Lower Pulse Pressure Amplification Research Articles

CHARACTERISTIC OF RESPONDERS TO RENAL DENERVATION - CROATIAN REAL-LIFE STUDY

Objective: Heterogeneity in response to renal denervation (RDN) is acknowledged phenomena and one of most important tasks in this field is to find reliable predictive biomarker for positive response. Our aim was to analyse characteristics of resistant hypertensive patients who were responders 6 months after RDN. Design and method: Out of 31 truly resistant patients whom secondary forms of hypertension were ruled out and were enrolled into the Croatian Spyral RDN registry, 18 (10 m, 8 w, average age 49.3) were eligible for analyses. Office BP, ABPM, central BP and PWV were measured with Omron M6, Molbilograph and Sphygmocor devices, respectively. Sympathetic/parasympathetic activity was measured with ANX-3.0 ANSAR device. Results: Responders were 6.7 years older, less obese with at basal slightly higher eGFR (88.6 vs. 79.8), uric acid (406.5 vs. 376.4), salt intake (12.6 g/day vs.9.8 g/day) and had significantly higher basal office BP (169.5/99.7 vs. 153.3/96.5) as well as ABPM values. Central aortic systolic BP and Aix were higher in responders (154.5 vs, 147.1; 31.5 vs 27.3) without difference in PWV (10.1 vs. 9.6). Responders had lower values of PP amplification (1.22 vs. 1.33). Significantly higher basal sympathetic activity (LFa/RFa) was determined in responders than in non-responders (6.68 vs. 1.25). Conclusions: Responders were older with higher basal office BP, ABPM but also higher central BP and Aix with lower pulse pressure amplification. They ingested more salt, had higher values of uric acid and importantly had more exaggerated sympathetic activity. Whether some of identified parameters could be considered as a biomarker for positive response in resistant hypertensive patients should be determined in larger cohort of patients.

Simultaneous adaption of the gain and phase of a generalized transfer function for aortic pressure waveform estimation

GoalThis paper proposes and validates a completely adaptive transfer function (CATF) based on an autoregressive exogenous (ARX) model which adjusts the gain and phase of a generalized transfer function (GTF) simultaneously to estimate the aortic pressure waveform from a brachial pressure waveform. MethodsInvasive aortic and brachial pressure waveforms were recorded from 34 subjects for the validation of the proposed method. Individual transfer functions (ITFs) were trained based on the pressure waveforms using an ARX model. The GTF was derived by averaging the ITFs. CATF was then obtained by adjusting both the gain and phase of the GTF using regression formulas calculated from the ITFs and brachial hemodynamic parameters. Meanwhile the quantitative contributions of the adaption of gain and phase of the GTF were investigated respectively. The root-mean-square-error of the total waveform and absolute errors of common hemodynamic indices including systolic and diastolic blood pressures (SBP and DBP, respectively), pulse pressure (PP) and augmentation index were used to evaluate the performance of the proposed method in the data divided into low, middle and high PP amplification groups. ResultsThe CATF achieved lower errors for DBP and PP in the low PP amplification group (1.79 versus 2.10 mmHg and 5.08 versus 6.23 mmHg, respectively, both P < 0.05) and PP in the middle amplification group (1.43 versus 1.92 mmHg, P < 0.05) compared with the GTF. SignificanceThe proposed method provides a step towards the development of an improved and clinically useful non-invasive approach for estimating the aortic pressure waveform from a peripheral pressure waveform.

Atrial fibrillation is associated with increased central blood pressure and arterial stiffness.

