Aortic Systolic Blood Pressure Research Articles

PS-C08-5: VALIDATE-CKD - PRELIMINARY FINDINGS ON CENTRAL BLOOD PRESSURE DEVICES ACCURACY IN PATIENTS WITH STAGES G4-G5 CHRONIC KIDNEY DISEASE

Objective: Measurement of brachial cuff blood pressure (BP) was designed as a convenient surrogate to the aortic BP, which is the BP that dictates perfusion to target organs. In the general population, brachial cuff systolic BP (SBP) has a somewhat acceptable accuracy towards aortic BP but less is know in populations with marked high arterial stiffness, such as in G4-G5 CKD. Central BP devices were designed to directly estimate the aortic BP through pulse wave analysis to a greater accuracy than brachial cuff BP. The aim of the ongoing VALIDATE-CKD study is to compare the accuracy of brachial and central BP readings towards the intraarterial aortic SBP, in patients with and without Stage G4-G5 CKD. Design and method: In patients with and without Stage G4-G5 CKD (eGFR < 30 ml/min/1.73m2) undergoing non-urgent coronary angiograms, invasive aortic and non-invasive (WatchBP and Mobil-o-graph devices) BPs were measured simultaneously following the ARTERY Society protocol. Accuracy was defined by the mean difference (± SD) between the aortic SBP and the corresponding non-invasive SBP. Results: To date, 8 individuals with Stage G4-G5 CKD and 26 control subjects are enrolled. The following table presents clinical characteristics and non-invasive BPs accuracies in patients with and without Stage G4-G5 CKD. Conclusion: These preliminary results indicate that brachial SBP significantly underestimates aortic SBP in patients with Stage G4-5 CKD as compared to control subject. Furthermore, central BP devices provide a highly accurate estimation of aortic SBP in this population. The ongoing VALIDATE-CKD study may support that the use of central BP devices could be beneficial for the management of patients with advanced CKD.

PS-C26-4: ASSOCIATIONS BETWEEN ARTERIAL STIFFNESS INDICES AND CHRONIC KIDNEY DISEASE CATEGORIES IN ESSENTIAL HYPERTENSIVE PATIENTS

Background: This study investigated the association between arterial stiffness indices and asymptomatic chronic kidney disease (CKD) risk categories in hypertensive patients by using oscillometric device. Methods: Arterial stiffness indices, including 24-hour brachial and aortic systolic blood pressure (SBP) and pulse wave velocity (PWV), were measured by an oscillometric Mobil-O-Graph device, brachial-ankle PWV (baPWV) by a volume-plethysmographic method, and renal resistive index (RI) by ultrasonography, in 184 essential hypertensive patients (66.0 ± 17.1 years, 47.3% male). CKD was categorized into 3 stages based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria, using a combination of estimated glomerular filtration and albuminuria. Results: The 24-hour aortic PWV (aPWV), baPWV, and RI increased with worsening severity of CKD risk category (all P < 0.01 for trend). Multivariate logistic regression analysis found that a 1 SD increase of nighttime aortic SBP (odds ratio [OR] 1.52), PWV (OR 4.80), or RI (OR 1.75) was an independent predictor of high or very-high CKD stage (all P < 0.05). After adjustment for potential confounders, day-to-night change in brachial SBP as well as in aPWV differed among groups (P < 0.05, respectively). In a multivariate regression model, day-to-night changes in aortic SBP and PWV, and RI were independently associated with day-to-night brachial SBP change. Conclusions: In hypertension, circadian hemodynamics in high CKD stage are characterized by higher nighttime values of aortic SBP and PWV and disturbed intrarenal hemodynamics. Further, the blunted nocturnal BP reduction in these patients might be mediated via disturbed intrarenal hemodynamics and circadian hemodynamic variation in aortic SBP and arterial stiffness.

PS-C07-8: CENTRAL BLOOD PRESSURE ESTIMATION USING THE RADIAL ARTERIAL PRESSURE WAVEFORM IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS

