Central Aortic Systolic Blood Pressure Research Articles

Validation of a new piezoelectric device for noninvasive measurement of central aortic systolic blood pressure

The objective of this study was to compare the aortic piezoelectric device for noninvasive measurement of central aortic systolic blood pressure (cSBP) with the SphygmoCor. A total of 85 participants from both sexes, aged 18-80 years, were stratified into three age groups (<30, 30-60, >60 years), with an equal number of healthy volunteers and hypertensive patients. We performed three cSBP measurements with each device, in an alternate manner, using the Bland-Altman method to determine the level of agreement. The standard of the Association for the Advancement of Medical Instrumentation for brachial blood pressure evaluation was used for the comparison. The mean cSBPs were 109.3±12.05 and 109.0±12.2 mmHg with the SphygmoCor and the Aortic device, respectively, showing a strong correlation (r=0.98, P<0.001). A mean difference of 0.35±2.43 mmHg (95% confidence interval: 0.17-0.87, P=NS) was obtained with the Bland-Altman method. The 95% limits of agreement was -4.4 to +5.1 mmHg. Complying with the Association for the Advancement of Medical Instrumentation criteria, cSBP measurements obtained with the Aortic and the SphygmoCor devices are equivalent.

Central Aortic Systolic Blood Pressure Exhibits Advantages Over Brachial Blood Pressure Measurements in Chronic Kidney Disease Risk Prediction in Women

Background/Aims: To investigate whether the invasively obtained central aortic systolic blood pressure (CSBP) predicts chronic kidney disease (CKD) better than brachial systolic blood pressure (SBP), brachial diastolic blood pressure (DBP) and brachial pulse pressure (PP) in the middle-aged Chinese population. Methods: A cross-sectional study was carried out across China in 2009-2010 among the subjects aged 35-64 years. CSBP was measured non-invasively by radial artery applanation tonometry B-pro (A-PULSE CASP and corresponding software). CSBP, SBP, DBP and PP were standardized with Z-score and the odds ratios were calculated with multivariable logistic regression model. Results: Data of 10197 participants were analyzed. The multivariable logistic regression after adjusting for possible confounders showed that a 1-standard deviation increment in each blood pressure measurement was associated with greater risk of CKD in both men and women (P < 0.05). The association of CSBP with CKD was stronger than SBP, DBP and PP in women, while in men the association of CSBP with CKD was stronger only than PP. With CSBP and SBP entering into the multivariable logistic regression models jointly, the odds ratio (95% confidence interval) for CSBP and SBP was 1.57 (1.39-1.79) and 1.22 (1.07-1.38) in women and 1.20 (1.03-1.39) and 1.48 (1.28-1.72) in men, respectively. With CSBP and DBP entering into the multivariable logistic regression models jointly, the odds ratio (95% confidence interval) for CSBP and DBP was 1.68 (1.52-1.84) and 1.15 (1.04-1.27) in women and 1.30 (1.15-1.46) and 1.45 (1.29-1.63) in men, respectively. With CSBP and PP entering into the multivariable logistic regression models jointly, the odds ratio (95% confidence interval) for CSBP and PP was 1.75 (1.58-1.94) and 1.06 (0.96-1.17) in women and 1.58 (1.41-1.77) and 1.04 (0.93-1.17) in men, respectively. Conclusion: CSBP and brachial blood pressure measurements are all predictors of CKD, however the non-invasively obtained CSBP may offer advantages over brachial blood pressure measurements in CKD risk prediction in women.

Reference Intervals of Central Aortic Blood Pressure and Augmentation Index Assessed with an Oscillometric Device in Healthy Children, Adolescents, and Young Adults from Argentina.