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and beta blockers (BBs) are the drugs of choice for rate or rhythm control in these patients. The purpose of this study was to describe differences in arterial stiffness (AS), central blood pressure (cBP), and the role of BBs on cBP in patients with AF compared to healthy individuals. The authors included 76 patients with paroxysmal/persistent AF. Carotid‐femoral pulse wave velocity (PWV) and cBP were measured and compared with data from 75 healthy individuals. Patients with AF had higher PWV (8.0 m/s vs. 7.2 m/s, p < .001), central systolic blood pressure (cSBP) (118 mm Hg vs. 114 mm Hg, p = .033), central pulse pressure (cPP) (39 mm Hg vs. 37 mm Hg, p = .035) and lower pulse pressure amplification (PPA) (1.24 vs. 1.30, p = .015), without differences in peripheral blood pressure (pBP) and heart rate (HR). AF patients had significantly increased PWV (β= 0.500, p = .010, adjusted R² = 0.37) after adjustment for confounding factors. The use of BBs significantly reduced PPA (β = ‐0.059, p = .017, adjusted R² = 0.30). AF patients have higher PWV, cSBP, cPP, and lower PPA, compared to healthy patients. These findings support the role of AS in the development of AF. Use of BBs is related to a potential adverse effect on cBP.

Wave reflections and systemic vascular resistance are stronger determinants of pulse pressure amplification than aortic stiffness in drug-naïve hypertensives

ABSTRACTBackground: Aortic-to-brachial pulse pressure (PP) amplification is a novel biomarker that prognosticates the cardiovascular risk above and beyond central aortic and brachial blood pressure. This phenomenon is modulated by left ventricular contractility and chronotrophy, large-artery stiffness and reflecting properties of microcirculation. However, the relative importance of these parameters as hemodynamic determinant of PP amplification remains elusive.Methods: A total of 88 consecutive drug-naïve hypertensives underwent a non-invasive assessment of central and peripheral hemodynamics via impedance cardiography and pulse wave analysis. Participants were classified into tertiles according to the magnitude of PP amplification. Hemodynamic determinants of low PP amplification were explored in univariate and multivariate regression analysis.Results: Compared with the high tertile, patients within the low PP amplification tertile were older and more commonly female and had lower height, weight and heart rate. Augmentation index (AIx) and systemic vascular resistance index (SVRI) were higher among patients within the low PP amplification tertile, whereas aortic pulse wave velocity (PWV) did not differ among groups. In multivariate analysis, higher AIx (OR: 1.27; 95% CI: 1.09–1.48) and higher SVRI were independently associated with higher odds for low PP amplification, whereas higher heart rate was the only parameter related to lower odds for low PP amplification (OR: 0.84; 95% CI: 0.71–0.99).Conclusion: This study shows that among newly-diagnosed drug-naïve hypertensives, elevated wave reflections and systemic vascular resistance are stronger determinants of PP amplification than aortic stiffness.

Central blood pressure and measures of early vascular disease in children with ADPKD

BackgroundThere is growing recognition of hypertension in a significant proportion of children with ADPKD. In this study, we assessed blood pressure and cardiovascular status in children with ADPKD.MethodsA prospective two-centre observational study of children (< 18 years) with ADPKD was compared against age- and BMI-matched healthy controls. Children underwent peripheral BP (pBP) measured using an aneroid sphygmomanometer and auscultation, 24-h ambulatory BP monitoring (ABPM), non-invasive central BP (cBP) measurement, carotid-femoral pulse wave velocity (PWVcf) measured using applanation tonometry and measurement of indexed left ventricular mass (LVMI) using echocardiography. This study received independent ethical approval.ResultsForty-seven children with ADPKD and 49 healthy controls were recruited (median age 11 years vs. 12 years). Children with ADPKD had significantly higher systolic pBP (mean 112 ± 13.5 mmHg vs. 104 ± 11 mmHg, p < 0.001), higher systolic cBP (mean 97 ± 12.8 mmHg vs. 87 ± 9.8 mmHg, p < 0.001) and lower pulse pressure amplification ratio (1.59 ± 0.2 vs. 1.67 ± 0.1, p = 0.04) compared to healthy children. Thirty-five percent of children with ADPKD showed a lack of appropriate nocturnal dipping on 24-h ABPM. There was no difference in PWVcf between children with ADPKD and healthy children (mean 5.74 ± 1 m/s vs. 5.57 ± 0.9 m/s, p = 0.46). Those with ADPKD had a significantly higher LVMI (mean 30.4 ± 6.6 g/m2.7 vs. 26.2 ± 6.2 g/m2.7, p = 0.01).ConclusionsThese data highlight the high prevalence of hypertension in children with ADPKD, also demonstrating early cardiovascular dysfunction with increased LVMI and reduced PP amplification despite preserved PWVcf, when compared with healthy peers. These early cardiovascular abnormalities are likely to be amenable to antihypertensive therapy, reinforcing the need for routine screening of children with ADPKD.