Objective: Evaluation of central blood pressure is useful in prevention and treatment of cardiovascular diseases. In this study, we examined the accuracy of non-invasively measured central blood pressure in children, adolescents, and young adults. Design and Method: This study enrolled 23 patients who had undergone a cardiac catheterization below 30 years old (10.4 ± 7.2 years, 16 males and 7 females). Ascending aortic blood pressure waveforms were invasively recorded using a pressure sensor-mounted catheter (model SPC-454D, Millar Instrument, Inc., Houston, Texas). Simultaneously, radial artery pulse waveforms were non-invasively recorded by tonometry (HEM-9000AI, Omron Healthcare Co., Ltd., Kyoto, Japan). The measurements were performed before and after angiogram (injection of contrast media) except for one case. We analyzed the degree of coincidence between ascending aortic systolic blood pressure (aSBP) and estimated central systolic blood pressure calculated by the instrument (estCBP) in 45 simultaneous recording of aSBP and estCBP. The HEM-9000AI calculates estCBP using rSBP2, which indicates reflected pressure on radial artery. Results: The aSBP was 96.2 ± 13.4 mmHg and estCBP was 92.9 ± 14.7mmHg. There was no significant correlation between the aSBPs before and after angiogram in the same case. There was a significant relationship between aSBP and estCBP (r = 0.83, p < 0.0001). The mean difference of the estSBP minus aSBP was -3.3 ± 8.3 mmHg by Bland-Altman analysis. The relationship between aSBP and rSBP1, which indicates forward pressure on radial artery, was stronger than the relationship between aSBP and rSBP2 (r = 0.88, p < 0.0001 vs. r = 0.83, p < 0.0001). The relationship between aSBP and the average of rSBP1 and rSBP2 (r = 0.90, p < 0.0001) was stronger than the relationship between aSBP and estCBP. Conclusions: The estSBP calculated using rSBP2 method by HEM 9000AI was significantly correlated to aSBP in children, adolescents, and young adults. However, the correlation coefficient between aSBP and rSBP2 was smaller than that between aSBP and rSBP1. The estCBP calculated by rSBP1 and rSBP2 was strongly correlated to aSBP rather than estCBP by rSBP2 alone.

PS-C08-1: ACCURACY OF CUFF BLOOD PRESSURE AND SYSTOLIC BLOOD PRESSURE AMPLIFICATION

Objective: Automated cuff measured blood pressure (BP) is the global standard used for diagnosing hypertension, but there are concerns regarding the accuracy of the method. Individual variability in systolic BP (SBP) amplification from central (aorta) to peripheral (brachial) arteries could be related to the accuracy of cuff BP, but this has never been determined and was the aim of this study. Methods: Cuff BP and invasive brachial BP were recorded in 755 participants (73% male, aged 64 ± 11 years) receiving coronary angiography at six independent research sites (using seven different automated cuff BP devices). SBP amplification was recorded invasively by catheter and defined as brachial SBP minus aortic SBP. Results: Compared with invasive brachial SBP, cuff SBP was significantly underestimated (130 ± 18 mmHg vs. 138 ± 22 mmHg, p < 0.001). The level of SBP amplification varied significantly among individuals (mean ± SD, 7.3 ± 9.1 mmHg; interquartile range, -2.4 to 12.3 mmHg) and was similar to level of difference between cuff and invasive brachial SBP (mean difference -7.6 ± 11.9 mmHg). SBP amplification explained most of the variance in accuracy of cuff SBP (R2 = 19%). The accuracy of cuff SBP was greatest among those participants in the lowest SBP amplification quintiles (ptrend< 0.001). After cuff BP values were corrected for SBP amplification, there was a significant improvement in the mean difference from the intra-arterial standard (p < 0.0001) and in the accuracy of hypertension classification according to 2017 ACC/AHA guideline thresholds (p = 0.005). Conclusions: The accuracy of automated cuff BP is markedly influenced by individual variability in SBP amplification. This knowledge can help improve the accuracy of cuff BP.

Orthostatic blood pressure adaptations, aortic stiffness, and central hemodynamics in the general population: insights from the Malmö Offspring Study (MOS)

PurposeArterial stiffness is independently associated with orthostatic hypotension in older individuals. The relationship between orthostatic blood pressure adaptation and aortic stiffness has not been thoroughly examined in a younger population. We investigated the relationship between orthostatic blood pressure adaptations, central aortic hemodynamics, and aortic stiffness in a cohort of predominantly younger and middle-aged adults.MethodsWe analyzed an observational, population-based study of 5259 individuals living in Malmö, Sweden. We related aortic stiffness and central hemodynamics assessed by carotid–femoral pulse wave velocity and pulse wave analysis at the arteria radialis using Sphygmocor to orthostatic blood pressure adaptation after 3 min standing.ResultsThe mean age of the population was 41.9 ± 14.5 years, and 52.1% were women. We observed the highest aortic stiffness and central aortic blood pressure measurements in the lowest and highest quartiles of orthostatic systolic blood pressure differences (p < 0.001). Aortic stiffness and central aortic blood pressure gradually decreased across increasing quartiles of orthostatic diastolic blood pressure difference (p < 0.001). After full adjustment, orthostatic diastolic blood pressure remained significantly associated with aortic stiffness (p = 0.001) and central aortic blood pressure (p < 0.001), whereas orthostatic systolic blood pressure was significantly associated only with central aortic systolic blood pressure (p = 0.009). No significant associations were found between subclinical orthostatic hypotension, aortic stiffness, and central hemodynamics.ConclusionsOur findings demonstrate that altered blood pressure responses to orthostatic challenges, both blood pressure reductions and blood pressure increases, are independently and inversely associated with markers of aortic stiffness (vascular aging) in a predominantly young to middle-aged population.

