Central Blood Pressure Research Articles

Progression in central blood pressure and hemodynamic parameters and relationship with cardiovascular risk factors in a Spanish population. EVA follow-up study.

The progression of Central Blood Pressure (CBP) values and central hemodynamic parameters and its relationship with cardiovascular risk factors is quite unknown. We sought to investigate this association in a Spanish adult population without cardiovascular diseases. Prospective observational research with a five-year follow-up. Randomly sampled 501 individuals (mean age 56±14 years, 50.3% women). After five years, 480 individuals had a follow-up. Measurements taken using the SphygmoCor® (AtCor Medical Pty Ltd., Head Office,West Ryde, Australia), following all the recommendations established in the "International task force"1, giving an estimate of central blood pressure relative to measured brachial blood pressure (type 1 device). Progressions during follow-up: central systolic blood pressure (cSBP): 4.16±13.71 mmHg; central diastolic blood pressure (cDBP): 2.45±11.37 mmHg; central pulse pressure (cPP): 1.72±12.43 mmHg; pulse pressure amplification (PPA): 2.85±12.20 mmHg; ejection duration (ED): 7.00±47.87ms; subendocardial viability ratio (SEVR): -8.04±36.24%. In multiple regression analysis: cSBP positively associated with: BMI (β=0.476); waist size (β=0.159); number of cigarettes per day (β=0.192). Inversely associated with peripheral systolic blood pressure (β=-0.282). cDBP increase positively associated with number of cigarettes per day (β=0.174). Inversely associated with peripheral diastolic blood pressure (β=-0.292). cPP increase positively associated with BMI (β=0.330). Inversely associated with peripheral pulse pressure (β=-0.262). PPA increase positively associated with: BMI (β=0.276); number of cigarettes per day (β=0.281). ED progress inversely associated with basal plasma glucose (β=-0.286). All measures increased except for SEVR. Progressions in CBP and PPA were positively associated with anthropometric parameters and number of cigarettes and CBP inversely associated with peripheral blood pressure, although this association was different according to sex.

Central Hemodynamics in African American Women: Examining the Role of Superwoman Schema Endorsement.

African American women bear a disproportionate burden of cardiovascular diseases, potentially due to altered central hemodynamics. Racism and sexism often lead to African American women taking on numerous caretaking roles and overall increases their use of the Strong Black Woman (ie, Superwoman) mindset, which may have negative health consequences. We hypothesized that endorsing the Superwoman role and its Obligation to Help Others dimension would be associated with a deleterious central hemodynamics profile in African American women. Using cross-sectional data, we examined central systolic blood pressure (mm Hg; n=408), augmentation index (percentage, adjusted for height and heart rate; n=408), and pulse wave velocity (m/s; n=368) in African American women aged 30 to 46 years. The Giscombe Superwoman Schema (SWS) questionnaire assessed endorsement of Overall SWS (range, 0-105) and SWS-Obligation to Help Others (range, 0-3). Multiple linear regression modeled associations between Overall SWS (10-unit increments) and SWS-Obligation to Help Others (1-unit increments) and central hemodynamics while adjusting for pertinent sociodemographic, clinical, and psychosocial factors. In fully adjusted models, central systolic blood pressure was significantly associated with Overall SWS (β=0.83 [95% CI, 0.19-1.47]) and SWS-Obligation to Help Others (β=2.03 [95% CI, 0.39-3.67]). Augmentation index was associated with Overall SWS (β=0.66 [95% CI, 0.02-1.30]) and SWS-Obligation to Help Others (β=2.21 [95% CI, 0.58-3.84]). Significant associations were not observed between pulse wave velocity and SWS. Greater endorsement of the Superwoman role and prioritizing caregiving over self-care were associated with higher central systolic blood pressure and augmentation index, which may contribute to adverse cardiovascular health among African American women.