Interest of Combined Blood Pressure Measurements in Very Old Frail Subjects: The PARTAGE Study.

Several clinical studies have shown that blood pressure (BP) measurements in very old frail individuals are of limited interest due to the fact that several age-related alterations and geriatric syndromes may modify BP. We studied in persons over 80-year old living in nursing homes the combined effects of 3 BP patterns on total mortality and major cardiovascular (CV) events: (i) low pulse pressure amplification (L-PPA) between carotid and brachial artery, (ii) systolic BP (SBP) <130 mm Hg (L-SBP), under >1 antihypertensive drugs, and (iii) changes in SBP between supine and upright position of >20 mm Hg in both directions (hypotension/hypertension, orthostatic SBP [O-SBP]). This analysis was performed in subjects of the PARTAGE study presenting all these 3 measurements (n = 883). The combined effects of L-PPA, L-SBP, and O-SBP were studied during the 2 years followed-up period. After adjusting for age, sex, and history of CV events, all 3 BP patterns were independent determinants of major CV events (L-PPA, (P = 0.023); L-SBP, (P = 0.050); O-SBP, (P = 0.015)), whereas L-PPA (P = 0.012) and L-SBP (P = 0.006) were also independent determinants of total mortality. Compared with the subjects without any BP pattern, the presence of 2 or 3 BP patterns was associated with an increase in total mortality and major CV events greater than 2 and 2.5 times, respectively. In very old frail subjects, there is a particular interest for using different BP measurement approaches, than in younger populations, in order to evaluate the risks related to the BP levels. Trial Number: NCT00901355 (Clinical Trials.gov).

Reflection Magnitude, a Measure of Arterial Stiffness, Predicts Incident Heart Failure in Men But Not Women: Multi-Ethnic Study of Atherosclerosis (MESA)

BackgroundArterial stiffness is a risk factor for heart failure (HF) and is higher in women. Our objective was to investigate sex differences between arterial stiffness and incident HF in the Multi-Ethnic Study of Atherosclerosis (MESA) population. Methods and ResultsApplanation tonometry from 5959 participants (52.8% women) was used to calculate augmentation index (AIx), pulse pressure amplification (PPA), and reflection magnitude (RM). Sex-specific risk of HF was assessed with the use of a competing-risk regression model. Women had higher AIx (P < .00001), higher RM (P = .023), and lower PPA (P < .00001) indicating greater arterial stiffness in women. However, increasing RM quartile independently predicted HF in men (adjusted hazard ratios and 95% confidence intervals: Q2: 2.05 [1.06–3.96; P = .033]; Q3: 2.49 [1.30–4.73; P = .006]; Q4: 3.26 [1.75–6.08; P = .0002]) but not in women (Q2: 1.04 [0.54–1.98; P = .91]; Q3: 1.30 [0.71–2.37; P = .4]; Q4: 0.79 [0.4–1.55; P = .49]). ConclusionWomen demonstrate greater arterial stiffness than men. Despite this, arterial stiffness, as measured by RM, predicts incident HF in men but not in women. RM represents a novel risk factor for HF in men but not in women. Further investigation of risk factors for HF in women is warranted. ConclusionArterial stiffness, measured by RM, predicts incident HF in men but not in women in this MESA cohort.

