Technique Of Applanation Tonometry Research Articles

O66 CONCORDANCE BETWEEN THE PULSE WAVE VELOCITY ESTIMATED WITH TOTAL ARTERIAL COMPLIANCE AND CAROTID-FEMORAL PULSE WAVE VELOCITY MEASUREMENTS

Background and Objective: Carotid-femoral pulse wave velocity (cfPWV), considered a reference measure of aortic stiffness, plays a role in cardiovascular risk stratification. However, its application in clinical settings has been limited due to the need for additional equipment and trained personnel. Recently, our group developed a non-invasive method to estimate pulse wave velocity (PWV) based on total arterial compliance (Ct). Yet, the validity of this method remains uncertain. The objective was to evaluate the concordance between PWV estimated using Ct and cfPWV. Methods: A cross-sectional study was conducted involving 56 adult patients who visited an outpatient cardiology center due to suspected hypertension. All participants underwent 24-hour ambulatory blood pressure monitoring (24-h ABPM). PWV was measured in all patients using two methods: i) the applanation tonometry technique, utilizing the SphygmoCor device (AtCor Medical, West Ryde, NSW, Australia); and ii) a novel method based on Ct derived from blood pressure and heart rate data obtained from 24-h ABPM, without the need for a pulse wave. This method utilized the relationship between Ct and PWV proposed by Vardoulis et al., derived from the Bramwell-Hill theory and experimental research, where PWV=√(36.7/Ct). Results: Among the participants, 58.9% were men, with an average age of 50.4±16.5 years and a body mass index of 28.0±4.3 kg/m2. The agreement of the PWV between the new method based on Ct and cfPWV was found to be very good (ICC 0.675; 95% CI 0.498 to 0.797), with a mean difference of 0.388±1.262 m/s (95% CI 0.050 to 0.726). Bland-Altman plots revealed that the differences between the methods were randomly distributed along the mean difference line (Figure). Conclusions: The ability to estimate PWV in humans using a new method based on Ct represents a significant advancement. This finding has the potential to streamline the implementation of PWV measurement as a risk marker in clinical practice.

Effect of Alcohol Consumption Habits on Early Arterial Aging in Subjects with Metabolic Syndrome and Elevated Serum Uric Acid.

Hyperuricemia is perceived as one of the risk factors for developing and progressing cardiovascular disease and metabolic syndrome through various pathological mechanisms. Endogenous synthesis and exogenous factors such as diet and beverages consumed play a major role in determining serum uric acid (sUA) levels. The aim of this study was to evaluate the effect of alcohol consumption on early arterial aging in middle-aged patients with metabolic syndrome (MetS) and hyperuricemia. This study included 661 middle-aged subjects (241 men and 420 women) from the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program. Characteristics of subjects such as blood pressure, laboratory testing, and the specialized nutrition profile questionnaire were evaluated. As an early marker of arterial stiffness, carotid-femoral pulse wave velocity (cfPWV) was assessed using a non-invasive applanation tonometry technique. Hyperuricemia was present in 29% of men and 34% of women. Hyperuricemic men reported 1.6 times higher rates of alcohol drinking compared to men with normal sUA levels. After analyzing the correlation between alcohol consumption and cfPWV, no statistically significant relationships were found at a significance level of α = 0.05 but lowering the significance level to 0.06 revealed significant associations in men with normal sUA (ε2ordinal = 0.05, p = 0.06) and in women with increased sUA levels (ε2ordinal = 0.05, p = 0.08). Regression analysis showed that hyperuricemic men, consuming more than one unit of alcohol per week, had a significant impact on increasing cfPWV, while men with normal sUA levels, abstaining from alcohol entirely, resulted in a statistically significant decrease in cfPWV. Our results showed statistically significant relationships only among a group of men, although the women in the hyperuricemic group had a statistically higher cfPWV than women with normal sUA levels. Drinking alcohol is associated with increased arterial stiffness among hyperuricemic middle-aged men with MetS.

