Peripheral Blood Pressure Measurements Research Articles

Blind Estimation of Central Blood Pressure Using Least-Squares with Mean Matching and Box Constraints.

Central aortic blood pressure (CABP) is a very-well recognized source of information to asses the cardiovascular system conditions. However, the clinical measurement protocol of this pulse wave is very intrusive and burdensome as it requires expert staff and complicated invasive settings. On the other hand, the measurement of peripheral blood pressure is much more straightforward and easy-to-get non-invasively. Several mathematical tools have been employed in the past few decades to reconstruct CABP waveforms from distorted peripheral pressure signals. More specifically, the cross-relation approach together with the widely used least-squares method, are shown to be effective as a way to estimate CABP waves. In this paper, we propose an improved cross-relation method that leverages the values of the diastolic and systolic pressures as box constraints. In addition, a mean-matching criterion is introduced to relax the need for the input and output mean values to be strictly equal. Using the proposed method, the root mean squared error is reduced by approximately 20% while the computational complexity is not significantly increased.

Reference values of office central blood pressure, pulse wave velocity, and augmentation index recorded by means of the Mobil-O-Graph PWA monitor.

Assessment of central blood pressure (BP), pulse wave velocity (PWV), and augmentation index (AIx) measurements may improve cardiovascular risk stratification. This study aimed to establish reference office values for central BP, PWV, and AIx by means of a Mobil-O-Graph PWA monitor and to evaluate the impact of cardiovascular risk factors (CVRFs) on these measurements. We cross-sectionally evaluated clinical characteristics, central BP, PWV, AIx, and peripheral BP measurements among 867 apparently healthy individuals (age = 46.0 ± 15.5 years, 39% males) who were free of obesity, hypertension, active smoking, dyslipidemia, and diabetes (CVRF-No) and 5632 individuals (age = 57.0 ± 14.7 years, 44% males) with at least one of these major CVRFs (CVRF-Yes). Reference values for central BP, PWV, and AIx were provided for the CVRF-No and CVRF-Yes groups, stratified by age and sex. PWV and AIx exhibited curvilinear increases with age, and there was an interaction between age and sex for central systolic BP and PWV in both the CVRF-No and CVRF-Yes groups. The results of a multivariable analysis including the whole sample (n = 6499) showed that obesity had a direct association with central BP, while diabetes was directly related to PWV. In addition, alcohol intake was directly associated with central BP, while performance of physical activity was inversely related to AIx. In conclusion, values of office-measured central BP, PWV, and AIx obtained in an apparently healthy population and in a population with CVRFs are now available according to age and sex and may be useful to build thresholds for use in clinical practice.

Myocardial functions, blood pressure changes, and arterial stiffness in children with severe hemophilia A

IntroductionProlonging the life span of patients with hemophilia has led to the emergence of comorbidities. Cardiovascular diseases are one of the important causes of mortality in patients with hemophilia. This study investigated the myocardial functions, blood pressure changes, arterial stiffness, and risk factors associated with cardiovascular diseases in children with hemophilia. Material and methodsIn total, 17 children with severe hemophilia A and 23 healthy children were included in the study. Myocardial functions were evaluated using standard and tissue Doppler echocardiography. Peripheral and central blood pressure measurements were performed, and arterial stiffness was evaluated. Carotid intima–media thicknesses (CIMT) serum glucose, insulin, insulin resistance index, and lipoprotein levels were measured. ResultsThere were no differences between the two groups in terms of age, and biochemical parameters (P > 0.05). The HDL-C levels in the hemophilia group were lower than those in the control group (P < 0.05). Five of the patients had insulin resistance (29.4%), whereas four had low HDL-C levels (23.5%). There were no differences between the groups in terms of the CIMT, peripheral blood pressure, and central systolic blood pressure (P > 0.05). In the hemophilia group, central diastolic blood pressure (cDBP), arterial stiffness, and myocardial performance index were higher (P < 0.05, P = 0.01, P < 0.01), whereas the ejection time was shorter than in the control group (P < 0.05). ConclusionsCompared with the control group, there is an onset of arterial stiffness, cDBP values tend to increase, and serum HDL-C levels are lower in the hemophilia group. Moreover, myocardial systolic functions demonstrate a deterioration that becomes more prominent with the increase in arterial stiffness.

