Evaluation Of Arterial Stiffness Research Articles

Blood Pressure Variability

A series of articles1–4⇓⇓⇓ published recently in The Lancet and Lancet Neurology raise an interesting issue that has implications for both the clinical management of hypertension and future research in hypertension, particularly in the development and use of different classes of blood pressure (BP)–lowering drugs. These studies, which were led by Peter Rothwell at the John Radcliffe Hospital in Oxford, United Kingdom, suggest that, whereas there is undoubted and well-proven benefit in the current practice of reducing mean BP to prevent cardiovascular events, there may be additional benefit in also reducing BP variability (BPV), especially to prevent stroke. The studies suggest, moreover, that different classes of drugs are superior to others in reducing BPV (calcium channel blockers being best and the β-blocker atenolol being worst). However, these articles, by virtue of their sheer volume (≈50 pages of printed text and many pages of supplementary web appendix data), could overwhelm all but the most stoic readers, and misinterpretation of the data could lead to confusion and have an adverse effect on clinical practice. It is important, therefore, to assess the scientific reality and determine how attention to BPV might benefit patients with hypertension. In the first analysis, systolic BPV between visits and maximum BP reached in 4 cohorts of patients with previous transient ischemic attacks were strong predictors for subsequent stroke.1 In treated hypertensive patients in the Anglo-Scandinavian Cardiac Outcome Trial-Blood Pressure Lowering Arm systolic BPV between visits was also a strong predictor of stroke and coronary events independent of mean clinic or ambulatory BP measurement (ABPM). BPV on ABPM was a weaker predictor overall but was related to visit-to-visit variability. Traditional measures of variability, such as SD and coefficient of variation (CV), were used in these analyses, but one of the problems encountered in the …

Application of ROC curve for the evaluation of arterial stiffness and heart function in hypertensive patients by quantitative artery stiffness

To apply the receiver operating characteristic (ROC) curves and QAS technology in exploring sensitive and feasible indices about the structure and function of heart and arterial stiffness so as to determine the optimal operating point (OOP) and evaluate its value of cardiovascular changes in hypertensive patients. The parameters of arterial stiffness and heart function were measured and calculated in hypertensive patients (n = 167) and control (n = 165). The results were compared and critical values obtained by receiver operating characteristic (ROC) curves. Interventricular septal thickness, posterior wall thickness of left ventricle, E/e and Tei of hypertensive group were significantly higher than those of control group (P < 0.05). In hypertensive group, the parameters of arterial stiffness including beta, and PWVbeta were significantly higher than those of control group (P < 0.05). The areas of under the ROC curves were 0.808, 0.843, 0.816, 0.827, 0.779 and 0.632. The sensitivity and specificity of detecting the cardiovascular changes of hypertension for interventricular septal thickness, posterior wall thickness of left ventricle, E/e, Tei, PWVbeta and beta were 78.6%/78.9%, 82.1%/84.2%, 67.9%/89.5%, 100%/52.6%, 82.1%/68.4% and 57.1%/63.2% respectively. The arterial stiffness and heart dysfunction may result from hypertension. Arterial stiffness can be one of monitoring indices in early-stage damage of heart function.

HYPERTENSIVE IMMIGRANTS ARE CHARACTERIZED BY LOWER PREVELANCE OF OBSTRUCTIVE SLEEP APNEA COMPARED TO NATIVE HYPERTENSIVES: A DIFFERENCE BEYOND ARTERIAL STIFFNESS: PP.32.281

