Peripheral Diastolic Blood Pressure Research Articles

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

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

THE ARTERIAL STIFFNESS AS RISK FACTOR FOR THE OCCURRENCE OF ARTERIAL HYPERTENSION IN POSTOPERATIVE CRITICALLY ILL PATIENTS

Objective: The aim of the present study is to investigate the predictive value of arterial stiffness in the occurrence of arterial hypertension in critically ill patients. Also, the study investigates the risk factors of arterial hypertension in ICU patients. Design and method: This is a prospective observational study. The study included postoperative patients who were admitted to the ICU. We collected demographic characteristics of the patients, their clinical characteristics (i.e. hemodynamic status), clinical severity (APACHE II, SOFA score), lifestyle data (i.e. smoking, alcohol, drugs), and medical history (diabetes mellitus, cardiovascular diseases). Arterial stiffness assessment is performed by recording and analyzing the pulse wave in postoperative patients during the first 24 hours of admission to the ICU. The Sphygmocor software was used for pulse wave analysis and IBM SPSS v.27.0 software was used for statistical analysis. Results: The sample of the study consisted of 74 patients. Most of them were males (70.3%) aged 59.3±18.6 yrs and the rest were females (29.7%) aged 63.3±16.9 yrs. Totally, 54.1% of patients had emergency surgery, 60.8% survived and discharged from ICU, 52.7% had arterial hypertension, 70.3% had diabetes mellitus, 58.1% were smoking, and 63.5% had hypercholesterolemia. The APACHE II score of patients was found 21.2±7.2 and the SOFA score 7.5±2.8 The value of peripheral systolic blood pressure (PSBP) was 138.7±19.4 mmHg, peripheral diastolic blood pressure (PDBP) was 67.1±13.2 mmHg, mean peripheral blood pressure (MPBP) was 90.7±14.6 mmHg, pulse pressure (PP) was 53.1±15.3 mmHg and AIX@75 was 22.3±13.1%. Older patients (69.1±14.9 vs. 52.7±17.3, p=0.001), patients with diabetes mellitus (92.3% vs. 7.7%, p=0.001), patients with hypercholesterolemia (92.3% vs. 7.7%, p=0.001), patients with higher value of Albumin (2.9±0.5 vs. 2.5±0.6, p=0.025), and patients with a higher value of AIX@75 (26.8±10.5 vs. 18.3±14.1, p=0.004) had statistically significant higher percentages of arterial hypertension. Higher AIX values are associated with a greater likelihood of arterial hypertension (OR: 1.027; 95%CI: 1.004-1.049, p=0.018). Conclusions: The arterial stiffness is an independent risk factor for arterial hypertension in postoperative critically ill patients.

Heartbeats and high scores: esports triggers cardiovascular and autonomic stress response.

Gaming is often labeled as sedentary behavior. However, competitive gaming, also known as esports, involves significant cognitive demands and may induce stress. This study aims to investigate whether the psychophysical demands during esports elicit a physiological stress response. Fourteen FIFA 21 and thirteen League of Legends players (23.3 ± 2.8 years) were recruited for the study. Heart rate (HR), root mean square of successive differences between normal heartbeats (RMSSD), peripheral and central blood pressure (BP), pulse wave velocity (PWV), and energy expenditure (EE) were assessed during supine rest, seated rest, and competitive FIFA or League of Legends matches. No significant group × condition interactions were observed for any of the outcomes. However, there were significant increases in mean HR (p < 0.001, = 0.383), RMSSD (p = 0.019, = 0.226), peripheral systolic BP (p < 0.001, = 0.588), peripheral diastolic BP (p = 0.005, = 0.272), central systolic BP (p = 0.005; = 0.369), central diastolic BP (p = 0.016, = 0.313), PWV (p = 0.004, = 0.333), and EE (p < 0.001, = 0.721) during both games compared to the seated rest condition. Despite the sedentary nature of esports, the psychophysical demands appear to elicit physiological responses. Interestingly, no significant differences were found between the different game genres.

