Central Augmentation Pressure Research Articles

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.

Association of severe preeclampsia and vascular damage assessed by noninvasive markers of arterial stiffness

BackgroundPreeclampsia (PE) is a hypertensive disorder of pregnancy associated with high maternal and fetal morbidity and mortality and increased future risk of cardiovascular complications. ObjectiveTo analyze whether women who have had PE with severe features in their pregnancy have higher arterial stiffness (AS) parameters than those whose PE course was without signs of severity. MethodsSixty-five women who developed PE during their gestation were evaluated, divided into two groups: PE group without severe features or non-severe PE (n=30) and PE group with severe features or severe PE (n=35). Carotid-femoral pulse wave velocity (cfPWV), central augmentation index corrected to a heart rate of 75 beats per minute (AIxc75) and central augmentation pressure (cAP) were determined one month and six months postpartum. Comparison of proportions was carried out using the chi-square test, comparison of means between groups using the Student’s t-test or the Mann–Whitney test, and comparison of means of the same group at different evolutionary moments, using the t-test or the Wilcoxon test. Correlation, with and between hemodynamic parameters, was carried out with Spearman’s correlation coefficient and the association between demographic variables, personal history and hemodynamic parameters, and altered arterial stiffness parameters was carried out using linear and logistic regression models. ResultsWomen with severe PE presented, both at 1 and 6 months postpartum, higher values of blood pressure, both central and peripheral, as well as AR and pulse amplification parameters, than those women whose PE was not severe. Central augmentation index (cAIx) values at 1 month and 6 months postpartum were higher, although not significantly, in the severe PE group compared to the non-severe PE group (24.0 (16.5–34.3) vs. 19.0% (14–29) and 24.0 (14.0–30.0) vs. 20.0% (12.3–26.8), respectively). Carotid-femoral pulse wave velocity (cfPWV) was significantly higher at both 1 and 6 months postpartum in the severe PE group compared to the non-severe PE group (10.2 (8.8−10.7) vs. 8.8m/s (8.3−9.6) and 10.0 (8.8−10.6) vs. 8.8m/s (8.3−9.3), respectively). Central systolic pressure and central pulse pressure amplification were also higher, although not significantly, in the severe PE group in comparison with the non-severe PE group. ConclusionsWomen who have had severe PE have more pronounced arterial stiffness parameters than those in whom PE was not particularly severe. The determination of cAIx and cfPWV, as a strategy for the assessment of cardiovascular risk, should be evaluated among women who have had PE.

Comparison of effects of peripheral vasculature on tonometric radial pulse and cuff-based brachial pulse waveform as used in estimation of central aortic pressures.

Aortic pressure estimation requires reliable peripheral pulse waveform acquisition. The peripheral waveform can change with local vascular effects that can be independent of aortic pressure. This study quantifies the effects of peripheral vasculature changes on radial and brachial waveforms. In 20 subjects (37± 15 years, 7 female), brachial volumetric displacement (cuff-based) and radial tonometry waveforms were simultaneously measured whilst a cuff around the hand on the same arm was inflated to induce transmural pressures of -60, -30, -15, 0, 15 and 30 mmHg, altering local peripheral resistance and compliance by graded arterial wall unloading. Aortic blood pressure (BP), augmentation index (AIx) and ejection duration were calculated from the measurements using a generalized transfer function. The parameters under unloaded conditions were compared to baseline measurements. Brachial systolic and diastolic BP did not change throughout the experiment. Altering peripheral resistance and compliance did not significantly change calculated aortic BP values, although changes were nominally greater for radial (maximum +8±1 mmHg) compared to brachial (maximum +2±1 mmHg) waveforms. AIx at 0 mmHg transmural pressure (maximum arterial wall unloading) was higher when derived from radial waveforms (+24±3%, p<0.001) but not when derived from brachial waveforms. Localized changes in peripheral resistance and compliance affect tonometer acquired radial waveforms but not volumetric displacement acquired brachial pressure waveforms, as judged by computed central aortic augmentation pressure parameters. This suggests aortic pressure estimation from the brachial cuff waveform is less sensitive to peripheral vasculature disturbances that alter the peripheral arterial pulse morphology.

Association of time-restricted feeding, arterial age, and arterial stiffness in adults with metabolic syndrome.