Pharmacological Management of Hypertension Guided by Central or Peripheral Blood Pressure Measurement: Comparison of Two Strategies on the Incidence of Intermediate Outcome

BackgroundCentral blood pressure values and arterial stiffness have demonstrated to be a useful tool to stratify cardiovascular risk and also as a biomarker. A question that is still unanswered is if hypertension treatment guided by central blood pressure parameters will be even better to promote cardiovascular protection than peripheral one.MethodsWith this proposition we have designed an open prospective multicentric randomized protocol to compare central (G1) and peripheral (G2) blood pressure targets during 1 year follow-up concerning target organ damage (carotid intima media thickness, left ventricular hypertrophy, microalbuminuria and pulse wave velocity). OMRON 1100 will be used to access peripheral and Mobil O’Graph to access central blood pressure and pulse wave velocity, TOSHIBA Xsario with longitudinal linear transdutor 7.5 MHz bidimensional mode B to access carotid and left ventricular parameters.Expected ResultsThis paper aims to describe methodological aspects concerning this research and we expect to find results to answer some open questions about hypertension treatment and cardiovascular protection.

Tonometric and Oscillometric Methods for Measurement of Central Blood Pressure Parameters: a Comparison in Patients with Borderline Hypertension or Stage 1 Hypertension

Abstract Background Changes in arterial compliance are among the first changes detectable in hypertensive syndrome. Methods with good reproducibility as compared with the gold standard for identifying such changes are desirable in clinical practice. Objectives To compare central pressure measurements and arterial stiffness obtained by two non-invasive methods (tonometry and oscillometry). Methods This was a descriptive, cross-sectional study with a convenience sample of patients with borderline hypertension or stage 1 hypertension. Peripheral and central blood pressure measurements were obtained by tonometry (SphygmoCor®), considered the gold standard, and oscillometry (Mobil O´graph®). Comparisons of results were made by unpaired t-test, and p values 0.05). Mean pressure wave velocity (PWV), 8.4 m/s vs. 7.4 m/s (p = 0.013) and mean central pulse pressure, 37.7 mmmHg and 30.9 mmHg (p = 0.013) were significantly higher by SphygmoCor® than Mobil O´graph®. Conclusion Values of central systolic blood pressure, AIx and pulse pressure amplification obtained by oscillometry were not statistically different compared with tonometry; values of PWV and cPP, however, were underestimated by oscillometry. (Int J Cardiovasc Sci. 2020; 33(2):145-150)

Agreement of aneroid and oscillometric blood pressure devices used in pregnancy.

The objective of this study was to compare three automated blood pressure devices (Microlife VSA, Uscom BP+ and Tensiomed Arteriograph) with an aneroid device in an Australian antenatal population to determine an accurate and reliable alternative method of measuring blood pressure in pregnant women. This observational, prospective study recruited a random sample of 200 pregnant women of any gestation attending an antenatal clinic in an Australian hospital. Each participant had two peripheral blood pressure measurements per instrument performed, resulting in eight measurements per participant. Intra- and inter-device reliability of peripheral blood pressure measurements made by the aneroid device and the three automated brachial-cuff oscillometric devices were assessed. The agreement between devices was graded according to standardised criteria. Both intra- and inter-device reliability of blood pressure measurements of the four devices in this study were found to be 'excellent' (ICCs > 0.75). Microlife VSA and Uscom BP+ showed acceptable levels of agreement (±5mmHg) when compared to the aneroid device. Arteriograph did not show an acceptable level of agreement with the aneroid device for systolic blood pressure, but did for diastolic blood pressure. Accurate automated devices may ensure consistent assessment of blood pressure in the antenatal setting. Our results suggest that Microlife VSA and Uscom BP+ may be suitable alternatives to the aneroid device for use in the antenatal setting. Further studies assessing both auscultatory and oscillometric blood pressure devices in pregnancy, and especially in hypertensive cohorts, are required.