Differential contribution of elbow flexion and knee extension on vascular and hemodynamic parameters and arterial stiffness indices after acute strength exercise in young adults

BackgroundDifferent types of exercise, performed acutely or chronically, have different repercussions on central hemodynamics, arterial stiffness, and cardiac function. In this study, we aim to compare the effects of acute elbow flexion (EFlex) and knee extension (KExt) exercises on vascular and hemodynamic parameters and arterial stiffness indices in healthy young adults.MethodsYoung adults (20 to 39 years) underwent randomized muscle strength tests to obtain 1 repetition maximum (1RM) for elbow flexion (EFlex) and knee extension (KExt). After a minimum interval of 48 h, cardiovascular parameters were assessed using Mobil-O-Graph® (Mobil-O-Graph, IEM, Germany) at three-time points: at baseline (before exercise), immediately after elbow flexion or knee extension exercises with a load corresponding to 50% of 1RM (T0) and after 15 min of rest (T15).ResultsImmediately after exercise (T0), peripheral systolic blood pressure, peripheral pulse pressure, central systolic blood pressure, and central pulse pressure were significantly higher in KExt than EFlex (Δ 3.13; Δ 3.06; Δ 5.65; Δ 5.61 mmHg, respectively). Systolic volume, cardiac output, and cardiac index were significantly higher immediately after KExt when compared with EFlex (Δ 4.2 ml; Δ 0.27 ml/min and 0.14 l/min*1/m2, respectively). The reflection coefficient and the pulse wave velocity were also significantly higher at T0 in KExt compared to EFlex ( Δ 8.59 and Δ 0.12 m/sec, respectively).ConclusionOur results show differential contribution of muscle mass in vascular and hemodynamic parameters evaluated immediately after EFlex and KExt. In addition, our study showed for the first time that the reflection coefficient, an index that evaluates the magnitude of the reflected waves from the periphery, was only affected by KExt.

Maternal vascular indices at 36 weeks' gestation in pregnancy with small or growth-restricted fetus.

To compare maternal vascular indices and hemodynamic parameters at 35-37 weeks' gestation in pregnancies complicated by delivery of a small-for-gestational-age (SGA) or growth-restricted (FGR) neonate. This was a prospective observational study of women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. The visit included recording of maternal demographic characteristics, medical history, vascular indices and hemodynamic parameters, which were obtained using a non-invasive operator-independent device and included pulse-wave velocity, augmentation index, cardiac output, stroke volume, central systolic and diastolic blood pressure, total peripheral resistance and heart rate. Women with hypertensive disorders of pregnancy were excluded. SGA was diagnosed if birth weight was < 10th percentile. FGR was diagnosed if, in addition to birth weight < 10th percentile, at the 35-37-week scan, uterine artery or umbilical artery pulsatility index (PI) was > 95th percentile or fetal middle cerebral artery PI was < 5th percentile. Among the 6413 women included in the study, there were 605 (9.4%) cases of SGA, 133 (2.1%) cases of FGR and 5675 (88.5%) cases that were unaffected by SGA or FGR. Women with SGA or FGR, compared to unaffected pregnancies, had increased peripheral vascular resistance and reduced cardiac output. Central systolic and diastolic blood pressure were increased in the FGR group compared with the unaffected group. Aortic stiffness, as assessed by pulse-wave velocity, and augmentation index did not differ between affected and unaffected pregnancies. In the FGR group, compared with the SGA group, central systolic and diastolic blood pressure were higher, whereas heart rate was lower. SGA and FGR pregnancies exhibit deranged maternal hemodynamic responses compared with unaffected pregnancies. Pregnancies with FGR have higher central blood pressure compared to those with SGA, but it remains unclear whether these differences are driven by the size of the fetus or pathological fetal growth. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Hemodynamic phenotypes in chronic kidney disease patients based on linear regression of blood pressure parameters.