Time-restricted feeding (TRF) is a kind of intermittent fasting defined as eating and drinking only during a certain number of hours in a day. It has been suggested that intermittent fasting may improve cardiovascular risk factors. This study evaluated the association of TRF and arterial stiffness, using pulse wave velocity (PWV), pulse wave analysis, and arterial age in metabolic syndrome participants. A cohort study was carried out among metabolic syndrome adults who were followed over the Ramadan fasting period (used as a model of TRF since food was only allowed for about 8 h/day). The subjects were divided into Ramadan fasting and Ramadan nonfasting groups. The aortic PWV and central aortic pressure waveform were measured. Central systolic pressure, central pulse pressure, and indices of arterial compliance, such as augmentation pressure and augmentation index (AIx), were determined from waveform analysis. Ninety-five adults (31.57% female, age: 45.46 ± 9.10 years) with metabolic syndrome (based on the International Diabetes Federation definition) participated in this study. Ramadan fasting and Ramadan nonfasting groups were including 80 and 15 individuals respectively. A significant reduction was seen in PWV (0.29 m/s), central systolic pressure (4.03 mmHg), central pulse pressure (2.43 mmHg), central augmentation pressure (1.88 mmHg), and central AIx (2.47) in the Ramadan fasting group (p = 0.014, p < 0.001, p = 0.001, p = 0.003, and p = 0.036 respectively). There were no significant changes in these indices among the Ramadan nonfasting group. This study suggested that TRF reduces arterial age and improves arterial stiffness among people with metabolic syndrome. This might be considered a beneficial nutrition strategy for extending healthspan (and perhaps longevity).

Correlation between pulse wave analysis parameters and left atrial strain and left ventricular myocardial work indices in patients with grade one hypertension

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Central arterial blood pressure and wave reflection characteristics are independent predictors of cardiovascular morbidity and mortality. Pulse wave analysis (PWA) can non-invasively assess these central hemodynamic indices, by deriving central aortic waveform from brachial waveform, and allowing evaluation of central systolic pressure (CSP), Pulse Pressure (PP), augmentation pressure (AP) and augmentation index (AIx), defined as the ratio of AP to central pulse pressure (PP). These parameters are thought to relate to reflected pressure waves. Purpose To investigate whether central hemodynamic indices can impact on left atrial (LA) and left ventricular (LV) performance in patients with grade one hypertension. Materials and Methods 80 pts (male 39; mean age 41 ± 13 years) were prospectively enrolled, distinguishing between not-hypertensives(n=40; male 21; mean age 39 ± 10 years)and newly diagnosed grade one hypertensives(n=40; male 18; mean age 42 ± 11 years), not yet under treatment. All underwent PWA measurement through a standard brachial cuff for measuring CSP (mmHg), PP (mmHg), AP (mmHg), Aix (%) and augmentation index normalized to 75 bpm heart rate (AIx75%). At the same time a complete transthoracic echocardiogram was performed, and LA strain and LV myocardial work parameters were calculated. Results Hypertensives have higher LV mass index(73±16 vs 70±24;p = 0,4) but without any significant difference. On the other hand, hypertensives have significantly higher values of LA volume index (LAVi) (25±6 vs 19±7 ml/mq;p = 0,02). LV global longitudinal strain (GLS) values (−19,4±2 vs −20,3±1,7 %;p = 0,1) don't statistically differ between the two groups. Global work efficiency (GWE) is reduced in Hypertensives than in controls (94±2 vs 96±1,2 %;p = 0,003), while Global wasted work (GWW) is higher in Hypertensives than in controls (146±75 vs 85±27 mmHg%; p = 0,02). Higher values of LAVi are associated with higher values of CSP (r=0,4;p&amp;lt;0,0001), PP (r=0,3;p = 0,01), AP (r=0,4;p&amp;lt;0,0001); Aix (r=0,3;p&amp;lt;0,0001) and Aix75% (r=0,3;p = 0,01). LA reservoir inversely correlates to AP (r=-0,3;p = 0,01), Aix (r=-0,3;p = 0,01) and Aix75% (r=-0,3;p = 0,02). LV mass index directly correlates with PP (r=0,3;p = 0,01), Aix (r=0,3; p = 0,001), AIx75% (r=0,3; p = 0,01) and AP (r=0,4; p&amp;lt;0,0001). Central systolic pressure directly correlates with GLS (r=0,3; p = 0,001) and GWW (r=0,5;p&amp;lt;0,0001) and inversely correlates with GWE (r=-0,5;p&amp;lt;0,0001). Higher values of augmentation pressure are associated with lower values of GWE (r=-0,3;p = 0,01). Higher diastolic dysfunction degrees are associated with higher values of CSP (r=0,5;p&amp;lt;0,0001), PP (r=0,5; p&amp;lt;0,0001), AP (r=0,4;p = 0,0001); Aix (r=0,3; p = 0,002) and Aix75%(r=0,4; p&amp;lt;0,0001). Conclusions: Higher central pressure and reflected pressure waves can impact on LA and LV function leading to an early damage that can be correctly identified by an integrated approach between PWA and Advanced Echocardiography.

Association of Pressure Wave Reflections With Left Ventricular Mass: a Systematic Review and Meta-Analysis.