Objective: Obstructive sleep apnea syndrome (OSAS) and essential hypertension (EH) are closely associated, while increased arterial stiffness is a marker of diffuse vascular disease. In light of the mass immigration of Eastern European residents, we sought to investigate the prevalence of OSAS along with the assessment of the arterial stiffness within this high risk population Design and Method: We studied 67 Eastern European immigrants with newly diagnosed untreated stage I-II EH (aged = 51.5 ± 15 years, 35 = male, office blood pressure (BP) = 158/92 mm Hg), who immigrated to Greece within the previous two years and 61 untreated hypertensive native inhabitants, matched for age, gender, office BP and smoking status. All participants underwent polysomnography (apnea/hypopnea index >5) and arterial stiffness evaluation on the basis of carotid to femoral pulse wave velocity (c-f PWV) by means of a computerized method (Complior SP), while metabolic profile and anthropometric data were assessed as well. Results: Hypertensive immigrants compared to native ones demonstrated decreased prevalence of OSAS (9.1% vs 12%,p = 0.014) and decreased levels of body mass index (29.3 ± 4 vs 32.2 ± 4 kg/m2,p < 0.05). There was evidence that c-f PWV was elevated in the group of immigrants (8.4 ± 0.3 vs 7.2 ± 0.5 m/sec,p < 0.05). Immigrants also exhibited decreased waist circumference (94 ± 3 vs101 ± 2 cm,p < 0.05). The two groups did not differ with regard to serum glucose and cholesterol levels (99 ± 9 vs102 ± 8 mg/dl and 226 ± 40 vs 228 ± 35 mg/dl, respectively,p = NS in both cases). Analysis of covariance revealed that the prevalence of OSAS and c-f PWV values remained statistically different between the two groups after adjustment for confounding factors (p < 0.05). Conclusions: Hypertensive immigrants demonstrate lower prevalence of OSAS but they seem to have stiffer aorta compared to native hypertensives. Efforts should be directed at this vulnerable population focusing on putative mechanisms for this unfavourable and apparently paradox BP phenotype.

Study on the relations between homodynamic parameters and structure of common carotid artery among the Ethnic She Population, China

To study the changes of intima-media thickness (IMT) in ambi-common carotid arteries (ambi-CCA) and how they correlated with factors related to quality intima-media thickness (QIMT). According to the Chinese Arterial Stiffness Evaluation (CASE) project, the IMT of (ambi-CCA) was measured by QIMT and 2-D ultrasound respectively in 433 She people aged 15 - 87 (mean 49.03 ± 13.54). Difference and tendency were analyzed on age, gender, body mass index (BMI), pulse pressure (PP), total cholesterol (TC), and triglyceride. The whole population was classified into 3 groups by tertiles of pulse pressure. (1) Significant positive correlations were found between ambi-CCA IMT and pulse pressure (P < 0.01). There was no significant difference between tertile1 and tertile 2 of IMT in the left CCA (P > 0.05) found, but with significant difference among the tertile groups, respectively (P < 0.05). There were significant differences among the three groups of IMT in the right CCA, respectively (P < 0.01). (2) The regression factors of IMT in left CCA were age, pulse pressure, weight, LDL-C, blood glucose (BG), TG, and their regression equation was LCC-IMT = 32.61 + 4.29 (age) + 1.77 (PP) + 1.87 (weight) + 16.52 (LDL-C) + 11.77 (BG) - 9.92 (TG), with r = 0.663 and r(2) = 0.44, (P < 0.001). The regression factors of IMT in right CCA were age, PP, height and their regression equation was RCC-IMT = 5.19 (age) + 1.61 (PP) + 2.62 (height) - 219.36, with r = 0.636 and r(2) = 0.41 (P < 0.001). There were differences seen on IMT of CCA in the PP and position and were correlated with age, PP, body weight, LDL-C, BG, TC and body height. The difference of ambi-CCA should be called for attention.