Abstract P298: Normotensive Habitual Caffeine Consumers Experience No Change in Blood Pressure or Pulse Wave Velocity Following the Combined Consumption of Caffeine and Dietary Nitrate

Intro: Caffeine intake may elevate blood pressure (BP), while habitual consumption leads to developed tolerance, providing conflicting evidence for incurred changes in BP. Dietary nitrate consumption decreases BP and reduces arterial stiffness in patients with atherosclerosis and hypertension due to increased plasma nitrite and enhanced bioavailability of nitric oxide. However, a decline in BP for a healthy cohort could be an unwanted side effect for normotensive individuals. Less is known about the combined effects of dietary nitrate and caffeine on resting hemodynamics in a healthy population. Hypothesis: We hypothesized that caffeine supplementation would increase systolic blood pressure (SBP) and pulse wave velocity (PWV) while combined dietary nitrate consumption would attenuate this rise. Methods: In a randomized, double-blind, counterbalanced study, eight healthy, young adults who typically consumed some but not more than 500 mg caffeine/day completed 4 separate visits to the laboratory, each visit separated by one week. Prior to each visit, participants consumed a 4-day supplementation regimen of either dietary nitrate (12.4 mmol, NIT) or a placebo nitrate (PLN) combined with either caffeine (3 mg/kg, CAF) or placebo caffeine (PLC); this comprised 1 of 4 treatments. The final dose of NIT or PLN was consumed 2.5 hours prior to assessments while CAF or PLC was consumed 1 hour prior. Participants minimized consumption of dietary nitrate rich foods and caffeine during the 4 days leading up to their scheduled visit. Each visit consisted of measurements of peripheral SBP and diastolic blood pressure (DBP) with aortic central systolic and diastolic blood pressure (cSBP and cDBP, respectively) assessed noninvasively using pulse wave analysis. Measurement of arterial stiffness via applanation tonometry determined PWV. A linear mixed effects model analysis was performed to determine if supplementation regimen influenced hemodynamic parameters. Results: SBP of NIT+CAF (115±6 mmHg), PLN+CAF (117±9 mmHg), NIT+PLC (115±6 mmHg) and PLN+PLC (115±6 mmHg)(p=0.591) and PWV of NIT+CAF (5.5±1.1 m/s), PLN+CAF (5.8±0.7 m/s), NIT+PLC (5.8±0.6 m/s) and PLN+PLC (5.6±1.0 m/s) (p=0.353) were not statistically different between treatments. In addition, DBP (p=0.496), cSBP (p=0.656), cDBP (p=0.548), aortic augmentation index (p=0.054), and resting heart rate (p=0.646) were not different between treatments. Conclusion: Following 4 days of caffeine supplementation, habitual caffeine users did not experience any changes in resting hemodynamics when compared to a placebo supplement. In addition, dietary nitrate did not incur any changes in resting metrics whether or not it was consumed alongside caffeine. In this regard, habitual caffeine users are not affected by 3mg/kg doses of caffeine, and dietary nitrate (12.4 mmol/day) does not further reduce the BP of healthy normotensive adults.

Short-Term Consumption of Cuban Policosanol Lowers Aortic and Peripheral Blood Pressure and Ameliorates Serum Lipid Parameters in Healthy Korean Participants: Randomized, Double-Blinded, and Placebo-Controlled Study.

The current study was designed to investigate the short-term effects of policosanol consumption on blood pressure (BP) and the lipid parameters in healthy Korean participants with prehypertension. A total of 84 healthy participants were randomly allocated to three groups receiving placebo, 10 mg of policosanol, or 20 mg of policosanol for 12 weeks. Based on an average of three measurements of peripheral BP, the policosanol 20 mg group exhibited the most significant reduction, that is, up to 7.7% reduction of average systolic BP (SBP) from 136.3 ± 6.1 mmHg (week 0) to 125.9 ± 8.6 mmHg (week 12, p < 0.001). Between group comparisons using repeated measures ANOVA showed that the policosanol 20 mg group had a significant reduction of SBP at 12 weeks (p = 0.020) and a reduction of diastolic BP (DBP) at 8 weeks (p = 0.041) and 12 weeks (p = 0.035). The policosanol 10 mg and 20 mg groups showed significant reductions in aortic SBP of 7.4% and 8.3%, respectively. The policosanol groups showed significant reductions of total cholesterol (TC) of 9.6% and 8.6% and low-density lipoproteins (LDL-C) of 21% and 18% for 10 mg and 20 mg of policosanol, respectively. Between group comparisons using repeated measures ANOVA showed that the policosanol (10 mg and 20 mg) groups at 12 weeks had a significant reduction of TC (p = 0.0004 and p = 0.001) and LDL-C (p = 0.00005 and p = 0.0001) and elevation of %HDL-C (p = 0.048 and p = 0.014). In conclusion, 12-week consumption of policosanol resulted in significant reductions of peripheral SBP and DBP, aortic SBP and DBP, mean arterial pressure (MAP), and serum TC and LDL-C with elevation of % HDL-C.

