Central Blood Pressure Values Research Articles

The role of non-invasive oscillometric method to detect aortic stiffness in patients with subclinical hypothyroidism

Introduction Subclinical hypothyroidism (SCH) is a biochemical condition that is diagnosed when peripheral free thyroid hormone levels are within normal reference laboratory range but serum thyroid-stimulating hormone (TSH) levels are mildly elevated. The aim of this study was to investigate the relationship between SCH and arterial stiffness using two different non-invasive methods, including echocardiography and oscillometric arteriography. Material and Methods The study included 33 newly diagnosed SCH patients and 34 age- and gender-matched healthy controls. Systolic and diastolic diameters and elastic parameters of the aorta were calculated by 2D Transthoracic echocardiography (TTE). Central blood pressure and aortic stiffness values of patient groups were measured noninvasively from the brachial artery using Mobil-O-Graph arteriography. Pulse wave velocity (PWV) and augmentation index (AIx) were used as arterial stiffness indicators. Results There was no significant difference between SCH and control groups with regard to age, gender, and body mass index (BMI). Aortic strain and aortic distensibility, were significantly lower in the SCH group than in the control group (p < 0.001). PWV and AIx which measured by Mobil-O-Graph arteriography were found to be significantly higher in the subclinical hypothyroid group compared to the control group (p < 0.05). Conclusion Aortic stiffness assessed by TTE and Mobil-O-Graph arteriography deteriorated in patients with SCH after excluding other cardiovascular risk factors. The assessment of aortic stiffness by the oscillometric method was easy and useful for widespread clinical use.

Changes of vascular stiffness and central blood pressure after endovascular aneurysm repair in patients with hypertension. Results of one-year follow-up

Aim. To assess the changes of arterial stiffness, central blood pressure (CBP), and determine the factors potentially influencing them in patients with descending thoracic and abdominal aortic aneurysm, in combination with hypertension, one year after endovascular aneurysm repair ((T)EVAR).Material and methods. Patients ≥18 years of age without clinically significant cardiac arrhythmias were included. Before surgery and a year later, we determined peripheral blood pressure, heart rate (HR), CBP, augmentation index (AIx), pressure at the point of maximum rise of the direct pulse wave (PT1h), time to return of the reflected pressure wave (Tr) and carotid femoral pulse wave velocity (cfPWV).Results. Fifty patients were included (mean age, 68±9 years; 41 men; 16 with descending thoracic aortic aneurysm, 34 with abdominal aortic aneurysm), 23 patients were reexamined. After (T)EVAR, an increase in cfPWV (+2,6 m/s, p&lt;0,001), PT1h (+5 mm Hg, p=0,026), peripheral pulse pressure (+7 mm Hg, p=0,039), heart rate (+5 beats/min, p=0,025). The CBP and AIx values have not changed. The dependence of Tr decrease on the stent-graft length (β=0,42) and the decrease in heart rate (β=-0,52) was found. During the year, 6 cardiovascular events were registered.Conclusion. Graft implantation is accompanied by an increase in cfPWV, regardless of aneurysm location. An increase in PT1h one year after (T)EVAR may reflect a decrease in aortic distensibility and worsening damping function. No changes of CBP and AIx is probably explained by reflected wave characteristics after surgery. Predictors of Tr are — increase in heart rate and implantation of longer stent grafts.

Prognostic value of central blood pressure on the outcomes of embolic stroke of undetermined source

We investigated the prognostic impact of central blood pressure (BP) on outcomes in patients with embolic stroke of undetermined source (ESUS). The prognostic value of central BP according to ESUS subtype was also evaluated. We recruited patients with ESUS and data on their central BP parameters (central systolic BP [SBP], central diastolic BP [DBP], central pulse pressure [PP], augmentation pressure [AP], and augmentation index [AIx]) during admission. ESUS subtype classification was arteriogenic embolism, minor cardioembolism, two or more causes, and no cause. Major adverse cardiovascular event (MACE) was defined as recurrent stroke, acute coronary syndrome, hospitalization for heart failure, or death. Over a median of 45.8 months, 746 patients with ESUS were enrolled and followed up. Patients had a mean age of 62.8 years, and 62.2% were male. Multivariable Cox regression analysis showed that central SBP and PP were associated with MACE. All-cause mortality was independently associated with AIx. In patients with no cause ESUS, central SBP and PP, AP, and AIx were independently associated with MACE. AP and AIx were independently associated with all-cause mortality (all p < 0.05). We demonstrated that central BP can predict poor long-term prognosis in patients with ESUS, especially those with the no cause ESUS subtype.

