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1
Edwards, David G., Matthew S. Roy, and Raju Y. Prasad. "Wave reflection augments central systolic and pulse pressures during facial cooling." American Journal of Physiology-Heart and Circulatory Physiology 294, no. 6 (June 2008): H2535—H2539. http://dx.doi.org/10.1152/ajpheart.01369.2007.
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Cardiovascular events are more common in the winter months, possibly because of hemodynamic alterations in response to cold exposure. The purpose of this study was to determine the effect of acute facial cooling on central aortic pressure, arterial stiffness, and wave reflection. Twelve healthy subjects (age 23 ± 3 yr; 6 men, 6 women) underwent supine measurements of carotid-femoral pulse wave velocity (PWV), brachial artery blood pressure, and central aortic pressure (via the synthesis of a central aortic pressure waveform by radial artery applanation tonometry and generalized transfer function) during a control trial (supine rest) and a facial cooling trial (0°C gel pack). Aortic augmentation index (AI), an index of wave reflection, was calculated from the aortic pressure waveform. Measurements were made at baseline, 2 min, and 7 min during each trial. Facial cooling increased ( P < 0.05) peripheral and central diastolic and systolic pressures. Central systolic pressure increased more than peripheral systolic pressure (22 ± 3 vs. 15 ± 2 mmHg; P < 0.05), resulting in decreased pulse pressure amplification ratio. Facial cooling resulted in a robust increase in AI and a modest increase in PWV (AI: −1.4 ± 3.8 vs. 21.2 ± 3.0 and 19.9 ± 3.6%; PWV: 5.6 ± 0.2 vs. 6.5 ± 0.3 and 6.2 ± 0.2 m/s; P < 0.05). Change in mean arterial pressure but not PWV predicted the change in AI, suggesting that facial cooling may increase AI independent of aortic PWV. Facial cooling and the resulting peripheral vasoconstriction are associated with an increase in wave reflection and augmentation of central systolic pressure, potentially explaining ischemia and cardiovascular events in the cold.
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Horton, William B., Linda A. Jahn, Lee M. Hartline, Kevin W. Aylor, James T. Patrie, and Eugene J. Barrett. "Insulin increases central aortic stiffness in response to hyperglycemia in healthy humans: A randomized four-arm study." Diabetes and Vascular Disease Research 18, no. 2 (March 2021): 147916412110110. http://dx.doi.org/10.1177/14791641211011009.
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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.
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Castro, Juan M., Victoria García-Espinosa, Santiago Curcio, Maite Arana, Pedro Chiesa, Gustavo Giachetto, Yanina Zócalo, and Daniel Bia. "Childhood Obesity Associates Haemodynamic and Vascular Changes That Result in Increased Central Aortic Pressure with Augmented Incident and Reflected Wave Components, without Changes in Peripheral Amplification." International Journal of Vascular Medicine 2016 (2016): 1–8. http://dx.doi.org/10.1155/2016/3129304.
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The aims were to determine if childhood obesity is associated with increased central aortic blood pressure (BP) and to characterize haemodynamic and vascular changes associated with BP changes in obese children and adolescents by means of analyzing changes in cardiac output (stroke volume, SV), arterial stiffness (aortic pulse wave velocity, PWV), peripheral vascular resistances (PVR), and net and relative contributions of reflected waves to the aortic pulse wave amplitude. We included 117 subjects (mean/range age: 10 (5–15) years, 49 females), who were obese (OB) or had normal weight (NW). Peripheral and central aortic BP, PWV, and pulse wave-derived parameters (augmentation index, amplitude of forward and backward components) were measured with tonometry (SphygmoCor) and oscillometry (Mobil-O-Graph). With independence of the presence of dyslipidemia, hypertension, or sedentarism, the aortic systolic and pulse BP were higher in OB than in NW subjects. The increase in central BP could not be explained by the elevation in the relative contribution of reflections to the aortic pressure wave and higher PVR or by an augmented peripheral reflection coefficient. Instead, the rise in central BP could be explained by an increase in the amplitude of both incident and reflect wave components associated to augmented SV and/or PWV.
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Mullan, Brian A., Ciaran N. Ennis, Howard J. P. Fee, Ian S. Young, and David R. McCance. "Protective effects of ascorbic acid on arterial hemodynamics during acute hyperglycemia." American Journal of Physiology-Heart and Circulatory Physiology 287, no. 3 (September 2004): H1262—H1268. http://dx.doi.org/10.1152/ajpheart.00153.2003.
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Mortality increases when acute coronary syndromes are complicated by stress-induced hyperglycemia. Early pulse wave reflection can augment central aortic systolic blood pressure and increase left ventricular strain. Altered pulse wave reflection may contribute to the increase in cardiac risk during acute hyperglycemia. Chronic ascorbic acid (AA) supplementation has recently been shown to reduce pulse wave reflection in diabetes. We investigated the in vivo effects of acute hyperglycemia, with and without AA pretreatment, on pulse wave reflection and arterial hemodynamics. Healthy male volunteers were studied. Peripheral blood pressure (BP) was measured at the brachial artery, and the SphygmoCor pulse wave analysis system was used to derive central BP, the aortic augmentation index (AIx; measure of systemic arterial stiffness), and the time to pulse wave refection ( Tr; measure of aortic distensibility) from noninvasively obtained radial artery pulse pressure (PP) waveforms. Hemodynamics were recorded at baseline and then every 30 min during a 120-min systemic hyperglycemic clamp (14 mmol/l). The subjects, studied on two separate occasions, were randomized in a double-blind, crossover manner to placebo or 2 g intravenous AA before the initiation of hyperglycemia. During hyperglycemia, AIx increased and Tr decreased. Hyperglycemia did not change peripheral PP but did magnify central aortic PP and diminished the normal physiological amplification of PP from the aorta to the periphery. Pulse wave reflection, as assessed from peripheral pulse wave analysis, is enhanced during acute hyperglycemia. Pretreatment with AA prevented the hyperglycemia-induced hemodynamic changes. By protecting hemodynamics during acute hyperglycemia, AA may have therapeutic use.