Pressure wave reflections (PWRs) within the circulation are assessed at various arterial sites by various noninvasive methods. We aimed at reviewing the conflicting data regarding the hypothesis that higher PWRs are associated with higher left ventricular mass and tested whether this association stands for all available indices of PWRs, all (proximal or distal to the heart) sites of assessment, and is modified by sex, age and heart rate. Based on a predefined protocol applying the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines, we identified eligible for meta-analysis data regarding: augmentation index, augmentation pressure, backward pressure (Pb), reflection index, and their association with left ventricular mass index (19 studies, total population n=8686). We found statistically significant associations, independent from blood pressure level, for all indices of PWRs at all arterial sites (carotid augmentation index; odds ratio; standardized beta coefficient [β]: 0.14 [95% CI, 0.07% to 0.21%], per SD increase), radial augmentation index (β: 0.21; 0.11 to 0.31), central augmentation pressure (β: 0.15; 0.03 to 0.27), central Pb (β: 0.23; 0.05 to 0.42), and central reflection index (β: 0.14; 0.06 to 0.22), except for aortic augmentation index as estimated by generalized transfer functions. Meta-regression analysis showed that the association between carotid augmentation index and left ventricular mass was higher among populations with higher heart rate (P=0.036, beta: 0.017 [95% CI, 0.001 to 0.033]) and tended to be higher in middle-aged (P=0.07, beta: -0.001; -0.021 to 0.001). A clinically meaningful association between PWRs and left ventricular mass, assessed at either central or peripheral arterial sites by most available methods was shown, suggesting that PWR reduction strategies might be useful. Based on the present evidence, such trials should target middle-aged populations with high normal heart rate.

Central blood pressure augmentation and central-to-peripheral blood pressure amplification in relation to cardiovascular end points.

Background: Central hemodynamic indices might provide additional prognostic information for cardiovascular risk beyond blood pressure (BP) and other conventional risk factors. The aim of the study is to investigate whether indices of central BP augmentation and central-to-peripheral BP amplification were associated with cardiovascular end points. Methods: In a population-based cohort study of 5,608 adults recruited in Europe, Asia and South America, baseline measurements included cardiovascular risk factors, central hemodynamic measurements derived from the radial pulse wave analysis by the tonometric method with the SphygmoCor device (Atcor, Australia). The primary outcome was a composite cardiovascular end point. Secondary end points included total mortality, fatal and nonfatal coronary events and fatal and nonfatal stroke. The multivariable-adjusted hazard ratios (HR) were expressed as the risk per 1-SD increment in central hemodynamic indices. Results: Among 5,608 participants (54.1% women; mean age, 54.2 years), median follow-up was 4.1 years. Central augmentation index, augmentation pressure, systolic BP (SBP) amplification (brachial SBP minus central SBP), pulse pressure (PP) amplification (brachial PP minus central PP) and PP amplification ratio (brachial PP/central PP*100%) averaged 26.8%, 12.7 mmHg, 10.3 mmHg, 11.4 mmHg and 130.9%, respectively. The primary composite cardiovascular end point occurred in 255 participants (4.5%). Central augmentation index (HR, 1.21; 95%CI, 1.00-1.47; P=0.048) and augmentation pressure (HR, 1.17; 95%CI, 1.01-1.36; P=0.033), but not amplification indices (P>=0.18), were significantly associated with the primary outcome. For secondary end points, central augmentation index (HR, 1.56; 95%CI, 1.17-2.09; P=0.003), augmentation pressure (HR, 1.36; 95%CI, 1.06-1.75; P=0.017) and PP amplification ratio (HR, 0.63; 95%CI, 0.44-0.91; P=0.015) were significantly associated with coronary end points, while there was no significant association with total mortality and stroke. Conclusions: In adult populations, central BP augmentation indices were associated with cardiovascular outcomes independent of conventional cardiovascular risk factors.

Central blood pressure estimation in type 1 diabetes: impact and implications of peripheral calibration method.

Peripheral blood pressure (BP) waveforms are used for noninvasive central BP estimation. Central BP could assist in cardiovascular risk assessment in patients with type 1 diabetes mellitus (T1DM). However, correct calibration of peripheral BP waveforms is important to accurately estimate central BP. We examined differences in central BP estimated by radial artery tonometry depending on which brachial BP (SBP/DBP vs. MAP/DBP) is used for calibration of the radial waveforms, for the first time in T1DM. A cross-sectional study in T1DM patients without known cardiovascular disease. Radial artery BP waveforms were acquired using applanation tonometry ( SphygmoCor ) for the estimation of central SBP, central pulse pressure (PP) and central augmentation pressure, using either brachial SBP/DBP or MAP/DBP for the calibration of the radial pressure waveforms. Fifty-four patients (age: 46 ± 9.5 years; T1DM duration: 27 ± 8.8 years) were evaluated. Central BP parameters were significantly higher when brachial MAP/DBP-calibration was used compared with brachial SBP/DBP-calibration (7.5 ± 5.04, 7.5 ± 5.04 and 1.5 ± 1.36 mmHg higher central SBP, central PP and central augmentation pressure, respectively, P < 0.001). In patients with T1DM, there are significant differences in central BP values estimated with radial artery tonometry, depending on the method used for calibration of the radial waveforms. Brachial MAP/DBP-calibration resulted in consistently higher central BP as compared to using brachial SBP/DBP, leading to patient re-stratification. Hence, the accuracy of noninvasive estimation of central BP by radial tonometry is dependent on calibration approach, and this problem must be resolved in validation studies using an invasive reference standard to determine which method best estimates true central BP.

