Higher Pulse Pressure Research Articles

Pulse pressure and the risk of renal hyperfiltration in young adults: Results from Korea National Health and Nutrition Examination Survey (2010-2019).

BackgroundHigh pulse pressure (PP) is associated with increased risk of decline of kidney function. However, little is known about the association between PP and RHF in young adults. This study aimed to evaluate the association between PP and RHF in healthy young adults.MethodsData were retrieved from the Korea National Health and Nutrition Examination Survey from 2010 to 2019. A total of 10,365 participants aged 19–39 years with no hypertension and normal kidney function were analyzed. RHF was defined as logarithm transformed estimated glomerular filtration rate (eGFR) with residuals >90th percentile after adjustment for sex, logarithm transformed age, weight, and height. Participants were divided into tertile based on PP levels.ResultsThe prevalence of RHF was higher in higher PP tertile group (6.6, 10.5, and 12.7% in T1, T2, and T3; P for trend < 0.001). In multivariable logistic regression analyses, the risk for RHF was increased in higher PP tertiles compared to the lowest tertile [odds ratio (OR), 1.42; 95% confidence interval (CI), 1.19–1.69 in T2; OR, 1.44; 95% CI, 1.20–1.73 in T3]. When PP levels were treated as continuous variable, the risk of RHF was increased 2.36 per 1.0 increase of PP (P < 0.001). In subgroup analyses stratified sex, histories of diabetes or dyslipidemia, and isolated systolic hypertension or isolated diastolic hypertension, there were no significant interactions with PP for the risk for RHF, suggesting that high PP was associated with increased risk of RHF regardless of subgroups. However, the subgroup with BMI showed significant interaction with PP for the risk of RHF, indicating that participants with BMI ≥ 25 kg/m2 were at higher risk of RHF with increasing PP levels than those with BMI < 25 kg/m2 (OR, 1.89; 95% CI, 1.25–2.87 in BMI < 25 kg/m2; OR, 3.16; 95% CI, 1.74–5.73 in BMI ≥ 25 kg/m2; P for interaction = 0.01).ConclusionHigh PP is associated with an increased risk of RHF in healthy young adults and this association is prominent in obese young adults. The assessment of PP and associated RHF may give benefit to early detect the potential risk of CKD development in young adults.

Interactive Effects of Pulse Pressure and Tau Imaging on Longitudinal Cognition.

Studies have demonstrated that both tau and cardiovascular risk are associated with cognitive decline, but the possible synergistic effects of these pathologic markers remain unclear. To explore the interaction of AD biomarkers with a specific vascular risk marker (pulse pressure) on longitudinal cognition. Participants included 139 older adults from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Biomarkers of tau, amyloid-β (Aβ), and vascular risk (pulse pressure) were assessed. Neuropsychological assessment provided memory, language, and executive function domain composite scores at baseline and 1-year follow-up. Multiple linear regression examined interactive effects of pulse pressure with tau PET independent of Aβ PET and Aβ PET independent of tau PET on baseline and 1-year cognitive outcomes. The interaction between pulse pressure and tau PET significantly predicted 1-year memory performance such that the combined effect of high pulse pressure and high tau PET levels was associated with lower memory at follow-up but not at baseline. In contrast, Aβ PET did not significantly interact with pulse pressure to predict baseline or 1-year outcomes in any cognitive domain. Main effects revealed a significant effect of tau PET on memory, and no significant effects of Aβ PET or pulse pressure on any cognitive domain. Results indicate that tau and an indirect marker of arterial stiffening (pulse pressure) may synergistically contribute to memory decline, whereas Aβ may have a lesser role in predicting cognitive progression. Tau and vascular pathology (particularly in combination) may represent valuable targets for interventions intended to slow cognitive decline.