Classic and non-classic cardiovascular (CV) risk factors accumulate in chronic kidney disease (CKD), contributing to vascular remodeling and hemodynamic abnormalities. This study aimed to determine hemodynamic phenotypes based on linear regression of blood pressure (BP) parameters in stage G3-G4 CKD patients at very high CV risk. 24-h ambulatory BP monitoring (ABPM), carotid-femoral pulse wave velocity (PWV) and central BP were obtained from 52 patients (aged 60±11years, BMI 30±6kg/m2) with stage G3-G4 CKD (eGFR 44±12mL/min./1.73m2). Linear BP regression coefficients were generated to determine hemodynamic phenotypes using ABPM data. Coexisting hypertension was present in 45 (86%) patients, out of whom 33 (73%) had BP controlled. 24-h mean systolic/diastolic BP was 128±18/75±12mm Hg. Twenty-six patients demonstrated the harmonious (H) and 26 patients diastolic dysfunctional (D) hemodynamic phenotypes. eGFR was not significantly different between both phenotypes. Compared to phenotype H, patients with phenotype D were older (57±11 vs. 63±10 years, p=.04), had higher PWV (8.2 [7.3-10.3] vs. 9.7 [8.3-10.9]m/s, p=.02), ambulatory arterial stiffness index (AASI) (0.31±0.1 vs. 0.40±0.1, p=.02), systolic BP (128 [122-130] vs. 137 [130-150] mm Hg, p=.001) and systolic BP variability (BPV) (11.7±2.3 vs. 15.7±3.4mm Hg, p<.0001). Our findings suggest that one in two patients with stage G3-G4 CKD demonstrates an unfavorable D hemodynamic phenotype based on a linear regression model, associated with higher PWV, AASI, systolic BP, and systolic BPV. Further studies are required to assess the clinical utility of hemodynamic phenotypes and whether the D phenotype may predict latent circulatory disorders and outcomes.

Accuracy of the WatchBP Office Central as a Type 2 device for non-invasive estimation of central aortic blood pressure in children and adolescents.

High blood pressure (BP) in childhood is a recognised precursor of elevated cardiovascular risk in adulthood. Brachial BP is normally used for clinical decision making, but central BP may be a better marker of pressure load on the heart. There is a paucity of validated non-invasive, automated devices for estimating central BP in children and adolescents. In this study, we compared the WatchBP Office Central (a Type 2 central pressure estimation device) against a high-fidelity micromanometer in the ascending aorta of anaesthetised patients undergoing clinically-indicated catheterisation (n = 15, age 4-16 years). As a secondary aim, central systolic BP (cSBP) was also compared to two non-invasive estimation methods in 34 awake patients undergoing routine cardiac MRI (age 10-18 years). WatchBP substantially overestimated cSBP compared to the intra-arterial gold-standard reference (26.1 ± 7.4mmHg), and recruitment was terminated at n = 11 (included in the analysis) due to high statistical certainty that the device would not pass the validation criteria of 5±8 mmHg. WatchBP cSBP was also substantially higher than values obtained from a phase contrast MRI method (11.8 ± 7.9 mmHg) and the SphygmoCor XCEL (13.5 ± 8.9 mmHg) in the awake patient group, which translate to 21-23 mmHg on average after accounting for known/estimated biases in these non-invasive comparators. Compared with invasive central diastolic and systolic BPs, the brachial measures from WatchBP yielded errors of 0.1 ± 5.6 and 12.5 ± 6.0 mmHg respectively. We conclude that the WatchBP substantially overestimates cSBP in children and adolescents. These findings reinforce the need for central BP-measuring devices to be further developed and validated in this population.

'Effects of dehydration on central blood pressure in young healthy adults'.

Brachial blood pressure (BP) is the current gold standard for BP assessment; however, measures of pulse wave velocity (PWV) and central blood pressure (CBP) may contribute uniquely to assessment of cardiovascular health status. As of yet, standards for assessment of CBP and PWV have not addressed the impact of hydration status on proper measurement. To understand the impact of hydration, PWV and CBP should be measured in a euhydrated and hypohydrated state. Forty-three young, healthy participants (21 ± 2 years) completed a dehydration protocol utilizing moderate aerobic activity until they lost 1%-2% of their body weight. PWV and CBP were measured before and following the dehydration protocol. Linear regression was utilized to assess change in hydration status and change in PWV and CBP. No significant relationships were observed between the change in hydration status (% body weight lost) and PWV (β = 0.05, p = 0.78) or central diastolic BP (β = -3.8, p = 0.10), however, a significant relationship was observed with central systolic BP (β = -5.0, p = 0.03). In conclusion, the assessment of hydration status before measurement of CBP or PWV may not be necessary in young, healthy individuals.

Is Arterial Stiffness Interconnected with Cardiovascular Drug Prescription Patterns, Body Composition Parameters, and the Quality of Blood Pressure Regulation in Hypertensive Patients?