Asociación de preeclampsia grave y daño vascular valorado por marcadores no invasivos de rigidez arterial

BackgroundPreeclampsia (PE) is a hypertensive disorder of pregnancy associated with high maternal and fetal morbidity and mortality and increased future risk of cardiovascular complications. ObjectiveTo analyze whether women who have had PE with severe features in their pregnancy have higher arterial stiffness (AS) parameters than those whose PE course was without signs of severity. MethodsSixty-five women who developed PE during their gestation were evaluated, divided into two groups: PE group without severe features or non-severe PE (n=30) and PE group with severe features or severe PE (n=35). Carotid-femoral pulse wave velocity (cfPWV), central augmentation index corrected to a heart rate of 75 beats per minute (AIxc75) and central augmentation pressure (cAP) were determined one month and six months postpartum. Comparison of proportions was carried out using the chi-square test, comparison of means between groups using the Student's t-test or the Mann-Whitney test, and comparison of means of the same group at different evolutionary moments, using the t-test or the Wilcoxon test. Correlation, with and between hemodynamic parameters, was carried out with Spearman's correlation coefficient and the association between demographic variables, personal history and hemodynamic parameters, and altered arterial stiffness parameters was carried out using linear and logistic regression models. ResultsWomen with severe PE presented, both at 1 and 6 months postpartum, higher values of blood pressure, both central and peripheral, as well as AR and pulse amplification parameters, than those women whose PE was not severe. Central augmentation index (cAIx) values at 1 month and 6 months postpartum were higher, although not significantly, in the severe PE group compared to the non-severe PE group (24.0 (16.5-34.3) vs. 19.0% (14-29) and 24.0 (14.0-30.0) vs. 20.0% (12.3-26.8), respectively). Carotid-femoral pulse wave velocity (cfPWV) was significantly higher at both 1 and 6 months postpartum in the severe PE group compared to the non-severe PE group (10.2 (8.8-10.7) vs. 8.8m/s (8.3-9.6) and 10.0 (8.8-10.6) vs. 8.8m/s (8.3-9.3), respectively). Central systolic pressure and central pulse pressure amplification were also higher, although not significantly, in the severe PE group in comparison with the non-severe PE group. ConclusionsWomen who have had severe PE have more pronounced arterial stiffness parameters than those in whom PE was not particularly severe. The determination of cAIx and cfPWV, as a strategy for the assessment of cardiovascular risk, should be evaluated among women who have had PE.

Impact of Obesity Phenotype on Central Aortic Hemodynamics and Arterial Stiffness in a Chinese Health Assessment Population

Background: This study aimed to explore the association between BMI and/or central obesity parameters and measures of arterial hemodynamics to assess the effect of obesity on function of large arteries. Methods: Data was obtained from 634 subjects undergoing health assessment at Ruijin Hospital, Shanghai. Subjects were divided into 3 groups according to their Body Mass Index (BMI (kg/m2) &lt;24 normal, 24–28 overweight, ≥28 obese). In addition, central obesity was described by waist-hip ratio (WHR) and waist-height ratio (WHtR). Radial arterial waveforms and carotid-femoral pulse wave velocity (cf-PWV) were measured with the subjects recumbent. Central arterial pressures were measured by pulse wave analysis of the radial waveform calibrated to peripheral cuff systolic (PSP) and diastolic pressure (PDP) to obtain central systolic pressure (CSP), central diastolic pressure (CDP), central pulse pressure (CPP), central augmentation pressure (CAP), and central augmentation index (cAIx). Pulse pressure was determined from the ratio of peripheral (PPP) and central (CPP) pulse pressure (PPP/CPP). Results: CAP and cAIx were lowest in the obese group (p &lt; 0.01). Pressure amplification was significantly higher as BMI increased (p &lt; 0.05). After adjusting for confounding factors, WC, WHtR and WHR were independent risk factors for cf-PWV (β = 0.120, p = 0.001, β = 0.103, p = 0.004, β = 0.092, p = 0.013), When BMI, WC, WHtR, WHR were put into the stepwise linear regression model, only WC was an independent risk factor for cf-PWV (β = 0.135, p &lt; 0.001). Conclusions: Central obesity (WC and WHR) measures may have greater predictive value for vascular stiffness than BMI. This possibility warrants further studies focused on arterial wave travel and its relationship with body fat distribution.

A Cease in Shift Work Reverses Arterial Stiffness but Increases Weight and Glycosylated Hemoglobin A 5-Month Follow-Up in Industry.