EARLY DIAGNOSIS OF HYPERTENSIVE DISEASE IN YOUTH WITH NORMAL SYSTOLIC AND DIASTOLIC BLOOD PRESSURE LEVELS

Objective: Hypertensive cardiovascular disease can develop functional and/or structural organ damage by the increase of the volume/pressure and arterial stiffness, even before the current cut-off level of the systolic/diastolic blood pressure. The aim of this study was to evaluate in a young population with normal blood pressure levels if they presented any cardiovascular risk factors, arterial stiffness, signs, and symptoms of hypertensive disease. Design and method: This is a retrospective cross-sectional study developed between the years 2007/2022 from 9,600 non-invasive applanation tonometry, females-males 200-103 were entered, with an age range of 18 and 30 years old, and an average age of 24 years. Patients made their first cardiology visit without a previous diagnosis of arterial hypertension or decompensated associated diseases with a blood pressure not higher than 130/80 mmHg. Anthropological data, systolic/diastolic blood pressure, and heart rate were registered. Central Haemodynamics Parameters were measured with a SphygmoCor-PVX device (AtCor, Australia), a validated system employing the high-fidelity technique of applanation tonometry according to established protocols. Results: The average systolic/diastolic blood pressure among female-male was 112.9/72.4 mmHg-119.8/73.9 mmHg, respectively. Also, the Central Aortic Pressure in the female-male groups was 100.0 mmHg/103.7 mmHg, while the maximum values are 101.5 mmHg/106.0 mmHg, but the differences between the observed values and the normal levels of the Augmentation Index (a surrogate measure of arterial stiffness) were higher than normal in female-male 3.6%-4.6% indicating an incipient arterial stiffness. Into the female-male groups, were observed hyperlipidemia 10%-10%, smoking 26%-20%, minimal-mitral regurgitation 5%-8%, headache 46%-26%, palpitations 33%-25%, asthenia 22%-14%, sweating 9%-14%, and chest-pain 16%-27%, respectively. The percentage of women who had a history the polycystic ovarian syndrome was 19%, and the women in current or former estrogen-progesterone therapy were 17%-12%, respectively. Among the female-male groups that do not register any risk factor, symptoms, signs, or arterial stiffness were 8.5%-10%. Conclusions: In young people with normal blood pressure values, it is important to know the risk factors, symptoms, signs, and arterial stiffness of hypertensive disease for early diagnosis and to be able to optimize the time to start therapy.

PS-C02-2: THE USE OF HYDROCHLOROTHIAZIDE FOR THE TREATMENT OF HYPERTENSION INCREASES THE CARDIOVASCULAR RISK ACCORDING TO THE CENTRAL HAEMODYNAMIC PARAMETERS

Objective: The chronic use of the diuretic hydrochlorothiazide (Hct) can activate the neurohormonal system, increasing metabolic risk factors it is potentially arrhythmogenic; and can stimulate the escape of aldosterone, even during Angiotensin Receptor Blockers (ARB) treatment. Aldosterone is a hormone with dangerous effects on the cardiovascular system, from arterial/myocardium stiffness to sodium and water retention; also, is involved in the production of reactive oxygen species and endothelial dysfunction. Psoriasis is a systemic disease that exemplifies the intersection of inflammation, immune dysregulation; and accelerating cardiovascular disease. This study aimed to know if the hydrochlorothiazide added to ARB therapy for the treatment of hypertension can produce a deleterious effect on the cardiovascular system similar to psoriasis, and compare the different responses of ARB therapy alone, according to the measuring of the Central Hemodynamic Parameters (CHP). Design & Methods: For this cross-sectional retrospective study data were collected from 994 patients divided into three groups, both sexes. One group of patients with psoriasis female-male (F-M) (65–57) average age (SD) 55.7 (14.7) - 52.1 (12.5). A second group, in the regime of ARB therapy, F-M (237–217) average age (SD), 62.6 (12.8) - 58.5 (13.6). In the third group, during ARB+Hct therapy, F-M (253–165) average age (SD) was 65.2 (11.2) - 61.9 (12.6). For this study were entered anthropomorphic measures, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Heart Rate, CHP, and the Difference between observed values and normal levels of Augmentation Index (Diff-AIx), the surrogate value of arterial stiffness, assessing with a validated device employing the high-fidelity technique of applanation tonometry according to standard methods (SphygmoCor-PVX). All patients had a therapy time length of more than 6 months. The presence in brief phases of atrial fibrillation was in 24hs-Holter monitoring in the 3 groups were registered. Results: Data of SBP, DBP, Central Aortic Pressure, End-Systolic Pressure, Mean Arterial Pressure and Diff-AIx were highest among the groups with ARB+Hct and psoriasis, and ARB therapy with a statistically significant difference, while between the group psoriasis and ARB+Hct was not found a statistically significant. The highest percentage of patients with phases of atrial fibrillation during 24hs-Holter monitoring were found in the group ARB+Hct (13.6%) than ARB therapy (7.5%) with a statistically significant (p < 0.001). Conclusions: The chronic use of Hydrochlorothiazide for hypertension treatment produces deleterious action on hemodynamics and cardiovascular parameters and can increase the development of atrial fibrillation.

PS-C01-14: IS SHORT STATURE A PROTECTIVE FACTOR IN AN OVERWEIGHT/OBESE AND HYPERTENSIVE OLD AGE POPULATION?