The relationship between pulse pressure with plasma PCSK9 and interleukin-6 among patients with acute ischemic stroke and dyslipidemia

Background and purposeA high plasma concentration of proprotein convertase subtilisin/kexin type 9 is characteristic of a prothrombotic state in cardiovascular diseases. Elevated inflammatory markers, such as interleukin-6, are associated with worse outcomes after ischemic stroke. We aimed to study the role of plasma PCSK9 and IL-6 in acute ischemic stroke with dyslipidemia. MethodsWe divided 123 enrolled patients with first-ever acute ischemic stroke into normotensive and high blood pressure groups and further into high and low pulse pressure subgroups. Clinical characteristics and inflammatory and metabolic parameters, including plasma PCSK9 and IL-6, were recorded. ResultsAfter the analysis of the normotensive and BP groups, there were positive correlations between PP and carotid stenosis (P = 0.031) and plaque numbers (P = 0.013) and between National Institute of Health Stroke Scale scores (P = 0.019) and carotid stenosis severity (P = 0.021) and resistance index (P = 0.04). There was a significant association between plasma cholesterol and PCSK9 (P = 0.044) in the low PP subgroup and IL-6 (P = 0.042) in the high PP subgroup. ConclusionsOur findings indicated that plasma PCSK9 levels were associated with the low PP subgroup, while IL-6 was associated with the high PP subgroup. Dyslipidemia control is also necessary for those who had a stroke and who have high PP. Further investigation to assess the role of PCSK9 and IL-6 in patients with stroke is required for early treatment and secondary prevention.

Reducing Risk for Acute Kidney Injury After Living Donor Hepatectomy by Protocolized Fluid Restriction: Single-Center Experience

BackgroundAcute kidney injury (AKI) is a potential complication after restricted fluid therapy for major surgery. The aim of this study was to evaluate the incidence of AKI for living liver donor hepatectomy in which applied intraoperative protocolized fluid restriction was used targeting a low central venous pressure (CVP) level with high pulse pressure variation (PPV) and systolic pressure variation (SPV). Material and MethodsLiving liver donors were admitted for this retrospective observational study. Low CVP <5 mm Hg with high PPV<20% and SPV<15% were the targets of the clinical protocol to reduce intraoperative blood loss via protocolized fluid management until the end of the hepatic parenchymal division. KDIGO criteria were used for AKI definition. The SPSS version 11.5 program was used for statistical analysis. ResultsThe study included 130 patients, 79 (60.8%) men and 51 (39.2%) women, with from 18 to 58 years of age. Donors underwent right and left lobe hepatectomies (116 and 14, respectively). The baseline CVP, the lowest CVP of hepatectomy, and the highest CVP measured after hepatectomy were 7.45 ± 2.41, 4.28 ± 1.12, 7.67 ± 2.09 mm Hg, respectively. Only 4 patients with right lobe hepatectomy developed AKI stage I (3.1%) in the first 24 hours. The 4 patients were recovered at 48 hours postoperatively. ConclusionThis study demonstrated that a CVP target of <5 mm Hg and high PPV/SPV via a simple fluid management modality with protocolized-fluid restriction until the procurement may not cause AKI in living liver donors in a closed follow-up anesthesia approach.

Accuracy Analysis of Sports Performance Prediction Based on BP Neural Network Intelligent Algorithm

With the increasing attention and popularity of competitive sports, the continuous progress of artificial intelligence, and deep learning theory, people’s sports performance prediction technology for professional athletes or sports students is also developing. Accurate and effective prediction can help athletes and students to carry out more targeted training, so as to further improve their performance. BP neural network (BPNN) is a multilayer feedforward neural network (NN). Therefore, based on the BPNN algorithm, this work conducts a deep research on the prediction of sports performance. First of all, this work uses the three-layer structure of BPNN to design the algorithm and then selects the weight, oxygen saturation, systolic and diastolic blood pressure, the previous best score, the worst score in the past period, and the average score of one week before the examination as the feature vector of the input sample. The students’ scores of two classes of physical education major in a university are selected as the prediction objects, and the time period of students’ relevant information data is selected from September 2018 to December 2018. The quantity of hidden units is calculated to be 15 by training. After the successful construction of BPNN sports performance estimation method, the PSO search approach is utilized to enhance the BPNN sports performance prediction model. Finally, the relationship between the two classes’ performance and the students’ performance is analyzed. 49% of the total number of times the error of class A was predicted to be 0, and the number of times that the error of class B was 0 was 50%, 58%, and 75%, respectively. There is no strong linear correlation between sports performance and body weight, but a high correlation systolic, pulse pressure, and plasma oxygen levels. This shows that the BPNN sports prediction model established in this work has high accuracy in predicting sports performance.

TEVAR and EVAR, the unknown knowns of the cardiovascular hemodynamics; and the immediate and long-term consequences of fabric material on major adverse clinical outcome.