LACK OF CORRELATION BETWEEN THREE INDICES OF ARTERIAL STIFFNESS IN YOUNG HYPERTENSIVE MEN: PP.10.417

Objective: To reveal correlation between three methods of arterial stiffness evaluation in young hypertensive men. Methods: Arterial stiffness was assessed in three groups of young men (18–25 years, mean age 20,9 ± 2,0 years) matching by height and weight: 74 with sustained arterial hypertension (AH), 45 with non-sustained AH, and 15 normotensive subjects. BP status was confirmed with repeated clinic measurement and ambulatory BP monitoring (ABPM). Carotid stiffness index (CS) was assessed as ratio of diastolic and systolic diameter difference and diastolic diameter of common carotid artery (Vivid 7, GE). Aortic pulse wave velocity (PWV) was measured between carotid and femoral artery with Sphygmocor device (AtCor, Australia). Ambulatory arterial stiffness index (AASI) was assessed on ABPM. Spearman's Rank Correlation test was done to evaluate correlation between the three methods of arterial stiffness measurements. Results: In normotensive subjects PWV was 8,6 ± 1,5 m/s, AASI 0,43 ± 0,14, CS 15,8 ± 2,5%. In those with non–sustained AH 8,3 ± 1,2 m/s, 0,47 ± 0,15, 16,0 ± 3,5%, respectively, and in subjects with sustained AH 9,2 ± 1,2 m/s, 0,51 ± 0,16, 14,4 ± 4,6%. Significant correlation was found between CS and AASI r = 0,26, p = 0,006 in all subjects. This correlation was stronger in subjects with sustained AH (r = 0,41, p = 0,0009). Conclusion: The obvious trend for lower arterial elasticity indices was found in young hypertensive men. No correlation between PWV as “gold standard” measure of arterial stiffness and other proposed arterial stiffness indices was found.

Vascular calcification in chronic kidney disease

VC (vascular calcification) is highly prevalent in patients with CKD (chronic kidney disease), but its mechanism is multifactorial and incompletely understood. In addition to increased traditional risk factors, CKD patients also have a number of non-traditional cardiovascular risk factors, which may play a prominent role in the pathogenesis of arterial calcification, such as duration of dialysis and disorders of mineral metabolism. The transformation of vascular smooth muscle cells into chondrocytes or osteoblast-like cells seems to be a key element in VC pathogenesis, in the context of passive calcium and phosphate deposition due to abnormal bone metabolism and impaired renal excretion. The process may be favoured by the low levels of circulating and locally produced VC inhibitors. VC determines increased arterial stiffness, left ventricular hypertrophy, a decrease in coronary artery perfusion, myocardial ischaemia and increased cardiovascular morbidity and mortality. Although current therapeutic strategies focus on the correction of phosphate, calcium, parathyroid hormone or vitamin D, a better understanding of the mechanisms of abnormal tissue calcification may lead to development of new therapeutic agents, which could reduce VC and improve cardiovascular outcome in CKD patients. The present review summarizes the following aspects: (i) the pathophysiological mechanism responsible for VC and its promoters and inhibitors, (ii) the methods for detection of VC in patients with CKD, including evaluation of arterial stiffness, and (iii) the management of VC in CKD patients.

EFFICACY AND SAFETY OF AMLODIPINE MALEATE IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND BRONCHIAL ASTHMA WITH CONCOMITANT ARTERIAL HYPERTENSION

Aim. To evaluate efficacy and safety of amlodipine maleate in patients with chronic obstructive pulmonary disease (COPD), bronchial asthma (BA) and concomitant arterial hypertension. Methods. Patients (n=40) with COPD (n=20) or BA (n=20) and hypertension of 1-2 degree were examined. Amlodipine maleate was used as antihypertensive drug. The spirometry, ambulatory blood pressure monitoring, vascular oscillometry (evaluation of arterial stiffness), vascular Doppler imaging (evaluation of endothelial function) was performed initially and in 6 months of treatment. Results. The high efficacy of amlodipine maleate as antihypertensive drug was found in patients with COPD or BA and hypertension without dependence on bronchial obstruction severity. The positive influence of amlodipine on endothelial function and vascular rigidity was also observed. Conclusion: study results confirm the rationales of amlodipine use in patients with COPD or BA and hypertension.