Arterial hypertension (AH) is a significant risk factor for cardiovascular disease and is associated with increased arterial stiffness, particularly as measured by pulse wave velocity (PWV). This study aims to explore the relationships between age groups, antihypertensive and new oral antidiabetic drugs, body composition, and arterial stiffness parameters in hypertensive patients. A single-center cross-sectional study was conducted including 584 participants who underwent 24 h ambulatory blood pressure monitoring (including central blood pressure (BP) and PWV measurement), body composition analysis, and provided medical history and current pharmacotherapy data. The study found that PWV was significantly higher in patients with poorly regulated BP in those aged 65 years and older. Significant PWV predictors included systolic BP, heart rate, peripheral mean arterial pressure, peripheral pulse pressure, augmentation index, calcium channel blockers, moxonidine, sodium-glucose co-transporter 2 inhibitors, urapidil, and statin prescription. Also, statistically significant negative correlations were found between PWV and visceral fat level, fat-free mass, and the percentage of muscle mass. The findings suggest that arterial stiffness is interconnected with peripheral and central blood pressure parameters, body composition parameters, and prescribed hypertensive and new antidiabetic drugs.

Genetic variation in CCDC93 is associated with elevated central systolic blood pressure, impaired arterial relaxation, and mitochondrial dysfunction.

Genetic studies of blood pressure (BP) traits to date have been performed on conventional measures by brachial cuff sphygmomanometer for systolic BP (SBP) and diastolic BP, integrating several physiologic occurrences. Genetic associations with central SBP (cSBP) have not been well-studied. Genetic discovery studies of BP have been most often performed in European-ancestry samples. Here, we investigated genetic associations with cSBP in a Chinese population and functionally validated the impact of a novel associated coiled-coil domain containing 93 (CCDC93) gene on BP regulation. An exome-wide association study (EWAS) was performed using a mixed linear model of non-invasive cSBP and peripheral BP traits in a Han Chinese population (N = 5,954) from Beijing, China genotyped with a customized Illumina ExomeChip array. We identified four SNP-trait associations with three SNPs, including two novel associations (rs2165468-SBP and rs33975708-cSBP). rs33975708 is a coding variant in the CCDC93 gene, c.535C>T, p.Arg179Cys (MAF = 0.15%), and was associated with increased cSBP (β = 29.3 mmHg, P = 1.23x10-7). CRISPR/Cas9 genome editing was used to model the effect of Ccdc93 loss in mice. Homozygous Ccdc93 deletion was lethal prior to day 10.5 of embryonic development. Ccdc93+/- heterozygous mice were viable and morphologically normal, with 1.3-fold lower aortic Ccdc93 protein expression (P = 0.0041) and elevated SBP as compared to littermate Ccdc93+/+ controls (110±8 mmHg vs 125±10 mmHg, P = 0.016). Wire myography of Ccdc93+/- aortae showed impaired acetylcholine-induced relaxation and enhanced phenylephrine-induced contraction. RNA-Seq transcriptome analysis of Ccdc93+/- mouse thoracic aortae identified significantly enriched pathways altered in fatty acid metabolism and mitochondrial metabolism. Plasma free fatty acid levels were elevated in Ccdc93+/- mice (96±7mM vs 124±13mM, P = 0.0031) and aortic mitochondrial dysfunction was observed through aberrant Parkin and Nix protein expression. Together, our genetic and functional studies support a novel role of CCDC93 in the regulation of BP through its effects on vascular mitochondrial function and endothelial function.

No Difference between the Efficacy of High-Nitrate and Low-Nitrate Vegetable Supplementation on Blood Pressure after 16 Weeks in Individuals with Early-Stage Hypertension: An Exploratory, Double-Blinded, Randomized, Controlled Trial.