Acute self-myofascial release modulates cardiac autonomic function and hemodynamic parameters at rest and reduces cardiovascular stress reaction

PurposeSelf-myofascial release (SMR) is a form of self-massage aiming to release tension, improve blood flow, and alleviate muscle soreness. This study aimed to determine whether a single session of SMR could impact cardiovascular parameters at rest and during a cold pressor test (CPT).MethodsTwenty male participants (aged 26 ± 2 years) underwent a 20-min SMR and a 20-min seated control condition (CON) on two separate test days in a randomized order. Peripheral and central blood pressure (BP), total peripheral resistance (TPR), pulse wave velocity (PWV), heart rate (HR), root mean square of successive RR interval differences (RMSSD), and the quotient of low-frequency power and high-frequency power (LF/HF) were measured both at rest and during a CPT before (t0), 2 min (t1), and 20 min (t2) after the SMR and CON.ResultsTime × condition interactions could be detected for peripheral and central diastolic BP, TPR, HR, and RMSSD. Following the SMR, peripheral diastolic BP, central diastolic BP, TPR, and RMSSD were reduced, while HR was increased compared to the CON. Regarding the CPT time × condition interactions could be detected for peripheral, and central diastolic BP, with lower values after SMR.ConclusionThe results of the present study suggest that a single bout of SMR confers favorable cardiovascular benefits in healthy normotensive individuals. Furthermore, SMR can attenuate the hemodynamic reactivity to a stress test. Future research should address whether regular SMR leads to chronic adaptations similar to regular, moderate aerobic exercise, massage therapy, and static stretching.

Acute inflammation elicits decreased blood pressure but similar arterial stiffness in young African American adults.

African Americans (AA) have a higher risk for cardiovascular disease (CVD) as compared to their White (W) counterparts. CVD is characterized by increased blood pressure (BP), arterial stiffness and systemic inflammation. An acute inflammatory stimulus may explain physiological manifestations responsible for amplified CVD in AA that are not apparent at rest. The purpose of this study was to evaluate central and peripheral BP, central and local arterial stiffness, and indices of pulse wave morphology in young healthy AA and W participants in response to acute inflammation. Concentrations of the inflammatory cytokine interleukin-6 (IL-6) and measures of central and peripheral BP, central arterial stiffness (carotid-femoral pulse wave velocity (cfPWV)), local carotid arterial stiffness (β-stiffness, elastic modulus (Ep)), and indices of pulse wave morphology were assessed in 28 participants (21±2years, AA: n = 11) at baseline (BL), 24h and 48h post-inflammation. Changes in IL-6 concentrations (ΔIL-6) were significantly greater at 24h as compared to 48h post-inflammation (0.652±0.644 vs. -0.146±0.532pg/μl, P≤0.0001). Among AA participants, central and peripheral diastolic BP were significantly decreased at 24h post-inflammation as compared to BL (aortic diastolic BP: -4±4mmHg, P=0.016; brachial diastolic BP: -4±4mmHg, P=0.014). AA participants also experienced a significant decrease in central and peripheral mean arterial BP at 48h post-inflammation as compared to BL (aortic mean arterial pressure: -4±4mmHg, P=0.009; brachial mean arterial pressure: -4±4mmHg, P=0.012). Despite haemodynamic changes, there were no differences in central or local carotid arterial stiffness or indices of pulse wave morphology.

Cardiovascular Risk Following Conversion to Belatacept From a Calcineurin Inhibitor in Kidney Transplant Recipients: A Randomized Clinical Trial

In kidney transplant recipients (KTRs), a belatacept-based immunosuppressive regimen is associated with beneficial effects on cardiovascular (CV) risk factors compared with calcineurin inhibitor (CNI)-based regimens. Our objective was to compare the calculated CV risk between belatacept and CNI (predominantly tacrolimus) treatments using a validated model developed for KTRs. Prospective, randomized, open-label, parallel-group, investigator-initiated, international multicenter trial. KTRs aged 18-80 years with a stable graft function (estimated glomerular filtration rate>20mL/min/1.73m2), 3-60 months after transplantation, treated with tacrolimus or cyclosporine A, were eligible for inclusion. Continuation with a CNI-based regimen or switch to belatacept for 12 months. Comparison of the change in the estimated 7-year risk of major adverse CV events and all-cause mortality, changes in traditional markers of CV health, as well as measures of arterial stiffness. Among the 105 KTRs randomized, we found no differences between the treatment groups in the predicted risk for major adverse CV events or mortality. Diastolic blood pressure, measured both centrally by using a SphygmoCor device and peripherally, was lower after the belatacept treatment than after the CNI treatment. The mean changes in traditional cardiovascular (CV) risk factors, including kidney transplant function, were otherwise similar in both the treatment groups. The belatacept group had 4 acute rejection episodes; 2 were severe rejections, of which 1 led to graft loss. The heterogeneous baseline estimated glomerular filtration rate and time from transplantation to trial enrollment in the participants. A limited study duration of 1 year. We found no effects on the calculated CV risk by switching to the belatacept treatment. Participants in the belatacept group had not only lower central and peripheral diastolic blood pressure but also a higher rejection rate. The trial has received a financial grant from Bristol-Myers Squibb. EudraCT no. 2013-001178-20.