Central blood pressure, arterial stiffness, and wave reflection: New targets of treatment in essential hypertension

Central blood pressure is dependent on the stiffness of large arteries and pulse wave reflection. These parameters are very important in the development of hypertensive target organ disease. Moreover, recent clinical studies have shown their independent predictive value for cardiovascular morbidity and mortality. Therefore, 2007 guidelines for the management of hypertension inserted the evaluation of central arterial stiffness as an important component for assessing total cardiovascular risk. Differences in the way various antihypertensive drugs affect arterial stiffness and central hemodynamics may explain the greater cardio-vascular protection provided by newer drugs (eg, renin-angiotensin system blockers or calcium channel blockers) independent of peripheral blood pressure reduction, as shown by recent clinical studies. However, the predictive value of the attenuation of arterial stiffness, wave reflections, and central blood pressure still needs to be confirmed in prospective, long-term, large-scale therapeutic trials. Thus, whether these measurements should be routinely performed as a diagnostic or therapeutic indicator remains debatable.

INFLUENCE OF ANTIHYPERTENSIVE DRUGS ON ARTERIAL STIFFNESS IN PATIENTS WITH ARTERIAL HYPERTENSION

Results of studies devoted to effects of various antihypertensive drugs on arterial stiffness in patients with arterial hypertension are presented. Advantages of angiotensin converting enzyme inhibitors and angiotensin receptor blockers are shown. Results of comparative studies on influence of combined therapy and monotherapy on arterial stiffness in hypertensive patients are also reviewed. Standard methods of arterial stiffness evaluation are estimated as mostly appropriate ones.

Assessment of pulse wave velocity

Summary Measurement of pulse wave velocity is of increasing importance for assessment of arterial stiffness and risk evaluation. Different techniques are available, based either on pressure, distension or Doppler waveforms. Techniques not only differ by the algorithm used to identify specific part of the pulse signal, but also in the preferred way to measure distance between sites. The merits of each technique are described, and a brief overlook of the marketed devices to measure pulse wave velocity is given.

Evaluation of arterial stiffness and cardiovascular risk stratification in a general population in Northern Italy. The Vobarno Study

Evaluation of arterial stiffness and cardiovascular risk stratification in a general population in Northern Italy. The Vobarno Study

Brachial-ankle pulse wave velocity: a new method for clinical evaluation of arterial stiffness compared with carotid-femoral pulse wave velocity

Brachial-ankle pulse wave velocity: a new method for clinical evaluation of arterial stiffness compared with carotid-femoral pulse wave velocity

Age and gender related patterns in carotid-femoral PWV and carotid and femoral stiffness in a large healthy, middle-aged population

The relationship between aortic (carotid-femoral) pulse wave velocity and stiffness measures based on local diameter and pressure readings is not yet fully understood. We compared the relationship with age and gender of aortic pulse wave velocity to stiffness indices (compliance and distensibility coefficient) evaluated at the common carotid and femoral arteries in 2195 (1131 women) apparently healthy subjects, aged 35-55 years participating in the Asklepios study. Aortic pulse wave velocity was further compared with previously reported central arterial stiffness parameters on the same population. Subjects were divided into four age groups for analysis. Femoral arterial stiffness was higher in men than in women (P < 0.001) but did not change with age and no age-gender interaction was evident. Carotid arterial stiffness increased with age (P < 0.001) and showed a significant (P < 0.001) age-gender interaction, with carotid stiffness increasing more rapidly in women than in men, crossing over around the age of 45. Aortic pulse wave velocity did not differ between men and women, but did increase with age (P < 0.001). No age-gender interaction was evident. The relation with age and gender of local and central stiffness measures is not the same over the age range 35-55 in apparently healthy men and women. Depending on the central stiffness parameter used, age-gender effects evident at the carotid artery are or are not found centrally. Though the relevance of these differences requires further evaluation in a longitudinal study with outcome data, they need to be kept in mind when designing or interpreting results from arterial stiffness evaluation studies.

Ambulatory Arterial Stiffness Index or Pulse Pressure: Which Correlates Better with Arterial Stiffness in Resistant Hypertension?