Age-related reference intervals (RIs) of central (aortic) systolic blood pressure (cSBP) and augmentation index (cAIx) obtained from large healthy population are lacking in Argentina (South America). Aims. To analyze the existence of associations among cSBP and cAIx with demographic, anthropometric, and hemodynamic parameters and to generate percentile curves and RIs adjusted to each level of age and gender and/or body height. cSBP and cAIx were measured in 1038 healthy children, adolescents, and young adults. First, we evaluated if RIs for males and females were necessary using correlation and covariate analysis. Second, mean (M) and standard deviation (SD) age-related equations were obtained for cSBP and cAIx, using parametric regression methods based on fractional polynomials. Third, age specific percentiles curves were generated. Fourth, body height specific percentiles curves were generated using a similar procedure. The obtained equations (considering age as independent variable) for all subjects (cSBP0.26 and (cAIx + 12.001)0.5) were as follows: cSBP Mean = 3.0581 + 0.2189 log(Age) − 0.001044Age; cSBP SD = −0.03919 + 0.1535 log(Age) − 0.004564Age; cAIx mean = 9.5226 − 6.1599 log(Age) + 0.1450Age; cAIx SD = 1.3880 − 0.8468 log(Age) + 0.03212Age. This study, performed in Argentinean healthy children, adolescents, and young adults with ages of 5 to 22 years, provides the first RIs and percentile curves of cSBP and cAIx. Additionally, specific body height-related cAIx percentiles are reported for the analyzed population. The RIs and percentiles contribute to the knowledge of arterial dynamic evolution along the normal aging process and the interpretation of data obtained in clinical research and daily clinical practice.

Evaluating Central Aortic Blood Pressures in a Tertiary South Indian Hospital

Abstract Background Of late, central aortic blood pressure (CABP) has emerged as a better parameter than peripheral blood pressure (BP) in the diagnosis of cardiovascular events. Advent of new technologies has facilitated the calculation of CABP from machine-derived peripheral BP. In this study, the author determined the differences between peripheral BP measured manually or by machine and machine-derived CABP and examined whether this difference is stable even after categorizing the sample pool based on sex, hypertension, diabetes status, and β-blocker use. Materials and Methods A total of 83 patients (both male and female) who attended the cardiology outpatient department were enrolled in the study. BP was recorded both manually and using Mobil-O-Graph pulse wave analyzer (ARC Solver) in the patient's sitting posture. The author compared the derived central, manual, and device-measured BP among the patient samples and assessed whether sex, hypertension, diabetes, and β-blocker use influence these differences. Results Among the study population, 28 were females and 55 were males; patients’ mean age was 59.97 ± 12.15 years. The mean peripheral systolic BP (SBP) and diastolic BP (DBP) measured manually were127.55 ± 20.15 and 79.73 ± 9.57 mm Hg, respectively. Similar measurements recorded by the device were 129.68 ± 19.93 and 78.92 ± 13.48, respectively. The derived mean central aortic SBP and DBP was 117.69 ± 17.78 and 80.15 ± 13.71, respectively. Statistically significant difference in the manual and central aortic SBP (9.85 ± 11.16; p &lt; 0.0001) was observed. This difference was significant irrespective of sex, hypertension, diabetes status, and β-blocker use. Similarly, difference between machine-derived peripheral SBP and central aortic SBP was statistically significant (p &lt; 0.0001). However, the difference in manual and central aortic DBP was nonsignificant (p = 0.6976). Interestingly, a small (−1.34 ± 2.28) but statistically significant difference (p &lt; 0.0001) between machine-derived peripheral DBP and central aortic DBP was observed. Further analysis to find out effect of β-blocker use on CABP revealed that the central aortic SBP is slightly, but statistically significantly, lower in β-blocker users (117.7 ± 17.71; p &lt; 0.0001) than that of β-blocker nonusers (118.9 ± 18.37; p&lt; 0.0001). Conclusion Central aortic systolic pressure is statistically significantly lower than the manually recorded peripheral SBP irrespective of sex, hypertension, diabetes status, and β-blocker use. A small but significant difference was observed between machine-derived peripheral DBP and central aortic DBP. Patients using β-blockers were observed to have marginally lower CABP values than those who are not using them.