Comparison of Influence of Blood Pressure and Carotid-Femoral Pulse Wave Velocity on Target Organ Damage in Hypertension.

ObjectivesAssessment of target organ damage (TOD) is an important part of the diagnosis and evaluation of hypertension. Carotid-femoral pulse wave velocity (cf-PWV) is considered to be the gold-standard for noninvasive arterial stiffness assessment. This study aims to analyze the risk of TOD in people with different phenotypes of peripheral blood pressure and cf-PWV.MethodsThe study cohort was recruited from December 2017 to September 2021 at Ruijin Hospital in Shanghai. It was divided into 4 groups according to peripheral blood pressure (pBP) and cf-PWV. TOD was assessed as carotid intima-media thickness (CIMT), chronic kidney disease (CKD), urinary albumin-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR) and left ventricular mass index (LVMI).ResultsA total of 1,257 subjects (mean age 53.13 ± 12.65 years, 64.2% males) was recruited. Age, body mass index (BMI) and fasting blood glucose (FBG), as well as peripheral systolic blood pressure (pSBP), peripheral diastolic blood pressure (pDBP), peripheral pulse pressure (pPP) were significantly different in the four groups (P < 0.01). eGFR, ACR, LVMI and CIMT were significantly different among different groups (P < 0.01). The risk of ACR abnormality was significantly higher in the group with elevated pBP (P = 0.005, OR 2.264, 95%CI 1.277–4.016; and in the group with elevated pBP and cf-PWV (P = 0.003, OR 1.482, 95%CI 1.144–1.920), while left ventricular hypertrophy (LVH) was significantly higher in the group with elevated cf-PWV (P = 0.002, OR 1.868, 95%CI 1.249–2.793).ConclusionDifferent profiles based on the status of PBP and cf-PWV associated with different TOD. Individuals with higher pBP have an increased risk of ACR abnormality, while individuals with only cf-PWV elevated have a higher risk of LVH.

Effects of trigeminal nerve stimulation on parameters derived from pulse wave analysis in young healthy subjects.

Studies on trigeminal nerve stimulation (TNS) by facial cooling (FC) could give an insight to physiological mechanisms of cardiovascular response to activation of both parasympathetic and sympathetic nervous systems. We hypothesised that trigeminal nerve stimulation would positively influence on the factors which increase left ventricle work. The aim of the present study was to investigate hemodynamic changes assessed by pulse wave analysis (PWA) in the very early phase of this reflex. In 15 young (aged 20.3±1.3 y/o; mean ±SD) healthy individuals (10 males) PWA was performed before and after 30 seconds of FC. TNS caused decrease in heart rate (76.8±9.4 bpm vs 66.6±9.8 bpm; p=0.0038; mean ±SD) and increase in peripheral diastolic blood pressure (68±5.9 mmHg vs. 70.9±8.6 mmHg; p=0.028; mean ±SD) and no changes in other blood pressure values (peripheral and central), nor augmentation index were observed. PWA showed decrease in time of the peak pressure of left ventricle contraction (107.6±15.9 ms vs. 100.2±12.06 ms; p=0.027; mean ±SD), increase in time of the peak pressure of the reflected wave return (cT2, 187±28.03 ms vs 198.6±27.9 ms; p=0.028; mean ±SD) and increase in the difference between cT2 and time of the beginning of the reflected wave return (43.3±18.7 ms vs. 59.7 vs. 59.7±20.99 ms; p=0.0076; mean ±SD). We conclude that in the early phase of response to TNS, there is an increase in contractility of left ventricle and aortic compliance, as well as increase in peripheral vascular resistance and pressure load of returning pulse wave occurs.

COMMON CAROTID ARTERY ELASTICITY, INTIMA-DIAMETER RATIO, AND TENSILE STRESS IN PEDIATRIC PATIENTS WITH PRIMARY HYPERTENSION