Objective: Age is the most powerful cardiovascular risk factor. Life expectancy is reduced due to hypertension and obesity. There is little information about height and longevity. Geographically in the human population, the short stature was observed as the island effect. The aim of this study is to know whether the short stature is a protective cardiovascular factor in the overweight/obese and hypertensive old age population. Design & Methods: For this cross-sectional epidemiological study was registered female-male 1145–729 overweight/obese hypertensive patients with an average age of 54.9–59.2 years. The range of age was from 18 to 94 years. Anthropological data, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and central hemodynamics parameters (CHP) were compared between the upper and the under quintile of stature, in each decade, and assessed the difference of them. The CHP was measured with a SphygmoCor System PVX, a validated device employing the high-fidelity technique of applanation tonometry according to established protocols. Patients, when entered at the registration were hypertensive with or without treatment or awareness that had hypertension. Results: The relation females-males were 1.57, similar to the Italian population 1.51 according to the National Institute of Statistics (census 2021) assessed between the 80 s years to the 90 s years. The body mass index of females-males was 30.4–29.7, respectively. When were assessed the first with the fifth quintile of the stature of each decade, the body mass index, SBP, DBP, HR, central aortic pressure, end-systolic pressure, mean arterial pressure, and pulse pressure does not find a clear statistically significant difference. Obviously, in the upper quintile, the stature and the weight were highest with statistically significant differences. In both sexes with increasing age were observed gradually a population with shorter statures. In this sample the population from the 30 s years to the oldest, the stature decreased in the female group from 162.5 cm to 147.7 cm (difference of 14.8 cm), and in the male group from 176.8 cm to 162.5 cm (difference of 14.3 cm), into both sexes near 2.9 cm by decade. Conclusion: High stature, over time, might cause a pernicious overload of work to the cardiovascular system in subjects with several risk factors at old age. The short stature in subjects of both sexes could be a protective factor in a population of older overweight/obese hypertensive, a fact more evident in the female group than the male group.

Is the minimal mitral regurgitation a marker of high blood pressure, and can predispose to the appearance of atrial fibrillation?

Abstract Background Leonardo da Vinci intuited that the cardiac valves were the key to the functioning of the heart. Minimal mitral regurgitation (MMR) in young's is often interpreted as haemodynamically insignificant, it is attributed that it starts from birth or named para-physiologic effect. Pathophysiological changes in the arterial wall can lead to mitral regurgitation, left atrial enlargement, and atrial fibrillation (AF). Purpose The aim of this study is to know if the presence of MMR is a consequence of the High Blood Pressure (BP), and whether in the own evolution can contribute to the appearance of the AF. Methods For this cross-sectional retrospective study, data were collected from 436 patients. Female-Male: 249–187 from the 20 to the 89 years old, mean age (±SD) 59.6 (16.5) – 59.7 (16.1), divided and analyzed in each one of them all 7 decades. All patients had MMR. Some patients were unaware of having hypertension, others with and without antihypertensive therapy. The measures of BP were registered in mmHg. The finding of AF was confirmed with the presence of brief phases in the 24hs-Holter monitoring. The Central Haemodynamic Parameters (CHP) were measured with a SphygmoCor System PVX (AtCor-Medical Australia), a validated device employing the high-fidelity technique of applanation tonometry according to established protocols. Also, the difference of Augmentation Index (between the normal levels and the observed values) was assessed according to the normal range by age. Results In all patients female - male, the mean (±SD) of SBP/DBP 142.7 (24.5)/83.7 (13.6) – 137.7 (20.2)/82.4 (11.3) was higher than normal levels of BP accepted by ESC/ESH. All measures of CHP and SBP/DBP increased with age in each decade, in female from the 20s 120.3 (18.9)/76.7 (14.1) to the 80s 160.4 (21.1)/86.0 (25), and in male from the 20s 133.7 (16.7)/78.9 (6.4) to the 70s 142.8 (23.5)/78.8 (12.4), but slightly decreased in the 80s 138.4 (20.4)/76.6 (8.0). The difference of Augmentation index (surrogate value of arterial stiffness) in all decades was higher too, for both genders. In the adult total sample, in female - male the AF reached 26.5% - 27.8%, beginning after 33 years old, and strongly increased its prevalence after the 60s to a top of 50.0% - 43.8% at 80s. Conclusions MMR can be an early marker of high BP levels, the prevalence increasing with age, and it would be a predisposing condition to evolving to AF. The appearance of MMR principally among younger can indicate that the brachial BP found is higher than “normal”, needing any time to modify the original ventricular geometry toward myocardial remodelling, Therefore, it should be reassessed the optimal levels of BP to avoid its complication. Funding Acknowledgement Type of funding sources: None.

WHAT DOES THE FINDING OF MINIMAL MITRAL REGURGITATION MEAN?