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Barnes, Jill N., Darren P. Casey, Casey N. Hines, Wayne T. Nicholson, and Michael J. Joyner. "Cyclooxygenase inhibition augments central blood pressure and aortic wave reflection in aging humans." American Journal of Physiology-Heart and Circulatory Physiology 302, no. 12 (June 15, 2012): H2629—H2634. http://dx.doi.org/10.1152/ajpheart.00032.2012.
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The augmentation index and central blood pressure increase with normal aging. Recently, cyclooxygenase (COX) inhibitors, commonly used for the treatment of pain, have been associated with transient increases in the risk of cardiovascular events. We examined the effects of the COX inhibitor indomethacin (Indo) on central arterial hemodynamics and wave reflection characteristics in young and old healthy adults. High-fidelity radial arterial pressure waveforms were measured noninvasively by applanation tonometry before (control) and after Indo treatment in young (25 ± 5 yr, 7 men and 6 women) and old (64 ± 6 yr, 5 men and 6 women) subjects. Aortic systolic (control: 115 ± 3 mmHg vs. Indo: 125 ± 5 mmHg, P < 0.05) and diastolic (control: 74 ± 2 mmHg vs. Indo: 79 ± 3 mmHg, P < 0.05) pressures were elevated after Indo treatment in older subjects, whereas only diastolic pressure was elevated in young subjects (control: 71 ± 2 mmHg vs. Indo: 76 ± 1 mmHg, P < 0.05). Mean arterial pressure increased in both young and old adults after Indo treatment ( P < 0.05). The aortic augmentation index and augmented pressure were elevated after Indo treatment in older subjects (control: 30 ± 5% vs. Indo 36 ± 6% and control 12 ± 1 mmHg vs. Indo: 18 ± 2 mmHg, respectively, P < 0.05), whereas pulse pressure amplification decreased (change: 8 ± 3%, P < 0.05). In addition, older subjects had a 61 ± 11% increase in wasted left ventricular energy after Indo treatment ( P < 0.05). In contrast, young subjects showed no significant changes in any of the variables of interest. Taken together, these results demonstrate that COX inhibition with Indo unfavorably increases central wave reflection and augments aortic pressure in old but not young subjects. Our results suggest that aging individuals have a limited ability to compensate for the acute hemodynamic changes caused by systemic COX inhibition.
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Heffernan, Kevin S., Sae Young Jae, Kenneth R. Wilund, Jeffrey A. Woods, and Bo Fernhall. "Racial differences in central blood pressure and vascular function in young men." American Journal of Physiology-Heart and Circulatory Physiology 295, no. 6 (December 2008): H2380—H2387. http://dx.doi.org/10.1152/ajpheart.00902.2008.
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Young African-American men have altered macrovascular and microvascular function. In this cross-sectional study, we tested the hypothesis that vascular dysfunction in young African-American men would contribute to greater central blood pressure (BP) compared with young white men. Fifty-five young (23 yr), healthy men (25 African-American and 30 white) underwent measures of vascular structure and function, including carotid artery intima-media thickness (IMT) and carotid artery β-stiffness via ultrasonography, aortic pulse wave velocity, aortic augmentation index (AIx), and wave reflection travel time (Tr) via radial artery tonometery and a generalized transfer function, and microvascular vasodilatory capacity of forearm resistance arteries with strain-gauge plethysmography. African-American men had similar brachial systolic BP (SBP) but greater aortic SBP ( P < 0.05) and carotid SBP ( P < 0.05). African-American men also had greater carotid IMT, greater carotid β-stiffness, greater aortic stiffness and AIx, reduced aortic Tr and reduced peak hyperemic, and total hyperemic forearm blood flow compared with white men ( P < 0.05). In conclusion, young African-American men have greater central BP, despite comparable brachial BP, compared with young white men. Diffuse macrovascular and microvascular dysfunction manifesting as carotid hypertrophy, increased stiffness of central elastic arteries, heightened resistance artery constriction/blunted resistance artery dilation, and greater arterial wave reflection are present at a young age in apparently healthy African-American men, and conventional brachial BP measurement does not reflect this vascular burden.
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SAVAGE, M. Tessa, Charles J. FERRO, Sarah J. PINDER, and Charles R. V. TOMSON. "Reproducibility of derived central arterial waveforms in patients with chronic renal failure." Clinical Science 103, no. 1 (June 11, 2002): 59–65. http://dx.doi.org/10.1042/cs1030059.