Objective: Elevated blood pressure (BP) lead to increased thickness of arterial wall and increased diameter of arteries, are risk factors of cardiovascular sequelae in adult populations. Intima-diameter ratio (IDR) and tensile stress (TS) may reflect arterial wall-remodeling to elevated BP. The aim was to evaluate common carotid artery elasticity, IDR, and TS in children with primary hypertension (PH). Design and method: 50 untreated patients with PH and we evaluated: common carotid artery(CCA) intima-media thickness (cIMT) and elasticity(E-tracking - ET), central BP and aortic elasticity (aPWV,AIx75HR), office BP and ABPM, and clinical, and biochemical data. IDR (cIMT/minimal diameter of CCA[D]) and TS (MAP∗D/cIMT) were calculated in all the subjects. Results: Patients with PH compared to CG were characterized by significantly higher peripheral, central office and ambulatory BP, BMI Z-score, uric acid, triglycerides, lower HDL-cholesterol and higher aPWV. PH patients had thicker cIMT and larger CCA D. The groups did not differ in parameters of CCA elasticity: beta stiffness index, CCA pulse wave velocity(PWVbeta) and pressure-strain elasticity modulus(Ep) and in IDR(0.08 ± 0.01vs.0.08 ± 0.02,p = 0.479) and TS(584.9 ± 135.5mmHg vs.529.7 ± 84.2,p = 0.095). We found correlations between cIMT(Z-score) and triglycerides, peripheral SBP Z-score, and ABPM MAP 24 h Z-score. CCA D correlated with BMI Z-score, uric acid and HDL-cholesterol, 24 h systolic blood pressure load(SBPL), Central systolic blood pressure(AoSBP) and peripheral diastolic BP Z-score. We found significant correlations between TS and uric acid, 24 h diastolic blood pressure load, and peripheral systolic and diastolic blood pressure Z-scores. There was no association between IDR and BP except for a weak correlation between IDR and SBPL. In PH patients, there was a strong correlation between cIMT and CCA D(r = 0.790,p &lt; 0.001). Conclusions: In children with PH, structural changes and decreased elasticity primarily affect the aorta and to a lesser extent the muscular arteries. In children with PH, both CCA wall thickness and internal diameter are associated with BP, and are significantly higher in children with PH. The changes observed in the carotid artery are probably adaptive in nature, not associated with impaired arterial function, thus intima-diameter ratio or tensile stress measurement does not appear to contribute additional information in this group of patients.

Gaming for better health? Comparison of cardiorespiratory and hemodynamic responses of exergaming with moderate endurance exercise

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Exergames are interactive video games that require the player to move their body to progress through the game. Even though numerous studies have determined a higher exercise intensity in exergames compared to sedentary videogames, the literature remains equivocal as to whether exergames elicit intensity levels that result in relevant physiological responses. The aim of the present study was to assess whether an exergaming session (ES) in an innovative exergame represents a physiological relevant exercise stimulus capable of producing favorable hemodynamic responses similar to moderate endurance exercise (MEE). Therefore, cardiovascular responses during and after an ES and an ET were assessed and compared. Methods Twenty-seven healthy young adults aged 25±4 years (48% female; BMI 23.0±2.1 kg/m2) participated in the study. The Maximum heart rate (HRmax) and the maximum oxygen consumption (VO2max) were determined during a cardiopulmonary exercise test on a treadmill. Furthermore, participants completed both a typical MEE (35 minutes, 65% of HRmax) on a treadmill and an ES (28 minutes). Heart rate (HR) and oxygen consumption were recorded during both training sessions. Both before and during the 45 minutes after the training sessions, the peripheral and central blood pressure (BP) were assessed. Results HR and oxygen consumption were significantly higher during ES than during MEE (p&amp;lt;0.001). Throughout the ES, the participants achieved a mean HR of 86±4 % of HRmax. Mean oxygen consumption reached 66±5 % of VO2max. 45 Minutes after the ES, there was a significant decrease in peripheral systolic (-6.2±2.9 mmHg; p&amp;lt;0.001) and diastolic (-4.8±5.7 mmHg; p&amp;lt;0.001), as well as in central systolic (-4.9±5.4 mmHg; p&amp;lt;0.001) and diastolic (-4.8±5.2 mmHg; p&amp;lt;0.001) BP compared to baseline. After MEE, only the peripheral diastolic (-2.3±3.4 mmHg; p=0.003), and central diastolic (-2.2±3.8 mmHg; p=0.006) pressure were significantly lower than the resting values before the exercise. The interaction effects showed significant differences in peripheral and central systolic BP as well as in peripheral diastolic BP (p=0.05). Conclusion The ES represents a vigorous exercise stimulus that triggers relevant peripheral and central BP reactions that are more pronounced than after an MEE. Exergaming may therefore be a promising tool for the prevention of cardiovascular diseases.

A Game-Based Approach to Lower Blood Pressure? Comparing Acute Hemodynamic Responses to Endurance Exercise and Exergaming: A Randomized Crossover Trial.