Arterial stiffness, plasma atherogenic index and soluble cell adhesion molecules in healthy young adults with reduced physical activity

Objective: To examine some anthropometric parameters, arterial stiffness, lipid profile, and soluble adhesion molecules in young adults with reduced physical activity.Material and methods: The study is carried on 54 healthy young adults aged 20.97 ± 2.04 years. Two groups: 23 with reduced physical activity (INAC) and 31 with optimal physical activity (AC). Body mass index (BMI), basal metabolic rate (BMR), central aortic systolic blood pressure (CSBP, mmHg), plasma atherogenic index (AIP), and serum soluble cell adhesion molecules (sICAM-1, sVCAM-1) are followed up.Results: CSBP [115.56 ± 10.22 vs. 105.13 ± 9.88*], AIP [−0.04 ± 0.18 vs. −0.08 ± 0.08**] and sICAM-1 [362.5 ± 49.95 vs. 281.75 ± 80.39**] are significantly higher, and BMR [1431 ± 297.9 vs. 1674.6 ± 365.57*] is significantly lower in the physically inactive young healthy adults.Conclusions: CSBP, AIP, and sICAM-1 are higher in young adults with reduced physical activity. This plays substantial role in the acceleration of atherogenic process and in long-term perspective could promote cardiovascular diseases.

Obstructive sleep apnoea severity in children is associated with increased central aortic systolic blood pressure

Obstructive sleep apnoea severity in children is associated with increased central aortic systolic blood pressure

Central aortic systolic blood pressure can predict prolonged QTc duration better than brachial artery systolic blood pressure in rural community residents

ABSTRACTObjectives: Previous studies have suggested that prolonged electrocardiogram QTc duration was independent risk factor for both increased cardiovascular and all-cause mortality, but there was no dating about the relationship between central aortic systolic blood pressure (CASP) and QTc duration. The aim of this study was to analyze the relationship between CASP and QTc duration, and assess whether CASP can predict prolonged QTc duration more than BSBP. Methods: A total of 500 patients were enrolled in this study, central and brachial aortic blood pressure and electrocardiogram QTc duration were measured. Pearson correlation was assessed for determining the associations of QTc duration with clinical conditions. Multivariate logistic regression analyses were performed to determine the independent predictor of prolonged QTc duration. Receiver operating characteristic (ROC) curve was used to evaluate the utility of blood pressure for prolonged QTc duration. Results: We found QTc durations were significantly positive with CASP (r = 0.308, p < 0.001), BSBP (r = 0.227, p < 0.001), and age (r = 0.154, p = 0.010), but negatively related to heart rate (r = −440, p < 0.001). A multiple logistic regression analysis demonstrated that the CASP was an independent determinant of prolonged QTc (OR = 1.648; 95%CI: 1.032, 2.101; p < 0.001). CASP had a better predictive value for prolonged QTc duration than (AUC: 0.771 vs. 0.646, p < 0.001) BSBP. Conclusion: Our results suggested that the non-invasive CASP is independently correlated with QTc duration, and CASP can predict prolonged QTc duration more than BSBP.

PP.19.09] CENTRAL AORTIC SYSTOLIC BLOOD PRESSURE CAN PREDICT PROLONGED QRS DURATION BETTER THAN BRACHIAL ARTERY SYSTOLIC BLOOD PRESSURE

Objective: Many studies suggested that central aortic systolic blood pressure (CASP) has been shown to be a stronger predictor of target-organ damage and cardiovascular events than brachial systolic blood pressure (BSBP), but there was no dating about whether CASP can predict prolonged QRS duration more than BSBP. We examined the association of CASP and BSBP with QRS duration in rural community residents.Design and method: This was a retrospective study. A total of 490 rural community residents were all from the Liaobu town, Guangdong, China, which a community cohort was managed by Guangdong general hospital. All participants underwent physical examinations, regular laboratory examinations, standard resting 12-lead ECG, and noninvasive CABP measurements. Linear regression was assessed the associations of QRS duration with clinical conditions. Logistic regression analyses were performed to determine the independent predictor of prolonged QRS duration. Receiver operating characteristic (ROC) curve was used to evaluate the utility of CASP for prolonged QRS duration. Results: We retrospectively analyzed 490 rural community residents who all of them CASP, BSBP and standard resting 12-lead electrocardiogram were measured. The prolonged QRS duration group showed higher CASP (139.38 ± 11.67 vs 135.36 ± 16.22, P = 0.031) and BSBP (136.03 ± 6.74 vs124.44 ± 13.01, P < 0.001) as compared with controls. Multivariate linear regression analysis showed that CASP, BSBP and heart rate were independently affecting QRS duration. Logistic regression analyses showed that CASP (OR 1.057, 95%CI: 1.027, 1.088, P < 0.001) and BSBP (OR 1.056, 95% CI: 1.027, 1.086, P = 0.032) were independent predictors of prolonged QRS duration after adjustment for age, sex, body mass index, heart rate. CASP had a better predictive value for prolonged QRS duration than (AUC: 0.793 vs 0.601, P < 0.001) BSBP. Conclusions: Our findings showed that both CASP and BSBP were risks for prolonged QRS duration, but CASP can better predict prolonged QRS duration more than BSBP.