Lower Heart Rate Variability Is Associated with Lower Pulse Pressure Amplification: Role of Obesity

Background: Heart rate variability (HRV), pulse pressure amplification, and obesity represent risk factors for cardiovascular events. The aims of the present study are (1) to explore the impact of HRV on pulse pressure amplification and (2) to investigate whether the association between HRV and pulse pressure amplification differs in obese and lean subjects. Methods: A total of 342 patients (age 61 ± 11 years) were enrolled. HRV was analyzed concerning both the frequency and time domain as well as concerning the HRV triangular index. Pulse pressure amplification was estimated as the ratio between brachial and carotid pulse pressure, the latter measured with SphygmoCor. Results: Time domain HRV indices were directly correlated with pulse pressure amplification (the lower the HRV indices, the lower the pulse pressure amplification). This association was stronger in obese than in lean subjects after controlling for age and sex. Conclusion: Larger controlled studies are needed to provide a more detailed insight into the relation between HRV and pulse pressure amplification and to determine which pathways are differentially activated in lean and obese subjects.

A Simple Adaptive Transfer Function for Deriving the Central Blood Pressure Waveform from a Radial Blood Pressure Waveform.

Generalized transfer functions (GTFs) are available to compute the more relevant central blood pressure (BP) waveform from a more easily measured radial BP waveform. However, GTFs are population averages and therefore may not adapt to variations in pulse pressure (PP) amplification (ratio of radial to central PP). A simple adaptive transfer function (ATF) was developed. First, the transfer function is defined in terms of the wave travel time and reflection coefficient parameters of an arterial model. Then, the parameters are estimated from the radial BP waveform by exploiting the observation that central BP waveforms exhibit exponential diastolic decays. The ATF was assessed using the original data that helped popularize the GTF. These data included radial BP waveforms and invasive reference central BP waveforms from cardiac catheterization patients. The data were divided into low, middle, and high PP amplification groups. The ATF estimated central BP with greater accuracy than GTFs in the low PP amplification group (e.g., central systolic BP and PP root-mean-square-errors of 3.3 and 4.2 mm Hg versus 6.2 and 7.1 mm Hg; p ≤ 0.05) while showing similar accuracy in the higher PP amplification groups. The ATF may permit more accurate, non-invasive central BP monitoring in elderly and hypertensive patients.

Abstract MP56: Association of Arterial Stiffness and Pressure Amplification with Mild Cognitive Impairment and Dementia: The Atherosclerosis Risk in Communities Study - Neurocognitive Study (ARIC-NCS)

Background: As a high-flow, low-impedance organ, the brain is sensitive to excessive pressure and flow pulsatility. Increased pulsatility and arterial stiffness are hypothesized to contribute to cerebral microvascular damage linked to cognitive impairment. The association of arterial stiffness with mild cognitive impairment (MCI) and dementia in a biethnic population is not well characterized, and the association of pressure amplification with MCI and dementia is relatively unexplored. Objectives: To quantify the cross-sectional association of arterial stiffness, measured by aortic pulse wave velocity (PWV), and pressure amplification with MCI and dementia in a biethnic population of older adults. Methods: We included 4,945 adults (2,903 females; 1,069 African Americans; mean age 75 years) from the population-based ARIC-NCS. The Omron VP-1000 plus system was used to measure arterial stiffness (carotid-femoral PWV (cfPWV)) and pressure amplification measures (central systolic blood pressure (cSBP), central pulse pressure (cPP), and pulse pressure amplification (PPA)). A neurologist and neuropsychologist classified MCI and dementia using psychometric assessments, medical history, cerebral magnetic resonance imaging, and physical examinations, with adjudication by a third reviewer. We used multinomial logistic regression to evaluate associations of race-specific 25th percentile cut points of PWV and pressure amplification with normal cognition (reference), MCI and dementia. We stratified by race and adjusted for age, sex, and heart rate, ApoE4, education, smoking status, and study center. Results: There were 760 Caucasians with MCI and 110 with dementia, and 201 African Americans with MCI and 47 with dementia. Among Caucasians, those with lower PPA had a higher prevalence of dementia, odds ratio (OR)=1.84 (95% confidence interval (CI): 1.15, 2.97), comparing participants below the 25th percentile to those above it, and those with higher cSBP had a higher prevalence of MCI, OR=1.33 (95% CI: 1.09, 1.63), comparing participants above the 75th percentile to those below it. Also among Caucasians, those with higher cPP had a higher prevalence of MCI, OR=1.25 (95%CI: 1.01, 1.55), and dementia, OR=1.66 (95% CI: 1.00, 2.73), comparing participants above the 75th percentile to those below it. There were no statistically significant associations with cfPWV, among African Americans, and no evidence for effect modification by hypertension or diabetes. Conclusion: Arterial stiffness and components of pressure amplification were associated with MCI and dementia in Caucasians but not in African Americans, possibly due to the limited sample size. Longitudinal characterization of the observed associations is warranted to determine whether these measures are independent predictors of MCI and dementia among Caucasian and African American older adults.