This review discusses the impact of endovascular aneurysm repair on cardiovascular (CV) hemodynamics and the role of stent-graft material, i.e., polytetrafluoroethylene (PTFE) vs. polyester in post-procedural outcomes. Endovascular aneurysm repair has been widely employed in the last decades for thoracic and abdominal aneurysm repair. However, aortic endografts are stiff and alter the native flow hemodynamics. This failure to simulate the native aorta could lead to added strain on the heart, manifesting as increased left ventricular strain, higher pulse pressure, and congestive heart failure later. This could result in adverse CV outcomes. Also, evidence is mounting to support the implication of stent-graft materials, i.e., PTFE vs. polyester, in adverse post-procedural outcomes. However, there is an absence of level one evidence. Therefore, the only way forward is to plan and perform a randomised controlled trial to demonstrate the alterations in the CV hemodynamics in the short and long run and compare the available stent-graft materials regarding procedural and clinical outcomes. We believe the best solution, for now, would be to reduce the stented length of the aorta. At the same time, in the longer term, encourage continuous improvement in stent-graft materials and design.

Natriuretic peptides, extracellular volume, and subclinical cardiovascular changes in chronic kidney disease stages 1–3: a pilot study

Natriuretic peptide levels are elevated in persons with chronic kidney disease (CKD) stages 1–3, but it remains unclear whether this is associated with extracellular volume excess or early cardiovascular changes....

CARDIOVASCULAR RISK AND SUBCLINICAL TARGET ORGAN DAMAGE IN A YOUNG ADULT POPULATION PROVIDED BY A PRIMARY HEALTHCARE UNIT

Objective: To evaluate cardiovascular (CV) risk factors and subclinical target organ damage in a young and apparently healthy population assisted in a Primary Healthcare unit Design and method: A cross-sectional population study for CV risk assessment in adults aged 20–50 years old provided by a Primary Healthcare Unit. A total of 632 individuals were evaluated (40% male; mean age 36 ± 9 years). Sociodemographic, anthropometric data, and traditional CV risk factors were recorded. All underwent office Blood Pressure (BP) and pulse pressure (PP) (systolic BP minus diastolic BP) was calculated. Ankle-brachial index (ABI) was also calculated after BP measurements in the 4 limbs. The median of the ABI was 1.14 [1.08–1.22], which is the cutoff point used to define early changes. All participants were submitted to ECG to calculate Sokolow-Lyon Index (SLI) and Cornell Voltage Index (CVI) for left ventricular hypertrophy diagnosis. We considered the median of the SLI (20 mm) and the CVI (11 mm) as the cutoff point for early alterations. Results: The prevalence of hypertension was 16%. The median [IQR] office PP was 46 [39–52] mmHg. Elevated Office PP (&gt; 60 mmHg) were identified in 64 participants. High office PP was more frequent in men, obese, with increased neck circumference and lower ABI (1.07 vs 1.16, p &lt; 0.001). It was also associated with higher voltage index: SLI 21.9 vs 19.8, p = 0.04 and CVI 13.4 vs 7.1, p = 0.03. Individuals with decreased ABI are more obese with smaller neck circumference (10 vs 5%, p = 0.03). They also had higher systolic BP (125 vs 119 mmHg, p &lt; 0.001) and PP (49 vs 43 mmHg, p &lt; 0.001). A total of 362 ECGs were performed. Increased SLI was more frequent in men, younger and overweight, in addition to a higher prevalence of hypertension and higher PP. Those with increased CVI are more often male, obese with higher BP levels. Conclusions: In this young population, early changes in subclinical target organ damage already identify a higher CV risk profile, indicating the importance of implementing primary prevention measures to reduce this risk.

The Relationship between Pulse Pressure and Periodontal Disease in Korean Populations with or without Hypertension

Aims: This study evaluated the relationship between pulse pressure (PP) and periodontal disease in Korean adults with or without hypertension (classified as HTN and non-HTN, respectively). Methods: Data on 3496 adults (≥20 years) were obtained from the Korean National Health and Nutrition Examination Survey (2015). We classified those with HTN as SBP ≥ 140 mmHg, DBP ≥ 90 mmHg, or current use of anti-hypertensive medications. Results: There were a few key findings: when logistic regression analysis was applied for periodontal disease (community periodontal index score ≥ 3), the odds ratios (OR) were significantly higher in the high PP (PP &gt; 60 mmHg) than in the normal PP (PP ≤ 60 mmHg) in the HTN group (OR, 2.131; 95% confidence interval (CI), 1.579–2.876). However, periodontal disease was not associated with high PP in the non-HTN group and was not significant (OR, 0.866; 95% CI, 0.494–1.518). Conclusions: In Korean adults, periodontal disease was positively associated with PP in the HTN group but not in the non-HTN group.