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Arterial stiffness potently predicts mortality in dialysis patients. Pulse-wave analysis permits the non-invasive assessment of indices of arterial stiffness and the central pressure waveform by applanation tonometry. The aim of this study was to assess the reproducibility of pulse-wave analysis in patients with chronic renal failure. A total of 188 subjects (23 healthy controls, along with 71 pre-dialysis, 67 dialysis and 27 transplant patients) took part. Duplicate measurements were recorded of brachial blood pressure using the semi-automated Omron 705 device and of the radial artery pressure waveform using applanation tonometry. The central pressure aortic waveform was then obtained by application of a transfer function incorporated into the SphygmoCor software. Central aortic mean blood pressure (MBP), indices of arterial stiffness [augmentation index (AIx) and time to reflection (TR)] and the subendocardial viability ratio (SEVR) were analysed for intra-observer, inter-observer and long-term reproducibility using Bland-Altman plots. The mean (±S.D.) intra-observer difference was 0±4% for AIx, 0±20 ms for TR, 0±3 mmHg for aortic MBP and 0±18% for the SEVR. Inter-observer mean differences were 0±3% for AIx, 1±7ms for TR, 1±4mmHg for aortic MBP and 1±9% for the SEVR. For the long-term study, the mean differences were -1±9% for AIx, -2±13mmHg for aortic MBP, -2±12ms for TR and 1±29% for the SEVR. Pulse-wave analysis showed excellent reproducibility in all the studies, and is therefore suitable for use in all patients with chronic renal failure. Further prospective and interventional studies are now required to assess whether AIx and TR are important prognostic indices of cardiovascular events, and therefore relevant surrogate indices of arterial stiffness in this susceptible population.
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VAN DIJK, Robert A. J. M., Frans J. VAN ITTERSUM, Nico WESTERHOF, Els M. VAN DONGEN, Otto KAMP, and Coen D. A. STEHOUWER. "Determinants of brachial artery mean 24 h pulse pressure in individuals with Type II diabetes mellitus and untreated mild hypertension." Clinical Science 102, no. 2 (January 3, 2002): 177–86. http://dx.doi.org/10.1042/cs1020177.
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Brachial artery pulse pressure is a predictor of (cardiovascular) morbidity, but its determinants in individuals with Type II diabetes and untreated mild hypertension have not been elucidated. We therefore cross-sectionally investigated determinants of brachial artery mean 24h pulse pressure in 60 individuals (40 males; age, mean±S.D., 57.8±7.5 years) with Type II diabetes [median diabetes duration (interquartile range), 6.3 (3.6-10.1) years] and untreated mild hypertension [sitting blood pressure >140/90mmHg and <190/120mmHg (mean of two consecutive auscultatory office measurements after 5min of rest)]. We measured (1) three potential determinants reflecting different aspects of central artery stiffness [the overall systemic arterial compliance, the aortic augmentation index and 1/(regional carotido-femoral transit time)], (2) structural and functional changes of the circulatory system often observed in Type II diabetes, and (3) diabetes-associated metabolic variables. After adjustment for age, gender and mean arterial pressure, brachial artery pulse pressure was associated with autonomic function [standardized regression coefficient (β), -0.27 (P = 0.01)], blood pressure decline during sleep [standardized β, -0.32 (P = 0.002)], fasting glucose concentration [standardized β, 0.26 (P = 0.01)], HbA1c concentration [standardized β, 0.27 (P = 0.003)] and diabetes duration [standardized β, 0.28 (P = 0.002)] in linear regression analyses. In a combined multivariate model, brachial artery pulse pressure was independently determined by gender [1 = male, 2 = female; standardized β, 0.24 (P = 0.01)], diabetes duration [standardized β, 0.18 (P = 0.03)], mean arterial pressure [standardized β, 0.32 (P = 0.002)], systemic arterial compliance [standardized β, -0.23 (P = 0.02)] and fasting glucose concentration [standardized β, 0.20 (P = 0.02)]. Aortic augmentation index and 1/(carotido-femoral transit time) were not independently associated with pulse pressure. In conclusion, in individuals with Type II diabetes and untreated mild hypertension, brachial artery pulse pressure is determined mainly by proximal aortic stiffness in a way which is not strongly influenced by peripheral pulse wave reflection. Approx. 60% of the variance in brachial artery pulse pressure could be explained by potentially modifiable determinants.
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Casey, Darren P., Darren T. Beck, and Randy W. Braith. "Progressive Resistance Training Without Volume Increases Does Not Alter Arterial Stiffness and Aortic Wave Reflection." Experimental Biology and Medicine 232, no. 9 (October 2007): 1228–35. http://dx.doi.org/10.3181/0703-rm-65.
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Endurance exercise is efficacious in reducing arterial stiffness. However, the effect of resistance training (RT) on arterial stiffening is controversial. High-intensity, high-volume RT has been shown to increase arterial stiffness in young adults. We tested the hypothesis that an RT protocol consisting of progressively higher intensity without concurrent increases in training volume would not elicit increases in either central or peripheral arterial stiffness or alter aortic pressure wave reflection in young men and women. The RT group ( n = 24; 21 ± 1 years) performed two sets of 8–12 repetitions to volitional fatigue on seven exercise machines on 3 days/week for 12 weeks, whereas the control group ( n = 18; 22 ± 1 years) did not perform RT. Central and peripheral arterial pulse wave velocity (PWV), aortic pressure wave reflection (augmentation index; AIx), brachial flow–mediated dilation (FMD), and plasma levels of nitrate/nitrite (NOx) and norepinephrine (NE) were measured before and after RT. RT increased the one-repetition maximum for the chest press and the leg extension ( P < 0.001). RT also increased lean body mass ( P < 0.01) and reduced body fat (%; P < 0.01). However, RT did not affect carotid-radial, carotid-femoral, and femoral-distal PWV (8.4 ± 0.2 vs. 8.0 ± 0.2 m/sec; 6.5 ± 0.1 vs. 6.3 ± 0.2 m/sec; 9.5 ± 0.3 vs. 9.5 ± 0.3 m/sec, respectively) or AIx (2.5% ± 2.3% vs. 4.8% ± 1.8 %, respectively). Additionally, no changes were observed in brachial FMD, NOx, NE, or blood pressures. These results suggest that an RT protocol consisting of progressively higher intensity without concurrent increases in training volume does not increase central or peripheral arterial stiffness or alter aortic pressure wave characteristics in young subjects.