COMPARISON OF NON-INVASIVE CENTRAL BLOOD PRESSURE MEASUREMENTS WITH PERIPHERAL BLOOD PRESSURE MEASUREMENTS IN THE DIAGNOSTIC, PROGNOSTIC AND THERAPEUTIC AREAS. SYSTEMATIC REVIEW

Objective: Arterial hypertension is a major public health problem and current recommendations call for a review of the literature on the contribution of non-invasive central blood pressure (BP) estimation. Design and method: We performed a systematic review of systematic reviews that compare non-invasive central BP with peripheral BP measurements in the diagnostic, prognostic and therapeutic areas, including a comprehensive research in databases and grey literature, and a qualitative analysis according to the ROBIS and AMSTAR tools. Results: Among 1738 bibliographic references, 8 publications were selected.This systematic review shows for central BP as compared to peripheral BP in terms of the diagnosis the importance of the calibration method, and in terms of the prognosis the absence of a significant effect on clinical events but a significant effect on surrogate endpoints. In terms of the treatment, it shows that antihypertensive drugs, and in particular bêta-blockers and thiazide diuretics have a greater effect on the decrease in peripheral BP than on non-invasive central BP, thus leading to a decrease in the arterial pressure amplification. Conclusions: Basic research on calibration methods is essential to obtain a better estimation of the central BP and to propose clinical studies on a larger scale.

INFLUENCE OF ANTIHYPERTENSIVE TREATMENT ON MMP-9 LEVELS IN CONTROLLED HYPERTENSIVE INDIVIDUALS

Objective: Ambulatory blood pressure monitoring (ABPM), in addition to peripheral blood pressure (BP) measurements, provides data on central hemodynamic, such as pulse wave velocity (PWV), augmentation index (AI 75%) and central pressure, which are associated with arterial stiffness. The development of arterial stiffness is related to an extracellular matrix enzyme called metalloproteinase-9 (MMP-9). The aim of the current study is to evaluate the correlation between the variables obtained by ABPM and levels of MMP-9 at different BP levels. Design and method: On-hundred and one individuals were enrolled: 21 normotensive (NT), 36 prehypertensive (PH), and 44 controlled hypertensive (CHT). Peripheral and central BP parameters were evaluated by ABPM using Mobil-O-Graph® 24-hour monitor and MMP-9 levels were determined in all participants. The levels of MMP-9 were assessed using the Human Matrix metalloproteinase-9 Quantikine ELISA kit (R & D Systems, Inc., Minneapolis, MN, USA) with a calculation of medians being presented as nanograms per milliliter (ng/mL). Subsequently, MMP-9 values were transformed into logarithms to reflect normal distribution for statistical analysis. Results: Age of the participants ranged from 30–71 years. MMP-9 concentration was significantly higher in the PH (log 4.74 ± 0.5) compared to CHT group (log 4.41 ± 0.5; p = 0.02). Mean PWV was greater in CHT than PH (8.1 ± 1.2 m/s vs. 6.9 ± 1 m/s; p-value = 0.0003, respectively), but no differences were found in AI 75% between CHT and PH groups. On the other hand, PH individuals had higher mean PWV than NT individuals (8.1 ± 1.2 m/s vs. 6.9 ± 1 m/s; p-value = 0.0003, respectively). MMP-9 levels correlated with cardiac output and peripheral vascular resistance in the three periods evaluated by ABPM (24 h, wakefulness and sleep). Conclusions: Prehypertensive individuals present greater arterial stiffness and MMP-9 levels than normotensive subjects, fact that demonstrate already structural alterations in this group. In its turn, higher levels of MMP-9 are observed in prehypertensive compared to controlled hypertensive subjects, suggesting that antihypertensive therapy may reduce MMP-9 plasma levels.

A Comparison and Calibration of a Wrist-Worn Blood Pressure Monitor for Patient Management: Assessing the Reliability of Innovative Blood Pressure Devices.