Objective: bjective: Leonardo da Vinci intuited that the cardiac valves were key to the functioning of the heart. Minimal mitral regurgitation in young's is often interpreted as haemodynamically insignificant. Morphological changes in the arterial wall can lead to mitral regurgitation, left atrial enlargement, and atrial fibrillation (AF). The aim is to know the measures of the central haemodynamic parameters (CHPs), brachial blood pressure (BP) values, and the prevalence of headache and AF, in both genders with minimal mitral regurgitation. Design and method: Design and Methods: For this cross-sectional retrospective study, data were collected from 323 patients: Female/Male 189/134, from 20 to 89 years old, divided and analyzed in each one of the 7 decades. Some patients were unaware of having hypertension, others with and without antihypertensive therapy. The finding of AF was confirmed with the presence of brief phases in the 24hs-Holter monitoring. The CHPs were measured with a SphygmoCor System PVX (AtCor-Medical Australia), a validated device employing the high-fidelity technique of applanation tonometry according to established protocols. Also, the difference of Augmentation Index (Diff-AIx) between the normal levels and the observed values was assessed according to normal range by age. Results: Results: Average BP was higher than normal: Female- Male 141/83–137/82 mmHg. CHPs and BP values increased in each one of the 7 decades, both genders. Frequently, the patients were symptomatic, among the female/male the headache was found in 61%/25%, with a high prevalence of up to 69 years old in 85%/88% of them. Also, they presented symptoms such as sweating, asthenia, thoracalgia, palpitations. Hypertension would not be silent chronic disease. AF was found in 49 patients (15%), female/male 22/ 27 (12%/20%), increasing the prevalence with age, after 50/60 years old was observed in 68/78%. Conclusions: Conclusions: Minimal mitral regurgitation would not be a bystander, it can be the consequence of the higher values of the brachial BP, the central haemodynamic parameters and the Diff-AIx. The appearance of minimal mitral regurgitation principally among younger can indicate that the brachial BP found is higher than normal and the optimal levels should be reassessed.

Blood pressure phenotypes in young patients with type 1 diabetes

Aim. To study phenotypes of clinic and 24-hour ambulatory blood pressure (BP), to determine their associations with arterial stiffness parameters, and to assess global cardiovascular risk (CVR) in young patients with type 1 diabetes (T1D).Material and methods. The presented cross-sectional single-center study included 81 T1D patients without a history of hypertension (HTN) and other cardiovascular diseases (CVD) (men — 39%; median age — 27 years; median duration of T1D — 6 years). All participants underwent a routine clinical and laboratory testing, measurement of clinic and 24-hour ambulatory BP (BPLab Vasotens), assessment of central BP and arterial stiffness parameters using applanation tonometry technique. BP phenotypes were analyzed with diagnostic criteria for HTN by ESC/ESH 2018 guidelines. CVR was assessed using the SCORE 10-year risk calculator (ESC 2019). The differences were considered significant at p<0,05.Results. The prevalence of true HTN was 6,2%, masked HTN — 38,3%. Isolated nocturnal HTN was revealed in 30,7% of patients with clinic BP <140/90 mm Hg. The subgroup with masked HTN was dominated by patients with normal clinic BP (58,1%) and in most cases was characterized by isolated diastolic BP increase (64,5%). Masked HTN was associated with a higher carotid-femoral pulse wave velocity (PWV) (median — 7,2 versus 6,3 m/s, p=0,002). The most common profiles of nocturnal BP decrease were non-dipper (63.9%) and night-picker (16.6%). High and very high CVR was recorded in 87,7% of patients. Conclusion. Hypertension occurs in 44,5% of young patients with type 1 diabetes and is characterized by a high prevalence of masked isolated nocturnal HTN and non-dipping. Masked HTN is associated with a higher carotid-femoral PWV. High and very high 10-year CVR was recorded in 87,7% of patients.

Intraocular Pressure Study in Ex Vivo Pig Eyes by the Laser-Induced Cavitation Technique: Toward a Non-Contact Intraocular Pressure Sensor

Traditional applanation tonometry techniques lack the necessary accuracy and reliability for measuring the intraocular pressure (IOP), and there is still a need for a reliable technique for in vivo diagnosis. A single laser-induced cavitation bubble event was optically monitored in order to precisely measure the first collapse time of the cavitation bubble, which presents a direct dependence on the liquid pressure. This can certainly be done within the IOP range. We now extend the partial transmittance modulation (STM) technique to determine its feasibility for directly measuring the IOP by studying the nanosecond (ns) pulsed laser-induced cavitation bubble dynamics for an externally pressurized fresh ex vivo porcine eye. The results demonstrate that it is possible to monitor the IOP by detecting the light of a continuous-wave (CW) laser beam which is intensity modulated by the bubble itself. This technique currently presents a measurement resolution of about 4 mmHg in the 5 to 50 mmHg pressure range, indicating the feasibility of this approach for measuring IOP. This technique provides a direct measurement within the anterior eye chamber, avoiding common pitfalls in IOP diagnosis, such as errors due to patient movement, varying physical properties of the eye globe, or central cornea thickness (CCT) effects.