The present randomized crossover study aimed to determine whether an exergaming session in an innovative, functional fitness game could be an effective exercise approach that elicits favorable blood pressure (BP) responses, such as a typical moderate endurance exercise (ET). Therefore, acute hemodynamic responses after a training session in the ExerCube and an ET on a treadmill were assessed and compared. Twenty-eight healthy recreational active participants (13 women; aged 24.8 ± 3.9 years) completed an exergaming session (EX) and an ET in a randomized and counterbalanced order. Before and throughout the 45 min after the training, the peripheral and central BP were measured. After the ET, there was a moderate decrease in both peripheral systolic (−1.8 mmHg; p = 0.14) and diastolic (−0.8 mmHg; p = 0.003), as well as central diastolic (−1.5 mmHg; p = 0.006) pressure compared to the resting value before the exercise. After the EX, there was a significant decrease in peripheral systolic (−6.3 mmHg; p < 0.001) and diastolic (−4.8 mmHg; p < 0.001), as well as central systolic (−5.8 mmHg; p < 0.001) and diastolic (−5.3 mmHg; p < 0.001) pressure compared to baseline. The interaction effects showed significant differences in peripheral and central systolic BP as well as in peripheral diastolic BP (p = 0.05). The EX seems to be an effective training approach that triggers relevant peripheral and central BP-responses, which are more pronounced than after a typical ET. Therefore, the ExerCube can be a time-efficient training tool to improve cardiovascular health.

EFFECTS OF THE MTORC1 INHIBITOR EVEROLIMUS ON HEMODYNAMIC CHARACTERISTICS OF PATIENTS WITH PRIMARY ALDOSTERONISM

Objective: We recently showed that treatment with the mTORC1 inhibitor everolimus lowers home measured blood pressure (BP) and improves renin suppression in subjects with primary aldosteronism (PA). Aldosterone levels were markedly reduced in a subset of subjects. The aim of this study was to perform an explorative, secondary analysis of hemodynamic parameters acquired during this trial. Design and method: Design and Methods: This is an explorative, secondary analysis of an open-label proof-of-concept trial. Fourteen adult patients with PA diagnosed according to the current guidelines of the American Endocrine Society were recruited between June 2017 and June 2018 at our institution. Subjects were treated with everolimus 0.75 mg orally twice daily for 2 weeks. Peripheral and central BP, heart rate, pulse wave velocity, cardiac index, inotropic state index, left stroke work index, stroke systemic vascular resistance and system-integrated hemodynamic maps were measured at baseline, after the treatment and after a 2-week washout. Hemodynamic profiles were generated by thoracic electrical bioimpedance method using the HOTMAN® System. Central BP and pulse wave velocity (PWA) where estimated using Mobil-O-Graph PWA. Results: Full hemodynamic data with good recording quality were available for 7 patients, central BP and PWV data for 10 patients, respectively. After treatment with everolimus, we found a significant decrease in peripheral (median 94 mmHg [IQR 85–104] to 88 mmHg [IQR 78–96], p = 0.049, N = 10) and central diastolic blood pressure (median 95 mmHg [IQR 87–106] to 89 mmHg [IQR 82–97], p = 0.037, N = 10), a trend towards decreased peripheral (median 149 mmHg [IQR 130–165] to 144 [IQR 124–149], p = 0.073, N = 10) and central systolic blood pressure (median 138 mmHg [IQR 121–157] to 137 mmHg [IQR 117–141], p = 0.166, N = 10) and significantly reduced hypervolemia (p = 0.008, N = 7). Other hemodynamic parameters of the system-integrated hemodynamic maps remained unchanged (Figure). Conclusions: Everolimus decreases central and peripheral diastolic blood pressure in subjects with primary aldosteronism which is possibly mediated by a decrease in preload and primary aldosteronism-induced hypervolemia.

Insulin increases central aortic stiffness in response to hyperglycemia in healthy humans: A randomized four-arm study.

Introduction:Increasing arterial stiffness is a feature of vascular aging that is accelerated by conditions that enhance cardiovascular risk, including diabetes mellitus. Multiple studies demonstrate divergence of carotid-femoral pulse wave velocity and augmentation index in persons with diabetes mellitus, though mechanisms responsible for this are unclear.Materials and methods:We tested the effect of acutely and independently increasing plasma glucose, plasma insulin, or both on hemodynamic function and markers of arterial stiffness (including carotid-femoral pulse wave velocity, augmentation index, forward and backward wave reflection amplitude, and wave reflection magnitude) in a four-arm, randomized study of healthy young adults.Results:Carotid-femoral pulse wave velocity increased only during hyperglycemic-hyperinsulinemia (+0.36 m/s; p = 0.032), while other markers of arterial stiffness did not change (all p > 0.05). Heart rate (+3.62 bpm; p = 0.009), mean arterial pressure (+4.14 mmHg; p = 0.033), central diastolic blood pressure (+4.16 mmHg; p = 0.038), and peripheral diastolic blood pressure (+4.09 mmHg; p = 0.044) also significantly increased during hyperglycemic-hyperinsulinemia.Conclusions:Hyperglycemic-hyperinsulinemia acutely increased cfPWV, heart rate, mean arterial pressure, and diastolic blood pressure in healthy humans, perhaps reflecting enhanced sympathetic tone. Whether repeated bouts of hyperglycemia with hyperinsulinemia contribute to chronically-enhanced arterial stiffness remains unknown.