BackgroundClinical guidelines recommend monitoring of blood pressure at home using an automatic blood pressure device for the management of hypertension. Devices are not often calibrated against direct blood pressure measures, leaving health care providers and patients with less reliable information than is possible with current technology. Rigorous assessments of medical devices are necessary for establishing clinical utility.ObjectiveThe purpose of our study was 2-fold: (1) to assess the validity and perform iterative calibration of indirect blood pressure measurements by a noninvasive wrist cuff blood pressure device in direct comparison with simultaneously recorded peripheral and central intra-arterial blood pressure measurements and (2) to assess the validity of the measurements thereafter of the noninvasive wrist cuff blood pressure device in comparison with measurements by a noninvasive upper arm blood pressure device to the Canadian hypertension guidelines.MethodsThe cloud-based blood pressure algorithms for an oscillometric wrist cuff device were iteratively calibrated to direct pressure measures in 20 consented patient participants. We then assessed measurement validity of the device, using Bland-Altman analysis during routine cardiovascular catheterization.ResultsThe precalibrated absolute mean difference between direct intra-arterial to wrist cuff pressure measurements were 10.8 (SD 9.7) for systolic and 16.1 (SD 6.3) for diastolic. The postcalibrated absolute mean difference was 7.2 (SD 5.1) for systolic and 4.3 (SD 3.3) for diastolic pressures. This is an improvement in accuracy of 33% systolic and 73% diastolic with a 48% reduction in the variability for both measures. Furthermore, the wrist cuff device demonstrated similar sensitivity in measuring high blood pressure compared with the direct intra-arterial method. The device, when calibrated to direct aortic pressures, demonstrated the potential to reduce a treatment gap in high blood pressure measurements.ConclusionsThe systolic pressure measurements of the wrist cuff have been iteratively calibrated using gold standard central (ascending aortic) pressure. This improves the accuracy of the indirect measures and potentially reduces the treatment gap. Devices that undergo auscultatory (indirect) calibration for licensing can be greatly improved by additional iterative calibration via intra-arterial (direct) measures of blood pressure. Further clinical trials with repeated use of the device over time are needed to assess the reliability of the device in accordance with current and evolving guidelines for informed decision making in the management of hypertension.Trial RegistrationClinicalTrials.gov NCT03015363; https://clinicaltrials.gov/ct2/show/NCT03015363 (Archived by WebCite at http://www.webcitation.org/6xPZgseYS)

Different Relevance of Peripheral, Central or Nighttime Blood Pressure Measurements in the Prediction of Chronic Kidney Disease Progression in Patients with Mild or No-Proteinuria

Background/Aims: Arterial hypertension is one of the leading factors aggravating the course of chronic kidney disease (CKD). It seems that the novel parameters used in the assessment of the blood pressure (BP) load (i.e. central blood pressure, nighttime blood pressure) may be more precise in predicting the cardiovascular risk and the progression of CKD in comparison with the traditional peripheral blood pressure measurements in the office conditions. The aim of the study was to assess the impact of the central, or nighttime blood pressure on the progression of CKD in patients with mild or no-proteinuria (autosomal, dominant polycystic kidney disease or IgA nephropathy). Methods: In each of the enrolled 46 patients with CKD stage 3 or 4, serum creatinine concentration was assessed, eGFR (MDRD) was calculated, also central blood pressure and pulse wave velocity (PWV) was assessed and the 24-hour ambulatory blood pressure monitoring (ABPM) was conducted at the beginning of the study and then repeated after one-year observation period. Results: During the observation period mean eGFR decreased from 44.1 (33.2-50.6) mL/min to 36.7 (29.7-46.3) mL/min. No significant differences were observed in the peripheral blood pressure or central blood pressure parameters. After one-year observation period the values of diastolic blood pressure dipping during the night significantly decreased from 16 (13-19) mmHg to 12 (10-15) mmHg; p< 0.05. The values of systolic dipping during the night or the mean BP values recorded in ABPM did not change significantly. Additionally, no significant differences in the PWV values were found. In the multivariate regression model the change of serum creatinine concentration was explained by the initial diastolic dipping values. Conclusion: 1. In patients with CKD stages 3 or 4 and mild or no- proteinuria, peripheral and central blood pressure did not change significantly during a one-year observation period despite the significant decline of eGFR and seems not to participate in the CKD progression. 2. Reduced magnitude of the diastolic dipping, which reflects the increase of diastolic blood pressure load during the nighttime, may play an important role in the pathogenesis of deterioration of kidney function in these patients.