Abnormal Wave Reflections and Left Ventricular Hypertrophy Late After Coarctation of the Aorta Repair.

Patients with repaired coarctation of the aorta are thought to have increased afterload due to abnormalities in vessel structure and function. We have developed a novel cardiovascular magnetic resonance protocol that allows assessment of central hemodynamics, including central aortic systolic blood pressure, resistance, total arterial compliance, pulse wave velocity, and wave reflections. The main study aims were to (1) characterize group differences in central aortic systolic blood pressure and peripheral systolic blood pressure, (2) comprehensively evaluate afterload (including wave reflections) in the 2 groups, and (3) identify possible biomarkers among covariates associated with elevated left ventricular mass (LVM). Fifty adult patients with repaired coarctation and 25 age- and sex-matched controls were recruited. Ascending aorta area and flow waveforms were obtained using a high temporal-resolution spiral phase-contrast cardiovascular magnetic resonance flow sequence. These data were used to derive central hemodynamics and to perform wave intensity analysis noninvasively. Covariates associated with LVM were assessed using multivariable linear regression analysis. There were no significant group differences (P≥0.1) in brachial systolic, mean, or diastolic BP. However central aortic systolic blood pressure was significantly higher in patients compared with controls (113 versus 107 mm Hg, P=0.002). Patients had reduced total arterial compliance, increased pulse wave velocity, and larger backward compression waves compared with controls. LVM index was significantly higher in patients than controls (72 versus 59 g/m2, P<0.0005). The magnitude of the backward compression waves was independently associated with variation in LVM (P=0.01). Using a novel, noninvasive hemodynamic assessment, we have shown abnormal conduit vessel function after coarctation of the aorta repair, including abnormal wave reflections that are associated with elevated LVM.

Relationship between 24-h urine sodium/potassium ratio and central aortic systolic blood pressure in hypertensive patients.

Studies evaluating the relationship between measured 24-h urine sodium (24HUNa), potassium (24HUK) and aortic blood pressure (BP) are rare, and no such study has been performed with an Asian population. We evaluated the relationship between 24HUNa, 24HUK, casual BP, 24-h ambulatory BP and aortic BP by analyzing data from 524 participants with valid 24-h urine collection, 24-h ambulatory BP and central BP measurements (mean age 48.1±9.8 years, 193 men). Hypertension was defined as a 24-h ambulatory BP ⩾130/80 mm Hg or current treatment for hypertension (n=219). The participants with hypertension and high 24HUNa (mean 210.5±52.0 mmol per day, range 151.0-432.0) showed higher 24-h systolic (P=0.037) and diastolic BP (P=0.037) and aortic systolic BP (AoSBP, P=0.038) than the participants with hypertension and low 24HUNa (mean 115.7±25.0 mmol per day, range 45.6-150.0), adjusted for confounders. The participants with hypertension and a high ratio of 24HUNa and 24HUK (24HUNa/24HUK, mean 4.03±1.00, range 2.93-7.96) had higher AoSBP than the participants with hypertension and a low 24HUNa/24HUK ratio (mean 2.13±0.54, range 0.53-2.91), adjusted for confounders (P=0.026). The participants with hypertension demonstrated a significant linear relationship between AoSBP and 24HUNa/24HUK ratio that was independent of 24HUNa, according to the multiple regression analysis (P=0.047). In hypertensive patients, 24HUNa/24HUK was positively and more strongly related to AoSBP compared with 24HUNa alone. The result indicates that high sodium and low potassium intake may increase the subsequent risk of cardiovascular disease by elevating AoSBP.