Enhancing central blood pressure accuracy through statistical modeling: A proof-of-concept study.

Non-invasive estimation of central blood pressure (BP) may have better prognostic value than brachial BP. The accuracy of central BP is limited in certain populations, such as in females and the elderly. This study aims to examine whether statistical modeling of central BP for clinical and hemodynamic parameters results in enhanced accuracy. This study is a cross-sectional analysis of 500 patients who underwent cardiac catheterization. Non-invasive brachial cuff and central BP were measured simultaneously to invasive aortic systolic BP (AoSBP). Central BP was calibrated for brachial systolic (SBP) and diastolic BP (Type I calibration; C1SBP) or brachial mean and diastolic BP (Type II calibration; C2SBP). Differences between central SBP and the corresponding AoSBP were assessed with linear regression models using clinical and hemodynamic parameters. These parameters were then added to C1SBP and C2SBP in adjusted models to predict AoSBP. Accuracy and precision were computed in the overall population and per age or sex strata. C1SBP underestimated AoSBP by 11.2 mmHg (±13.5) and C2SBP overestimated it by 6.2 mmHg (±14.8). Estimated SBP amplification and heart rate were the greatest predictors of C1- and C2-AoSBP accuracies, respectively. Statistical modeling improved both accuracy (0.0 mmHg) and precision (±11.4) but more importantly, eliminated the differences of accuracy seen in different sex and age groups. Statistical modeling greatly enhances the accuracy of central BP measurements and abolishes sex- and age-based differences. Such factors could easily be implemented in central BP devices to improve their accuracy.

Menopause influences aortic pulse pressure and pressure wave responses to metaboreflex activation in women.

Postmenopausal women (post-MW) have greater risk of heart failure due to aortic pulsatile overload on the left ventricle associated with increased backward wave pressure (Pb). Post-MW have exaggerated peripheral blood pressure (BP) response to exercise mediated by metaboreflex (postexercise muscle ischemia [PEMI]) overactivation. Increased forward wave pressure (Pf) and Pb are determinants of aortic pulse pressure (PP) during isometric handgrip exercis (IHG) in young adults. We hypothesized that aortic PP and pressure wave responses to PEMI are augmented in nonhypertensive post-MW compared with premenopausal women (pre-MW). Aortic BP, Pf, Pb, and reflection magnitude were assessed at rest and during IHG and PEMI by applanation tonometry in 15 pre-MW and 16 post-MW. Aortic systolic BP during PEMI similarly increased in both groups. The increase in diastolic BP was lower in post-MW (post-MW Δ6 ± 2 vs pre-MW Δ11 ± 2 mm Hg, P < 0.05). Aortic PP (post-MW Δ8 ± 2 vs pre-MW Δ3 ± 2), Pf (post-MW Δ6 ± 1 vs pre-MW Δ0 ± 1), and Pb (post-MW Δ5 ± 1 vs pre-MW Δ2 ± 1) augmented during PEMI in post-MW ( P < 0.05 for all), but not in pre-MW. Reflection magnitude increased during PEMI only in pre-MW (pre-MW Δ7 ± 2 vs post-MW Δ-1 ± 2, P < 0.05) due to concurrent increases in Pf and Pb in post-MW. Even in nonhypertensive postmenopausal women, increases in Pf and Pb and decrease in aortic DBP are important factors that contribute to the augmented aortic PP response to PEMI.

Assessment of arterial stiffness to predict blood pressure response to renal sympathetic denervation.

Recent trials support the efficacy of renal sympathetic denervation (RDN) to reduce blood pressure (BP). Nevertheless, about one third of patients are considered non-responders to RDN. Previous retrospective analyses suggest arterial stiffness could predict BP response to RDN. We prospectively assessed the potential of invasive pulse wave velocity (iPWV) to predict BP response to RDN. Additionally, we aimed to establish non-invasive models based on arterial stiffness to predict BP response to RDN. iPWV, magnetic resonance imaging-based markers of arterial stiffness and the carotid-femoral pulse wave velocity were recorded prior to RDN in patients with treatment resistant hypertension. Changes in daytime BP after 3 months were analysed according to the prespecified iPWV cut-off (14.4 m/s). Regression analyses were used to establish models for non-invasive prediction of BP response. Results were compared to iPWV as reference and were then validated in an external patient cohort. Eighty patients underwent stiffness assessment before RDN. After 3 months, systolic 24h and daytime BP were reduced by 13.6±9.8 mmHg and 14.7±10.6 mmHg in patients with low iPWV, versus 6.2±13.3 mmHg and 6.3±12.8 mmHg in those with high iPWV (p<0.001 for both). Upon regression analysis, logarithmic ascending aortic distensibility and systolic baseline BP independently predicted BP change at follow-up. Both were confirmed in the validation cohort. iPWV is an independent predictor for BP response after RDN. In addition, BP change prediction following RDN using non-invasive measures is feasible. This could facilitate patient selection for RDN treatment.