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Franzen, Klaas F., Moritz Meusel, Julia Engel, Tamara Röcker, Daniel Drömann, and Friedhelm Sayk. "Differential Effects of Angiotensin-II Compared to Phenylephrine on Arterial Stiffness and Hemodynamics: A Placebo-Controlled Study in Healthy Humans." Cells 10, no. 5 (May 5, 2021): 1108. http://dx.doi.org/10.3390/cells10051108.
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The α1-adrenoceptor agonist phenylephrine (PE) and Angiotensin II (Ang II) are both potent vasoconstrictors at peripheral resistance arteries. PE has pure vasoconstrictive properties. Ang II, additionally, modulates central nervous blood pressure (BP) control via sympathetic baroreflex resetting. However, it is unknown whether Ang II vs. PE mediated vasoconstriction at equipressor dose uniformly or specifically modifies arterial stiffness. We conducted a three-arm randomized placebo-controlled cross-over trial in 30 healthy volunteers (15 female) investigating the effects of Ang II compared to PE at equal systolic pressor dose on pulse wave velocity (PWV), pulse wave reflection (augmentation index normalized to heart rate 75/min, AIx) and non-invasive hemodynamics by Mobil-O-Graph™ and circulating core markers of endothelial (dys-)function. PE but not Ang II-mediated hypertension induced a strong reflex-decrease in cardiac output. Increases in PWV, AIx, total peripheral resistance and pulse pressure, in contrast, were stronger during PE compared to Ang II at equal mean aortic BP. This was accompanied by minute changes in circulating markers of endothelial function. Moreover, we observed differential hemodynamic changes after stopping either vasoactive infusion. Ang II- and PE-mediated BP increase specifically modifies arterial stiffness and hemodynamics with aftereffects lasting beyond mere vasoconstriction. This appears attributable in part to different interactions with central nervous BP control including modified baroreflex function.
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Tai, Yu Lun, Erica M. Marshall, Alaina Glasgow, Jason C. Parks, Leslie Sensibello, and J. Derek Kingsley. "Pulse wave reflection responses to bench press with and without practical blood flow restriction." Applied Physiology, Nutrition, and Metabolism 44, no. 4 (April 2019): 341–47. http://dx.doi.org/10.1139/apnm-2018-0265.
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Resistance exercise is recommended to increase muscular strength but may also increase pulse wave reflection. The effect of resistance exercise combined with practical blood flow restriction (pBFR) on pulse wave reflection is unknown. The purpose of this study was to evaluate the differences in pulse wave reflection characteristics between bench press with pBFR and traditional high-load bench press in resistance-trained men. Sixteen resistance-trained men participated in the study. Pulse wave reflection characteristics were assessed before and after low-load bench press with pBFR (LL-pBFR), traditional high-load bench press (HL), and a control (CON). A repeated-measures ANOVA was used to evaluate differences in pulse wave reflection characteristics among the conditions across time. There were significant (p ≤ 0.05) interactions for heart rate, augmentation index, augmentation index normalized at 75 bpm, augmentation pressure, time–tension index, and wasted left ventricular energy such that they were increased after LL-pBFR and HL compared with rest and CON, with no differences between LL-pBFR and HL. Aortic pulse pressure (p < 0.001) was elevated only after LL-pBFR compared with rest. In addition, there was a significant (p ≤ 0.05) interaction for aortic diastolic blood pressure (BP) such that it was decreased after LL-pBFR compared with rest and CON but not HL. The subendocardial viability ratio and diastolic pressure–time index were significantly different between LL-pBFR and HL compared with rest and CON. There were no significant interactions for brachial systolic or diastolic BP, aortic systolic BP, or time of the reflected wave. In conclusion, acute bench press resistance exercise significantly altered pulse wave reflection characteristics without differences between LL-pBFR and HL.
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Lieber, Ari, Sandrine Millasseau, Laurent Bourhis, Jacques Blacher, Athanase Protogerou, Bernard I. Levy, and Michel E. Safar. "Aortic wave reflection in women and men." American Journal of Physiology-Heart and Circulatory Physiology 299, no. 1 (July 2010): H236—H242. http://dx.doi.org/10.1152/ajpheart.00985.2009.
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Augmentation index (AIx), a marker of the number of aortic wave reflections (AWRs), is influenced not only by the magnitude of incident and reflected pressure waves but also by the time of return. A new triangulation method has been developed, enabling us to better quantify AWRs and to determine their sex differences, which may relate to body size or pulse pressure (PP) amplification, measured from the brachial PP-to-carotid PP (B/C) ratio. With the use of pulse wave analysis, AWRs were evaluated in 51 women and 72 men treated for hypertension and studied in relationship to age, blood pressure, and pulse wave velocity. When women were compared with men, AIx (expressed in %PP and adjusted to heart rate) was significantly higher, together with a significant decrease of the B/C ratio and an increase of the reflection magnitude and of the amplitude (but not the timing) of the backward pressure wave. The significance of the amplitude difference between men and women was enhanced after an adjustment to heart rate or pulse wave velocity but was abolished after an adjustment to body height or the B/C ratio. In the overall population, AIx and the reflection magnitude index were positively ( r2 = 0.39) and independently associated, after excluding confounding factors such as drug treatment. In conclusion, when compared with men, women treated for hypertension have increased AIx, related to the increased amplitude, and not timing, of backward pressure waves. This finding relates to sex differences in body size and mostly brachial-carotid PP amplification, a parameter highly related to the sex difference of cardiovascular risk.