Formation Principle and Characteristics of Self-Supercharging Pulsed Water Jet

High-pressure pulsed water jet technology has considerable development potential in the field of rock fragmentation. To overcome the shortcomings of existing pulsed jets, a self-supercharging pulsed water jet (SSPWJ) generation method is proposed, which is based on the theory of the pulsed water jet and the principle of hydraulic boosting. The proposed method changes the flow direction of the fluid medium through the valve core to make the piston reciprocate in the cylinder and relies on the effective area difference between the front and rear chambers in the stroke stage of the piston to realize the organic combination of “pulse” and “supercharging” of the jet, thus forming an SSPWJ. On the basis of the formation principle of the SSPWJ, a SSPWJ testing platform was constructed, and tests were performed on the jet pressure acquisition, morphology capture, and granite erosion. Both the jet pressure and the jet morphology exhibited periodic changes, and a higher pulse pressure was obtained at lower inlet pressure. The error of the pressure ratio calculated according to the experimental results was <3% relative to the theoretical design value, confirming the feasibility of the method. The pulse pressure and pulse frequency are controllable; that is, as the inlet flow rate increases in the stroke stage of the piston, the pulse pressure and pulse frequency increase, and the pulse duration decreases. As the inlet flow rate increases in the backward-stroke stage of the piston, the pulse frequency increases, and the pulse pressure and pulse duration remain unchanged. Under the combined action of the water-hammer pressure, high-speed lateral flow, and high-frequency dynamic load of the SSPWJ, local flaky exfoliation was observed when the granite surface was eroded. The results of this study lay the foundation for enriching the theory of pulsed jet generation and expanding its application range.

Elastin Insufficiency Accelerates Age‐Related Impairment of Renal Hemodynamics

Gradual loss of functional elastin fibers during aging leads to increased arterial stiffening and decreased compliance. Elastin insufficiency in mice and humans has been shown to be associated with arteriopathy and the development of hypertension. However, it is unclear whether elastin insufficiency in the resistance vasculature, as occurs in the renal vascular bed, contributes to age‐related decline in renal function. We hypothesized that elastin insufficiency exacerbates age‐related impairment of renal hemodynamics by accelerating functional and structural changes of the renal microvasculature. We assessed renal hemodynamics in anesthetized young (4‐6‐month‐old) and old (14–16‐month‐old) female wild‐type (WT) and elastin heterozygous (Eln+/‐) mice. Renal autoregulation was assessed by a stepwise increase in renal perfusion pressure (RPP) by simultaneously occluding the superior mesenteric and celiac arteries. Autonomic activity was clamped by continuous infusion of a cocktail containing vasoactive hormones. Baseline systolic blood pressure (SBP; 91.1±4.2 vs 90.1±3.1mmHg) and renal vascular resistance (RVR; 13.1±2.4 vs 10.0±1.5 mmHg/μL/min/g left kidney weight) were elevated in old versus young WT mice. Renal blood flow (RBF; 7.3±1.7 vs 9.8±1.4 μL/min/g left kidney weight), renal plasma flow (RPF; 5±1.2 vs 6±1mL/min/g left kidney weight) and glomerular filtration rate (GFR), all trended lower in old WT mice compared to young WT mice. However, in Eln+/‐mice, SBP was lower in old mice (78.2±9.4 vs 104.6±4.9mmHg), while RVR (13.5± 2.6 vs 14.4±1.1), RBF (6.7±1.2 vs 7.5±0.6), RPF (4.2±0.7 vs 4.5±0.3) and GFR were all similar between young and old mice. Increasing RPP caused a robust RVR and RPF response in young vs old WT mice. In contrast, the maximal changes in RBF (5.8±0.6 vs 5.5±1 μL/min/g left kidney weight), RVR (23.8±2.5 vs 21.8±7.0 mmHg/μL/min/g left kidney weight) were less robust and similar between young and old Eln+/‐mice. Autoregulatory index average values were closer to 0 in young and old Eln+/‐and old WT miceindicating greater impairment of renal autoregulation compared to young WT mice. Correlation analysis between pulse pressure and RBF showed that a high pulse pressure was more positively correlated to high RBF in young and old Eln+/‐mice as well as old WT mice. Together, our data demonstrate that elastin insufficiency accelerates age‐related impairment of renal hemodynamics and autoregulation likely mediated by functional and structural remodeling of the renal microvasculature.