Comparison of the Assessment of Orthostatic Hypotension Using Peripheral and Central Blood Pressure Measurements.

BackgroundOrthostatic hypotension (OH) is associated with falls and cardiovascular events. There is growing evidence that central blood pressure (CBP) is better than peripheral blood pressure (PBP) in predicting adverse outcomes. The objectives of this study were to assess 1) the prevalence of OH identified using PBP and CBP and the levels of agreement, 2) the respective associations between OH and falls and cardiovascular comorbidities, by PBP and CBP, and 3) the association of OH with arterial wall stiffness markers (augmentation pressure (AP) and augmentation index (AI)).MethodsAn observational case-control study of subjects aged 50 years and above was conducted at the University of Alberta Hospital inpatient wards and outpatient clinics. This study used a non-invasive technology called SphygmoCor to assess changes in CBP between lying, 1, 3 and 6 min of standing. AP and AI, which are markers of arterial wall stiffness, were also measured in this study. Dementia, significant psychological problems, and isolation precautions were exclusion criteria. Both PBP and CBP were measured with arm cuffs in lying and standing positions. OH was diagnosed using consensus criteria.ResultsOf the 71 participants recruited, mean age was 72.3 ±10.3 years, 52% were males, 32% had a history of falls and 72% had hypertension. OH occurred within 1, 3 or 6 min of standing (transient OH) in 31% by PBP and 27% by CBP (kappa = 0.56). OH persisted for all 6 min (persistent OH) in 16% by both PBP and CBP (kappa = 0.68). A significant relationship was observed between transient OH by CBP and baseline hypertension (P = 0.05) and dyslipidemia (P = 0.02). There was a significant difference in the mean AP between subjects with and without central persistent OH (P = 0.02), but not between subjects with and without peripheral persistent OH. The mean AI was not significantly different between subjects with or without central or peripheral persistent OH and between subjects with and without peripheral or central transient OH.ConclusionPrevalence of OH was similar between PBP and CBP. However, there was only moderate agreement with OH identified by PBP and CBP indicating some inconsistencies across the sample in identifying OH.

Cross-sectional variations of white and grey matter in older hypertensive patients with subjective memory complaints.

Mild cognitive impairment and Alzheimer's dementia involve a grey matter disease, quantifiable by 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET), but also white matter damage, evidenced by diffusion tensor magnetic resonance imaging (DTI), which may play an additional pathogenic role. This study aimed to determine whether such DTI and PET variations are also interrelated in a high-risk population of older hypertensive patients with only subjective memory complaints (SMC).Sixty older hypertensive patients (75 ± 5 years) with SMC were referred to DTI and FDG-PET brain imaging, executive and memory tests, as well as peripheral and central blood pressure (BP) measurements. Mean apparent diffusion coefficient (ADCmean) was determined in overall white matter and correlated with the grey matter distribution of the metabolic rate of glucose (CMRGlc) using whole-brain voxel-based analyses of FDG-PET images.ADCmean was variable between individuals, ranging from 0.82 to 1.01.10− 3 mm2 sec− 1, and mainly in relation with CMRGlc of areas involved in Alzheimer's disease such as internal temporal areas, posterior associative junctions, posterior cingulum but also insulo-opercular areas (global correlation coefficient: − 0.577, p < 0.001). Both the ADCmean and CMRGlc of the interrelated grey matter areas were additionally and concordantly linked to the results of executive and memory tests and to systolic central BP (all p < 0.05).Altogether, our findings show that cross-sectional variations in overall white brain matter are linked to the metabolism of Alzheimer-like cortical areas and to cognitive performance in older hypertensive patients with only subjective memory complaints. Additional relationships with central BP strengthen the hypothesis of a contributing pathogenic role of hypertension.