Randomized Pilot Study on the Effects of Sarcocornia as a Salt Substitute in Arterial Blood Pressure and Vascular Function in Healthy Young Adults.

Previous studies have shown that excessive salt intake is strongly associated with high blood pressure (HT), vascular dysfunction, and the overall risk of cardiovascular diseases. The aim of this study was to evaluate Sarcocornia effectiveness as a salt substitute, addressing its effect on cardiovascular function in healthy young individuals. Thirty healthy participants, aged 18 to 26 years, were randomized into two groups: the control group (CG) and the intervention group (IG). The IG used Sarcocornia powder as a salt substitute for cooking, and the CG used regular salt, during a period of 1 month. A baseline evaluation was performed before the participants started the intervention phase, and was repeated after a 30-day intervention period. Each evaluation included blood pressure (BP) measurement, carotid-femoral pulse wave velocity (PWV), and carotid pulse wave analysis (PWA), and blood samples were also collected for analysis. Sodium excretion was measured at baseline and after intervention through spot urine collection and analysis, a method suitable for this population but with known limitations. Baseline parameters were similar between groups and were within the normal range. Sodium excretion remained unchanged in the two evaluations in the CG, but significantly decreased after intervention in the IG. The reduction in sodium excretion in the IG was followed by a significant reduction in brachial and aortic systolic (SBP) and diastolic blood pressure (DBP), and also in PWV. No significant changes were observed in the CG in terms of cardiovascular parameters. This preliminary study conveys positive results in favor of Sarcocornia as a dietary substitute for regular salt, providing added evidence of the negative cardiovascular effects of high salt intake in young and healthy adults.

Impact Of Age On Aortic Pressure And Pressure Waves Responses To Metaboreflex Activation In Women

INTRODUCTION: Aging and hypertension are related to exaggerated peripheral blood pressure (BP) responses to exercise and metaboreflex activation (post-exercise muscle ischemia, PEMI). Postmenopausal (POST) women have greater risk of heart failure with preserved ejection fraction due to increased aortic pulsatile load on the left ventricle induced by increased systolic BP (SBP) and decreased diastolic BP (DBP) at rest. Age-related aortic stiffening augments pressures of the forward (Pf) and the reflected wave (Pb) traveling from peripheral arteries to the aorta. Increases in Pf and Pb contribute to elevated aortic SBP and pulse pressure (PP) responses to exercise, increasing the risk for cardiovascular events. However, the influence of Pf and Pb on aortic pulsatile load during isometric handgrip (IHG) and PEMI in normotensive premenopausal (PRE) and POST women have not been examined. PURPOSE: To investigate the effect of age on aortic BP, Pf, and Pb during IHG and PEMI in normotensive PRE and POST women. METHODS: Fifteen PRE (age: 24 ± 1 years) and 16 POST women (age: 59 ± 1 years) participated in this study. Brachial BP was obtained using an automated device and radial arterial tonometry was used to capture aortic waveforms to estimate aortic BP and pressure waves at rest, during a 2-min IHG at 30% of maximal force, and during a 3-min PEMI. RESULTS: BP responses to IHG were similar in both groups. Brachial PP (POST: Δ9 ± 1 mmHg vs PRE: Δ0 ± 2 mmHg, P < 0.01), aortic PP (POST: Δ8 ± 1 mmHg vs PRE: Δ3 ± 2 mmHg, P = 0.03), Pf (POST: Δ6 ± 1 mmHg vs PRE: Δ0 ± 1 mmHg, P < 0.01), and Pb (POST: Δ5 ± 1 mmHg vs PRE: Δ2 ± 1 mmHg, P = 0.02) responses to PEMI were significantly increased in POST compared to PRE women. Aortic DBP (POST: Δ6 ± 1 mmHg vs PRE: Δ11 ± 2 mmHg, P = 0.04) responses to PEMI was significantly lower in POST than PRE women. Brachial and aortic SBP significantly (P < 0.001) increased during PEMI in both PRE and POST women, but there was no difference (P > 0.05) between groups. CONCLUSION: Normotensive POST women have augmented aortic PP response to PEMI compared to PRE women due to increases in pressure of the forward and backward waves and a decrease in DBP. Our findings suggest that the age-related increase in muscle metaboreflex activation does not induce a systolic overload and the increase in aortic PP is attributed to reduced DBP in normotensive POST women.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Clinical implications of central blood pressure measured by radial tonometry and automated office blood pressure measured using automatic devices in cardiovascular diseases.