Association of Aortic Phenotypes and Mechanical Function With Left Ventricular Diastolic Function in Subjects With Normally Functioning Bicuspid Aortic Valves and Comparison to Subjects With Tricuspid Aortic Valves

A bicuspid aortic valve (BAV) is often associated with dilation or aneurysm of the ascending aorta (AA) despite of absence of significant valve dysfunction. Bicuspid aortopathy and consequent aortic stiffness may adversely affect left ventricular (LV) diastolic function. This study aimed to investigate the impact of global and regional aortic mechanical function on LV diastolic function in subjects with BAV. Fifty-six subjects with BAV (45 men, mean age 52 ± 13 years) without significant valve dysfunction and 56 age- and gender-matched controls with tricuspid aortic valve were studied. The aortic phenotypes were classified into 3 groups: normal shape, predominant dilatation of the sinus of Valsalva, and predominant dilatation of the AA. Structural and functional parameters of the AA and LV were measured using 2-dimensional echocardiography. Global aortic mechanical function was assessed by radial artery tonometry. The subjects with BAV showed a higher incidence of a predominant AA phenotype (53.6% vs 17.9%, p <0.001), larger indexed aortic diameters, increased augmentation index, lower pulse pressure amplification, lower early diastolic mitral annular (e') velocity, and higher E/e' than those with tricuspid aortic valve . The e' velocity and E/e' varied with different aortic phenotypes in subjects with BAV. Correlations between e' velocity and parameters of aortic stiffness were stronger in subjects with BAV than those in controls. Multiple regression analysis revealed that augmentation index normalized for a heart rate of 75 beats/min was an independent determinant of e' velocity (β = -0.24, p = 0.044) and E/e' (β = 0.30, p = 0.018) in subjects with BAV even after controlling for confounding factors. LV diastolic function is closely related to aortic phenotype and mechanical alteration in subjects with BAV.

Do Arterial Hemodynamic Parameters Predict Cognitive Decline Over a Period of 2 Years in Individuals Older Than 80 Years Living in Nursing Homes? The PARTAGE Study

ObjectivesSeveral studies have highlighted a link between vascular alterations and cognitive decline. The PARTAGE study showed that arterial stiffness as evaluated by carotid-femoral pulse wave velocity (cfPWV) was associated with a more pronounced cognitive decline over a 1-year period in very old frail institutionalized individuals. The aim of the present analysis was to assess the role of hemodynamic parameters, such as blood pressure (BP), heart rate (HR), cfPWV, and central/peripheral pulse pressure amplification (PPA) on cognitive decline over 2 years in very old frail individuals. MethodsA total of 682 individuals from the PARTAGE study cohort, aged older than 80 years (mean age at inclusion: 87.5 ± 5.0 years) and living in French and Italian nursing homes, were analyzed. Mini-Mental State Examination (MMSE) score was assessed at baseline (BL) and at the end of the first and second year of follow-up (2y-FU). Those with a decrease in MMSE of 3 or more points between BL and 2y-FU were considered as “decliners.” The cfPWV and PPA at baseline were assessed with an arterial tonometer. ResultsAfter adjustment for baseline MMSE, HR, body mass index, age, education level, and activities of daily living (ADLs), cfPWV was higher and PPA lower in “decliners” compared with “nondecliners,” whereas BP did not differ between the 2 groups. Logistic multivariate analysis also revealed that high cfPWV, low PPA, high HR, and low ADLs were all determinants of MMSE decline. ConclusionThis 2-year longitudinal study in very old institutionalized individuals shows that arterial stiffness and high HR enabled us to identify subjects at higher risk of cognitive decline, whereas BP alone did not appear to have a significant predictive value. These findings highlight the contribution of vascular determinants in cognitive decline even in this very old population.