Predictors and reference equations for augmentation index, an arterial stiffness marker, in healthy children and adolescents

OBJECTIVES:To investigate predictors and propose reference equations for the augmentation index normalized to 75 bpm heart rate (AIx@75) in healthy children and adolescents.METHODS:This was a cross-sectional, observational study involving 134 healthy children and adolescents aged 9 to 19 years old. Participants were categorized into child (n=53) and adolescent (n=81) groups, as well as into male (n=69) and female (n=65) groups. We evaluated AIx@75, vascular and hemodynamic parameters, anthropometric data, physical activity profile, and quality of life (Peds-QL4.0; physical, emotional, social and school domains).RESULTS:The predictors of AIx@75 in the whole sample were age, peripheral diastolic blood pressure (pDBP), mean arterial pressure, pulse pressure amplification (PPA), systolic volume (SV), cardiac index (CI), and pulse wave velocity (PWV; R2=80.47%). In the male group, the predictors of AIx@75 were SV, CI, total vascular resistence (TVR), and PWV (R2=78.56%), while in the female group, they were pDBP, PPA, SV, and PWV (R2=82.45%). In the children, they were pDBP, PPA, SV, and PWV (R2=79.17%), while in the adolescents, they were body mass index, pDBP, PPA, SV, TVR, and PWV (R2=81.57%).CONCLUSION:In the present study, we used a representative sample from Belo Horizonte to establish normality values of AIx@75. We also identified, for the first time, independent predictors of AIx@75 in healthy children and adolescents categorized by sex and age. Determining AIx@75 reference equations may facilitate the early diagnosis of preclinical atherosclerosis and allow an objective measure of the vascular effects of therapeutic interventions aimed at modifying cardiovascular risk factors.

Assessing the Relationship between Digit Ratio as a Marker for Prenatal Androgen Exposure and Different Blood Pressure Components among North Indian Males: A Pilot Study

Introduction: Digit ratio (2D:4D) has been associated with cardiovascular diseases using association with surrogate markers. Studies showing an association of digit ratio with cardiovascular parameters within normal limits are scarce. Aim: To explore the relation between different blood pressure components and digit ratio in normal young males within physiological range. Materials and Methods: In this cross-sectional pilot study, 25 apparently healthy male volunteers were included. Digit ratio (2D:4D) was measured. Body Mass Index (BMI) was estimated. Peripheral blood pressure, central aortic blood pressure and all four limb blood pressures were measured using periscope arterial health and cardiovascular analysis system. Blood pressure was measured using oscillometric method from all peripheral sites and estimated central aortic pressure by a validated transfer function. Pearson’s correlation studies were performed to assess any preliminary association. Two groups were formed of low and high digit ratio and Student’s t-test was performed to assess any significant difference between the groups. Results: Digit ratio of both hands correlated best with peripheral Diastolic Blood Pressure (DBP) (Right 2D:4D r=0.43, p&lt;0.05/Left 2D:4D r=0.40, p&lt;0.05). No significant association observed for peripheral systolic pressure (p&gt;0.05) and digit ratio of both hands. Significant association observed for all four limb blood pressure components and digit ratio. Pulse pressure components did not show any association with digit ratio. Significant difference of blood pressure components was observed when low and high digit ratio groups were compared. It was observed that blood pressure components were on higher side within the normal limits among the subjects with high digit ratio. Conclusion: Preliminary observations from this pilot study suggests that in normal young adult males digit ratio associate positively with different blood pressure components in normotensive males and has the potential to be used as a potent marker for early changes in cardiovascular diseases.

Adherence to Treatment, Arterial Stiffness and Cognitive Function in Irbesartan- Treated Newly Diagnosed Hypertensive Patients.