How should blood pressure be measured? Con: the peripheral blood pressure is sufficient

It has been shown in the past decades that the central blood pressure (cBP) values measured in the aorta differ significantly from the peripheral measured blood pressure (pBP) values. In the aorta, the systolic blood pressure is cushioned by the high elasticity, and the increased stiffness amplifies the blood pressure to the peripheral arteries. In old age, there is a loss of the elastic function, and thus, an augmentation and an associated increase in the cBP in relation to pBP are observed.1 In everyday clinical practice, however, only the pBP is currently measured, and we do not use the cBP measurements.

S-34-1: CENTRAL HYPERTENSION IS A NON-NEGLIGIBLE CARDIOVASCULAR RISK FACTOR

High blood pressure (BP) confers cardiovascular risk. However, the clinical value of central BP remains debatable. Central and brachial BPs are closely correlated. In most prospective investigations, elevated central and peripheral BPs were similarly associated with adverse outcomes. Outcome-driven thresholds of the central systolic BP estimated by the type I device were on average 10 mmHg lower than their brachial counterparts. Cross-classification based on the central and brachial BPs identified that nearly 10% of patients had discrepancy in their status of central and brachial hypertension. Irrespective of the brachial BP status, central hypertension was associated with increased cardiovascular risk, highlighting the importance of central BP assessment in the management of hypertensive patients. Newer antihypertensive agents, including renin-angiotensin-aldosterone system inhibitors and calcium channel blockers, were more efficacious than older agents in central BP reduction. Clinical trials are warranted to demonstrate whether controlling central hypertension with an optimized antihypertensive drug treatment will be beneficial beyond the control of brachial hypertension.

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.

Central hypertension is a non-negligible cardiovascular risk factor.

High blood pressure (BP) confers cardiovascular risk. However, the clinical value of central BP remains debatable. In this article, we aim to briefly review the prognosis, diagnosis, and treatment of central hypertension. Central and brachial BPs are closely correlated. In most prospective investigations, elevated central and peripheral BPs were similarly associated with adverse outcomes. Outcome‐driven thresholds of the central systolic BP estimated by the type I device were on average 10 mmHg lower than their brachial counterparts. Cross‐classification based on the central and brachial BPs identified that nearly 10% of patients had discrepancy in their status of central and brachial hypertension. Irrespective of the brachial BP status, central hypertension was associated with increased cardiovascular risk, highlighting the importance of central BP assessment in the management of hypertensive patients. Newer antihypertensive agents, such as renin–angiotensin–aldosterone system inhibitors and calcium channel blockers, were more efficacious than older agents in central BP reduction. Clinical trials are warranted to demonstrate whether controlling central hypertension with an optimized antihypertensive drug treatment will be beneficial beyond the control of brachial hypertension.

PHARMACOLOGICAL TREATMENT OF ARTERIAL HYPERTENSION GUIDED BY PERIPHERAL OR CENTRAL BLOOD PRESSURE: COMPARISON OF THE TWO STRATEGIES IN THE INCIDENCE OF INTERMEDIATE OUTCOMES