Dietary inorganic nitrate lowers blood pressure (BP) in healthy individuals through improved nitric oxide (NO) bioavailability. However, there is limited evidence examining the long-term effects of dietary nitrate for managing hypertension. We aimed to determine whether the sustained intake of dietary nitrate improved BP and cardiovascular disease (CVD) risk factors in individuals with early-stage hypertension. The Dietary Nitrate (NO3) on BP and CVD Risk Factors (DINO3) Trial was a multi-center, double-blinded, parallel, randomized, controlled trial in participants with elevated BP. Participants were supplemented with high-nitrate (HN) (~400 mg nitrate) or low-nitrate (LN) vegetable powder (~50 mg nitrate) on top of their usual diets for 16 weeks. The primary outcome was office systolic BP at 16 weeks. The secondary outcomes were 24 h ambulatory BP, central BP, heart-rate-corrected augmentation index (AIx75), carotid-femoral pulse wave velocity (cf-PWV), lipids, and high-sensitivity C-reactive protein (hs-CRP). Sixty-six participants were randomized at baseline (39M:27F, age: 51.5 ± 10.8 years, BMI:27.9 ± 3.2 kg/m2). In an intention-to-treat analysis, no differences were observed between HN and LN groups in terms of office systolic BP at 16 weeks (3.91 ± 3.52 mmHg, p = 0.27) or secondary outcomes. In this exploratory study, sustained HN vegetable supplementation did not exhibit more favorable vascular effects than LN vegetable supplementation in individuals with elevated BP.

P083 CHANGES IN STANDARD CUFF AND CENTRAL BLOOD PRESSURES ARE EQUALLY ASSOCIATED WITH CHANGES IN LEFT VENTRICULAR MASS: LONGITUDINAL ANALYSIS FROM THE UK BIOBANK COHORT STUDY

Background and objective. Central blood pressure (BP) measurement purports to aid hypertension management. This concept is founded on cross-sectional studies, however, findings are mixed and none report longitudinal relationships between changes in BP and outcomes. This study aimed to determine associations of changes in cuff BP and central BP with changes in left ventricular mass index (LVMi), as an important hypertension-related clinical outcome. Methods. Standard cuff BP and central BP (Vicorder, Skidmore Medical, UK; SBP/DBP calibration of waveforms) were measured at the same time as cardiac magnetic resonance imaging for LVMi among a cohort of adults from the UK Biobank Cohort Study assessed at two time points (2014+ and 2019+). Linear regression adjusted for demographic and clinical characteristics were used to determine cross sectional associations and associations between changes in cuff BP and central BP with LVMi. Results. Data were evaluable for 681 participants (aged 50.1±7.1 years, 54% female) followed over 1161±582 days (mean ± SD). Cross-sectional analysis showed the association of cuff systolic BP with LVMi (β±SE 3.47x10-2±6.38x10-3 g/m2.7/mmHg) and central systolic BP with LVMi (β±SE=3.52x10-2±6.40x10-3 g/m2.7/mmHg) were comparable (p&lt;0.001 both). In the longitudinal analysis, associations between the changes in BP and changes in LVMi were identical for both central and cuff systolic BP (β±SE=0.011±0.003 g/m2.7/mmHg; p&lt;0.001 both). Conclusion. Changes over time in standard cuff BP provides similar information to central BP on risk for hypertension-related changes in LVMi. These findings are likely to be generalisable to central BP devices using SBP/DBP calibration.

O31 VALIDATION ASSESSMENT OF A CUFF-BASED CENTRAL BLOOD PRESSURE DEVICE ACCORDING TO ARTERY SOCIETY RECOMMENDATIONS

Background and objective. Uscom BP+ is a cuff-based blood pressure (BP) device designed to non-invasively estimate central BP as distinct from conventional brachial BP. This study aimed to assess the accuracy of the Uscom BP+ device compared to invasively measured BP. Methods. Automated non-invasive cuff central BP (using the Uscom BP+ device) and invasive central aortic BP (using fluid-filled catheters) were recorded simultaneously in 191 participants (65% male, aged 66±11 years) receiving coronary angiography at three independent research sites (Hobart, Australia, Perugia, Italy and Wroclaw, Poland). Validation assessment procedures were undertaken according to the Artery Society recommendations and with a minimal acceptable error of ≤5±≤8 mmHg as pass criteria. Results. Using the device default calibration technique (brachial cuff systolic [SBP] and diastolic BP [DBP]), cuff central SBP underestimated invasive central SBP [mean(SD) difference: -10.2(11.2) mmHg] and cuff central DBP overestimated invasive central DBP [mean(SD) difference: 9.7(8.6) mmHg]. When calibrating by cuff mean arterial pressure and DBP in a sub-group (n=140), SBP accuracy was improved, but variability remained high [mean(SD) difference: -6.4(13.8) mmHg, p=0.002 vs default calibration], whereas DBP accuracy and variability remained similar [mean(SD) difference: 9.0(8.4) mmHg, p=0.23 vs default calibration]. Conclusions. The Uscom BP+ cuff device does not pass the Artery Society accuracy criteria compared with invasively measured central BP.