Specifics of daily blood pressure monitoring in patients with systemic hypertension and obstructive sleep apnoea: a case-control study

Background. The comorbidity of arterial hypertension (AH) and obstructive sleep apnea syndrome (OSA) is becoming increasingly common in clinical practice. However, the priority strategy for selecting antihypertensive therapy in such patients is yet to be defined. 24-hour blood pressure monitoring is important for determining an approach to controlling hypertension.Objectives. To study specific features of 24-hour blood pressure monitoring in comorbid AH– OSA patients.Methods. A total of 130 AH patients were surveyed. The main cohort (1) included AH–OSA patients (n = 90, mean age 54.93 ± 1.04 years), control cohort (2) — non-OSA AH patients (n = 40, mean age 57.92 ± 1.29 years). All patients had a general clinical examination with 24-hour blood pressure monitoring. OSA was verified in overnight respiratory polygraphy using an Alice PDx diagnostic appliance (USA).Results. The following specific features of 24-hour blood pressure monitoring were identified in the comorbid patients: a statistically significant growth of mean 24-hour systolic and average BP, as well as mean nocturnal systolic, diastolic and average BP; a statistically significant growth of mean 24-hour systolic, diastolic and average BP load indices. In addition, the AH-OSA patients had the statistically higher pulse pressure, systolic and average BP variability, as well as morning BP surge rate. The 24-hour BP dynamics in OSA patients had predominant morbid profiles and higher non-dipper and night-peaker rates compared to the control cohort.Conclusion. The identified specific features reflect a high risk of adverse cardiovascular events in AH–OSA comorbid patients, an earlier damage of target organs and negative prognosis of comorbidity, which warrants a further analysis of AH-specific clinical picture and personalisation of blood pressure control measures in such patients.

Prospective 5-year follow-up of patients with acute coronary syndrome and percutaneous coronary intervention

Background. The study of predictors that negatively affect the long-term prognosis of patients with an increased risk of coronary syndrome can improve the effectiveness of measures for the secondary prevention of cardiovascular events.&#x0D; Aim. To determine the factors that have a negative impact on 5-year survival in patients with acute coronary syndrome and percutaneous coronary intervention.&#x0D; Material and methods. 135 patients with acute coronary syndrome enrolled in the Register of percutaneous coronary interventions in 20122013 at the Tyumen Cardiology Center, a branch of the Tomsk Research Institute of Cardiology of the Russian Academy of Sciences, were included in the study. After 12 and 60 months, the clinical status of patients and ongoing drug therapy were evaluated, and an examination including echocardiography with an ultrasound scanner, daily monitoring of the electrocardiogram and standard blood pressure measuring was performed. Laboratory studies included general and biochemical blood tests. To calculate the factors associated with poor prognosis, a Cox proportional hazards regression model with stepwise inclusion was used. Survival was assessed by the KaplanMeier method using the Log-rank test (logarithmic test).&#x0D; Results. After 1 year, only three-quarters of patients continued the recommended drug therapy, a similar trend continued after 5 years of follow-up. The number of patients without any antiplatelet therapy increased from 19.9% after 12 months to 29.7% after 60 months. Overall survival after 1 year was 97.1%, after 5 years 86.7%. The risk of death increased in the presence of chronic kidney disease (risk ratio 15.1; 95% confidence interval 4.3052.93; p=0.001); type 2 diabetes mellitus (risk ratio 3.67; 95% confidence interval 1.1811.43; p=0.025), history of stroke (risk ratio 9.07; 95% confidence interval 1.8544.60; p=0.007), in patients with a heart rate 80 beats per minute [risk ratio 4.3; (95% confidence interval 1.5112.26; p=0.006) and at pulse pressure 60 mm Hg (risk ratio 4.68; 95% confidence interval 1.6013.72; p=0.005)].&#x0D; Conclusion. The predictors that influenced the 5-year survival of patients after acute coronary syndrome and percutaneous coronary intervention were chronic kidney disease, diabetes mellitus, a history of stroke, high pulse pressure, and increased heart rate of more than 80 beats per minute.