P4559Assess of angiotensin receptor blockers therapy associated to mineralocorticoid receptor antagonists or to calcium channel blockers plus hydrochlorothiazide according central haemodynamic parameters

Abstract Background Protective effect of Angiotensin-II Receptor Blockers (ARBs) on major cardiovascular events might be partly independent of the degree of blood pressure reduction. Calcium channel blockers (CCBs), lower arterial pressure by decreasing total peripheral resistance without reducing cardiac output. Hydrochlorothiazide (Hctz) is one of the most commonly prescribed antihypertensive drugs worldwide, but associated with more frequent adverse effects, such as hypokalaemia, hyponatraemia, hyperuricaemia and may increase the glycaemia, It sensitizes the endothelium to the action of angiotensin II, might act on the aldosterone release. The phenomenon of “aldosterone escape” occurs even in the presence of combination therapy with ARBs. The harmful effects of aldosterone are innumerable: induced cardiac and renal fibrosis, sodium and water retention, inflammation, oxidative stress, arrhythmias, glucose intolerance, insulin resistance, among others, that are involved in arterial and myocardium remodelling. Mineralocorticoid Receptor Antagonists (MRAs) therapy improve diastolic function, decrease plasma volume and vascular/myocardial fibrosis. Purpose This study aimed to assess the responses of two groups of therapy such as ARBs associated to MRAs or to CCBs+Hctz according to central haemodynamic parameters (CHPs) in hypertensive patients, both genders, with normal kidney function. Methods For this cross-sectional retrospective study, data were collected from 391 hypertensive patients who were assisted in the hypertension centre. Female/male 239/152, each gender divided into two groups of therapy: ARB+MRA/ARB+CCB+Hctz. Female 210/29 (average age 57/70) and male 125/27 (average age 55/61). The CHPs were measured with a SphygmoCor System PVX (AtCor-Medical Australia), a validated device employing the high-fidelity technique of applanation tonometry according to established protocols. Also, the difference of Augmentation Index (Diff-AIx) between the observed values and the expected levels was assessed according to normal range by age. No patients had cardiovascular, endocrine, renal and metabolic decompensated diseases. Results After measuring the body mass index, waist circumference and heart rate, the two therapy groups were confronted, both genders, had not found the statistically significant difference. The results of CHPs (Central Aortic Pressure, End-Systolic Pressure, Mean Arterial Pressure, Pulse Pressure, Augmentation Pressure), systolic and diastolic blood pressure during association of ARBs+MRAs therapy compared to ARBs+CCBs+Hctz, both genders, showed the lowest values with a highly statistically significant difference. In the female/male the Diff-AIx was found p=0.05/0.04. Conclusion These findings suggest that ARBs+MRAs treatment reaches the best haemodynamic conditions because improve the levels of CHPs and arterial stiffness (Diff-AIx) giving an adequate reduction of the stress to the arterial-ventricular coupling.

Should we calculate arterial stiffness gradient in middle-aged women with increased cardiovascular risk?

Purpose: The study was designed to evaluate clinical and laboratory determinants pulse wave velocity (PWV) ratio in women at the age of 50–65 years without overt cardiovascular disease but having elevated cardiovascular risk, such as hypertension, obesity, diabetes and hypercholesterolemia.Materials and methods: We analyzed data from 1170 women enrolled in the national-wide primary prevention program. Univariate and multivariate linear regression analysis was used to establish independent risk factors in groups based on clinical data, laboratory values, and comorbidities. Arterial stiffness was evaluated using applanation tonometry technique (SphygmoCor). The PWV ratio was calculated by dividing cfPWV to crPWV.Results: In multivariate logistic regression analysis, age (OR = 1.109, p < .001), waist circumference (OR = 1.021, p = .001) and mean arterial pressure (OR = 1.031, p < .001) were found as independent clinical determinants of PWV ratio, while independent laboratory determinants were urine albumin to creatinine ratio (OR = 1.189, p = .010), triglycerides (OR = 1.161, p = .034), glucose (OR = 1.28, p = .001) and eGFR (OR = 0.998, p = .007). Diabetes (OR = 1.811, p = .029), hypertension (OR = 2.784, p = .042) and menopause (OR = 1.054, p = .018) were established as independent factors in comorbidities group. The analysis confirmed that PWV ratio (R2 = 0.0667, p < .001), as well as carotid radial (R2 = 0.0341, p < .001) and carotid femoral PWV (R2 = 0.1752, p < .001) is affected by mean arterial blood pressure.Conclusions: Age, abdominal obesity, blood pressure, triglycerides, glucose, kidney function parameters and menopause all are associated with PWV ratio. More importance to women with high cardiovascular risk should be given whilst screening and stratifying further progression of the disease.