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Husmann, Marc, Vincenzo Jacomella, Christoph Thalhammer, and Beatrice R. Amann-Vesti. "Markers of arterial stiffness in peripheral arterial disease." Vasa 44, no. 5 (September 2015): 341–48. http://dx.doi.org/10.1024/0301-1526/a000452.
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Abstract. Increased arterial stiffness results from reduced elasticity of the arterial wall and is an independent predictor for cardiovascular risk. The gold standard for assessment of arterial stiffness is the carotid-femoral pulse wave velocity. Other parameters such as central aortic pulse pressure and aortic augmentation index are indirect, surrogate markers of arterial stiffness, but provide additional information on the characteristics of wave reflection. Peripheral arterial disease (PAD) is characterised by its association with systolic hypertension, increased arterial stiffness, disturbed wave reflexion and prognosis depending on ankle-brachial pressure index. This review summarises the physiology of pulse wave propagation and reflection and its changes due to aging and atherosclerosis. We discuss different non-invasive assessment techniques and highlight the importance of the understanding of arterial pulse wave analysis for each vascular specialist and primary care physician alike in the context of PAD.
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Edwards, David G., Amie L. Gauthier, Melissa A. Hayman, Jesse T. Lang, and Robert W. Kenefick. "Acute effects of cold exposure on central aortic wave reflection." Journal of Applied Physiology 100, no. 4 (April 2006): 1210–14. http://dx.doi.org/10.1152/japplphysiol.01154.2005.
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The purpose of this study was to determine the effects of acute cold exposure on the timing and amplitude of central aortic wave reflection and central pressure. We hypothesized that cold exposure would result in an early return of reflected pressure waves from the periphery and an increase in central aortic systolic pressure as a result of cold-induced vasoconstriction. Twelve apparently healthy men (age 27.8 ± 2.0 yr) were studied at random, in either temperate (24°C) or cold (4°C) conditions. Measurements of brachial artery blood pressure and the synthesis of a central aortic pressure waveform (by noninvasive radial artery applanation tonometry and use of a generalized transfer) were conducted at baseline and after 30 min in each condition. Central aortic augmentation index (AI), an index of wave reflection, was calculated from the aortic pressure waveform. Cold induced an increase ( P < 0.05) in AI from 3.4 ± 1.9 to 19.4 ± 1.8%. Cold increased ( P < 0.05) both brachial and central systolic pressure; however, the magnitude of change in central systolic pressure was greater ( P < 0.05) than brachial (13 vs. 2.5%). These results demonstrate that cold exposure and the resulting peripheral vasoconstriction increase wave reflection and central systolic pressure. Additionally, alterations in central pressure during cold exposure were not evident from measures of brachial blood pressure.
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Kahkashan, Nudrath, Mehnaaz Sameera Arifuddin, Mohammed Abdul Hannan Hazari, Safia Sultana, Farah Fatima, and Syyeda Anees. "Variation in carotid-femoral pulse wave velocity, augmentation pressure and augmentation index during different phases of menstrual cycle." Annals of Medical Physiology 2, no. 3 (November 28, 2018): 27–32. http://dx.doi.org/10.23921/amp.2018v2i3.10454.
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Physiological variation of estrogen and progesterone during menstrual cycle is well known. They not only have an effect on blood pressure control, but also seem to have a role in regulating arterial compliance. This study was done to find out whether there are any changes in central arterial parameters during different phases of menstrual cycle. Thirty female subjects in the age group of 18-22 years with normal, regular menstrual cycles participated in this prospective observational study at our teaching hospital. Anthropometric parameters were recorded. Blood pressure in all 4 limbs was recorded using cardiovascular risk analyzer-Periscope™ on Day 3rd to 5th (follicular phase), Day 12th to 14th (ovulation phase), Day 22nd to 24th (luteal phase) of their menstrual cycle. We collected blood samples during these three phases for estimation of estradiol and progesterone by ELISA technique. Analysis of variance and correlation statistics were done using SPSS 17.0 statistical software. No significant statistical changes were observed in systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse pressure, aortic systolic pressure, aortic diastolic pressure, aortic augmentation pressure, aortic index and pulse wave velocity during the three recorded phases of the menstrual cycle. There are many studies which correlate changes in peripheral artery blood pressure with different phases of menstrual cycle. But there is scarcity in data available which correlates central arterial pressures and arterial stiffness with natural hormonal variations in different phases of menstrual cycle. However, our results show that although there are subtle changes in blood pressure parameters along with estrogen and progesterone levels throughout the menstrual cycle, yet these were not statistically significant.
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Salvi, Paolo, Filippo Valbusa, Anna Kearney-Schwartz, Carlos Labat, Andrea Grillo, Gianfranco Parati, and Athanase Benetos. "Non-Invasive Assessment of Arterial Stiffness: Pulse Wave Velocity, Pulse Wave Analysis and Carotid Cross-Sectional Distensibility: Comparison between Methods." Journal of Clinical Medicine 11, no. 8 (April 15, 2022): 2225. http://dx.doi.org/10.3390/jcm11082225.