Pulse pressure is associated with cognitive performance in Japanese non-demented population: a cross-sectional study

BackgroundGrowing evidence suggests that vascular risk factors, especially hypertension, relate not only to cardiovascular disease but also to cognitive impairment. However, the impact of pulse pressure on cognitive function remains controversial. In this study, we evaluated the associations between pulse pressure and cognitive function in a Japanese health examination cohort using propensity matching analysis.MethodsWe examined 2,546 individuals with a mean age of 60.8 ± 10.3 years who voluntarily participated in health examination. Clinical variables included pulse pressure, and brain magnetic resonance imaging (MRI). We divided the participants into the high and low pulse pressure groups with a pre-defined cut-off value of 65 mmHg and evaluated their physical examination data, cognitive functions including Okabe’s test, Kohs’ test, and silent brain lesions using propensity matching. To clarify whether pulse pressure and blood pressure have different implications for cognitive function, a mediating analysis was also conducted.ResultsFrom the 2,546 subjects, 439 (17.2%) were in the high PP group. The propensity matching algorithm produced 433 pairs of patients with similar propensities. Higher pulse pressure corresponded to lower Okabe and Kohs’ scores (44.3 ± 7.1 vs 42.7 ± 7.5; p = 0.002, 97.9 ± 18.0 vs 95.0 ± 18.1 p = 0.019, respectively). The relationship between pulse pressure and cognitive impairment was not significantly mediated by systolic blood pressure. We observed no significant associations between silent brain lesions and pulse pressure.ConclusionHigh pulse pressure was associated with lower cognitive performance without systolic blood pressure mediation in Japanese subjects without dementia.

High pulse pressure predicts primary arteriovenous fistula failure within 1 year.

The arteriovenous fistula is the preferred access route for hemodialysis, although its high primary failure rate remains a clinical challenge. Multiple studies have attempted to determine the risk factors for primary arteriovenous fistula failure; however, none have identified pulse pressure as a potential predictive marker. High pulse pressure is a surrogate poor arterial compliance endpoint and leads to inferior cardiovascular outcomes. Our aim was to determine whether elevated pulse pressure indicates poor arteriovenous fistula maturation. We retrospectively reviewed 274 patients who underwent an arteriovenous fistula index operation between September 1, 2018 and May 31, 2019. Demographic, clinical data, and operative parameters were collected and analyzed. The maximum follow-up period was 365 days. Arteriovenous fistula failure was defined as the inability to achieve functional use during the follow-up period. We identified risk factors for arteriovenous fistula failure by performing a multivariate logistic regression analysis using backward elimination procedures. A total of 274 patients were included in the study. The patients' average age was 61.3 ± 14.0 years, approximately half of the patients (n = 161, 58.8%) were male, and the majority had hypertension. At the end of the follow-up period, 68 (24.8%) had arteriovenous fistula failure. The proportion of patients with pulse pressure values of >60 mmHg was significantly higher in the failure group than in the maturation group (66.0% vs 80.9%; p = 0.021). A PP value of >60 mmHg (odds ratio = 2.25; 95% confidence interval = 1.14-4.42; p = 0.019) and coronary artery disease or myocardial infarction (odds ratio = 1.97; 95% confidence interval = 1.01-3.84; p = 0.045) were found to be independent risk factors for primary arteriovenous fistula failure. High pulse pressure is an independent risk factor for primary arteriovenous fistula failure.

Higher Pulse Pressure Is Associated With Increased Risk of Cardio-cerebrovascular Disease and All-Cause Mortality: A Korean National Cohort Study.