Background: Literature suggests an association between shift work and cardiovascular disease (CVD). Limited evidence is available on how a cessation of shift work affects CVD risk factors. Aim: We investigated whether a five-month plant shutdown affected CVD risk factors in 30 industrial shift workers. Methods: We collected demographic data, self-reported data on physical activity (PA) and medical history by questionnaire. Pre- and post-plant shutdown, we measured blood pressure (BP), heart rate, lipids, glycosylated hemoglobin (HbA1c) and C-reactive protein (CRP). Additionally, we collected markers of inflammation, Matrix metalloproteinase-9 (MMP-9), Interleukin-6 (IL-6), Monocyte chemoattractant protein-1 (MCP-1), Tumor necrosis factor-alpha (TNF-α), P-selectin, Interleukin-1 beta (IL-1β), and Interleukin-23 (IL-23). We also examined arterial stiffness (central blood pressure, augmentation pressure, and pulse wave velocity) by means of SphygmoCor® (AtCor Medical Pty Ltd., Sydney, Australia). We monitored sleep by actigraphy prior to and after plant shutdown, with additional registration of sleep quality and assessment of insomnia symptoms. Results: After five months of plant shutdown, we found that HbA1c increased by 1.9 mmol/mol, weight by 1 kg and MCP-1 by 27.3 pg/mL, all unexpectedly. The other markers of inflammation did not change during shutdown, but CRP decreased close to significant levels. There were no changes in lipids during follow-up. Pulse-wave velocity (PWV) was reduced from 8.1 m/s (SD = 1.5) to 7.6 m/s (SD = 1.5), p = 0.03. The workers reported fewer signs of insomnia after shutdown. Conclusions: Our findings suggest that a five-month cessation in shift work increases weight and HbA1c, but also improves insomnia symptoms and reverses arterial stiffening.

CENTRAL BLOOD PRESSURE ESTIMATION IN TYPE 1 DIABETES: IMPACT OF PERIPHERAL BLOOD PRESSURE CALIBRATION APPROACH

Objective: Pulse wave analysis (PWA) of peripheral arterial pressure waveforms is used for non-invasive estimation of central blood pressure (BP), which can assist in cardiovascular (CV) risk assessment in populations with a high CV burden such as patients with type 1 diabetes (T1DM). However, correct calibration of peripheral BP waveforms is important in order to accurately estimate central BP. The impact of peripheral BP waveform calibration on central BP is not investigated yet in T1DM. Therefore, this study aims first for the first time in a T1DM patient cohort, to examine differences in central BP parameters estimated by PWA of radial BP waveforms, depending on which brachial BP (SBP/DBP vs. DBP/MAP) is used for calibration of the radial BP waveforms. Design and method: Cross-sectional study, in which adult T1DM patients without known CVD were enrolled. Radial artery BP waveforms were acquired using applanation tonometry (SphygmoCorâ) for the estimation of central systolic BP (central SBP), central pulse pressure (central PP) and central augmentation pressure (central AP), using either brachial SBP/DBP or DBP/MAP for calibration of the radial pressure waveforms. Brachial MAP was calculated using a fixed form factor of 40% (MAP = brachial DBP + 0.40 × brachial PP). Results: 54 patients (M/F: 32/22; age: 46 ± 9.5 yrs; T1DM duration: 27 ± 8.8 yrs) were evaluated. All three estimated central BP parameters were significantly higher when brachial DBP/MAP was used compared to SBP/DBP calibration (7.5 ± 5.04 mmHg, 7.5 ± 5.04 mmHg and 1.5 ± 1.36 mmHg higher central SBP, PP and AP, respectively, p &lt; 0.001). Brachial-to-radial SBP amplification was estimated at 10 ± 7.1 mmHg (p &lt; 0.001). Conclusions: This study confirms for the first time that in patients with T1DM there are significant differences in central BP parameters estimated with PWA, depending on the method used for calibration of the radial pressure waveforms. Brachial DBP/MAP calibration resulted in consistently higher central BP parameters as compared to using SBP/DBP. Hence, it seems that brachial-to-radial SBP amplification is important to take into account in the estimation of central BP parameters also in patients with T1DM.

THE ACTION OF ANTIHYPERTENSIVES ON CENTRAL VESSEL STIFFNESS IN THE ELDERLY: A SUBSTUDY OF EVOUPIU (BRAZILIAN STUDY OF PULSE WAVE VELOCITY IN ELDERLY)

Objective: Central arterial stiffness (CAS) is increased in the elderly, and its acceleration may be induced by systemic hypertension. The increased pulsatile pressure may promote damage to vital organs. Antihypertensive drugs can act on the CAS and decrease these patients’ cardiovascular risk. The present study aimed to compare the CAS of hypertensive elderly patients with different therapeutic schemes, using only two antihypertensive drugs: hydrochlorothiazide (HCTZ) as monotherapy or HCTZ associated with another class of antihypertensive drugs Design and method: This study is a cross-sectional analysis of elderly patients included in the data bank of EVOPIU. The data were extracted from the first medical consultation of the study. A total of 293 elderly hypertensive patients were separated into seven groups: those taking no antihypertensive medication (NAM, n = 47); hydrochlorothiazide alone (HCTZ, n = 25), HCTZ, and beta-blockers (n = 51); HCTZ and calcium channel blockers (n = 24); HCTZ and AII receptor blockers (n = 59); HCTZ and AII-converting enzyme inhibitors (n = 61); and HCTZ and spironolactone (HCTZ +SPIRO, n = 27). CAS was measured by femoral-carotid wave velocity (c-fPWV). Results: When compared to NAM patients, only the HCTZ + SPYRO group showed significantly lower values in c-fPWV (12.1 ± 0.44 vs. 10.5 ± 0.56 ms; P &lt; 0.05, respectively), central pulse pressure (PP) augmentation index (Alx) (52.0 ± 1.9 vs. 45.6 ± 2.5 mmHg, P &lt; 0.05), brachial PP (68.6 ± 2.1 vs. 61.5 ± 2.7 mmHg, P &lt; 0.05). This group did not show higher serum potassium levels than the other groups studied. Conclusions: The results suggest that arterial stiffness in elderly patients may be, at least in part, caused by an effect of aldosterone on the arterial wall. CAS may be partially reversible with spironolactone. Its effect seems independent of observed effects on systemic arterial blood pressure.