Objective: To compare the parameters of central and peripheral blood pressure measurements, arterial stiffness, target organ damage (TOD), biochemical and renal profiles among participants who had the therapeutic strategy guided by central (CG) and peripheral (PG) blood pressure values. Design and method: Randomized study in two groups: CG and PG. Five visits were carried out, the first (V1) being selection and randomization followed by intermediate visits, every 3 months, to assess blood pressure and adjust antihypertensive drugs. The procedures performed in the initial and final visit (V5) were: measurement of central arterial pressure and pulse wave velocity (PWV) (mobil-o-graph) and peripheral (OMRON HEM1100), carotid ultrasound, echodopplercardiogram and laboratory tests. Paired and unpaired t and chi-square tests were used. Adopted significance level of 5% and a confidence interval of 95%. Results: A total of 59 participants were evaluated (30 from the CG and 29 from the PG). Age, BMI, central and peripheral blood pressure measurements, PWV, left ventricular mass index (LVMI), carotid intimal mean thickness, biochemical profile and glomerular filtration rate did not differ between the two groups (p &gt; 0.05) in randomization. The augmentation index (AIx) was higher in the CG than in the PG at randomization (27.3% ± 12.2% vs 20.3% ± 13.3% p 0.041). After 1 year of follow-up, in the analysis between the groups, the central diastolic pressure was lower in the CG (78.9mmHg ± 9.7mmHg vs 84.3 ± 10.4mmHg, p 0.024) and the difference in AIx between the groups ceased to exist. When intra-group comparisons were made before and after the intervention, a reduction in the PWV (p &lt; 0.001) and LVMI (p = 0.018) was observed in the CG. In PG there was an increase in PWV (p &lt; 0.001) and LVMI (p = 0.003). Conclusions: The intervention guided by central pressure, after 1 year of follow-up, was able to reduce the central diastolic pressure and correct the AIx parameter and, in the intra-group analysis, it promoted a reduction in PWV and LVMI. There was no difference between the two groups regarding the improvement of outcomes related to central and peripheral blood pressure, cardiac and vascular TOD, biochemical and renal profile.

Objectively Assessed Habitual Sleep Duration Is Associated with Peripheral and Central Blood Pressure in Non‐Hypertensive Young Adults

Habitual short sleep duration (&lt;6 hrs/night) has been reliably shown to predict higher blood pressure (BP) and hypertension in adults. However, most studies evaluating this association in free‐living adults (i.e., non‐experimental settings) have: 1. relied on subjective sleep duration estimates or actigraphy‐derived estimates spanning ≤7 days; 2. failed to consider central BP, which has been reported to provide greater insight into future cardiovascular risk as compared to peripheral BP; and 3. neglected to consider the influence of sleep duration the night prior to BP evaluation despite evidence that episodes of acute sleep loss (e.g., experimentally shortened sleep duration) increases peripheral BP values in young adults. Therefore, the purpose of the present study was to investigate the association between objectively measured habitual sleep duration (HSD) with peripheral and central BP in non‐hypertensive, non‐shift working, apparently healthy, young adults free of sleep disorders. This study also examined whether changes in sleep duration the night before BP measurement (ΔSD) influenced these relationships. We hypothesized that shorter HSD would significantly predict higher peripheral and central BP values, but that the association would be weakened after adjusting for ΔSD the night before assessment. Sleep duration (the total time scored as sleep between sleep onset and offset) was measured via wrist‐worn actigraphy for 14 consecutive nights (days 1‐14) and mean HSD was generated. Additionally, ΔSD was calculated as the difference between sleep duration the night before testing (day 14) and mean sleep duration across days 1‐13. On the morning following the final night of sleep monitoring (day 15), resting supine peripheral BP was measured, and central BP was estimated using pulse wave analysis. BP measures included systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP). The associations between HSD and peripheral and central BP values were evaluated using linear regression models of BP values. Regression models were further adjusted for ΔSD to determine whether this influenced these associations. The analytic sample consisted of 28 participants (11M/17F; 27±7 yrs). Mean HSD for the sample was 6.91±0.74 hours per night. ΔSD sleep was ‐25±53 minutes, indicating that on average, sleep duration was shorter the night before testing. Shorter mean HSD significantly predicted both higher peripheral BP (SPB: β= ‐6.44, SE= 2.11, p&lt; 0.01; DBP: β= ‐5.03, SE= 1.63, p&lt; 0.01; MAP: β= ‐5.42, SE= 1.63, p&lt; 0.01) and higher central BP (cSBP: β= ‐5.79, SE= 2.00, p&lt; 0.01; cDBP: β= ‐5.06, SE= 1.59, p&lt; 0.01; cMAP: β= ‐5.45, SE= 1.74, p&lt; 0.01) values. When models were adjusted for ΔSD, HSD remained a significant predictor of peripheral BP (SPB: β= ‐5.45, SE= 2.06, p= 0.01; DBP: β= ‐4.50, SE= 1.66, p= 0.01; MAP: β= ‐4.71, SE= 1.60, p= 0.01) and central BP (cSBP: β= ‐4.91, SE= 2.00, p= 0.02; cDBP: β= ‐4.57, SE= 1.62, p= 0.01; cMAP: β= ‐4.81, SE= 1.75, p= 0.01). Our findings support prior evidence that HSD plays a key role in peripheral BP regulation and newly demonstrate that HSD is also significantly inversely associated with central BP values. Acute alterations in sleep duration the night prior to BP evaluation has a minimal influence on the association between HSD and BP in young, otherwise healthy free‐living adults.