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Background: The stiffening of large elastic arteries is currently estimated in research and clinical practice by propagative and non-propagative models, as well as parameters derived from aortic pulse waveform analysis. Methods: Common carotid compliance and distensibility were measured by simultaneously recording the diameter and pressure changes during the cardiac cycle. The aortic and upper arm arterial distensibility was estimated by measuring carotid–femoral and carotid–radial pulse wave velocity (PWV), respectively. The augmentation index and blood pressure amplification were derived from the analysis of central pulse waveforms, recorded by applanation tonometry directly from the common carotid artery. Results: 75 volunteers were enrolled in this study (50 females, average age 53.5 years). A significant inverse correlation was found between carotid distensibility and carotid–femoral PWV (r = −0.75; p < 0.001), augmentation index (r = −0.63; p < 0.001) and central pulse pressure (r = −0.59; p < 0.001). A strong correlation was found also between the total slope of the diameter/pressure rate carotid curves and aortic distensibility, quantified from the inverse of the square of carotid–femoral PWV (r = 0.67). No correlation was found between carotid distensibility and carotid–radial PWV. Conclusions: This study showed a close correlation between carotid–femoral PWV, evaluating aortic stiffness by using the propagative method, and local carotid cross-sectional distensibility.
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Fedorishina, O. V., K. V. Protasov, and A. M. Torunova. "THE EFFECT OF STATIN ADDED TO ANTIHYPERTENSIVE THERAPY ON ARTERIAL STIFFNESS IN HYPERTENSIVE PATIENTS AT HIGH CARDIOVASCULAR RISK." Acta Biomedica Scientifica 3, no. 5 (October 29, 2018): 27–32. http://dx.doi.org/10.29413/abs.2018-3.5.4.
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Background.Little is known about the effect of statins addition to standard antihypertensive therapy on blood pressure level and vascular stiffness in high-risk hypertensive patients.The aimof the study was to assess the dynamics of vascular stiffness in hypertensive patients of high or very high cardiovascular risk under the influence of rosuvastatin addition to combined two-component amlodipine and lisinopril antihypertensive therapy.Materials and methods.We investigated 60 hypertensive patients who were randomized into two groups: the 1st group received a fixed amlodipine/lisinopril combination, the 2nd one followed the same regimen of therapy with addition of 20 mg rosuvastatin. Mean office and ambulatory blood pressure as well as central aortic blood pressure and pulse wave velocity were evaluated in both groups before and after 24-week follow-up period.Results.At end of follow-up period the office and average daily blood pressure significantly decreased in both groups, with more prominent office diastolic blood pressure decline in the 2nd one. The central aortic blood pressure equally decreased in both groups. The augmentation index significantly reduced in both groups, mostly in the 2nd one. The carotid-femoral pulse wave velocity declined in both groups to the same extent. The carotid-radial pulse wave velocity decreased statistically only in the second group.Conclusions.Addition of rosuvastatin to a fixed amlodipine/lisinopril combination in high/very high cardiovascular risk hypertensive patients was accompanied by more pronounced decline of diastolic blood pressure and augmentation index, as well as significantly reduction of pulse wave velocity.
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Edwards, David G., Corey R. Mastin, and Robert W. Kenefick. "Wave reflection and central aortic pressure are increased in response to static and dynamic muscle contraction at comparable workloads." Journal of Applied Physiology 104, no. 2 (February 2008): 439–45. http://dx.doi.org/10.1152/japplphysiol.00541.2007.
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We determined the effects of static and dynamic muscle contraction at equivalent workloads on central aortic pressure and wave reflection. At random, 14 healthy men and women (23 ± 5 yr of age) performed a static handgrip forearm contraction [90 s at 30% of maximal voluntary contraction (MVC)], dynamic handgrip contractions (1 contraction/s for 180 s at 30% MVC), and a control trial. During static and dynamic trials, tension-time index was controlled by holding peak tension constant. Measurements of brachial artery blood pressure and the synthesis of a central aortic pressure waveform (by radial artery applanation tonometry and generalized transfer function) were conducted at baseline, during each trial, and during 1 min of postexercise ischemia (PEI). Aortic augmentation index (AI), an index of wave reflection, was calculated from the aortic pressure waveform. AI increased during both static and dynamic trials (static, 5.2 ± 3.1 to 11.8 ± 3.4%; dynamic, 5.8 ± 3.0 to 13.3 ± 3.4%; P < 0.05) and further increased during PEI (static, 18.5 ± 3.1%; dynamic, 18.6 ± 2.9%; P < 0.05). Peripheral and central systolic and diastolic pressures increased ( P < 0.05) during both static and dynamic trials and remained elevated during PEI. AI and pressure responses did not differ between static and dynamic trials. Peripheral and central pressures increased similarly during static and dynamic contraction; however, the rise in central systolic pressure during both conditions was augmented by increased wave reflection. The present data suggest that wave reflection is an important determinant of the central blood pressure response during forearm muscle contractions.
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Harvey, Ronée E., Jill N. Barnes, Emma C. J. Hart, Wayne T. Nicholson, Michael J. Joyner, and Darren P. Casey. "Influence of sympathetic nerve activity on aortic hemodynamics and pulse wave velocity in women." American Journal of Physiology-Heart and Circulatory Physiology 312, no. 2 (February 1, 2017): H340—H346. http://dx.doi.org/10.1152/ajpheart.00447.2016.