Achieving the Latest American Heart Association and American College of Cardiology Therapeutic Goals for Hypertension With Combination Therapy and Its Effects on Blood Pressure and Central Hemodynamic Parameters

The present United States and European treatment guidelines recommend that antihypertensive therapy be initiated with a combination of agents from different classes to facilitate the achievement of control of blood pressure (BP). This prospective, randomized, open-label study was conducted at 3 tertiary hospitals in India to evaluate the effects of combination therapy with an angiotensin receptor blocker and a calcium antagonist on office BP and central hemodynamic parameters in patients with untreated hypertension or uncontrolled BP (>130/>80 mm Hg) during treatment with antihypertensive monotherapy. Patients were randomized to treatment with telmisartan 40 mg/day+amlodipine 5 mg/day or telmisartan 40 mg/day+cilnidipine 10 mg/day. Change from baseline to 8 weeks of treatment was assessed for seated office BP, ambulatory BP monitoring, and seated central hemodynamics (central BP, aortic augmentation index, central aortic augmentation pressure, and pulse wave velocity). A total of 94 of 96 enrolled patients completed the study. From baseline to 8 weeks a significant decrease was observed in both telmisartan+amlodipine and telmisartan+cilnidipine groups for mean BP (148.0 ± 12.80 to 124.0 ± 10.4 and 144.5 ± 10.2 to 123.0 ± 10.0 mm Hg, respectively; both p <0.001); in only telmisartan+amlodipine group for mean central aortic systolic and diastolic BP (131.1 ± 19.1 to 119.7 ± 14.9 mm Hg [p <0.001] and 93.3 ± 12.0 to 89.2 ± 14.6 mm Hg [p=0.0008], respectively) and for central aortic pulse wave velocity (7.6 ± 1.4 to 7.2 ± 1.3 m/s, p=0.0011); in only telmisartan+cilnidipine group for aortic augmentation index (27.5 ± 14.6 to 22.3 ± 12.2; p=0.0178). Heart rate was unchanged in both treatment groups. Combination therapy with an angiotensin receptor blocker and a calcium antagonist effectively reduced BP to below the new <130/80 mm Hg target and had favorable effects on central hemodynamics.

ACUTE TRANSCRANIAL DIRECT CURRENT STIMULATION (tDCS) IMPROVES VENTILATORY VARIABILITY AND AUTONOMIC MODULATION IN RESISTANT HYPERTENSIVE PATIENTS

Here, we assessed the impact of one session of transcranial direct current stimulation (tDCS) or SHAM (20 min, each) on ventilatory responses to cardiopulmonary exercise test, central and peripheral blood pressure (BP), and autonomic modulation in resistant hypertensive (RHT) patients. RHT subjects (n = 13) were randomly submitted to SHAM and tDCS crossing sessions (1 week of “washout”). Patients and a technician who set the tDCS/Sham room up were both blind. After brain stimulation, patients were submitted to a cardiopulmonary exercise test to evaluate ventilatory and cardiovascular response to exercise. Hemodynamic (Finometer®, Beatscope), and autonomic variables were measured at baseline (before tDCS/Sham) and after incremental exercise. ResultsOur study shows that tDCS condition improved heart rate recovery, VO2 peak, and vagal modulation (after cardiopulmonary exercise test); attenuated the ventilatory variability response, central and peripheral blood pressure well as sympathetic modulation (after cardiopulmonary exercise test) in comparison with SHAM. These data suggest that acute tDCS sessions prevented oscillatory ventilation behavior during the cardiopulmonary exercise test and mitigated the increase of systolic blood pressure in RHT patients. After the exercise test, tDCS promotes better vagal reentry and improved autonomic modulation, possibly reducing central blood pressure and aortic augmentation index compared to SHAM. Brazilian Registry of Clinical Trials (ReBEC): https://ensaiosclinicos.gov.br/rg/RBR-8n7c9p.