Isolated systolic hypertension — evaluation of the scale of the problem among medical students — pilot study

Introduction. Interest in isolated systolic hypertension (ISH) in young people has increased in recent years. The applanation tonometry technique provides new diagnostic opportunities in this group of patients. The aim of the study was to evaluate the incidence of ISH among young adults and factors contributing to its occurrence. Material and methods. One hundred and two medical students aged 21 to 26 years were examined. The study was based on three peripheral blood pressure measurements and central blood pressure measurement. Information on health status and physical activity was collected using the author-developed questionnaire. Results. Based on the mean of peripheral blood pressure measurements, hypertension (HT) was detected in 23 students (22.55%): 18 had ISH, 4 — combined systolic/diastolic HT and 1 — isolated diastolic HT. Pulse wave analysis showed that all individuals with ISH had central blood pressure within the normal range — higher than those without HT, but lower than in the combined systolic/diastolic HT group (p < 0.001). Subjects with ISH were characterized by higher pulse pressure amplitude and lower augmentation index (AIx) compared to those with normal blood pressure. Subjects with ISH were taller, had a higher body mass index (BMI) and were more likely to have a positive family history of HT compared to normotensives. They also reported more frequent coffee consumption; and 22% of them used creatine supplements (vs. 0% in non-HT group). Conclusions. Measurement of central arterial blood pressure by applanation tonometry should be an integral part of the assessment of young patients with ISH. The study confirmed that ISH patients are characterized by higher growth, weight and physical activity. Further studies are needed to assess the clinical significance of ISH.

Methodology and technology for peripheral and central blood pressure and blood pressure variability measurement: current status and future directions - Position statement of the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability.

Office blood pressure measurement has been the basis for hypertension evaluation for almost a century. However, the evaluation of blood pressure out of the office using ambulatory or self-home monitoring is now strongly recommended for the accurate diagnosis in many, if not all, cases with suspected hypertension. Moreover, there is evidence that the variability of blood pressure might offer prognostic information that is independent of the average blood pressure level. Recently, advancement in technology has provided noninvasive evaluation of central (aortic) blood pressure, which might have attributes that are additive to the conventional brachial blood pressure measurement. This position statement, developed by international experts, deals with key research and practical issues in regard to peripheral blood pressure measurement (office, home, and ambulatory), blood pressure variability, and central blood pressure measurement. The objective is to present current achievements, identify gaps in knowledge and issues concerning clinical application, and present relevant research questions and directions to investigators and manufacturers for future research and development (primary goal).

Acute aortic dissection presenting as painless paraplegia: a case report

BackgroundAcute aortic dissection is an extreme emergency that is generally manifested by violent chest pain irradiating to a patient’s back and abdomen. Paraplegia due to spinal cord ischemia and infarction as a presenting manifestation of aortic dissection has been found in 2 to 5 % of patients. However, painless paraplegia is exceedingly rare and limited to a few case reports in the literature. We describe a new case with this unusual presentation of aortic dissection and here we emphasize that this condition must be considered in all patients with painless paraplegia.Case presentationA 70-year-old Arab man with no previous known medical or surgical conditions was hospitalized for brutal heaviness of his lower limbs associated to urinary retention. A neurological examination revealed flaccid paraplegia without sensory disorder. His blood pressure and his pulse were in normal ranges. He was afebrile. His peripheral pulses were not checked. Laboratory investigations eliminated multiple organ failure. Spinal magnetic resonance imaging realized in emergency was normal. He had a cardiopulmonary arrest 1 day after his hospitalization. His autopsy report concluded a type A aortic dissection with an intimal tear at his aortic isthmus with intrapericardial rupture and extension to his intercostal and lumbar arteries.ConclusionsAcute aortic dissection is an extreme emergency that can lead to death unless there is an early diagnosis. It must be considered in any patient with paraplegia even painless. Clinical examination has a major role to play in diagnosing this condition. Apart from the neurological examination, palpation of peripheral pulses and blood pressure measurements in all four limbs is of paramount importance. Then further investigations must be carried out consisting of aortic angiography by computed tomography or by magnetic resonance imaging.

Central blood pressure and vascular damage

Background and objectiveThe aim of this study was to assess the relationship between central blood pressure and vascular damage. Patients and methodsThis cross-sectional study involved 393 never treated hypertensive patients (166 women). Clinical blood pressure (BP), 24h blood pressure (BP24h) and central blood pressure (CBP) were measured. Vascular organ damage (VOD) was assessed by calculating the albumin/creatinine ratio (ACR), wave pulse pressure velocity and echocardiographic left ventricular mass index (LVMI). ResultsPatients with VOD had higher values of BP, BP24h, and CBP than patients without ACR. When comparing several systolic BP, systolic BP24h had a higher linear correlation with CBP (Z Steiger test: 2.26; P=.02) and LVMI (Z Steiger test: 3.23; P=.01) than PAC. In a multiple regression analysis corrected by age, sex and metabolic syndrome, all pressures were related with VOD but systolic BP24h showed the highest correlation. In a logistic regression analysis, having the highest tercile of systolic BP24h was the stronger predictor of VOD (multivariate odds ratio: 3.4; CI 95%: 2.5–5.5, P=.001). ConclusionsCBP does not have more correlation with VOD than other measurements of peripheral BP. Systolic BP24h is the BP measurement that best predicts VOD.