ObjectiveCentral aortic systolic blood pressure (CBP) measured by carotid-femoral pulse wave analysis (cfPWA) is a gold standard method to estimate true arterial pressure. However, the impact of the CBP level measured by radial PWA on cardiovascular (CV) risk assessment is unclear. This study aimed to determine the impact on CV outcome assessment and the association between the optimal levels of non-invasively measured CBP and automated office blood pressure (OBP) in clinical practice.Materials and methodsA total of 2,115 patients underwent non-invasive semiautomated radial artery applanation tonometry (Omron HEM-9000AI) in the Department of Internal Medicine, St. Vincent’s Hospital, from July 2011 to December 2015. The patients were followed for at least 5 years, and atherosclerotic cardiovascular (ASCVD) outcomes were collected.ResultsAmong 2,115 patients (mean age 58 ± 14 years, 50.4% men) who were followed up, the median follow-up period was 52 months (range: 1–104 months). The total number of patients with ASCVD events was 163 (7.70%). In multivariate Cox regression analysis, a CBP of more than 125 mmHg and an automated OBP of more than 131 mmHg were independently associated with a significant increase in ASCVD outcomes. After adjusting for confounding factors, the hazard ratio for ASCVD events increased by 12.5, 11.7, and 12.7%, for every 10 mmHg increase in automated OBP, CBP, and central pulse pressure (PP), respectively.ConclusionThis study demonstrated that the automated OBP measured using the method used in real clinical practice and CBP measured by radial tonometry were associated with an increased risk for adverse ASCVD outcomes.

Sex Differences in Blood Pressure and Potential Implications for Cardiovascular Risk Management.

Accurate blood pressure (BP) measurement is critical for optimal cardiovascular risk management. Age-related trajectories for cuff-measured BP accelerate faster in women compared with men, but whether cuff BP represents the intraarterial (invasive) aortic BP is unknown. This study aimed to determine the sex differences between cuff BP, invasive aortic BP, and the difference between the 2 measurements. Upper-arm cuff BP and invasive aortic BP were measured during coronary angiography in 1615 subjects from the Invasive Blood Pressure Consortium Database. This analysis comprised 22 different cuff BP devices from 28 studies. Subjects were 64±11 years (range 40-89) and 32% women. For the same cuff systolic BP (SBP), invasive aortic SBP was 4.4 mm Hg higher in women compared with men. Cuff and invasive aortic SBP were higher in women compared with men, but the sex difference was more pronounced from invasive aortic SBP, was the lowest in younger ages, and the highest in older ages. Cuff diastolic blood pressure overestimated invasive diastolic blood pressure in both sexes. For cuff and invasive diastolic blood pressure separately, there were sex*age interactions in which diastolic blood pressure was higher in younger men and lower in older men, compared with women. Cuff pulse pressure underestimated invasive aortic pulse pressure in excess of 10 mm Hg for both sexes in older age. For the same cuff SBP, invasive aortic SBP was higher in women compared with men. How this translates to cardiovascular risk prediction needs to be determined, but women may be at higher BP-related risk than estimated by cuff measurements.

Sleep duration irregularity is associated with elevated blood pressure in young adults

ABSTRACT Sleep irregularity (i.e., highly variable sleep patterns) is an emerging risk factor for cardiometabolic disease. Though irregular sleep patterns are common among young adults, the cardiometabolic health (CMH) repercussions of sleep irregularity in this population are unclear. We examined associations between sleep duration and irregularity with measures of CMH in 44 (24 M/20 F, 23 ± 5y, BMI 26 ± 4 kg/m2, blood pressure (BP): 125/71 ± 14/9 mmHg) young adults. Participants wore actigraphy monitors for seven-days and sleep duration irregularity was operationalized as the standard deviation of nightly sleep duration (sleep SD). CMH variables of interest included brachial and aortic BP, arterial stiffness (cf-PWV), augmentation index (AIx75), and fasting blood glucose and lipids. Associations between sleep duration and sleep SD with CMH variables were assessed via correlations adjusted for sex and BMI. Sleep duration generally was not associated with CMH indices. However, sleep SD was associated with brachial systolic (r = 0.433, p = .027) and diastolic BP (r = 0.415, p = .035). Similarly, sleep duration SD was associated with aortic systolic BP (r = 0.447, p = .022). Our findings show that sleep irregularity, but not duration, is associated with higher brachial and central BP in young adults. Abbreviations: AIx75: augmentation index at a heart rate of 75 beats per minute; BP: blood pressure; CMH: cardiometabolic health; cf-PWV: carotid-femoral pulse wave velocity; DXA: dual x-ray absorptiometry; mg/dl: milligrams per deciliter; PWA: pulse wave analysis; PWV: pulse wave velocity; sleep duration SD: standard deviation of nightly sleep duration

Arterial Wave Reflection and Aortic Valve Stenosis: Diagnostic Challenges and Prognostic Significance.