Linear and non-linear analyses of autonomic modulation in uncontrolled and controlled elderly resistant hypertensives.

Resistant hypertension (RHT) is associated with worse outcomes among patients, and sympathetic overactivity is a challenge in treating this clinical condition. Here, we evaluated the autonomic modulation (by linear and non-linear analyses), central blood pressure, and pulse wave velocity in controlled and uncontrolled RHT patients, as well as those in use of beta-blockers. We observed that uncontrolled RHT patients display, in addition to an increase in peripheral blood pressure, presented higher central blood pressure values concerning controlled RHT. Furthermore, despite the use of beta-blockers, both patients in the RHT+beta-blockers and uncontrolled RHT groups had negative changes in autonomic balance as compared with controlled RHT. These results reinforce the importance of autonomic nervous system interventions in managing arterial hypertension.

Twenty-four-hour profile of peripheral and central blood pressure in young patients with high-normal blood pressure and hypertension

Aim. To evaluate indicators of daily monitoring of peripheral and central blood pressure in young patients with high-normal blood pressure (HNBP) and essential hypertension (HTN).Material and methods. One hundred twelve patients with HNBP or untreated hypertension aged 25-44 years were included. General clinical investigations were performed. An office blood pressure (BP) were assessed using an automatic BP monitor OMRON M2 Basic. Twenty-four-hour ambulotary BP monitoring (ABPM) on the brachial artery and aorta was carried out for 24 hours using the BpLAB system (OOO Petr Telegin) with an integrated Vasotens system. Depending on BP, patients were divided into groups: with HNBP and hypertension. Statistical processing and comparative analysis of the obtained data were carried out.Results. HNBP group consisted of 47 patients, while the HTN group consisted of 65 patients. The mean age of patients was 34,7±3,2 years. The parameters of daytime and nighttime peripheral BP had significant differences between the HNBP and HTN groups. Aortic BP monitoring revealed following differences: in patients with HTN, central BP values during the day and at night reflected higher values compared to patients from the HNBP group. The number of dippers for peripheral systolic blood pressure (SBP) was more by a quarter (p=0,038) in the HNBP group than in the HTN group. There were no differences in the reduction of diastolic blood pressure (DBP). The reduction in aortic SBP between the groups of HNBP and HTN were comparable. Among hypertensive patients, DBP dippers on the aorta were 20% higher (p=0,04) than in the HNBP group. According to the augmentation and the amplification index reduced to heart rate, there were no significant differences between the groups.Conclusion. Intergroup and intragroup differences were revealed depending on the types of 24-hour profile depending on peripheral and central BP. Reference values and predictive value of central BP require further research.