Do Cardiovascular Risk Factors and Severity and Complexity of Coronary Atherosclerosis Predict Aortic Pulse Pressure during Cardiac Catheterization?

Pulse pressure (PP), estimated from the peripheral blood pressure measurements, has been linked with adverse cardiovascular events. But, the association of PP and coronary artery disease is not well studied. There is a lack of data on the association of invasively measured aortic PP and cardiovascular risk factors and severity of coronary atherosclerosis. We determined the predictive factors of aortic PP during cardiac catheterization. Electronic medical records from 2010 to 2013 were retrospectively reviewed. A total of 368 patients were eligible. The data on demographics, cardiovascular risk factors, coronary lesion characteristics, and medication use was collected. On multivariable regression analysis, aging (β = 0.34, p = 0.001, 95% confidence interval [CI] 0.14-0.53) and prior aspirin use (β = 5.09, p = 0.015, 95% CI 0.99-9.18) were associated with higher aortic PP. Increasing estimated glomerular filtration rate (β = - 0.52, p = 0.040, 95% CI -0.90 to -0.23) was associated with lower aortic PP. Severity and complexity of coronary lesions, SYNTAX score, and number of obstructed vessels were not associated with aortic PP. Aging, prior aspirin use, and declining renal function were associated with an increase in aortic PP. Aortic PP may not predict the severity and complexity of coronary atherosclerosis. Therefore, the risk of adverse cardiovascular events associated with an elevated aortic PP may not be mediated by the severity of coronary atherosclerosis.

PP.38.05

Objective: Studies of peripheral blood pressure (BP) measurement suggested that ambulatory BP is superior to clinic measurements in predicting preclinical target-organ damage. This study investigated this relationship regarding central BP measurement in a young population in whom the central-peripheral BP discrepancy might be considerable. Design and method: Apparently healthy adolescents and young adults referred for elevated BP and healthy volunteers (age 12–26 years) were subjected to: (i) central clinic BP measurement (sitting, triplicate measurement, 1 visit) and subsequently (same day) to 24-hour ambulatory central BP monitoring using the same noninvasive brachial cuff-based oscillometric device (Mobil-O-Graph 24 h PWA); (ii) echocardiographic determination of left ventricular mass index (LVMI); (iii) measurement (ultrasonography) of the common carotid intima-media thickness (IMT). Results: Data from 49 subjects were analyzed (mean age 19.4 ± 4.7 years, 37 males, body mass index [BMI] 24.4 ± 5.1 kg/m2, 22 volunteers, 9 with elevated ambulatory peripheral BP [24-hour peripheral BP > =95th percentile for adolescents or >=130/80 mmHg for adults]). Clinic central BP was closely correlated with all components of ambulatory (24-hour/awake/asleep) central BP (r = 0.85/0.82/0.77 respectively for systolic BP, all p < 0.001). Regarding the associations with target-organ damage, LVMI was correlated with both clinic and ambulatory (24-hour/awake/asleep) central systolic BP to a comparable level, but with a trend towards stronger correlations with ambulatory BP (r = 0.52 and 0.56/0.57/0.46 respectively, all p < 0.01). A similar trend was observed for carotid IMT which was associated with both clinic and ambulatory (24-hour/awake/asleep) central pulse pressure (r = 0.31 and 0.40/0.41/0.25 respectively, all p < 0.05 except for asleep BP). In multivariate stepwise regression analyses (independent variables: gender, age, BMI, clinic, 24-hour/awake/asleep ambulatory central BP) the variation of LVMI was predicted (R2 = 0.50) by BMI and awake ambulatory central systolic BP, whereas IMT (R2 = 0.50) by male gender and 24-hour ambulatory central pulse pressure. Conclusions: These preliminary results suggest that in young individuals central ambulatory BP appears to present marginal superiority to central clinic BP in predicting preclinical target-organ damage.