The ambulatory arterial stiffness index (AASI) is a recently proposed index derived from 24-h ambulatory blood pressure monitoring (ABPM) for the evaluation of arterial stiffness. In this cross-sectional study we investigated whether AASI reflects arterial stiffness in patients with resistant hypertension by comparing AASI and ambulatory pulse pressure (PP) with aortic pulse wave velocity (PWV), a measure of arterial stiffness, in 391 resistant hypertensives. Clinical, laboratory and echocardiographic variables, 24-h ABPM and aortic PWV (measured using the Complior device) were obtained. AASI was calculated as 1--the regression slope of 24-h diastolic on systolic blood pressure (BP). Statistical analysis involved single and multiple linear regressions to assess the correlations between the two ABPM variables and PWV, both unadjusted and adjusted for potential confounders (age, gender, body height, presence of diabetes, 24-h mean arterial pressure [MAP], heart rate, and nocturnal BP reduction). Ambulatory PP and aortic PWV were independently associated with age, gender, presence of diabetes, and 24-h MAP, whereas AASI was associated with age, diabetes, and nocturnal diastolic BP reduction. PP showed stronger unadjusted (r=0.39, p<0.001) and adjusted (r=0.22, p<0.001) correlations with aortic PWV than AASI (r=0.12, p=0.032 and r= -0.04, p=0.47, respectively). In the analysis of subgroups stratified by gender, age, presence of atherosclerotic diseases and diabetes, dipping pattern, and ambulatory BP control, the superiority of PP over AASI was apparent in all subgroups. In conclusion, 24-h ambulatory PP was better correlated to arterial stiffness, as evaluated by aortic PWV, than the novel AASI, in patients with resistant hypertension.

Arterial Stiffness Evaluation by SphygmoCor and Arteriograph

Arterial Stiffness Evaluation by SphygmoCor and Arteriograph

P40 Evaluation of arterial stiffness and endothelial function in patients with systemic lupus erythematosus

P40 Evaluation of arterial stiffness and endothelial function in patients with systemic lupus erythematosus

Non-invasive evaluation of arterial stiffness in patients with increased risk of cardiovascular morbidity: A cross-sectional study

Objectives: Cardiovascular disease (CVD) is associated with a generalized atherosclerotic process that begins in the large arteries, representing vascular pathology leading to increased cardiovascular morbidity and mortality. Pulse wave velocity (PWV) is a simple, accurate, reproducible and a good prognostic marker of arterial stiffness. Testing arterial stiffness with non-invasive techniques provides an opportunity to evaluate large patient populations with cardiovascular risk. Therefore, the aim of the present study was to evaluate non-invasively the arterial stiffness (AS) in patients with high cardiovascular risk. Materials and Methods: Totally 3969 subjects [CAD - 845, DM - 973, ESRD - 942, RA - 221 and 988 age-matched healthy controls] were enrolled in the study approved by the IEC, NIMS; and all the subjects gave written informed consent to participate. Pulse wave velocity was determined non-invasively by PeriScope (M/S Genesis Medical Systems, Hyderabad, India). Results: In patients with CAD, DM, ESRD and RA, heart rate (HR), blood pressure (BP) and PP were significantly more than healthy controls. Peripheral and central arteries' PWVs were higher in these patients' group. The mean HR was maximum in RA patient, while systolic blood pressure (SBP) was highest in ESRD patient. There was a good correlation between ba PWV and PP in all patients' group and healthy controls except RA patients. Conclusion: Our study findings emphasize the importance of the PWV in identifying the vascular damage in patients with high CV risk. Increased PWV was found to be a good independent predictor of cardiovascular morbidity.