IntroductionArterial wave reflection is an important component of the left ventricular afterload, affecting both pressure and flow to the aorta. The aim of the present study was to evaluate the impact of wave reflection on transvalvular pressure gradients (TPG), a key parameter for the evaluation of aortic valve stenosis (AS), as well as its prognostic significance in patients with AS undergoing a transcatheter aortic valve replacement (TAVR).Materials and MethodsThe study population consisted of 351 patients with AS (mean age 84 ± 6 years, 43% males) who underwent a complete hemodynamic evaluation before the TAVR. The baseline assessment included right and left heart catheterization, transthoracic echocardiography, and a thorough evaluation of the left ventricular afterload by means of wave separation analysis. The cohort was divided into quartiles according to the transit time of the backward pressure wave (BWTT). Primary endpoint was all-cause mortality at 1 year.ResultsEarly arrival of the backward pressure wave was related to lower cardiac output (Q1: 3.7 ± 0.9 lt/min vs Q4: 4.4 ± 1.0 lt/min, p < 0.001) and higher aortic systolic blood pressure (Q1: 132 ± 26 mmHg vs Q4: 117 ± 26 mmHg, p < 0.001). TPG was significantly related to the BWTT, patients in the arrival group exhibiting the lowest TPG (mean TPG, Q1: 37.6 ± 12.7 mmHg vs Q4: 44.8 ± 14.7 mmHg, p = 0.005) for the same aortic valve area (AVA) (Q1: 0.58 ± 0.35 cm2 vs 0.61 ± 0.22 cm2, p = 0.303). In multivariate analysis, BWTT remained an independent determinant of mean TPG (beta 0.3, p = 0.002). Moreover, the prevalence of low-flow, low-gradient AS with preserved ejection fraction was higher in patients with early arterial reflection arrival (Q1: 33.3% vs Q4: 14.9%, p = 0.033). Finally, patients with early arrival of the reflected wave (Q1) exhibited higher all-cause mortality at 1 year after the TAVR (unadjusted HR: 2.33, 95% CI: 1.17–4.65, p = 0.016).ConclusionEarly reflected wave arrival to the aortic root is associated with poor prognosis and significant aortic hemodynamic alterations in patients undergoing a TAVR for AS. This is related to a significant decrease in TPG for a given AVA, leading to a possible underestimation of the AS severity.

Accuracy Difference of Noninvasive Blood Pressure Measurements by Sex and Height

Women are at higher risk of cardiovascular events than men with similar blood pressure (BP). Whether this discrepancy in risk is associated with the accuracy of brachial cuff BP measurements is unknown. To examine the difference in brachial cuff BP accuracy in men and women compared with invasively measured aortic BP and to evaluate whether noninvasive central BP estimation varies with sex. This cross-sectional study enrolled 500 participants without severe aortic stenosis or atrial fibrillation from January 1 to December 31, 2019, who were undergoing nonurgent coronary angiography at a tertiary care academic hospital. Simultaneous measurements of invasive aortic BP and noninvasive BP. Sex differences in accuracy were determined by calculating the mean difference between the noninvasive measurements (brachial and noninvasive central BP) and the invasive aortic BP (reference). Linear regression and mediation analyses were performed to identify mediators between sex and brachial cuff accuracy. This study included 500 participants (145 female [29%] and 355 male [71%]; 471 [94%] White; mean [SD] age, 66 [10] years). Baseline characteristics were similar for both sexes apart from body habitus. Despite similar brachial cuff systolic BP (SBP) (mean [SD], 124.5 [17.7] mm Hg in women vs 124.4 [16.4] in men; P = .97), invasive aortic SBP was higher in women (mean [SD], 130.9 [21.7] in women vs 124.7 [20.1] mm Hg in men; P < .001). The brachial cuff was relatively accurate compared with invasive aortic SBP estimation in men (mean [SD] difference, -0.3 [11.7] mm Hg) but not in women (mean [SD] difference, -6.5 [12.1] mm Hg). Noninvasive central SBP (calibrated for mean and diastolic BP) was more accurate in women (mean [SD] difference, 0.6 [15.3] mm Hg) than in men (mean [SD] difference, 8.3 [14.2] mm Hg). This association of sex with accuracy was mostly mediated by height (3.4 mm Hg; 95% CI, 1.1-5.6 mm Hg; 55% mediation). In this cross-sectional study, women had higher true aortic SBP than men with similar brachial cuff SBP, an association that was mostly mediated by a shorter stature. This difference in BP measurement may lead to unrecognized undertreatment of women and could partly explain why women are at greater risk for cardiovascular diseases for a given brachial cuff BP than men. These findings may justify the need to study sex-specific BP targets or integration of sex-specific parameters in BP estimation algorithms.