Abstract 12182: Candesartan vs Lisinopril on Measures of Arterial Stiffness and Wave Reflections in Older, Hypertensive Adults

Introduction: Higher arterial stiffness independently predicts risk of future cardiovascular events. Although angiotensin converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARBs) reduce blood pressure, their impact on vascular function may vary. Hypothesis: We hypothesized differences in the impact of ACEi compared to ARBs on arterial stiffness, wave reflections and microvascular function in hypertension among older men and women. Methods: We measured vascular function at baseline and after 1 year in 176 (87 Candesartan, 89 Lisinopril therapy) hypertensive participants with mild cognitive impairment (age 65.9 +/-7.7 years, 57% female). Pulse-wave velocity (PWV), central pulse pressure (CPP) and central augmentation index (AIx) were measured using applanation tonometry and the reactive hyperemia index using digital pulse amplitude tonometry. Results: While Candesartan and Lisinopril lowered blood pressure equally, only Lisinopril therapy resulted in a lower PWV (-0.7 ± 0.4 m/s, p=0.03) and CPP (-7 ± 4 mmHg, p=0.01) after 1 year, while Candesartan produced no significant change. There was a significant interaction by sex whereby arterial stiffness was lowered only in women with Lisinopril. Candesartan lowered AIx more than Lisinopril (-4 ± 7% vs -1.5 ± 8%, p=0.05) in both sexes. After adjustment for sex and cardiovascular risk factors, Lisinopril remained a significant predictor of lower PWV and CPP after 1 year (all p&lt;0.05). Conclusions: In a cohort of older hypertensive patients, despite equipotent anti-hypertensive effects, Lisinopril was more effective than Candesartan at lowering arterial stiffness in women. Candesartan was effective in lowering wave reflections compared to Lisinopril.

Association of arterial hemodynamics with left ventricular systolic function in hypertensive patients: A longitudinal study

BACKGROUND Left ventricular (LV) systolic impairment, particularly in the longitudinal direction, is considered an early and sensitive marker of hypertensive heart disease and increased cardiovascular risk. The evidence indicates that aortic stiffness and central hemodynamic factors are important determinants of LV performance, mediating the interaction between the heart and vascular load. Despite the existence of cross-sectional analyses linking central blood pressure (BP) parameters with LV mechanics, no longitudinal data are available which include serial measurements in the course of antihypertensive treatment. OBJECTIVES To investigate the associations between changes in LV longitudinal and circumferential function with alterations in arterial hemodynamics and ventricular-arterial coupling (VAC) in patients with uncomplicated hypertension during a 12-month follow-up. MATERIAL AND METHODS In this retrospective study, 216 patients (age 64.3 ±7.6 years) underwent echocardiography including left ventricular longitudinal (GLS) and circumferential strain (GCS) analysis, brachial BP measurements, VAC (combining echocardiography and brachial BP), and arterial hemodynamics using radial tonometry at baseline and after 12 months of antihypertensive therapy. Patients were grouped into 2 subsets: with improvement in GLS (n = 103) and with deterioration in GLS (n = 113). RESULTS No significant differences were observed in the majority of cardiovascular, demographic or clinical characteristics between the groups. The subset with improvement in GLS demonstrated more favorable changes over follow-up in pulse wave velocity (p = 0.03), central augmentation pressure (p = 0.01) and ventricular-arterial coupling (p = 0.04) compared to patients showing deterioration in GLS. In the multivariable analysis, independent determinants of changes in GLS were: GLS at baseline (-0.48; p < 0.001), changes from baseline to follow-up in central augmentation pressure (-0.29; p = 0.002) and ventricular-arterial coupling (-0.25; p = 0.004). Independent determinants of analogous changes in GCS were: GCS at baseline (-0.46; p < 0.001) and changes in central augmentation pressure (-0.22; p = 0.02). CONCLUSIONS Left ventricular longitudinal and circumferential functional remodeling over time in hypertensive patients is associated with arterial hemodynamics and ventricular-arterial coupling.

Associations of urinary sodium excretion with central hemodynamics and changes in vascular structure and function at high altitude.

Research reports on associations of urinary sodium excretion with central hemodynamic parameters and vascular changes are quite limited in general or non‐hypertensive population. The purpose of the current study was to explore such associations in Chinese general Tibetans living at high altitude. This cross‐sectional study was conducted in Luhuo County, Ganzi Tibetan Autonomous Prefecture with average elevation of 3800 meters from December 2018 to January 2019. A total of 294 Tibetans were included in the current study. Twenty‐four hour urinary sodium excretion was estimated by second fasting spot urine in the morning using Kawasaki formula. Central hemodynamic parameters, including central systolic blood pressure (CSBP), central diastolic blood pressure (CDBP), central pulse pressure (CPP), central mean arterial pressure (CMAP), augmentation pressure (AP), and augmentation index standardized for heart rate of 75 (AIx75), were evaluated using the SphygmoCor system. Vascular structures and functions were assessed by carotid intima media thickness (CIMT) test and brachial ankle pulse wave velocity (baPWV), respectively. Estimated mean 24h urinary sodium excretion of Tibetans in Luhuo County was 5.26±1.61 g. After adjustment, estimated 24h urinary sodium was positively associated with CSBP (β = 1.15, p = .008) and CPP (β = 0.87, p = .013). Line graph of means across urinary sodium quartiles showed that associations of 24 h urinary sodium excretion with AIx75 and baPWV presented approximate “J” shape after controlling for confounders. Estimated 24 h sodium excretion was independently and positively associated with CSBP and CPP. Moreover, association between urinary sodium excretion and arterial elasticity, as evaluated by baPWV and AIx75, presented “J” shape. Further studies are needed to verify J‐shaped association and “safe” zone of sodium intake.