This study aimed to investigate the association of pulse pressure (PP) with the cardio-cerebrovascular disease (CCVD) risk and all-cause mortality according to blood pressure level using Korean national cohort data. This study was retrospectively designed and based on the Korean National Health Insurance Service-National Health Screening Cohort. Participants aged 40-69 years at baseline were categorized into normal, elevated, stage 1, and stage 2 groups according to blood pressure. Each group was further classified into 5 groups separated by 10-mm Hg increments in PP. The primary composite outcome was defined as CCVDs and all-cause mortality. Cox proportional hazards regression models were adopted after stepwise adjustment for confounders to investigate the composite outcome. During the follow-up period (median follow-up period, 12.0 years), the primary composite outcome occurred in 18,444 (15.0%) of 122,783 men and 10,096 (11.4%) of 88,550 women. After complete adjustment for confounders, in the stage 1 hypertensive men, the hazard ratio (95% confidence intervals [CIs]) of the 31-40, 41-50, 51-60, and >60 mm Hg PP groups was 1.112 (1.013-1.221), 1.035 (0.942-1.137), 1.009 (0.907-1.123), and 1.324 (1.130-1.551) in comparison with the ≤30 mm Hg PP group. In the stage 2 hypertensive men, the HRs (95% CIs) were 1.069 (0.949-1.204), 1.059 (0.940-1.192), 1.123 (0.999-1.263), and 1.202 (1.061-1.358) compared to the ≤30 mm Hg PP group. However, these associations were not significant in women. Hypertensive men with an increased PP have an increased risk of CCVDs and all-cause mortality.

Abstract P037: Age Modifies The Inverse Association Between Standing Height And Pulse Pressure

Purpose: While standing height is positively associated with blood pressure in the pediatric population, studies have suggested an inverse association in adults. We sought to therefore determine whether age modified the association between standing height and pulse pressure (PP). Methods: The study included adults ≥20 years from the 1999-2018 National Health and Nutrition Examination Surveys who were not taking antihypertensive medications. Standing height was categorized into gender-specific quintiles (Table). High PP was defined as PP ≥60 mmHg. We estimated odds ratios (OR) using logistic regression, adjusting for covariates, accounting for the complex survey design, and stratifying by 10-year age groups. Results: Among the 26,779 adults (mean [SD] age of 43 [30], 50% female, 70% White), 16% had elevated PP, ranging from 23% in the lowest height quintile (Q1) to 11% in the highest quintile (Q5). Those in Q5 were younger, of higher socioeconomic status, had greater waist circumference, and less likely to have cardiovascular disease or diabetes compared to those in Q1. Those in Q5 had 46% lower adjusted odds of high PP compared to Q1. Race and gender did not modify associations (race: p for interaction = 0.28; gender: p =0.34). When stratifying by 10-year age groups, odds of high PP significantly decreased with increasing age up to 70 years (Table, P-trend &lt;0.001). Conclusion: Standing height was found to be negatively associated high PP, especially in adults 30-69 years. We speculate that augmented pulse wave deflection in shorter individuals may play a role in age-related increases in arterial stiffness.

Abstract P010: Relationship Of Pulse Pressure And Cognitive Performance In Individuals With Advanced Carotid Atherosclerosis

Introduction: Elevation in pulse pressure (PP), the difference between systolic and diastolic blood pressure, is associated with vascular remodeling, arterial stiffness, and carotid plaque instability (i.e. strain indices and ulceration), which is a risk factor for vascular cognitive decline. We have previously demonstrated that increased carotid plaque strain indices are associated with poorer cognitive performance in individuals with advanced carotid atherosclerosis. We examined the relationship between pre-operative pulse-pressure and cognition in individuals undergoing clinically indicated carotid endarterectomy. We hypothesized that higher PP will be associated with poorer cognitive performance. Methods: Patients with advanced carotid atherosclerosis (&gt;60 % stenosis NASCET, ACAS criteria) underwent neurocognitive testing, blood pressure measurements, and PP calculation (n=128). Cognition was measured using a 60-minute neuropsychological battery recommended by the National Institute of Neurological Disorders and Canadian Stroke Network (NINDS-CSN). Kendell Tau correlations were used to examine the relationship between cognitive tests, ulceration and PP. Results: Participants were a median age of 72 (IQR 13) years of age, 50 females (40%), 78 males (60%), median 70% stenosis (IQR 10.8), median systolic blood pressure of 132 (IQR 26) mmHg, median diastolic blood pressure of 71.5 (IQR 15) mmHg, and median PP of 58.5 mmHg (IQR 23.75). PP ranged from 36 mmHg to 163 mmHg. Results did demonstrate evidence of an association between PP and WAIS-IV Block Design in asymptomatic patients (τ=-0.23, p=0.02). It did not show a significant relationship between PP and other subtests (all p-values&gt;0.05). There was no significant association between PP and operative plaque ulceration scores (p=0.542). Conclusions: PP was not associated with cognitive performance in individuals with advanced carotid atherosclerosis except for the relationship between PP and WAIS-IV Block Design in asymptomatic patients. This finding is consistent with prior work that suggests visuospatial processing presenting as one of the earliest declines in patients with cerebrovascular disease. Though asymptomatic patients did not show classic signs of stroke, they likely had silent strokes due to plaque instability.