P060 A NOVEL NON-INVASIVE METHOD FOR ESTIMATING CENTRAL SYSTOLIC BLOOD PRESSURE USING AMBULATORY BLOOD PRESSURE MONITORING

Background and Objective: Central blood pressure (BP) holds superior prognostic value compared to peripheral BP in predicting cardiovascular events. Despite its significance, measuring central BP in outpatient settings is impractical. To address this limitation, our research group devised a novel non-invasive method for estimating central systolic blood pressure (cSBP) using peripheral data based on the equation proposed by Chemla et al. However, its validity remains uncertain. The objective was to assess the validity of our new non-invasive method for estimating cSBP by comparing it to a validated brachial oscillometric method. Methods: A cross-sectional study was conducted, involving 132 patients who underwent 24-hour ambulatory blood pressure monitoring (24-h ABPM). A total of 8,112 BP records were obtained. The cSBP was measured during 24-h ABPM using a Custo Screen 310 device (Custo, Ottobrunn, Germany), which has been validated. The cSBP was estimated using the formula: cSBP= MAP2/DBP, where MAP2 represents the estimated mean arterial pressure using the equation: MAP2=(Ts/T) × SBP + (Td/T) × DBP, where T, Ts, and Td denote the cardiac, systolic, and diastolic periods, respectively. The SBP indicate systolic blood pressure and DBP denote diastolic blood pressure. Ts was calculated as: Ts=0.2061+ (Age/2244) + (T/8.17). Results: Among the participants, 53.8% were men, with an average age of 55±16 years. The average height was 1.65±0.1 m, weight 74±12 kg, heart rate 71±12 bpm, SBP 125±19 mmHg, DBP 79±12 mmHg, and cSBP 120±19 mmHg. The agreement of cSBP between the new method and the brachial oscillometric method was very good. Bland-Altman plots revealed that the differences between the methods were randomly distributed along the mean difference line (Figure). Conclusions: The new non-invasive method to estimate cSBP from peripheral BP data, using MAP2 and cardiac periods, has been demonstrated to be valid. The equation, which allows for the estimation of cSBP without a pulse wave, could be easily implemented in conventional 24-h ABPM systems.

Comparative analysis of central aortic blood pressure, pulse wave velocity & arterial stiffness in patients with obstructive airway disease.

As the pulmonary system and cardiovascular system are intimately linked, patients with chronic obstructive pulmonary disease (COPD) and asthma have high risk for developing cardiovascular diseases (CVDs) and altered central hemodynamic. We aim to assess the central aortic blood pressure (CABP) indices, pulse wave velocity (PWV) and other indicators of arterial stiffness in Indian patients with COPD and bronchial asthma. This is a single-center, cross-sectional study conducted in outpatients diagnosed with either chronic stable phase of COPD or bronchial asthma. CABP indices, vascular age, arterial stiffness and central hemodynamics were measured in patients. Of 193 patients with obstructive airway disease who were enrolled, (n = 81 had COPD and n = 112 had partially-controlled bronchial asthma) the proportion of male patients was higher in both groups. The PWV, augmentation index (AI) and vascular age (VA) were significantly higher in patients with COPD compared to those with bronchial asthma (all, p < 0.05). The study showed that PWV, AI and VA were higher in patients with stable COPD without any cardiac comorbidities compared to bronchial asthma.