Association between handgrip strength and vascular function in patients with hypertension

ABSTRACTBackground: Increased handgrip strength has been associated with lower cardiovascular and non-cardiovascular mortality in different populations. In patients with hypertension, arterial stiffness relates to cardiovascular mortality. However, whether muscle strength is associated with arterial stiffness in hypertensives is unknown. Thus, the objective of this study was to analyze the association between handgrip strength and arterial stiffness parameters in hypertensive patients.Methods: Seventy-two hypertensive patients completed all evaluations and were included in the analysis. The ambulatory arterial stiffness index (AASI) was obtained based on 24-h ambulatory blood pressure monitoring. Carotid-femoral pulse wave velocity (cfPWV), and reflected wave indicator (AIx and AIx@75) were estimated using applanation tonometry technique, whereas handgrip strength test was performed using a digital dynamometer. Crude and adjusted linear regression models were performed.Results: The crude analysis revealed a negative association between handgrip strength and AASI (b = −0.41, p = 0.002) and AIx (b = −0.49, p < 0.001), and AIx@75 (b = −0.54, p < 0.001) which remained significant after adjustments for age, sex, and body mass index, mean blood pressure, and heart rate only for AASI (b = −0.46, p = 0.028) and AIx@75 (b = −0.24, p- = 0.040). Handgrip strength was not associated with cfPWV (p > 0.05).Conclusion: Handgrip strength is negatively associated with AASI and AIx@75, but not with AIx and cfPWV in hypertensive patients.

AORTIC POST-RESISTANCE EXERCISE HYPOTENSION IN PATIENTS WITH PERIPHERAL ARTERY DISEASE

ABSTRACT Introduction: A single session of resistance training decreases brachial blood pressure (BP) in patients with peripheral artery disease (PAD). However, it is not known whether similar responses occur in aortic BP, which is a better predictor of cardiovascular risk. Objective: This study aimed to analyze the effects of a single session of resistance training on aortic BP in PAD patients. Methods: This randomized, crossover, controlled trial involved 16 patients. All of them performed a session of resistance training (R - 3 x 10 reps in eight exercises, 5-7 on the OMNI Scale) and a control session (C - resting for 50 min). Before and after each session, aortic BP was assessed by applanation tonometry technique. Results: There was an increase in systolic (P&lt;0.002) and mean (P&lt;0.001) aortic BP in both sessions; however, higher increases were observed in C session (P&lt;0.001). Additionally, diastolic aortic BP only increased after C session (P=0.004). The hypotensive effect of the exercise on systolic, diastolic, and mean aortic BP were -12±2, -6±2, and -7±2 mmHg, respectively. Conclusion: A single session of resistance training promoted a hypotensive effect on aortic BP of patients with PAD, indicating an acute reduction in cardiovascular risk in this population. Level of Evidence I; Therapeutic studies - Investigating the results of treatment.

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.

Inverse relations of serum phosphatidylcholines and lysophosphatidylcholines with vascular damage and heart rate in patients with atherosclerosis

Background and aimsThe rapidly growing discipline of lipidomics allows the study of a wide spectrum of lipid species in body fluids and provides new insights into the pathogenesis of cardiovascular disease. We investigated serum phosphatidylcholine (PC) and lysophosphatidylcholine (lysoPC) species in relation to arterial stiffness, hemodynamics, and endothelial dysfunction in symptomatic patients with atherosclerosis and in healthy controls. Methods and resultsThirty-two patients with peripheral arterial disease (age 61.7 ± 9.0 years), 52 patients with coronary artery disease (age 63.2 ± 9.2 years), and 40 apparently healthy controls (age 60.3 ± 7.1 years) were studied. Serum levels of 90 glycerophospholipids were determined with the AbsoluteIDQ™ p180 kit (BIOCRATES Life Sciences AG, Innsbruck, Austria). The technique of applanation tonometry was used for non-invasive pulse wave analysis and carotid-femoral pulse wave velocity (cf-PWV) assessment. Decreased serum levels of several individual PC and lysoPC species (e.g., PC aa C28:1, PC aa C30:0, PC aa C32:2, PC ae C30:0 and PC ae C34:2, lysoPC a C18:2) were observed for the patient groups in comparison to the healthy subjects. In addition, a considerable number of PCs and lysoPCs were inversely related to either cf-PWV, heart rate, asymmetric dimethylarginine (ADMA) or ADMA/arginine for patients with symptomatic atherosclerosis but not for the controls. ConclusionWe found altered relationships between PC and lysoPC profiles, inflammation, and arterial function in atherosclerotic patients, compared to healthy subjects.