NON-INVASIVE CENTRAL BLOOD PRESSURE ESTIMATIONS IN PATIENTS WITH OR WITHOUT CHRONIC KIDNEY DISEASE: A PILOT PROJET

Objective: Central systolic blood pressure (SBP) is a better surrogate for hemodynamic strain on the myocardium, brain and kidneys. In the context of chronic kidney disease (CKD), where the blood flow to the kidneys is reduced and there is a higher degree of aortic stiffness, estimation of central BP through non-invasive methods needs to be validated. The aim of our study is to determine the accuracy of brachial and central SBP, as measured and estimated by two devices, towards the invasively measured aortic BP, in CKD patients compared to patients without CKD. Design and method: This is a multicenter pilot study taking place at the hospitals Hotel-Dieu de Québec and Sacré-Coeur de Montréal. Patients undergoing non-urgent coronary angiograms are undergoing evaluation of non-invasive and invasive BPs simultaneously in supine position. In brief, intraarterial aortic BPs are recorded in the aorta within 3 cm of the aortic valve for every heartbeat for 30 seconds then averaged. Non-invasive central and brachial BP measures are recorded concurrently to the intraarterial aortic BP recordings with WatchBP central and Mobil-o-graph. All measurements are recorded on the contralateral arm used for angiography. Results: In 34 subjects (29% female, mean age 64.2 ± 8.7). In the CKD group (n = 8, eGFR &lt; 30 ml/min/1.73m2) and the control group (n = 26, eGFR&gt; 30 ml/min/1.73m2). Brachial cuff-SBP underestimated aortic SBP in CKD (-10.0 ± 19.6 mmHg) but overestimated aortic SBP (3.9 ± 16.3 mm Hg) in the control group. Mobil-o-graph estimations are more precise than the brachial BP in CKD (0.0 ± 10.1 mmHg) but not in the control group (6.5 ± 14.7 mmHg). WatchBP Central SBP estimations are also more precise than the brachial BP in CKD (1.2 ± 10.8) but overestimated aortic SBP in the control group (13.4 ± 18.9). Conclusions: The preliminary results indicate that brachial SBP underestimates aortic SBP by in CKD as compared to controls, and that estimation of central BP by both devices provide a better estimate of aortic SBP in CKD than in controls. These preliminary results suggest that the use of central BP estimations could be beneficial for the management of hypertension in CKD.

AORTIC CALCIFICATION INCREASES CENTRAL BLOOD PRESSURE RELATIVE TO BRACHIAL BLOOD PRESSURE IN CKD PATIENTS – A STUDY IN PATIENTS UNDERGOING ELECTIVE CORONARY ANGIOGRAPHY

Objective: Chronic kidney disease (CKD) and arterial stiffness are associated with increased central (aortic) systolic blood pressure (cSBP) relative to brachial systolic blood pressure (bSBP). This study examined the impact of aortic calcification on cSBP relative to bSBP in patients with CKD. Design and method: Patients with or without CKD undergoing elective coronary angiography (CAG) at Aarhus University Hospital were considered for inclusion in this cross-sectional study. During CAG, cSBP was measured in the ascending aorta with a fluid-filled catheter while bSBP was measured simultaneously with an oscillometric device using a cuff. Furthermore, patients underwent a non-contrast computed tomography (CT) scan of the entire aorta with subsequent blinded Agatston-scoring of the aorta from (but excluding) the aortic valve to the aortic bifurcation. Carotid-femoral pulse wave velocity was measured in duplicate using a Sphygmocor device. Data are presented as mean ± standard deviation unless stated otherwise. Statistical comparisons were made using Wilcoxon rank sum test for differences between 2 groups and Bonferroni-adjusted Kruskal-Wallis test when testing for differences between &gt; 2 groups. Results: 149 patients were included in the study. Of these, 134 patients had a CT-scan of sufficient quality to allow analysis. Patient characteristics and measurements of BP and pulse wave velocity are presented in Table 1. Agatston-score was higher in CKD patients as compared to patients with normal kidney function (table 1, P &lt; 0.001). bSBP was 6.5 ± 13.1 mmHg higher than cSBP in patients categorized into the first tertile of Agatston-scores. This difference was reduced to 3.3 ± 11.0 mmHg in the second tertile (p = 0.31, compared to first tertile) and -2.6 ± 16.8 mmHg in the third tertile (p &lt; 0.01, compared to first tertile). Conclusions: Patients with CKD have a higher degree of aortic calcification. Furthermore, patients with a high degree of aortic calcification have a higher invasively measured cSBP as compared to the bSBP measured with an ordinary oscillometric BP device.