Non-adherence to antihypertensive agents leads to reduced blood pressure (BP) control. Data supporting the correlation of adherence with arterial stiffness (AS) are few. Furthermore, the causal relationship between AS and cognitive dysfunction (CO/DY) has not been clearly established. It is suggested that angiotensin II receptor blockers (ARBs) exhibit the lowest discontinuation rate among antihypertensive drugs. We followed up with patients receiving monotherapy with irbesartan. CO/DY was assessed with the Mini-Mental State Examination (MΜSE) and other tests. Patients [n=77; mean age: 56±11 years; 39 men (50.6%)] were followed-up for 16.1±10.9 months. At the end of follow up, significant reductions were observed in mean peripheral systolic BP (135±117 vs 153±11 mmHg; p<0.005), mean peripheral diastolic BP (85±11 vs 95±10 mmHg; p<0.005), mean central systolic BP (130±11 vs 142±12 mmHg; p<0.005) as well as in mean central diastolic BP (85±8 vs 95±97 mmHg; p<0.005). AS indices [carotid-femoral pulse wave velocity and augmentation index] also improved significantly: 7.7±1.4 vs 8.2±1.4 m/sec (p<0.005), and 29.1±8.3 vs 32.3±9.1 (p<0.005), respectively. At the end of the study, a significant improvement was observed in the MMSE test (29.7±0.7 vs. 29.2±0.9; p<0.02), as well as a significant reduction in 24h urine albumin (94±82 vs. 204±112 mg/24h, p<0.005). The level of adherence was high in 60/77 (77.9%), medium in 9/77 (11.6%) and low in 8/77 (10.38%) patients. Hypertensive patients receiving mono-therapy with an ARB showed reduced AS, cognitive improvement, significant reductions in BP (peripheral and central) and decreased 24h urinary albumin excretion.

Abstract 12973: Atrial Fibrillation is Associated With Increased Central Blood Pressure and Arterial Stiffness

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice, yet there is a lack of information about the hemodynamic profile and arterial stiffness of these patients. Purpose: The purpose of this study is to describe the differences in arterial stiffness and central blood pressures in patients with paroxysmal/persistent AF compared to a healthy control group. Methods: We included 76 patients with paroxysmal and persistent AF who underwent electrical cardioversion or pulmonary vein isolation (PVI) for AF. Carotid-femoral pulse wave velocity (cfPWV), augmentation index (AIx) and central blood pressure (cBP) were measured by applanation tonometry. All measurements were done in sinus rhythm (SR). We compared the results with 75 healthy age matched individuals. Results: Patients with a history of AF had higher cfPWV compared to the control group (8,0 m/s vs 7,2 m/s, p&lt;0,001). AF patients also had higher central systolic blood pressure (cSBP) (118 mmHg vs 114 mmHg, p=0,03) and central pulse pressure (cPP) (39 mmHg vs 37 mmHg, p=0,03), without differences in peripheral systolic pressure (pSBP) (127 mmHg vs 123 mmHg, p=0,13), peripheral diastolic blood pressure (pDPB) (78 mmHg vs 76 mmHg, p=0,14) and peripheral pulse pressure (pPP) (48 mmHg vs 47 mmHg, p=0,37). There was no difference in heart rate (HR) (58 vs 61 bpm, p=0,08) (Table 1). In a multiple regression analysis (adjusted R 2 = 0,37) where cfPWV was set as the dependent variable and adjusting for age, sex, HR, weight, mean central arterial pressure (cMAP), estimated glomerular filtration rate (eGFR), the AF group remained to be an independent predictor for cfPWV (p=0,016). Conclusions: Patients with atrial fibrillation have a higher cSBP, cPP and cfPWV compared to healthy subjects without differences in peripheral blood pressure and HR. These findings support the hypothesis that arterial stiffness may play an important role in the development of atrial fibrillation.

Alterations in central hemodynamic in patients with COPD after acute high intensity exercise

The present study investigated the relationship between central hemodynamics and lung function and the response to an acute bout of exercise in COPD. MethodsBased on the severity of COPD, moderate group (MOD, n = 12) and more mild group (MLD, n = 12) underwent central hemodynamic assessments pre- and post-peak exercise. ResultsIn the entire cohort (n = 24), central diastolic blood pressure (cDBP) was associated with pulmonary function. Post-exercise, cDBP remained elevated (p < 0.01), however, peripheral diastolic blood pressure (pDBP) was reduced (p = 0.02). Prior to exercise, the MOD showed higher cDBP and heart rate (HR) than the MLD (p = 0.02 and p = 0.01, respectively), but no difference in central aortic/arterial stiffness (p > 0.05). These findings remained similar post-exercise. ConclusionCentral diastolic blood pressure is linked to pulmonary function in COPD and it is elevated after exercise-induced reductions in pDBP. Central diastolic blood pressure is higher in the MOD than the MLD, however, there was no difference in central aortic/arterial stiffness between groups.