GW27-e0570 The predictive risk factors of silent ischemic stroke event is nocturnal blood pressure and central aortic systolic blood pressure in Metabolic Syndrome

GW27-e0570 The predictive risk factors of silent ischemic stroke event is nocturnal blood pressure and central aortic systolic blood pressure in Metabolic Syndrome

Quantification of peripheral and central blood pressure variability using a time-frequency method.

Systolic blood pressure variability (BPV) is associated with cardiovascular events. As the beat-to-beat variation of blood pressure is due to interaction of several cardiovascular control systems operating with different response times, assessment of BPV by spectral analysis using the continuous measurement of arterial pressure in the finger is used to differentiate the contribution of these systems in regulating blood pressure. However, as baroreceptors are centrally located, this study considered applying a continuous aortic pressure signal estimated noninvasively from finger pressure for assessment of systolic BPV by a time-frequency method using Short Time Fourier Transform (STFT). The average ratio of low frequency and high frequency power band (LFPB/HFPB) was computed by time-frequency decomposition of peripheral systolic pressure (pSBP) and derived central aortic systolic blood pressure (cSBP) in 30 healthy subjects (25-62 years) as a marker of balance between cardiovascular control systems contributing in low and high frequency blood pressure variability. The results showed that the BPV assessed from finger pressure (pBPV) overestimated the BPV values compared to that assessed from central aortic pressure (cBPV) for identical cardiac cycles (P<;0.001), with the overestimation being greater at higher power.

Aortic stiffness and its influencing factors in patients with chronic kidney disease

Objective: To investigate the changes of aortic stiffness and its influencing factors in patients with chronic kidney diseases (CKD). Methods: Eightyfour patients with CKD from Department of Nephrology, Zhejiang Provincial People's Hospital were divided into the dialysis group (CKD stage 5, n=48) and non-dialysis group (CKD stage 3-5, n=36). Clinical data, biochemical parameters and echocardiography findings were collected. SphygmoCor pulse wave analysis system was used to obtain pulse wave analysis (PWA) parameters including central aortic systolic blood pressure (CSP), central pulse pressure (CPP), augmented pressure (AP), augmentation index (AIX), and heart rate 75-adjusted augmentation index (HR75AIX). The influencing factors of aortic stiffness were analyzed by spearman correlation analysis and multiple regression analysis. Results: CSP, CPP, AP, AIX and HR75AIX in dialysis patients had no significant differences compared with those in non-dialysis group (all P>0.05). Spearman correlation analysis showed that CSP was positively correlated with systolic blood pressure, diastolic blood pressure, cholesterol, low-density lipoprotein cholesterol, left atrial diameter (LA),left ventricular systolic diameter (LVDs), left ventricular diastolic diameter (LVDd), and negatively correlated with calcium and hemoglobin levels. CPP was positively correlated with systolic blood pressure, age, LA, LVDd, and negatively correlated with diastolic blood pressure and hemoglobin levels. AP was positively correlated with systolic blood pressure, age, LA, LVDd, and negatively correlated with hemoglobin levels. AIX was positively correlated with systolic blood pressure, age, sodium, and negatively correlated with phosphorus levels. HR75AIX was positively correlated with systolic blood pressure, sodium, cholesterol, and negatively correlated with hemoglobin and albumin levels. Multiple regression analysis showed that higher systolic blood pressure was the independent risk factor for CSP (β=0.944, P<0.01); lower diastolic blood pressure (β=0.939, P<0.01) and higher systolic blood pressure (β=-1.010, P<0.01) were the independent risk factors for CPP; older age (β=0.237, P<0.01) and higher systolic blood pressure (β=0.200, P<0.01) were the independent risk factors for AP; higher systolic blood pressure (β=0.163 and 0.115, P<0.05 and P<0.01) and higher sodium (β=0.646 and 0.625, all P<0.05) were independent risk factors for both AIX and HR75AIX. Conclusions: No significant correlation is observed between aortic stiffness and CKD of different stages. Control blood pressure and restrict sodium intake may be effective means of delaying arterial stiffness in patients with CKD.

Effect of angiotensin receptor blockade on central aortic systolic blood pressure in hypertensive Asians measured using radial tonometry: an open prospective cohort study.