Subendocardial viability ratio and ejection duration as parameters of early cardiovascular risk in children.

The purpose of this study was to investigate subendocardial viability ratio (SEVR) and ejection duration (ED) in children and adolescents with common cardiovascular risk factors such as arterial hypertension, obesity, and hypercholesterolemia. Four groups of pediatric patients were analyzed: 31 children and adolescents had hypertension, 36 were overweight, 49 were overweight and had hypertension, and 70 had hypercholesterolemia. The patients were compared to a control group of 50 healthy individuals. Subjects were sampled by opportunity sampling at the Department of Pediatrics Maribor, Slovenia. In each patient, blood pressure, anthropometrical parameters, and pulse wave analysis (PWA) measurements using applanation tonometry technique were performed and calculated. The results show a statistically-significant difference in ED (p=0.013) but not in SEVR (p=0.074) in the hypercholesterolemia group in comparison to the control group. In other research groups, no statistically-significant differences were found. In all study groups, SEVR correlated significantly with age (positive, moderate) and heart rate (negative, strong) as well as with central mean pressure (CMP). Our study does not show a significant role of SEVR and ED in early cardiovascular risk determination in children. However, some results do indicate a potential role of both, at least in hypercholesterolemia, and should be further investigated. .

Relationship between subendocardial viability ratio and hemoglobin in patients with chronic kidney disease.

Pulse wave analysis (PWA) uses the technique of applanation tonometry to obtain a peripheral pulse pressure waveform from which central hemodynamic information is derived. Using PWA, subendocardial viability ratio (SEVR) can be measured. SEVR represents a noninvasive measure of myocardial perfusion. It is related to the work of the heart, the oxygen consumption, and the energy supply of the heart. Anemia is a common complication of chronic kidney disease (CKD). A complex relationship exists between CKD, cardiovascular disease (CVD), and anemia. The aim of our study was to assess the relationship between SEVR and hemoglobin in non-dialysis CKD patients. We examined the associations between PWA hemodynamic parameters, 24-hour ambulatory blood pressure (BP) measurements, and laboratory variables including hemoglobin, cardiac biomarkers troponin I, NT-proBNP, and hs-CRP in a cohort of 91 nondialysis CKD patients. PWA was assessed by radial applanation tonometry (SphygmoCor, Atcor, Sydney, Australia). The patients were divided into two groups according to the median value of hemoglobin. Mean age of included patients was 60.2 years, 67% were men, 44% were smokers, 25.3% had diabetes. A significant correlation between hemoglobin and SEVR was found (r=0.26; p=0.012). With multivariate regression analysis, SEVR as dependent variable turned out to be statistically significantly associated with hemoglobin (β=0.344, p=0.013) and with troponin I (β=-0.217, p=0.037). Patients in the group with lower hemoglobin had statistically-significantly higher serum creatinine, cystatin C, NT-proBNP, and 24-hour ambulatory systolic BP and lower e-GFR, SEVR, and office diastolic BP. Results of our study show that SEVR is independently associated with hemoglobin in nondialysis CKD patients. CKD patients with lower hemoglobin have lower SEVR. .

PP.13.11] BENEFIT IN CENTRAL HAEMODYNAMIC PARAMETERS BY ASSOCIATION ANGIOTENSIN II RECEPTOR BLOCKERS AND CANRENONE THERAPY IN HYPERTENSIVE PATIENTS WITH NORMAL KIDNEY FUNCTION