Twenty-four-hour profile of peripheral and central blood pressure in young patients with high-normal blood pressure and hypertension

Aim. To evaluate indicators of daily monitoring of peripheral and central blood pressure in young patients with high-normal blood pressure (HNBP) and essential hypertension (HTN).Material and methods. One hundred twelve patients with HNBP or untreated hypertension aged 25-44 years were included. General clinical investigations were performed. An office blood pressure (BP) were assessed using an automatic BP monitor OMRON M2 Basic. Twenty-four-hour ambulotary BP monitoring (ABPM) on the brachial artery and aorta was carried out for 24 hours using the BpLAB system (OOO Petr Telegin) with an integrated Vasotens system. Depending on BP, patients were divided into groups: with HNBP and hypertension. Statistical processing and comparative analysis of the obtained data were carried out.Results. HNBP group consisted of 47 patients, while the HTN group consisted of 65 patients. The mean age of patients was 34,7±3,2 years. The parameters of daytime and nighttime peripheral BP had significant differences between the HNBP and HTN groups. Aortic BP monitoring revealed following differences: in patients with HTN, central BP values during the day and at night reflected higher values compared to patients from the HNBP group. The number of dippers for peripheral systolic blood pressure (SBP) was more by a quarter (p=0,038) in the HNBP group than in the HTN group. There were no differences in the reduction of diastolic blood pressure (DBP). The reduction in aortic SBP between the groups of HNBP and HTN were comparable. Among hypertensive patients, DBP dippers on the aorta were 20% higher (p=0,04) than in the HNBP group. According to the augmentation and the amplification index reduced to heart rate, there were no significant differences between the groups.Conclusion. Intergroup and intragroup differences were revealed depending on the types of 24-hour profile depending on peripheral and central BP. Reference values and predictive value of central BP require further research.

The predictive value of central aortic blood pressure on new onset stroke and differences between brachial blood pressure in a Chinese hypertensive population, a prospective cohort study

Abstract Objectives This study aimed to investigate the association between noninvasive central aortic blood pressure and the risk of first stroke in a Chinese community–based population, meanwhile compare the prediction ability of central SBP and peripheral SBP. Methods A total of 8473 Chinese participants without history of stroke and atrial fibrillation at baseline were selected from “Hypertension and Stroke Prevention and Control Project” for analysis. The endpoint of the study was first total stroke and stroke subtypes (ischemic stroke and hemorrhagic stroke). Cox proportional hazards regression, smoothing curve fitting, subgroup analysis, and Kaplan-Meier curve were used to analysis the relationship between central/peripheral systolic blood pressure and first stroke. Results Participants were 60.9±9.6 years old, 63.5% were males, and 96.1% had hypertension. After a mean 3.3-year follow-up, the incidence of first total stroke, first ischemic stroke and first hemorrhagic stroke were 5.1%, 4.6%, and 0.5%, respectively. In multivariate logistic-regression analyses, central and peripheral SBP were both independently associated with first total stroke and first ischemic stroke after adjusting for various confounders. Peripheral SBP's significant association with first total and ischemic stroke disappeared when combined analyzed with central SBP, whereas central SBP was still significantly related with first total and ischemic stroke after adjustment of peripheral SBP. For first hemorrhagic stroke, no significant differences were observed between central SBP and peripheral SBP. Subgroup analysis showed that the central SBP-first stroke association was significantly stronger in males (HR: 1.38; 95% CI: 1.16, 1.63) than in females (HR: 1.10; 95% CI: 0.97, 1.24; P-interaction = 0.028). Conclusions Among the Chinese community–based population, central SBP is a stronger predictor compared with peripheral SBP for first stroke, especially ischemic stroke. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Key R&amp;D Projects, JiangxiOutstanding Person Foundation

Role of increased central arterial stiffness in macro and microvascular damage in patients with coronary artery disease

BackgroundPatients with heart disease frequently have renal dysfunction manifested by a decrease in glomerular filtration rate (GFR) and/or increase of albuminuria. ObjectivesThe objective was to study the possible role of increased aortic stiffness in the presence and extent of coronary artery disease (CAD) and kidney dysfunction in a group of patients with suspected CAD. Patients and methodsWe studied forty-eight patients undergoing coronariography for suspected coronary disease (CAD). Using applanation tonometry on the radial artery and applying a transfer function, central blood pressure values were calculated. The study of aortic stiffness was done by determining the carotid-femoral pulse velocity (Pvc-f). ResultsOf the 48 patients, 11 had no significant coronary lesions, 24 showed significant lesions in 1 or 2 coronary arteries and 13 in ≥ 3 arteries.The group with a higher degree of CD had significantly higher cPP values than the group without CD. The Pvc-f increased progressively and significantly with the degree of CD. The logistic regression showed that Pvc-f independently predicted the presence of CD. The relative risk of CD increased 2.5 times for each meter of increase in Pvc-f. The GFR was negatively and significantly correlated with age and Pvc-f was associated with albuminuria. ConclusionsIn patients with stable CD, Pvc-f, expression of aortic stiffness, is independently associated with the existence of CD and its degree of extension. The increase in arterial stiffness also participates in the decrease in GFR and in the increase in albuminuria.