Central aortic systolic pressure (CASP) has been shown to be a stronger predictor of cardiovascular events than brachial blood pressure (BP). Different classes of drugs have differential effects on CASP and brachial BP. This open prospective cohort study aimed to observe changes in CASP (measured using radial tonometry) among hypertensive Asians after 12 weeks of treatment with valsartan, an angiotensin receptor blocker (ARB). Patients with treatment-naïve hypertension or uncontrolled hypertension who were on non-ARB therapy were eligible for inclusion. Patients with uncontrolled BP (i.e. ≥ 140/90 mmHg) received valsartan for 12 weeks. The patients' brachial systolic and diastolic BP (SBP and DBP), and CASP changes were monitored using the BPro® watch. The mean age of the 44 enrolled patients was 35 years. At baseline, the mean BP and CASP were 150.2/91.4 ± 10.6/9.4 mmHg and 136.3 ± 12.2 mmHg, respectively. Valsartan reduced SBP, DBP and CASP by 14.9 ± 10.7 mmHg, 10.9 ± 8.4 mmHg and 15.3 ± 10.9 mmHg, respectively (all p < 0.001). Every 1.0-mmHg reduction in brachial SBP resulted in a 0.8-mmHg reduction in CASP (p < 0.001). A CASP cut-off of 122.5 mmHg discriminated between controlled and uncontrolled BP (sensitivity 74%, specificity 88%). Using radial tonometry, we demonstrated good correlation between CASP and brachial SBP reductions after 12 weeks of treatment with valsartan in our study cohort. Correlation analysis between CASP and SBP reductions may be useful for demonstrating whether a drug is able to lower CASP beyond lowering SBP.

Electrocardiogram derived QRS duration associations with elevated central aortic systolic pressure (CASP) in a rural Australian population.

BackgroundProlonged electrocardiogram QRS durations are often present in hypertensive patients. Small increases in QRS duration serve as independent risk factors for both increased cardiovascular and all-cause mortality. Aortic stiffness is associated with increases in central aortic systolic blood pressure (CASP). However CASP and ECG QRS duration interactions have not been established in rural community populations. Our aims are to determine if QRS duration > 100 msec is associated with an elevated CASP measure in an Australian rural population.MethodsA retrospective cross sectional population was obtained from the CSU Diabetes Screening Research Initiative data base where 68 participants had both central aortic pressure recorded and ECG derived QRS duration. Central aortic pressure was determined by directly recording radial arterial tonometry and brachial cuff pressure (HealthStats, Singapore). Resting 12-lead electrocardiograms were obtained from each subject using a Welch Allyn PC-Based ECG system.ResultsThe population had a mean CASP of 137.8 mmHg, higher than previously reported in other population studies. In 8/68 subjects with a prolonged cardiac QRS duration >120 msec, CASP ranged from 129 mmHg – 182 mmHg. When subgroup analysis was stratified on the basis QRS duration <100 msec and ≥100 msec significant differences (p = 0.036) were observed for mean CASP, 130.6 mmHg ± 15.6 (SD) versus 140.6 mmHg ± 16.8 (SD), respectively.ConclusionsOur results suggest that an arbitrary CASP reading greater than a value 140 mmHg raises suspicion of a prolonged QRS duration. QRS durations ≥100 msec in an aging rural population are associated with higher CASP measures. Our results also suggest in aging Australian rural populations CASP is likely to be elevated, possibly due to age related aortic stiffening.

Is Noninvasive Brachial Systolic Blood Pressure an Accurate Estimate of Central Aortic Systolic Blood Pressure?