Sex differences in aortic hemodynamics and associations with white matter hyperintensities in middle‐aged and older adults

Elevated blood pressure (BP) in midlife increases the risk of developing white matter hyperintensities (WMH) in the brain. WMH are associated with increased risk of cognitive decline and dementia. Structural changes of the large central arteries occur prior to changes in brachial BP. We have previously reported positive associations between aortic hemodynamics and WMH in normotensive postmenopausal women. The purpose of this study was to evaluate sex differences in aortic hemodynamics and associations with WMH burden in middle‐aged and older adults. Ninety‐nine participants (age = 63 ± 4y), including n = 35 men and n = 64 postmenopausal women participated in this study. Aortic hemodynamics were derived from radial artery pressure waveforms measured using applanation tonometry. Aortic systolic blood pressure (aSBP), aortic diastolic blood pressure (aDBP), augmented pressure (AP), aortic augmentation index (AIx), and aortic transit time were calculated. WMH lesion volume and intracranial volume (ICV) were measured using a FLAIR and T1 scan on a 3T MRI scanner, respectively. WMH fraction was calculated as (WMH lesion volume/ICV)*100 and cubic root transformed to reduce skewness. Age‐adjusted multiple linear regressions were used to determine the influence of aortic hemodynamics on WMH fraction. There were no sex differences in aSBP or aDBP. AP was greater in women compared with men (16 ± 5 mmHg vs. 11 ± 5 mmHg; P &lt; 0.001). AIx was also greater in women compared with men (28 ± 6 % vs. 18 ± 9 %; P &lt; 0.001). Aortic transit time was lower in women compared with men (140 ± 11 ms vs. 151 ± 12 ms; P &lt; 0.001). There were no sex differences in WMH fraction. There was a positive association between aSBP and WMH fraction in both men (r = 0.37, P = 0.015) and women (r = 0.36, P = 0.017). In addition, aDBP was positively associated with WMH fraction in men (r = 0.47, P = 0.003) and women (r = 0.36, P = 0.017). AP was positively associated with WMH fraction in men (r = 0.34, P = 0.027), but not women (r = 0.24, P = 0.296). AIx was positively associated with WMH fraction in men (r = 0.46, P = 0.004), but not women (r = 0.22, P = 0.570). There were no significant associations between aortic transit time and WMH fraction. In conclusion, AP and AIx were greater in women compared with men. The positive associations between AP and WMH fraction and AIx and WMH fraction were only apparent in men. These findings suggest a sex‐specific association between augmented pressure and augmentation index and WMH burden in middle‐aged and older adults.

Effect of Aquatic Exercise Training on Left Ventricular Afterload in in Middle‐aged and Older Normotensives: Evaluation by Polar coordinate description

Regular aerobic physical activity has been recommended to prevent the age‐related increase in cardiovascular disease risks. However, the effect of in‐water aerobic exercise training (e.g., swimming, head‐out aquatic exercise) on the aortic augmentation index (AIx), an index of left ventricular afterload, is inconsistent. Recently, there has been a gaining recognition about the limitations of dimensionless ratio‐based metrics, including AIx (=augmentation pressure [AP]/pulse pressure [PP]). The single‐use of ratio would provide incomplete information relative to the “content” of the two components: since AP is a component of PP, the training‐induced change in AP might be masked by the corresponding change in PP. Accordingly, using the newly proposed companion metrics of AIx by polar coordinate description, we determined the effect of head‐out aquatic exercise training on left ventricular afterload in middle‐aged and older adults. We evaluated aortic hemodynamics in 15 normotensives (62±10 y.o., four men) before and after a 15‐week aquatic exercise course. Aortic hemodynamics were estimated from brachial arterial pressure waveforms via the general transfer function method. Companion metrics of AIx (AIxC=√{AP2+PP2}) were calculated as measures of arterial load. The participation rate in the training course was 86 %. Aortic systolic blood pressure (SBP) decreased after the training course (from 112±8 to 108±11 mmHg, P=0.02). AIxC also decreased (from 45±7 to 42±7 mmHg2, P=0.01). In contrast, AIx remained unchanged (from 47±10 to 45±11 %, P=0.148) presumably due to parallel changes in AP (from 19±5 to 17±5 mmHg, P=0.002) and PP (from 41±6 to 39±6 mmHg, P=0.01). These findings suggest that head‐out aquatic exercise training might lower the left ventricular afterload in middle‐aged and older normotensives. The newly introduced companion metric may provide better insight into underlying physiology.