Hemodynamic Effects of a Multidisciplinary Geriatric Rehabilitation Program.

BackgroundGeriatric rehabilitation programs primarily aim at an increase of mobility and functional autonomy of the elderly. The cardiovascular effects of these programs, however, remain elusive. Since regular physical exercise is associated with numerous beneficial cardiovascular effects including a reduction of blood pressure (BP), the present prospective study investigates the hemodynamic effects of a representative standardized rehabilitation program.MethodsA total of 74 subjects who were hospitalized in a German university hospital for geriatric rehabilitation were enrolled in the study. Peripheral BP, central aortic BP, 24h-ambulatory BP, heart rate and pulse wave velocity as a measure of arterial stiffness were assessed at admission and before discharge from the hospital. The program contained 4–5 sessions of physical activity of individualized intensity per week (≥30 min/session, eg, walking, cycling, stair rising).ResultsThe mean age of the study population was 82.4±6.9 years; all patients suffered from arterial hypertension (stage 2–3) with a median number of three antihypertensive drugs. The most frequent cause for admission was injurious falls. The mean duration of the rehabilitation program was 17 days and comprised at least 20 physical activity sessions including occupational therapy. The program led to a significant improvement of mobility (Timed Up & Go 29.5±18.5 vs 19.1 ±9.3 s, p<0.001) and Barthel index of activities of daily living score (46.6±19.1 vs 69.8±16.5, p<0.001). Peripheral systolic BP decreased from 135.4±19.0 mmHg at baseline to 129.0±18.4 mmHg at follow-up (p=0.03), whereas peripheral diastolic BP, central aortic BP, 24h-ambulatory BP, heart rate and pulse wave velocity as a measure of arterial stiffness were not significantly altered (p>0.05 each).ConclusionThe present representative standardized geriatric rehabilitation program was able to improve mobility, which showed a mild effect on systolic BP but did not affect 24h-ambulatory BP.

Primary Prevention: No Associations of Strength and Cardiorespiratory Fitness Status With Arterial Stiffness in Young School Children.

Pulse wave velocity (PWV) and central systolic blood pressure (CSBP) are well-established biomarkers of arterial stiffness. Further, fitness is known to be an important protective factor in adults in respect of vascular stiffening. However, the association of both muscular and cardiorespiratory fitness (CRF) with arterial properties in younger individuals has been inconsistent. The aim of the present study was to investigate the relationship between anthropometric data, CRF, strength status, and arterial stiffness parameters in German primary school children. A total of 76 children, age 6–11 years (63.2% males) were examined. Peripheral systolic blood pressure (PSBP) [mmHg] and peripheral diastolic blood pressure (PDBP) [mmHg] and PWV [m/s] were measured non-invasively after 10 min of rest with the oscillometric cuff-based Mobil-O-Graph (IEM, Healthcare, Stolberg, Germany). CSBP [mmHg] was calculated using the ARCSolver Algorithm (Austrian Institute of Technology, Vienna, Austria) based on the recorded brachial pulse waves. CRF was measured using the validated Progressive Aerobic Cardiovascular Endurance run (PACER), also called shuttle-run test, for estimating maximal aerobic capacity (VO2max). Hand-grip strength as an indicator of overall muscle strength was determined with the Jamar Analog Hand Dynamometer. The results were recorded in kilograms [kg]. For more detailed analyses, the study group was divided into subcohorts, namely a risk group including children with abnormal blood pressure or high body weight, and a healthy subgroup. Healthy children showed a positive association between PWV and body mass index (BMI) (p = 0.016) and CSBP and BMI (p = 0.033), respectively. Hand-grip strength was positively associated with CSBP (left: p = 0.013, right: p = 0.015) and PWV (left: p = 0.008, right: p = 0.002), as well as the number of shuttle run rounds were positively correlated to PWV (p = 0.038) in the whole cohort. No significant association of converted VO2max with arterial PWV was found. The multivariate regression analysis explained 38.8% (R2 = 0.388) of the variance and the model was a significant predictor of PWV [F(6, 29) = 3.060, p = 0.019], however, none of the integrated covariates (BMI, number of shuttle run rounds, VO2max, dominant hand-grip strength) contributed significantly to the model. The lack of associations between fitness, strength and arterial stiffness might be explained by the few harmful lifestyle factors influencing vascular changes in the first decade of life.