Impact of central haemodynamics on left ventricular function in individuals with an exaggerated blood pressure response to exercise.

The impact of exaggerated blood pressure response (EBPR) to exercise on left ventricular function and the mechanism of its association are poorly understood. This study investigated the impact of arterial stiffening on left ventricular function in individuals with an EBPR to exercise. We hypothesized that individuals with low pulse pressure (PP) amplification during exercise would have worse left ventricular function than those with high PP amplification in individuals with an EBPR to exercise. Fifty-nine individuals with an EBPR to exercise (18 men, age 57 ± 12 years) and 59 age and sex-matched controls were studied. Radial artery tonometry was performed at rest and immediately after exercise during supine bicycle exercise echocardiography. There were no differences in left ventricular structure or function between individuals with an EBPR to exercise and controls. When individuals with an EBPR to exercise were divided into two groups on the basis of PP amplification after exercise [Group 1 (n = 30), high PP amplification after exercise; Group 2 (n = 29), low PP amplification after exercise], group 2 showed larger left atrial volume and lower early diastolic (e') and systolic (S') mitral annular velocities. Left ventricular apical rotation was also exaggerated in group 2. In multiple regression, PP amplification after exercise was an independent determinant of e' (β = 0.16, P = 0.019) and S' (β = 0.25, P = 0.009) in individuals with an EBPR to exercise. In individuals with an EBPR to exercise, the degree of left ventricular dysfunction is variable. EBPR to exercise in the presence of arterial stiffening contributes to the deterioration of left ventricular function.

Habitual intake of fruit juice predicts central blood pressure

Despite a common perception that fruit juice is healthy, fruit juice contains high amounts of naturally occurring sugar without the fibre content of the whole fruit. Frequent fruit juice consumption may therefore contribute to excessive sugar consumption typical of the Western society. Although excess sugar intake is associated with high blood pressure (BP), the association between habitual fruit juice consumption and BP is unclear. The present study investigated the association of fruit juice consumption with brachial and central (aortic) BP in 160 community dwelling adults. Habitual fruit juice consumption was measured using a 12 month dietary recall questionnaire. On the same day, brachial BP was measured and central (aortic) BP was estimated through radial artery applanation. Frequency of fruit juice consumption was classified as rare, occasional or daily. Those who consumed fruit juice daily, versus rarely or occasionally, had significantly higher central systolic BP (F (2, 134) = 6.09, p < 0.01), central pulse pressure (F (2, 134) = 4.16, p < 0.05), central augmentation pressure (F (2, 134) = 5.98, p < 0.01) and central augmentation index (F (2, 134) = 3.29, p < 0.05) as well as lower pulse pressure amplification (F (2, 134) = 4.36, p < 0.05). There were no differences in brachial BP. Central systolic BP was 3–4 mmHg higher for those who consumed fruit juice daily rather than rarely or occasionally. In conclusion, more frequent fruit juice consumption was associated with higher central BPs.