Noninvasive brachial systolic blood pressure (nSBP-B) usually approaches invasive central systolic blood pressure (iSBP-C) with a high correlation. Whether nSBP-B is an accurate estimate of iSBP-C remained to be investigated. Thus, this study aimed to compare the errors of nSBP-B and noninvasive central systolic blood pressure (nSBP-C) with different techniques in estimating iSBP-C. Simultaneous invasive high-fidelity central aortic pressure waveforms and the noninvasive left brachial pulse volume recording (PVR) waveform were recorded in a Generation group ( N = 40) and a Validation group ( N = 100). The accuracy of the noninvasive estimates of iSBP-C obtained from analysis of the calibrated PVR waveform using the generalized transfer function (GTF), pulse waveform analysis (PWA), and N-point moving average (NPMA) methods was examined in the Validation group by calculating the mean absolute error (MAE). In Generation group, the MAE was 4.6±4.1mm Hg between nSBP-B and invasive brachial SBP, and 6.8±5.5mm Hg between nSBP-B and iSBP-C. In comparison, the MAE of between iSBP-C and nSBP-C with PWA, NPMA, and GTF were 5.5±4.5, 5.8±4.9, and 5.9±5.0mm Hg, respectively. In Validation group, the MAE of nSBP-B (6.9±4.6mm Hg) for estimating iSBP-C was significantly greater than that of PWA (5.0±3.4mm Hg) and NPMA (6.1±4.4mm Hg), and GTF (6.1±4.9mm Hg). The percentage of absolute band error ≤5mm Hg was 62% for nSBP-B, 69% for GTF, 83% for PWA, and 69% for NPMA. The accuracy of nSBP-B was inferior to the n SBP-C measures in estimating iSBP-C.

Impact of Ivabradine on Central Aortic Blood Pressure and Myocardial Perfusion in Patients With Stable Coronary Artery Disease.

Treatment of hypertensive patients with β-blockers reduces heart rate and decreases central blood pressure less than other antihypertensive drugs, implying that reducing heart rate without altering brachial blood pressure could increase central blood pressure, explaining the increased cardiovascular risk reported with β-blocker. We describe a randomized, double-blind study to explore whether heart rate reduction with the If inhibitor ivabradine had an impact on central blood pressure. We included 12 normotensive patients with stable coronary artery disease, heart rate ≥70 bpm (sinus rhythm), and stable background β-blocker therapy. Patients received ivabradine 7.5 mg BID or matched placebo for two 3-week periods with a crossover design and evaluation by aplanation tonometry. Treatment with ivabradine was associated with a significant reduction in resting heart rate after 3 weeks versus no change with placebo (-15.8±7.7 versus +0.3±5.8 bpm; P=0.0010). There was no relevant between-group difference in change in central aortic systolic blood pressure (-4.0±9.6 versus +2.4±12.0 mm Hg; P=0.13) or augmentation index (-0.8±10.0% versus +0.3±7.6%; P=0.87). Treatment with ivabradine was associated with a modest increase in left ventricular ejection time (+18.5±17.8 versus +2.8±19.3 ms; P=0.074) and a prolongation of diastolic perfusion time (+215.6±105.3 versus -3.0±55.8 ms with placebo; P=0.0005). Consequently, ivabradine induced a pronounced increase in Buckberg index, an index of myocardial viability (+39.3±27.6% versus -2.5±13.5% with placebo; P=0.0015). In conclusion, heart rate reduction with ivabradine does not increase central aortic blood pressure and is associated with a marked prolongation of diastolic perfusion time and an improvement in myocardial perfusion index. URL: https://www.clinicaltrialsregister.eu. Unique identifier: 2011-004779-35.

Calcium Channel Blockers--Benefits Upon Vascular Biology in Hypertensive Patients.

Calcium channel blockers (CCB) are widely used in cardiovascular medicine expressing high hopes upon decreasing cardiovascular risk, morbidity and mortality. Here, the potency of CCBs on 58 Romanian asymptomatic hypertensive patients, with no atherothrombotic cardiovascular disease, was studied by clinical and in silico methods. In our study, arterial elasticity/stiffness was assessed; anthropometric, metabolic (lipidic) parameters were quantified. We concluded that lercanidipine 10 mg once daily, during three weeks, is able to dramatically improve central aortic systolic blood pressure, aortic pulse wave velocity. Lipid profile improvement is an essential condition to improve elastic vascular properties in order to decrease the risk for further cardiovascular events. Besides, the potency of lercanidipine is expressed as the contribution of molecular descriptors (van der Waals and solvent accessible surface areas), electronic (molecular polarisability) and hydrophobic (water/octanol partition coefficient) by means of blocker effect on calcium channel, compared with cilnidipine and other 30 dihydropyridines, using molecular simulation techniques.