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Central (aortic) blood pressure, arterial stiffness, and sympathetic nerve activity increase with age in women. However, it is unknown if the age-related increase in sympathetic activity influences aortic hemodynamics and carotid-femoral pulse wave velocity (cfPWV), an index of central aortic stiffness. The goal of this study was to determine if aortic hemodynamics and cfPWV are directly influenced by sympathetic nerve activity by measuring aortic hemodynamics, cfPWV, and muscle sympathetic nerve activity (MSNA) in women before and during autonomic ganglionic blockade with trimethaphan camsylate. We studied 12 young premenopausal (23 ± 4 yr) and 12 older postmenopausal (57 ± 3 yr) women. These women did not differ in body mass index or mean arterial pressure ( P > 0.05 for both). At baseline, postmenopausal women had higher aortic pulse pressure, augmented pressure, augmentation index adjusted for a heart rate of 75 beats/min, wasted left ventricular pressure energy, and cfPWV than young women ( P < 0.05). During ganglionic blockade, postmenopausal women had a greater decrease in these variables in comparison to young women ( P < 0.05). Additionally, baseline MSNA was negatively correlated with the reductions in aortic pulse pressure, augmented pressure, and wasted left ventricular pressure energy during ganglionic blockade in postmenopausal women ( P < 0.05) but not young women. Baseline MSNA was not correlated with the changes in augmentation index adjusted for a heart rate of 75 beats/min or cfPWV in either group ( P > 0.05 for all). Our results suggest that some aortic hemodynamic parameters are influenced by sympathetic activity to a greater extent in older postmenopausal women than in young premenopausal women. NEW & NOTEWORTHY Autonomic ganglionic blockade results in significant decreases in multiple aortic pulse wave characteristics (e.g., augmented pressure) and central pulse wave velocity in older postmenopausal women but not in young premenopausal women. Certain aortic pulse wave parameters are negatively influenced by sympathetic activity to a greater extent in older postmenopausal women.
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Holewijn, Suzanne, Jenske J. M. Vermeulen, Majorie van Helvert, Lennart van de Velde, and Michel M. P. J. Reijnen. "Changes in Noninvasive Arterial Stiffness and Central Blood Pressure After Endovascular Abdominal Aneurysm Repair." Journal of Endovascular Therapy 28, no. 3 (April 9, 2021): 434–41. http://dx.doi.org/10.1177/15266028211007460.
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Purpose: To evaluate the impact of elective endovascular aneurysm repair (EVAR) on the carotid-femoral pulse wave velocity (cfPWV) and central pressure waveform, through 1-year follow-up. Materials and Methods: A tonometric device was used to measure cfPWV and estimate the central pressure waveform in 20 patients with an infrarenal abdominal aortic aneurysm scheduled for elective EVAR. The evaluated central hemodynamic parameters included the central pressures, the augmentation index (AIx), and the subendocardial viability ratio (SEVR). AIx quantifies the contribution of reflected wave to the central systolic pressure, whereas SEVR describes the myocardial perfusion relative to the cardiac workload. Measurements were performed before EVAR, at discharge, and 6 weeks and 1 year after EVAR. Results: CfPWV was increased at discharge (12.4±0.4 vs 11.3±0.5 m/s at baseline; p=0.005) and remained elevated over the course of 1-year follow-up (6 weeks: cfPWV = 12.2±0.5 m/s; 1 year: cfPWV = 12.2±0.7 m/s, p<0.05). After an initial drop in systolic central pressure at discharge, all the central pressures increased thereafter up to 1 year, without significant differences compared with baseline. The same was observed for the AIx and SEVR. Conclusion: Endovascular aortic aneurysm repair caused an increase in pulse wave velocity compared with baseline, which remained elevated through 1 year follow-up, which may be related to an increased cardiovascular risk. However, no differences in central pressure, augmentation index, and subendocardial viability ration were observed during follow-up.
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Panchenkova, L. A., L. A. Andreeva, K. A. Khamidova, T. E. Yurkova, and A. I. Martynov. "ARTERIAL HYPERTENSION ASSOCIATED WITH METABOLIC SYNDROME: FOCUS ON DAILY PROFILES OF CENTRAL AORTIC PRESSURE AND VASCULAR STIFFNESS." Eurasian heart journal, no. 3 (September 30, 2016): 6–12. http://dx.doi.org/10.38109/2225-1685-2016-3-6-12.
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Purpose: to evaluate the parameters of the central aortic pressure and arterial stiffness during the day in patients with arterial hypertension (AH) with metabolic syndrome (MS) Material and methods: The study included 48 subjects divided into 2 groups: 23 (47,9%) subjects with AH, 25 (52,1%) subjects with AH with MS (AH+MS). Control group (CG) were 22 practically healthy subjects. All the subjects underwent examination ABPM with oscillometric sensor (BPLabVasotens, Russia) with assessment CAP (systolic blood pressure, SBPao; diastolic blood pressure DBPao; pulse pressure,PPao; Augmentation index, Alxao; amplification of pulse pressure, PPA) and arterial stiffness (pulse wave velocity, PWVao; Reflected Wave Transit Time, RWTT; Arterial Stiffness Index, ASI; Augmentation index, AIx). Results: Analysis of CAP demonstrated significant differences between the day / night SBP ao, DBP ao., mean BP ao in AH and AH + MS groups compared to the CG. No significant differences in the parameters of pulse pressure (PP) during the day in these groups are not mentioned, but PP is higher in AH + MS group. Augmentation Index for 24 hours significantly higher, amplification of pulse pressure was significantly lower in the AH + MS compared to CG and AH group. Evaluation of daily arterial stiffness parameters revealed significantly higher rates in PWVao in AH + MS group comparison with the CG and AH group. RWTT statisticaly significant lower in AH + MS and AH groups compared to CG. Conclusion: 24-hour monitoring of CAP and AS revealed a deterioration of the elastic properties of central arteries in hypertensive subjects with metabolic syndrome. Thus, the results of our study confirm the importance of the study of arterial stiffness and the CAP and in the long term could be considered as markers in hypertensive patients, especially in the presence of comorbid pathology.