Value of haemodynamic profiling to the response of antihypertensive therapy

BackgroundEssential hypertension is characterised by alterations in haemodynamics. Hence haemodynamic profiling could lead to improved blood pressure (BP) control in these patients. We tested if baseline haemodynamic indices predict the BP lowering effects of different classes of antihypertensive drugs in hypertensive patients. MethodsIn this double-blind placebo-controlled crossover study we randomised 53 hypertensive patients to receive doxazosin 4 mg, candesartan 16 mg, bisoprolol 5 mg, isosorbide mononitrate (ISMN) 50 mg, and placebo daily for 6 weeks. Brachial and central BP, augmentation index (AIx), aortic pulse wave velocity (aPWV), stroke volume (SV), cardiac output (CO), peripheral vascular resistance (PVR), and pulse pressure amplification (PPA) were measured at baseline and after each drug. ResultsBaseline AIx and PPA determined BP reduction with antihypertensive therapy, particularly with bisoprolol. In patients with low baseline AIx (1.7–28.9%) and high PPA (1.22–1.87), bisoprolol had a weak antihypertensive effect, while the opposite was observed in patients with high AIx (36.3–48.2%) and low PPA (1.05–1.11). With candesartan, BP reduction was the largest, regardless of baseline AIx or PPA levels. ConclusionsOur study suggests that ARBs reduce BP the most irrespective of the underlying haemodynamic profile. Antihypertensive therapy guided by AIx and PPA may have some merit in the guidance of antihypertensive drug treatment, particularly if beta-blockers are considered for treatment. However, larger studies are needed to confirm these results.Clinical Trials Registry number: EudraCT 2006-006981-40.

Arterial stiffness and pulse wave reflection are increased in patients suffering from severe periodontitis.

AimThis single blind cross-sectional study compared the vascular health of subjects suffering from severe chronic periodontitis, severe aggressive periodontitis and periodontal healthy controls by evaluating pulse wave velocity (PWV), augmentation index (AIx) and pulse pressure amplification (PPA).Material and MethodsIn a total of 158 subjects, 92 suffering from severe periodontitis and 66 matched periodontal healthy controls, PWV, AIx, central and peripheral blood pressure were recorded using an oscillometric device (Arteriograph).ResultsSubjects suffering from severe chronic or aggressive periodontitis exhibited significantly higher PWV (p = 0.00004), higher AIx (p = 0.0049) and lower PPA (p = 0.028) than matched periodontal healthy controls.ConclusionsThe results of this study confirm the association between periodontal inflammation and increased cardiovascular risk shown by impaired vascular health in case of severe periodontitis. As impaired vascular health is a common finding in patients suffering from severe periodontal disease a concomitant routine cardiovascular evaluation may be advised.

Second Trimester Trough Followed by a Steady Increase of Pulse Pressure Amplification and Arterial Stiffness in Low-Risk, Uncomplicated Pregnancies

Arterial stiffness, a composite indicator of vascular health, is an independent predictor of cardiovascular disease and events. Pulse pressure amplification (PPA) is a physiological marker of the pressure amplification from central to brachial arteries. Central pulse pressure (PP) is lower than brachial PP in young, healthy individuals, and a low PPA ratio is a risk factor for the development of CV diseases. We assessed the effect of low-risk, uncomplicated pregnancies on vessel hemodynamics and arterial stiffness.

Association of Longer QT Interval With Arterial Waveform and Lower Pulse Pressure Amplification: The Nagahama Study

Central systolic blood pressure (cSBP) has been postulated to correlate closely with cardiovascular risk. Identifying factors associated with cSBP is therefore important. Prolonged QT interval is known to be associated with cardiovascular outcomes and might also be associated with the arterial waveform and cSBP. We investigated the possible associations between electrocardiogram wave interval and cSBP in general population samples. Brachial blood pressure and radial arterial waveform were measured simultaneously. Augmentation index (AIx) was calculated from the radial waveform as the ratio of the height of the late systolic peak to that of the first peak. cSBP was defined as the absolute pressure of the late systolic peak. In the first panel (n = 8,085), QT interval was strongly association with AIx (r = 0.330; P < 0.001). This association remained significant even in the heart rate-adjusted analysis (r = 0.184; P < 0.001). Although subjects with a longer QT interval were older and had higher blood pressure, heart rate, and pulse wave velocity, multivariable analysis with adjustment for these covariables nevertheless identified longer corrected QT interval as an independent determinant of increased AIx and smaller pulse pressure amplification (PPa; brachial SBP minus cSBP) (β = -0.066; P < 0.001). This association was replicated in the independent second panel (n = 1,412) (β = -0.105; P < 0.001). In contrast, QRS interval was positively associated with PPa (β = 0.056; P < 0.001). Longer QT interval and short QRS duration were significantly associated with arterial waveform and PPa. Our results provide a clue to the elucidation of unidentified mechanisms of the increased cardiovascular outcome and mortality risks in subjects with longer QT interval.