2D.04

Objective: To evaluate arterial stiffness in young patients from a very high CV risk country presented with a first acute ST-elevated myocardial infarction and to analyse association between increased arterial stiffness and the severity of coronary artery disease. Design and method: Consecutive patients with age less than 45 years admitted in our department for a first acute STEMI between January 2013 – January 2014 were enrolled in the study after signing a written informed consent. All patients underwent primary PCI at inclusion for evaluation of coronary artery disease (normal, univascular lesions, bivascular lesions, trivascular lesions). Arterial stiffness was assessed by aortic pulse wave velocity, aortic augmentation index, and central aortic systolic blood pressure measurements by an oscillometric device. Association between traditional CV risk factors and the severity of CAD was assessed by bivariate correlation analysis with adjustments for major confounders. Results: Mean age of the study sample was 40.13 ± 4.36years. Gender distribution showed a male preponderance (86,7%). The majority of the patients (25 cases, 83,33%) had significant atherosclerotic lesions on the MI related artery. More, bivascular and trivascular atherosclerotic lesions were recorded eight cases (13.33%) each, while the majority has univascular lesions (18 cases, 60%).. Mean (range) PWVao values were: PWVao 9.10 ± 1.77m/s (7–14.4m/s), 23.33% of cases having PWVao > 10m/s. Increased PWVao values were correlated with: smoking [rs2 = 0,343; p < 0,0001], increased BMI [rs2 = 0.190; p = 0.001], presence of hypercholesterolemia [rs = rs2 = 0.192; p = 0.001], presence of hypertriglyceridemia rs2 = 0.285; p < 0,0001], hyperglycaemia [rs = rs2 = 0.194; p = 0.001] and the severity of coronary atherosclerotic lesions [rs2 = 0,270; p = 0,003]. Conclusions: Results of our study shows that in young STEMI patients increased arterial stiffness is correlated with both atherosclerotic risk factors (such as smoking, dislipidemic, BMI) and with the severity of coronary artery disease. Although the majority of the patients had significant atherosclerotic lesions, only a minority has PWVao > 10m/s suggesting that the actual cut-off value of this parameter could be lower in this group of patients.

The Relationship between Serum Oxalic Acid, Central Hemodynamic Parameters and Colonization by Oxalobacter formigenes in Hemodialysis Patients

Background/Objective: Elevated pulse wave velocity (PWV) and central aortic blood pressures are independent predictors of increased cardiovascular morbidity and mortality in hemodialysis (HD) patients. Oxalic acid is a uremic retention molecule that is extensively studied in the pathogenesis of calcium oxalate stones. Oxalobacter formigenes, a member of the colon microbiota, has important roles in oxalate homeostasis. Data regarding the colonization by and the exact role of O. formigenes in the pathogenesis of oxalic acid metabolism in HD patients are scant. Hence, we aimed to determine the relationship between fecal O. formigenes colonization, serum oxalic acid and hemodynamic parameters in HD patients with regard to the colo-reno-cardiac axis. Methods: Fifty HD patients were enrolled in this study. PWV and central aortic systolic (cASBP) and diastolic blood pressures (cADBP) were measured with a Mobil-O-Graph (I.E.M. GmbH, Stolberg, Germany). Serum oxalic acid levels were assessed by ELISA, and fecal O. formigenes DNA levels were isolated and measured by real-time PCR. Results: Isolation of fecal O. formigenes was found in only 2 HD patients. One of them had 113,609 copies/ml, the other one had 1,056 copies/ml. Serum oxalic acid levels were found to be positively correlated with PWV (r = 0.29, p = 0.03), cASBP (r = 0.33, p = 0.001) and cADBP (r = 0.42, p = 0.002) and negatively correlated with LDL (r = -0.30, p = 0.03). In multivariate linear regression analysis, PWV was independently predicted by oxalic acid, glucose and triglyceride. Conclusions: This is the first study that demonstrates the absence of O. formigenes as well as a relation between serum oxalic acid and cASBP, cADBP and PWV in HD patients. Replacement of O. formigenes with pre- and probiotics might decrease serum oxalic acid levels and improve cardiovascular outcomes in HD patients.