12 MoM, p<0.0001), and SBPAo (1.09, IQR 1.02-1.20 MoM vs. 1.00, IQR 0.94-1.08 MoM, p<0.0001). In those that subsequently developed GH, compared to unaffected controls, there was no significant difference in the uterine artery PI, PAPP-A or PWV but AIx-75 and SBPAo were increased (p<0.0001). In the GDM group there was an increase in PWV (1.06, IQR 0.96-1.19 MoM vs. 1.00, IQR 0.90-1.13 MoM, p=0.001) and SBPAo (1.03, IQR 0.98-1.14 vs. 1.00, IQR 0.94-1.08, p<0.0001), but no significant difference in the AIx-75 (1.02, IQR 0.89-1.22 MoM vs. 1.00, IQR 0.87-1.17 MoM, p=0.118). Compared to women who had term delivery, women who had iatrogenic PTD had significantly higher AIx-75 (1.08, IQR 0.91-1.27 MoM vs. 1.00, IQR 0.86-1.16 MoM, p<0.001) and SBPAo (1.06 MoM, IQR 0.98-1.15 vs. 1.00, IQR 0.93-1.07, p<0.001). A high proportion of women who develop PE, GDM or iatrogenic PTD have increased SBPAo and arterial stiffness that is apparent from the first trimester of pregnancy.

Maternal Hemodynamics at 11–13 Weeks’ Gestation in Gestational Diabetes Mellitus

Objective: Women who develop gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes and subsequent cardiovascular mortality and morbidity. Individuals with cardiovascular disorders have increased central aortic systolic blood pressure (SBP_Ao) and arterial stiffness. The hypothesis of this study is that increased SBP_Ao and arterial stiffness are apparent before the development of GDM. Methods: In this screening study, SBP_Ao, pulse wave velocity (PWV) and augmentation index (AIx) were measured in women with singleton pregnancies attending for routine antenatal care at 11–13 weeks’ gestation. We compared SBP_Ao, PWV and AIx, expressed as multiples of the median (MoM), after adjustment for maternal characteristics affecting these measurements, in women who subsequently developed GDM (n = 105) with the values in non-GDM controls (n = 6,736). Results: In the GDM group, compared to non-GDM controls, there was an increase in PWV [1.04 MoM, interquartile range (IQR) 0.93–1.15 vs. 1.00 MoM, IQR 0.90–1.12; p = 0.013] and SBP_Ao (1.03 MoM, IQR 0.98–1.14 vs. 1.00 MoM, IQR 0.94–1.08; p < 0.0001) but no significant difference in the AIx (1.02 MoM, IQR 0.89–1.22 vs. 1.00 MoM, IQR 0.87–1.17; p = 0.118). Conclusion: Women who develop GDM have increased SBP_Ao and arterial stiffness from the first trimester of pregnancy before the clinical onset of GDM.

Comparison of two generalized transfer functions for measuring central systolic blood pressure by an oscillometric blood pressure monitor

Central aortic systolic blood pressure (SBP-C) can be estimated from a cuff oscillometric waveform derived during the pulse volume plethysmography (PVP) by applying a device-specific aortic pressure-to-PVP waveform-generalized transfer function (A2P(GTF)). The present study compared the performance of an aortic-to-brachial pressure waveforms generalized transfer function (A2B(GTF)), which is independent of any PVP devices, with an A2P(GTF). Generalized transfer function of aortic-to-brachial (A2B(GTF)) and aortic-to-PVP (A2P(GTF)) were generated from the simultaneously obtained central aortic and brachial pressure waveforms recorded by a high-fidelity dual pressure sensor catheter, and the PVP waveform recorded by a customized noninvasive blood pressure monitor during cardiac catheterization in 40 patients, and were then applied in another 100 patients with simultaneously recorded invasive aortic pressure and noninvasively calibrated (using cuff SBP and diastolic blood pressures) PVP waveforms. The mean difference±s.d. between the noninvasively estimated and invasively recorded SBP-C was -2.1±7.7 mm Hg for A2B(GTF), which was not greater than that of -3.0±7.7 mm Hg for A2P(GTF) (P<0.01). In conclusion, SBP-C can be measured reliably using a noninvasive blood pressure monitor by applying either an A2P(GTF) or A2B(GTF) to a noninvasively calibrated PVP waveform. The performance of an A2B(GTF) is not inferior to that of an A2P(GTF).

Central aortic blood pressure and augmentation index: comparison between Vasotens&amp;reg; and SphygmoCor&amp;reg; technology

Central aortic blood pressure and augmentation index: comparison between Vasotens&reg; and SphygmoCor&reg; technology Anatoliy N Rogoza,1 Aleksandr A Kuznetsov21Cardiology Research Complex, Moscow, Russian Federation; 2Therapy Research Institute, Siberian branch of Russian Academy of Medical Science, Novosibirsk, Russian FederationIntroduction: The aim of this study is the comparison of Vasotens&reg; technology as used in a device with an oscillometric method of blood pressure measurement (BPLab, Petr Telegin Ltd, Nizhny Novgorod, Russian Federation) against the validated tonometric system (SphygmoCor&reg;, AtCor Medical Pty Ltd, West Ryde, Australia).Methods: The examinations were carried out in two medical centers. Exclusion criteria included atrial fibrillation, severe cardiac anomalies, heart failure, arrhythmia, decompensated diabetes, the presence of an artificial pacemaker, pregnancy, and BMI &gt; 30. Overall, 160 patients and healthy volunteers were examined. Central aortic systolic blood pressure (aSBP) and augmentation index (aAIx) were obtained by means of applanation tonometry and the oscillometric method was compared.Results: aSBP and aAIx measured using the BPLab device equates significantly with the same parameters measured by SphygmoCor.Conclusion: This finding allows the recommendation of Vasotens technology, which can be used with the 24-hour BPLab monitoring system for wide clinical use.Keywords: central aortic blood pressure, augmentation index, validation, Vasotens&reg;, BPLab&reg;

Maternal haemodynamics at 11-13 weeks of gestation and adverse pregnancy outcomes

ObjectiveWomen who develop pre-eclampsia (PE) or gestational diabetes (GDM) are at increased risk of cardiovascular disease. In individuals with cardiovascular disorders there is increased central aortic systolic blood pressure (SBPAo)...