Reference values of central blood pressure and central haemodynamic parameters and their relationship with cardiovascular risk factors in a Spanish population: early vascular ageing study.

Central blood pressure (BP) predicts mortality independent of office brachial BP. The aim was to describe reference values for central blood pressure and pulsatile hemodynamic parameters, and their relationship with cardiovascular risk factors in an adult Spanish population without cardiovascular disease. Cross-sectional study. We included 501 participants stratified by age and sex by random sampling, with a mean age of 56 years (50.3% women). The SphygmoCor System device's pulse wave analysis software was used to perform the measurements. The following values were obtained: central blood pressure median (109/76 mmHg), central pulse pressure (33 mmHg), pulse pressure amplification (8.5 mmHg), ejection duration (130 ms) and subendocardial viability ratio (163%). All parameters were greater in men, except heart rate and ejection duration. In the logistic regression analysis, controlled for age, sex and taking antihypertensive drugs, being hypertensive was associated with cSBP (OR = 1.265), cDBP (OR = 1.307), cPP (OR = 1.067), pulse wave amplification (OR = 1.034) and SEVR (OR = 0.982); being diabetic was associated with SEVR (OR = 0.982); being obese was associated with cSBP (OR = 1.028) and cDBP (OR = 1.058) and being a smoker was associated with ejection duration (OR = 0.980) and SEVR (OR = 0.984). This study provides reference values for central blood pressure and parameters derived from the pulse wave analysis in a random sample of the Spanish population. The only risk factor that is not associated with any of the parameters analysed is dyslipidaemia. https://clinicaltrials.gov/ct2/show/NCT02623894.

Subjective sleep score is associated with central and peripheral blood pressure values in children aged 7-12years.

Shortened and poor-quality sleep have emerged as non-traditional risk factors for the development of hypertension in adults, and it is likely these relations extend to paediatric populations when evaluating sleep subjectively. Therefore, we aimed to evaluate subjective sleep metrics and their associations with central and peripheral blood pressure (BP) values in children. We hypothesized that poor-quality sleep and short sleep duration would be associated with elevated pressures in healthy children. Subjective sleep habits and sleep duration were evaluated using the Children's Sleep Habits Questionnaire (CSHQ) in 29 children aged 7-12years (13 male/16 female). A total sleep score was generated by summing subscale scores: a higher score indicates poorer sleep habits. Peripheral BP was measured, and central pressures were estimated using pulse wave analysis. Pearson's r correlations were used to assess relations between total sleep score, sleep duration, and sleep score subscales with BP values. Sleep score was positively associated with central and peripheral systolic pressure (r=0.43, p=0.02 and r=0.41, p=0.03, respectively), diastolic pressure (r=0.42, p=0.02 and r=0.36, p=0.05, respectively) and mean arterial pressure (r=0.40, p=0.03 and r=0.36, p=0.03, respectively). Sleep duration was negatively associated with central and peripheral diastolic pressure (r=-0.40, p=0.03 and r=-0.41, p=0.03, respectively). Regarding the CSHQ subscales, daytime sleepiness and parasomnias were consistently positively associated with BP values. These findings support sleep as a primordial prevention target for hypertension and the maintenance of cardiovascular health during childhood. Consideration of a variety of sleep habits using tools such as the CSHQ may provide important insights into early-life cardiovascular risk.