P084 BLOOD PRESSURES MEASUREMENT WITH SITTING ON THE FLOOR POSITION FOR THE HOME BLOOD PRESSURE MONITORING FOR ASIAN LIFESTYLE

Objectives: The current standard method for home blood pressure (BP) measurement involves taking measurements while sitting in a chair. In cultures where floor sitting is common as like in Asian countries, the protocol only using sitting on the chair position can not be applied because of a lack of research for interchangeability. Methods &amp; Materials: Among the participants who visited for evaluation of central blood pressure or pulse wave velocity, a total of 116 participants who agreed to participate in the study were randomly selected. All subjects rested for 5 minutes, and BP measurements were taken at 1-minute intervals according to a randomly assigned order of standard method (chair-sitting) and BP in a seated on the floor (floor-sitting). Results: Of the 116 participants, the median age was 67.5 (with an interquartile range of 59.0 to 75.0), and 82% were male. There were no significant differences in systolic BP (SBP, 127.0 [115.0, 142.2] mmHg in chair-sitting and 129.0 [115.5, 142.2] mmHg in floor-sitting, P = 0.228) and diastolic BP (DBP, 73.5 [66.0, 83.0] mmHg in chair-sitting and 72.0 [66.8, 81.3] mmHg in floor-sitting, P = 0.839) between the two positions. Conclusions: These findings provide important insights into securing the reliability of home BP measurements through the commonly practiced floor-sitting posture in cultures where floor sitting is common. Furthermore, this could serve as substantial evidence for providing specific home BP measurement guidelines to patients who adhere to a floor-sitting lifestyle.

Assessment of aortic stiffness during atrial fibrillation: solutions and considerations.

Methods to assess aortic stiffness are not validated during ongoing atrial fibrillation (AF) We aimed to determine whether aortic stiffness can be assessed reliably in patients during AF. Carotid-to-femoral and aortic pulse wave velocity (cf/aoPWV), central blood pressure (BP), and augmentation index (AIx) were assessed by a two-site applanation method and a one-site cuff-based oscillometric method in 40 patients with persistent AF and repeated after cardioversion to SR. Mean age was 63 ± 8 years, 73% male, 50% hypertensive. For the two-site method, cfPWV values were slightly higher in AF than in SR (9.3 ± 1.8 vs. 8.5 ± 1.6 m/s, p < 0.001), whereas the one-site method provided similar values in AF and SR (10.1 ± 1.5 vs. 10.0 ± 1.8 m/s).The variability indices from the device was higher in AF for the two-site method (SD 2.5 ± 1.7 vs. 1.0 ± 0.5 m/s, p < 0.001) but similar in AF and SR with the one-site method (SD 0.7 ± 0.2 vs. 0.6 ± 0.2 m/s). Both methods yielded higher central BP (+4.8/+6.6 and +4.1/+5.7 mm Hg) and lower Aix (-6.8 and -9.1 mm Hg) in AF. Aortic stiffness can be assessed during AF. Both methods yielded higher central BP and lower AIx in AF, but similar results for PWV in AF and SR, also when adjusted for BP changes. The two-site method showed high variability necessitating repeated measurements. The one-site method showed lower device-calculated variability and needed fewer repeated measurements.

Development of a comprehensive risk prediction model for arterial stiffness assessment in individuals with obesity.

Obesity in adults is a known risk factor for cardiovascular events and is associated with a decline in arterial elasticity. This study aims to evaluate the utility of pulse wave analysis (PWA) parameters in routine clinical practice for the primary prevention of cardiovascular events by developing a prediction model for arterial stiffness among obese and overweight individuals. The study enrolled 84 adult patients, aged 18 to 85 years, with varying degrees of weight status, including optimal weight, overweight, and obesity. The lifestyle habits, the personal and family history of cardiometabolic diseases, as well the clinical evaluation that included BMI (body mass index), WHR (waist-to-hip ratio), WC (waist circumferance) were performed. PWA evaluation was conducted using the Mobil-O-Graph device, assessing the following parameters: pulse wave velocity (PWV), augmentation index (AIx), heart rate (HR), central pulse pressure (cPP), peripheral and central blood pressure (SBP, DBP, cSBP, cDBP). Body composition analysis was performed using the TANITA BC-418 body analyzer. Laboratory results from the past 3 months were also collected during initial nutritional consultations for each patient. Family history of cardiovascular events showed positive correlations with all PWA parameters, while diabetes history only with PWV and family history of obesity with PWV, DBP, and cSBP. Insufficient sleep duration showed positive associations with all arterial stiffness parameters except cDBP. Smoking status correlated with significantly elevated PWV and Aix values, while insufficient physical activity was associated solely with PWV. Positive correlations were showed between current weight and PWV, while WC demonstrated positive associations with PWV, SBP, and cSBP. Body composition analysis revealed significant associations between trunk adipose tissue mass (%) and PWV, SBP, and cSBP. Hydration status (%) emerged as an independent predictor for PWV, exhibiting an inverse relationship. HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) showed a strong positive correlation with PWV. Negative associations were observed with HDL-c and vitamin D. Threshold values for age, cDBP and Cardiac Index providing positive diagnostic for vascular impairment. The assessment of arterial stiffness can be considered a reliable approach to prevent obesity-related cardiovascular events and facilitate the comprehensive management of such pathologies.