Objective: Arterial hypertension is an important risk factor for cardiovascular disease-related morbidity and mortality. Aldosterone is now consider a major cardiovascular risk hormone. Treatment strategies based on association angiotensin II receptor blockers (ARBs) and canrenone (Cr) in hypertensive patients could give benefits aldosterone-induced detrimental effects like increase of superoxide radicals, endothelial dysfunction, collagen deposition, arterial stiffness and cardiac remodeling. Design and method: This retrospective cross-sectional study aimed to compare the effect of ARBs, ARBs+Cr and ARBs+hydrochlorothiazide (Hct) therapy on central haemodynamic parameters (CHPs) in hypertensive patients with normal kidney function. The most frequently administered ARBs were candesartan, irbesartan and valsartan (80%). The average dose used in both genders of Cr and Hct was 37 and 15 mg, respectively. Were measured CHPs in the supine position after at least 10 minutes of rest, by the SphygmoCor System (AtCor-Medical Australia), a validated device employing the high-fidelity technique of applanation tonometry. Was assessed the difference between the observed values and the expected values of AIx (Diff-AIx) according to normal ranges by age. Results: Data were collected from 809 hypertensive patients (60% females). CHPs were analyzed by gender and therapy subgroups. Results show that the combination of ARBs+Cr (female/male 211/125) provided the lowest CHP values, compared to ARBs alone (female/male 150/116) and ARBs+Hct (female/male 122/85), this was true for each parameter considered. The difference among treatment groups was statistically significant for all CHPs except for Pulse-Pressure and Augmentation-Pressure between male patients receiving ARBs and ARBs+Hct. Particularly, ARBs+Cr therapy but not ARBs alone or with Hct lowered AIx below the reference value in both male (Diff-AIx: -1.0, +0.8 and +2, respectively) and female patients (Diff-AIx: -2.1, 0 and +2.3, respectively). Interestingly, the value of the End-Systolic-Pressure (mmHg) in the ARBs+Cr group (female/male 101/100.4) was lower than ARBs alone (female/male 108.2/104.5) and ARBs+Hct (female/male 114.7/111.6). Conclusions: The findings suggest that ARBs+Cr treatment produces best haemodynamic conditions in hypertensive patients, it could be helpful to reduce or prevent the short- and long-term harmful effects of angiotensin-aldosterone system such as diastolic dysfunction, left ventricular post-load, and consequently the atrial fibrillation.

Metabolomic profiles of lipid metabolism, arterial stiffness and hemodynamics in male coronary artery disease patients

Background/objectivesMetabolomic profiling allows to take a detailed look at lipid metabolism and to study the levels and roles of its numerous intermediates and products in the pathogenesis of cardiovascular disease (CVD). This study aimed to investigate the relationship between the metabolic profiles of lipid metabolism, arterial stiffness and hemodynamics in patients with coronary artery disease (CAD) and for healthy controls. MethodsSerum levels of 186 metabolites were determined with the AbsoluteIDQ™ p180 kit (BIOCRATES Life Sciences AG, Innsbruck, Austria). The technique of applanation tonometry was used for non-invasive pulse wave analysis and carotid-femoral pulse wave velocity (cf-PWV) assessments. Principal component analysis (PCA) was carried out in order to reduce the large number of correlated metabolites to fewer uncorrelated factors. ResultsElevated levels of C16:1, C18:1, C3-DC(C4-OH), PC aa C40:6, Met-SO/Met, and reduced levels of lysoPC a C18:2 were observed in the CAD group compared to the healthy controls. The cf-PWV showed positive correlations with C14, C16:1, (C2+C3)/C0, C2/C0 and the CPT-1 ratio for the CAD group. Moreover, PCA-derived factor 3 (medium- and long-chain acylcarnitines) proved to be an independent determinant of cf-PWV for these patients. ConclusionsWe demonstrated an independent association between the serum medium- and long-chain acylcarnitine profile and aortic stiffness for the CAD patients. In addition to the lipid-related classical CVD risk markers, the intermediates of lipid metabolism may serve as novel indicators for altered vascular function.

Early Biomarkers of Renal Damage in Relation to Arterial Stiffness and Inflammation in Male Coronary Artery Disease Patients

Background/Aims: Plasma neutrophil gelatinase-associated lipocalin (NGAL), urinary liver-type fatty acid-binding protein (L-FABP) and urinary kidney injury molecule-1 (KIM-1) have emerged as promising biomarkers for both acute and chronic kidney injury that also provide prognostic value for cardiovascular morbidity and mortality. Our aim was to evaluate their relationships with arterial stiffness and inflammation in coronary artery disease (CAD) patients and in clinically healthy controls. Methods: We studied 52 patients with CAD (age 63.2 ± 9.2 years) and 41 healthy controls (age 60.1 ± 7.2 years). Urinary L-FABP and KIM-1 as well as serum NGAL, adiponectin and resistin levels were measured using the enzyme-linked immunosorbent assay method. The technique of applanation tonometry was used for non-invasive pulse wave analysis and pulse wave velocity assessments. Results: Urinary L-FABP and KIM-1 were independent determinants of cf-PWV for the CAD patients (R²=0.584, P<0.001) but not for the controls. Adiponectin correlated with log-KIM-1 (r=0.31, P=0.028) only for the patients, while NGAL correlated with WBC count (rho=0.29, P=0.038; r=0.35, P=0.029) and resistin (rho=0.60, P<0.001; r=0.57, P<0.001) for both the CAD and control groups, respectively. Conclusion: Our findings suggest that urinary L-FABP and KIM-1 may be independently associated with aortic stiffness in individuals with CAD.