Papel del aumento de la rigidez arterial central en el daño macro y microvascular en pacientes con enfermedad coronaria

BackgroundPatients with heart disease frequently have renal dysfunction manifested by a decrease in glomerular filtration rate (GFR) and / or increase of albuminuria. ObjectivesThe objective was to study the possible role of increased aortic stiffness in the presence and extent of coronary artery disease (CAD) and kidney dysfunction in a group of patients with suspected CAD. Patients and methodsWe studied forty-eight patients undergoing coronariography for suspected coronary disease (CAD). Using applanation tonometry on the radial artery and applying a transfer function, central blood pressure values were calculated. The study of aortic stiffness was done by determining the carotid-femoral pulse velocity (Pvc-f). ResultsOf the 48 patients, 11 had no significant coronary lesions, 24 showed significant lesions in 1 or 2 coronary arteries and 13 in ≥ 3 arteries.The group with a higher degree of CD had significantly higher cPP values than the group without CD. The Pvc-f increased progressively and significantly with the degree of CD. The logistic regression showed that Pvc-f independently predicted the presence of CD. The relative risk of CD increased 2.5 times for each meter of increase in Pvc-f. The GFR was negatively and significantly correlated with age and Pvc-f was associated with albuminuria. ConclusionsIn patients with stable CD, Pvc-f, expression of aortic stiffness, is independently associated with the existence of CD and its degree of extension. The increase in arterial stiffness also participates in the decrease in GFR and in the increase in albuminuria.

COMPARISON OF ATTENDED AND UNATTENDED CENTRAL AND PERIPHERAL OFFICE BLOOD PRESSURE MEASUREMENTS IN HYPERTENSIVE PATIENTS IN GENERAL PRACTICE

Objective: Central hemodynamic indices have been established as parameters of arterial health, but the prognostic value of central vs. conventional office blood pressure (OBP) measurements remains unclear. Furthermore, the use of attended vs. unattended automated OBP measurements is a current topic of controversy. Design and method: We conducted a prospective cohort study in general practice in Germany and included 42 consecutive patients with hypertension. The Mobil-O-Graph oscillometric device was used for the automated OBP recordings in all patients. Measurements were performed in a separate quiet room after five minutes rest in seated position. We compared in random order in each patient the attended vs. unattended automated central and peripheral systolic OBP (SOBP), diastolic OBP (DOBP), and pulse velocity wave (PVW). Results: The mean age of patients was 71 years (range 34–89 years, 54.8% females). Patients were treated on average with 1.95 antihypertensive drugs. The mean attended and unattended automated peripheral SOBP (131.7 and 131.6 mmHg, respectively) and DOBP (83.4 and 82.4 mmHg, respectively) values recorded by the device were not significantly different. In addition, there was no difference between the mean attended and unattended central aortic SOBP (120.1 and 120.2 mmHg, respectively) and DOBP (84.7 and 83.7 mmHg, respectively) values. Bland-Altman analysis revealed the small inter-individual differences between attended und unattended peripheral and central SOBP and DOBP values. There was no asymmetry and narrow limits of agreement between the two methods. Finally, no significant difference for PVW was found between attended and unattended measurements (10.1 and 10.2 m/sec, respectively). Conclusions: The attended versus unattended status of automated OBP measurements had no impact on derived peripheral OBP, central OBP and PVW values in general practice when using the Mobil-O-Graph oscillometric device.