Associations of 24-Hour Central Systolic Blood Pressure With Multiorgan Damage in Nondialysis Patients With Chronic Kidney Disease.

Multiple target-organ damages (TODs) in the same patient are common and further increase the risk of cardiovascular disease. However, the relationship between ambulatory central systolic blood pressure (SBP) and multiple TODs has yet to be explored. MobilO-Graph PWA was used to monitor the participants' ambulatory blood pressure, and the presence of left ventricular hypertrophy, carotid hypertrophy, and kidney injury were used to define TOD. Logistic regression analyses and receiver operating characteristic analyses were used to explore the correlation between SBP and TOD. Overall, 2018 nondialysis patients with chronic kidney disease were included and 580 (28.74%) had multiple TODs. Twenty-four-hour central SBP with c2 calibration exhibited a stronger correlation with the increasing number of TOD compared with 24-hour brachial SBP in ordinal logistic regression analyses. In the multivariable analyses with the presence of multiple TODs, the odds ratios were 1.786 (95% CI, 1.474-2.165; P<0.001) for 24-hour brachial SBP and 1.949 (95% CI, 1.605-2.366; P<0.001) for 24-hour central SBP with c2 calibration. The receiver operating characteristic analyses also showed that 24-hour central SBP with c2 calibration had higher discrimination than 24-hour brachial SBP regarding multiple TODs (P<0.001). In addition, using 130/135 mm Hg as the threshold for 24-hour brachial SBP/central SBP with c2 calibration to cross-classify, the prevalence of multiple TODs was greater in cases of concordant hypertension compared with cases of isolated brachial hypertension and concordant normotension, with no difference between the latter 2 conditions. Twenty-four-hour central SBP with c2 calibration was more associated with the presence of multiple TODs compared with 24-hour brachial SBP and was helpful in risk classification of multiple TODs among nondialysis patients with chronic kidney disease.

Association of cardiovascular risk scores using intra-arterial invasive central and peripheral blood pressure with cardiovascular events in stable coronary artery disease

Association of cardiovascular risk scores using intra-arterial invasive central and peripheral blood pressure with cardiovascular events in stable coronary artery disease

Central blood pressure and peripheral augmentation index following acute submaximal arm versus leg exercise.

Aerobic exercises like running and cycling may lower cardiovascular disease (CVD) risk through favorable effects on central blood pressure and vascular function. Arm ergometry is a popular exercise modality used in rehabilitation settings, but little is known regarding the central hemodynamic and vascular effects of this form of exercise. To compare the acute effects of leg versus arm exercise on central blood pressure and vascular function. Twenty-one participants (n = 11 female, Age 21 ± 3, BMI 24.5 ± 3.2kg/m2) completed two visits to the Human Performance Laboratory. Central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), and peripheral augmentation index (pAIx) were measured using a brachial oscillometric blood pressure cuff with measures being taken before and after 20min of acute moderate-intensity (submaximal) arm or leg cycling exercise. There was a condition-by-time interaction for pAIx (p = 0.011). pAIx slightly increased following arm exercise but significantly decreased following leg exercise. There was a condition-by-time interaction for cDBP (p = 0.011). cDBP significantly decreased following arm exercise but increased immediately following leg exercise. There was no condition-by-time interaction for cSBP (p = 0.721). There were similar acute increases in cSBP immediately post-exercise for both conditions. Arm exercise increased pAlx and decreased cDBP compared to leg exercise. As an increase in pAIx may increase left ventricular work and a reduction in cDBP may reduce coronary perfusion pressure, these findings suggest that a single bout of arm exercise may not have the same favorable acute effect on central hemodynamic load as a single bout of leg exercise.