Impact of chronic kidney disease on clinical outcomes in patients with Stage B progressive aortic regurgitation (mild to moderate and moderate grades).

BackgroundChronic kidney disease (CKD) is a significant comorbidity in patients with heart failure and valvular heart disease. Renal impairment is not well evaluated in the patients with Stage B progressive aortic regurgitation (AR) (mild to moderate and moderate grades in this study), for estimating outcome.HypothesisWe sought to investigate the prognostic factor, especially CKD, in the patients with progressive AR.MethodsWe enrolled 262 patients with Stage B progressive AR and preserved left ventricular systolic function (ejection fraction ≥ 50%). Based on the presence of CKD, the patients were divided into CKD (n = 70) and non‐CKD (n = 192) groups, which CKD was defined as estimated glomerular filtration rate < 60 ml/min/1.73 m2. The primary outcome was major adverse cardiac events (MACEs), including cardiac death, myocardial infarction, hospitalization for heart failure, and aortic valve replacement.ResultsThe median follow‐up duration was 41.5 (interquartile range: 16.2–71.7) months. Between groups, the CKD patients were older; they had a higher pulse pressure and higher incidence of hypertension, diabetes mellitus, dyslipidemia, cerebrovascular accident, and atrial fibrillation. Compared to the non‐CKD group, the CKD group had lower eʹ velocity (4.36 ± 2.21 vs. 5.20 ± 2.30 cm/s, p = .009), higher right ventricular systolic pressure (38.02 ± 15.79 vs. 33.86 ± 11.77 mmHg, p = .047). The CKD group was associated with increased risk of MACEs (41.4% vs. 22.4%; unadjusted hazard ratio [HR]: 1.78, 95% confidence interval [CI]: 1.11–2.85, p = .017). In multivariate Cox regression analyses, the risk of MACEs was significantly different between groups (adjusted HR: 1.71, 95% CI: 1.11–2.62, p = .015); furthermore, the risk of hospitalization for heart failure (10.0% vs. 2.6%; adjusted HR: 2.30, 95% CI: 1.16–4.55, p = .017) was significantly higher in the CKD group than in the non‐CKD group.ConclusionsIn patients with Stage B progressive AR, CKD is an independent prognostic factor for clinical outcomes (composite clinical outcome, hospitalization for heart failure).

High intraoperative pulse pressure is a risk factor for postoperative acute kidney injury in a cohort of abdominal surgery patients: An exploratory study.

Both intraoperative hypotension and hypertension have been reported to increase the occurrence of acute kidney injury (AKI). However, the impact of the intraoperative pulse pressure (PP) on the latter complications remains relatively unknown. To explore whether high intraoperative PP values are associated with postoperative AKI. The data for this study come from a prospective cohort study in which patients who underwent abdominal surgery between October 1, 2018 and July 15, 2019 in university hospital in Katowice, Poland were included in the analysis. Preand intraoperative data, including blood pressure measurements, were acquired from medical charts. Several PP thresholds were applied: >50, >55, >60, >65, >70, >75, >80, >85, and >90 mm Hg. Additionally, by analyzing the maximal PP during the procedures, the cutoff point for the occurrence of outcomes was estimated. Postoperative AKI was considered as the outcome of the study. Univariable and multivariable analyses were performed to assess PP relationship with AKI. Four hundred and ninety-four patients were included in the analysis. The AKI was present in 32 (6.5%) cases. The receiver operating characteristic (ROC) curve analysis estimated a cutoff point of >84 mm Hg of maximal PP to be associated with the outcome. The PP values above 80 mm Hg and onward were successfully included in the multivariable statistical models. A model in which PP > 90 mm Hg (odds ratio (OR) = 4.03; 95% confidence interval (95% CI): [1.53; 10.62]) was included, had the best predicting value in predicting hypoperfusion injury (area under the receiver operating characteristics (AUROC) = 0.88). Apart from PP, intraoperative hypotension, presence of chronic arterial hypertension, chronic kidney disease, and procedure duration were independently associated with AKI. High intraoperative PP may be associated with the occurrence of postoperative AKI. However, the effect of high PP should be confirmed in other noncardiac populations to prove the generalizability of our results.