Arterial Stiffness and Pulse-Pressure Amplification in Overweight/Obese African- American Adolescents: Relation With Higher Systolic and Pulse Pressure

Obesity is associated with a higher systolic blood pressure (BP) and pulse pressure (PP) in African-American youths, increasing their risk for developing hypertension. However, it is unknown whether arterial stiffness and wave reflection are associated with a higher systolic BP and PP or with smaller PP amplification in overweight/obese (OW/OB) African-American adolescents. We measured carotid-femoral pulse wave velocity (CF-PWV), carotid-radial PWV (CR-PWV), the augmentation index (AIx) adjusted to a heart rate of 75 bpm (AI75), the augmentation pressure (AugP), PP amplification, and body composition in 227 healthy African-American adolescents (age, 16.9 ± 0.2 years; 54% male). Adolescents who were OW/OB (n = 86, body mass index (BMI) ≥ 85th percentile) demonstrated 5%-6%, 13%-16%, and 2.5% higher aortic and brachial systolic BP, brachial and aortic PP, and mean arterial pressure (MAP), respectively (all P < 0.05), than adolescents of normal-weight (NW, n = 141, BMI < 85th percentile). The OW/OB adolescents had a 7% higher CF-PWV, 5% lower CR-PWV, and 3.5% lower PP amplification than the NW group (all P < 0.05), but no differences in AI75 or AugP. In the entire cohort after adjustment for age, sex, heart rate, height, and MAP, CF-PWV was positively correlated, and CR-PWV and PP amplification were negatively correlated, with total and abdominal/hip adiposity. Additionally, CF-PWV, AI75, and AugP were positively correlated with MAP and negatively correlated with PP amplification. CR-PWV, AI75, and AugP were negatively correlated with brachial and aortic PP. Higher aortic stiffness is associated with smaller PP amplification with increasing adiposity in African-American adolescents. Whether a reduction in PP amplification predicts increased CVD risk in obese African-American adolescents requires further study.

Mortality and Cardiovascular Events Are Best Predicted by Low Central/Peripheral Pulse Pressure Amplification But Not by High Blood Pressure Levels in Elderly Nursing Home Subjects: The PARTAGE (Predictive Values of Blood Pressure and Arterial Stiffness in Institutionalized Very Aged Population) Study

The aim of the longitudinal PARTAGE study was to determine the predictive value of blood pressure (BP) and pulse pressure amplification, a marker of arterial function, for overall mortality (primary endpoint) and major cardiovascular (CV) events, in subjects older than 80 years of age living in a nursing home. Assessment of pulse indexes may be important in the evaluation of the CV risk in very elderly frail subjects. A total of 1,126 subjects (874 women) who were living in French and Italian nursing homes were enrolled (mean age, 88 ± 5 years). Central (carotid) to peripheral (brachial) pulse pressure amplification (PPA) was calculated with the help of an arterial tonometer. Clinical and 3-day self-measurements of BP were conducted. During the 2-year follow-up, 247 subjects died, and 228 experienced major CV events. The PPA was a predictor of total mortality and major CV events in this population. A 10% increase in PPA was associated with a 24% (p < 0.0003) decrease in total mortality and a 17% (p < 0.01) decrease in major CV events. Systolic BP, diastolic BP, or pulse pressure were either not associated or inversely correlated with total mortality and major CV events. In very elderly individuals living in nursing homes, low PPA from central to peripheral arteries strongly predicts mortality and adverse effects. Assessment of this parameter could help in risk estimation and improve diagnostic and therapeutic strategies in very old, polymedicated persons. In contrast, high BP is not associated with higher risk of mortality or major CV events in this population. (Predictive Values of Blood Pressure and Arterial Stiffness in Institutionalized Very Aged Population [PARTAGE]; NCT00901355).