Angiotensin II Receptor Antagonists Supplementation is Associated with Arterial Stiffness: Insight from a Retrospective Study in 116 Peritoneal Dialysis Patients

Background. Brachial-ankle pulse wave velocity (baPWV), a non-invasive waveform analysis, is a useful tool for the vascular evaluation of arterial stiffness. Increased baPWV values have been found increased in patients with arterial stiffness. The aim of this study was to investigate retrospectively the association between arterial stiffness and the common medications used in peritoneal dialysis patients. Methods. In all, 116 peritoneal dialysis patients (35 males and 81 females) received peritoneal dialysis for more than four months. Patients who had dialysis-related peritonitis or other infection within six months prior to this study, inflammation disease, fasting serum sugar ≥126 mg/dL, and/or use of oral hypoglycemic agents or insulin injections were excluded. The medications that were enrolled in our study were calcium-containing phosphate binders, vitamin-B complex, folic acid, and antihypertensive medications. baPWV was determined using an automated, non-invasive, waveform analysis device. Results. In a step-wise multiple linear regression analysis, baPWV correlated independently with systolic blood pressure (t = 8.4, p < 0.001) and age (t = 5.5, p < 0.001), and inversely correlated with body mass index (t = −3.19, p = 0.002) and the use of angiotensin II receptor antagonists (t = −2.35, p = 0.021). Conclusion. In this retrospective study of peritoneal dialysis patients, we found that angiotensin II receptor antagonists (ARBs) in peritoneal dialysis patients may be an independent factor for arterial stiffness. Hence, we suggest that compared with other antihypertensive drugs, ARBs may be a good choice for lowering arterial stiffness in PD patients. However, further studies on the optimal treatment of arterial stiffness in peritoneal dialysis patients are warranted.

Monitoring vascular health beyond blood pressure

It is well recognized that vascular changes, including atherosclerosis, begin early in life as a silent, asymptomatic disease process and are associated with cardiovascular (CV) risk factors. Importantly, CV risk factors persist or track from childhood to adulthood and are predictive of CV disease risk in adults. Evaluation of arterial stiffness and its predictors may help identify asymptomatic individuals at risk, before blood pressure is elevated above an "arbitrary" level that we currently identify as hypertension. Currently, measurements of arterial stiffness are being used in the research setting and also as part of cardiovascular risk prediction clinics. As the various techniques become more widely available, it is conceivable that the measurement of arterial stiffness could become an important part of the routine assessment of patients in daily practice, as a supplement to blood pressure measurement. Measurement of arterial stiffness will not only be helpful in the detection of early vascular disease but also will be a tool in the follow-up monitoring of strategies aimed at preventing hypertension or reducing further progression of vascular disease before blood pressure elevation can be detected.

From 24-Hour Blood Pressure Measurements to Arterial Stiffness

The articles by Li et al1 and Dolan et al,2 in this issue of Hypertension and focused on the development of a new approach to estimate arterial stiffness, highlight the role of arterial mechanical properties in the determination of cardiovascular risk. In the past, arterial stiffening and increases in systolic blood pressure (SBP) and pulse pressure (PP) have been considered a part of normal aging, and no treatment for these alterations has been proposed. The pathophysiology, structural bases, and determinants of arterial stiffness have been extensively studied these last years.3–5 Although arterial stiffening is a common situation, it has now been confirmed that aortic stiffness is an independent predictor for total and cardiovascular mortality, coronary morbidity—mortality, and fatal stroke in patients with essential hypertension, diabetes mellitus, or end-stage renal failure, and in the general population in the elderly.6,7 It is therefore important to identify subjects who are at higher risk for developing arterial stiffness with aging and determine the environmental and genetic factors that can accelerate arterial stiffening. In recent years, several devices have been developed for the evaluation and measurement of arterial stiffness. Arterial stiffness can be quantified by the measurement of several parameters such as cross-sectional arterial distensibility and compliance, pulse wave velocity (PWV), analysis of pulse wave contours (mainly augmentation index and reflection waves), measurements of elastic modulus, stress-strain relationships, etc. During the past 5 years, among these approaches, PWV and augmentation index (AI) have become the most reliable for the evaluation of arterial stiffness in clinical and epidemiological studies.8 PWV depends mainly on the mechanical properties of large …