GEOGRAPHIC VARIATION IN VASCULAR STIFFNESS VALUES IN CROATIAN AND INDIAN PATIENTS WITH HYPERTENSIVE URGENCY

Objective: The food habits, life style and genetic constitution are different for every country and contribute to a significant raise in blood pressure. Objective was to estimate the values of pulse wave velocity (PWV) and central blood pressure (CBP) in hypertensive urgency (raise in systolic and diastolic blood pressure with no end target organ damage) in patients from two different geographical areas Croatia (C) and India (I) for the first time non-invasively. Design and method: We identified 17 patients from Croatia and 20 patients from India with a clinical diagnosis of hypertensive crisis with no end target organ damage, who entered the emergency outpatient clinics in respective countries. The PWV, pulse pressure (PP), CBP, brachial pressure (BP) were evaluated using the noninvasive Agedio B900 device (Germany). Statistical data was processed in SPSS software, significant differences were considered at p &lt; 0,05. Results: Average age of patients in C (64,18 ± 10,87 years, 58,82% were females and 41,18% were males); I (63.35 ± 9.74 years, 30% were females and 70% males). Average brachial systolic BP in C and I was found to be 191,17 ± 10,98 mmHg and 191,42 ± 9,88 mmHg respectively. Average central systolic blood pressure in C and I was 149.23 ± 18.93 mmHg, 178.35 ± 28.61 and average central diastolic blood pressure was 99.23 ± 17.22 mmHg; 115.64 ± 8.01 respectively. PWV for each patient was higher than the reference range for age with average values of 10,5 ± 2,01 m/s in C and 11.74 ± 1.74 in I population. Student's t-test showed statistically significant difference between PWV measured in patients from Croatia and India (C- 10.54 ± 2.15, I- 11.17 ± 1.74; p = 0.008). Values of PWV showed a positive correlation with age in both patient groups C (r = 0.9471, p &lt; 0.00001); I (r = 0.838, p &lt; 0.00001). Central systolic blood pressure shows a weak positive correlation with PWV, C (r = 0.5225, p = 0.03);I (r = 0.1294, p = 0.05). Conclusions: It is clear from the results that the PWV, CBP and vascular age were higher in Indian population than the Croatian data. This is explained by the irregular lifestyle, high risk of diabetes, obesity and high salt diet corresponds to increased vascular stiffness.

RESISTANT HYPERTENSION ON TREATMENT (RESHYPOT) TRIAL: SEQUENTIAL NEPHRON BLOCKADE COMPARED TO DUAL BLOCKADE OF THE RENIN- ANGIOTENSIN-ALDOSTERONE SYSTEM PLUS BISOPROLOL

Objective: Resistant hypertension (RHTN) is a clinical entity, difficult to manage. To identify the contribution of the volume as well as the renin activity from the maintenance of blood pressure levels could individualize the treatment. Objectives : To demonstrate the efficacy of therapy of sequential nephron blocking (SNB) in relation to the double blockade of the renin-angiotensin system associated with beta-blockers (DBRAS) in patients with RHTN with &gt; 85%-adherence rate after 20 weeks of treatment. Design and method: A prospective study was conducted, open, randomized, parallel comparison between two regimens for RHT: SNB versus DBRAS. SNB consists in a progressive increase of sodium depletion with thiazide, followed by a blockade of mineralocorticoid receptor, followed by progressive doses of loop diuretics and finally blocking sodium channels. DBRAS consists in reinforcing the effect of angiotensin receptor blocker (ARB) with an angiotensin converting enzyme inhibitors (ACEI), followed by betablockers to decrease the renin secretion. Seventy-two patients were randomized (35 to SNB 13 M/22F and 37 to RASDB 14 M/23F) coming from the tertiary outpatient clinic (HB-FAMERP). We used the criteria of the Brazilian VII Guidelines for Hypertension and V Guidelines for ABPM and HBPM. The BP was monitored with the SpaceLabs 90207. Results: Baseline clinical characteristics and laboratory parameters of the 72 RHTM randomized to SNB (n = 35) or DBRAS (n = 37) were similar across both study groups. At the end of the study, a significant reduction of the office pressure was observed (SBP and DBP) in both post-intervention groups (SNB group: initial SBP: 174.5 ± 21.08; final SBP: 127.0 ± 14.74; Initial DBP: 105.3 ± 15.5, final DBP: 78.11 ± 9.28 (p &lt; 0.0001), RAASDB group: initial SBP: 178.4 ± 21.08, final SBP: 134.4 ± 23.25, initial DBP: 102.7 ± 11.07, final DBP: 77.33 ± 13.75 (p &lt; 0.0001). No discontinuation due drug-related adverse events in both study groups. Conclusions: SNB and DBRAS associated with the beta-blocker in RHTN patients with full adherence to the treatment showed excellent therapeutic efficacy. However, the SNB group disclosed a greater absolute reduction of central blood pressure values.