Medium-term Effects of Enhanced External Counterpulsation in the Structural and Functional Parameters of Blood Vessels in Patients with Coronary Artery Disease

Aim. To study the mid-term effects of enhanced external counterpulsation (EECP) in the structural and functional parameters of blood vessels, exercise tolerance and quality of life indicators in patients with verified coronary artery disease (CAD).Material and methods. Patients (n=70) with verified stable CAD (angina pectoris class II-III) complicated by chronic heart faillure class II-III (NYHA) were included in the study. Data from 65 patients (48 to 74 years old; 45 men and 20 women) are included in the final analysis. All patients had a course of EECP (35 hours procedures with a compression pressure of 220-280 mm Hg). All patients at baseline, 3 and 6 months later had a 6 walk minute test (6WMT), an assessment of the clinical status, quality of life of patients (Minnesota Living with Heart Failure Questionnaire, SF-36). Computer nailfold video capillaroscopy, photoplethysmography with pulse wave recording and contour analysis, applanation tonometry to assess central aortic systolic pressure and radial augmentation index were performed to assess the structural and functional state of large and microcirculatory vessels.Results. Significant improvement in exercise tolerance both after 3 and after 6 months (increase in distance in 6WMT by 44.6% after 3 months and 34.3% after 6 months, p &lt;0.05), improved quality of life (increased overall score on the SF-36 questionnaire from 50.3±8.1 to 59.8±8.8, p&lt;0.05), an increase in the left ventricular ejection fraction were found. Significant improvement in indicators showing the function of the endothelium of both large vessels (phase shift: from 5.6 [2.45; 7.3] to 6.8 [3.1; 8.1] m / s) and microcirculatory vessels (occlusion index: from 1.51 [1.21; 1.7] to 1.66 [1.2; 1.9]), as well as a decrease in functional disorders of the capillary bed of the skin (% of perfused capillaries, density of the capillary network in the test with reactive hyperemia) were found after 3 months. However, after 6 months, there were no significant changes in these parameters compared to the baseline value. No significant change in indicators showing structural remodeling of both large vessels and microcirculatory vessels was found.Conclusion. The positive effect of the EECP course on the functional status (exercise tolerance) and quality of life in patients with stable coronary artery disease complicated by chronic heart faillure was found both after 3 and 6 months. Positive dynamics of the functional state of large vessels and microvasculature was found only after 3 months.

Total vascular resistance, augmentation index, and augmentation pressure increase in patients with peripheral artery disease.

Peripheral arterial disease (PAD) is one of major vascular diseases which frequently coexists with coronary arterial disease and cerebrovascular disease. The patients with PAD have a poor prognosis when it progresses. A new blood pressure testing device enables to simultaneously measure brachial blood pressure (BP), central BP, and several vascular parameters, with easy and non-invasive, in a short time. Here, we aimed to evaluate these arterial stiffness parameters in patients with PAD.In this study, 243 consecutive patients who were suspected of having PAD and referred to our hospital from September 2016 to June 2019, were registered. Several parameters, such as brachial BP, central BP, aortic pulse wave velocity (aPWV), total vascular resistance (TVR), augmentation index (AI) and augmentation pressure (AP), were determined by Mobil-O-Graph. Ankle-brachial pressure index (ABI) was used to define PAD (ABI ≤ 0.9 as PAD). The relationship between PAD and central BP, aPWV, TVR, AI, or AP were investigated.One hundred sixty-two patients (67%) were categorized as the PAD group and 81 patients (33%) as the non-PAD group. In the PAD group, the systolic brachial BP and central systolic BP were significantly higher than those in the non-PAD group (138 ± 24 mmHg vs 131 ± 19 mmHg, P < .05, 125 ± 22 mmHg vs 119 ± 18 mmHg, P < .05, respectively). TVR, AI, and AP were significantly higher in the PAD group (1785 ± 379 dyn s/cm5 vs 1661 ± 317 dyn s/cm5, P < .05, 26.2 ± 13.0% vs 22.2 ± 13.3%, P < .05, 13.5 ± 9.4 mmHg vs 10.7 ± 7.2 mmHg, P < .05, respectively). No significant differences in diastolic BP, central diastolic BP, and aPWV were found between the groups. Multivariate logistic regression analysis revealed that PAD was significantly associated with TVR, AI, and AP (P < .05, respectively).TVR/AP/AI were significantly higher in the PAD group than in the non-PAD group.