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Hametner, Bernhard, Hannah Kastinger, and Siegfried Wassertheurer. "Simulating re-reflections of arterial pressure waves at the aortic valve using difference equations." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 234, no. 11 (July 20, 2020): 1243–52. http://dx.doi.org/10.1177/0954411920942704.
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Re-reflections of arterial pressure waves at the aortic valve and their influence on aortic wave shape are only poorly understood so far. Therefore, the aim of this work is to establish a model enabling the simulation of re-reflection and to test its properties. A mathematical difference equation model is used for the simulations. In this model, the aortic blood pressure is split into its forward and backward components which are calculated separately. The respective equations include reflection percentages representing reflections throughout the arterial system and a reflection coefficient at the aortic valve. While the distal reflections are fixed, different scenarios for the reflection coefficient at the valve are simulated. The results show that the model is capable to provide physiological pressure curves only if re-reflections are assumed to be present during the whole cardiac cycle. The sensitivity analysis on the reflection coefficient at the aortic valve shows various effects of re-reflections on the modelled blood pressure curve. Higher levels of the reflection coefficient lead to higher systolic and diastolic pressure values. The augmentation index is notably influenced by the systolic level of the reflection coefficient. This difference equation model gives an adequate possibility to simulate aortic pressure incorporating re-reflections at the site of the aortic valve. Since a strong dependence of the aortic pressure wave on the choice of the reflection coefficient have been found, this indicates that re-reflections should be incorporated into models of wave transmission. Furthermore, re-reflections may also be considered in methods of arterial pulse wave analysis.
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Tan, Isabella, Hosen Kiat, Edward Barin, Mark Butlin, and Alberto P. Avolio. "Effects of pacing modality on noninvasive assessment of heart rate dependency of indices of large artery function." Journal of Applied Physiology 121, no. 3 (September 1, 2016): 771–80. http://dx.doi.org/10.1152/japplphysiol.00445.2016.
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Studies investigating the relationship between heart rate (HR) and arterial stiffness or wave reflections have commonly induced HR changes through in situ cardiac pacing. Although pacing produces consistent HR changes, hemodynamics can be different with different pacing modalities. Whether the differences affect the HR relationship with arterial stiffness or wave reflections is unknown. In the present study, 48 subjects [mean age, 78 ± 10 (SD), 9 women] with in situ cardiac pacemakers were paced at 60, 70, 80, 90, and 100 beats per min under atrial, atrioventricular, or ventricular pacing. At each paced HR, brachial cuff-based pulse wave analysis was used to determine central hemodynamic parameters, including ejection duration (ED) and augmentation index (AIx). Wave separation analysis was used to determine wave reflection magnitude (RM) and reflection index (RI). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Pacing modality was found to have significant effects on the HR relationship with ED ( P = 0.01), central aortic pulse pressure ( P = 0.01), augmentation pressure ( P < 0.0001), and magnitudes of both forward and reflected waves ( P = 0.05 and P = 0.003, respectively), but not cfPWV ( P = 0.57) or AIx ( P = 0.38). However, at a fixed HR, significant differences in pulse pressure amplification ( P < 0.001), AIx ( P < 0.0001), RM ( P = 0.03), and RI ( P = 0.03) were observed with different pacing modalities. These results demonstrate that although the HR relationships with arterial stiffness and systolic loading as measured by cfPWV and AIx were unaffected by pacing modality, it should still be taken into account for studies in which mixed pacing modalities are present, in particular, for wave reflection studies.
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Kim, Jin-Su, and Moon-Hyon Hwang. "Acute Effect of Moderate-Intensity Aerobic Exercise on Arterial Stiffness in Fine Particulate Matter Environment: A Pilot Study." Exercise Science 30, no. 2 (May 31, 2021): 257–63. http://dx.doi.org/10.15857/ksep.2021.30.2.257.
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PURPOSE:This study aimed to examine the effect of one bout of moderate-intensity aerobic exercise on arterial stiffness under ambient fine particulate matter (PM2.5) exposure.METHODS: In a randomized crossover design, seven healthy young men performed 30 minutes of treadmill running at 70% of heart rate peak under high PM2.5 and low PM2.5 exposure. Arterial stiffness was assessed by measuring the carotid-femoral pulse wave velocity and augmentation index, a measure of pulse wave reflection before and after each exercise intervention.RESULTS: Regardless of the PM2.5 exposure, brachial systolic blood pressure and heart rate increased in response to one bout of moderate-intensity aerobic exercise (<i>p</i><.05). However, the augmentation index adjusted at a heart rate of 75 beats/min, central diastolic blood pressure, central mean arterial pressure, and brachial diastolic blood pressure were increased after one bout of moderate-intensity aerobic exercise under the high PM2.5 condition (<i>p</i><.05).CONCLUSIONS: Moderate-intensity aerobic exercise at the high PM2.5 level may result in acute negative arterial stiffness and blood pressure responses even in healthy young men.
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Mironova, S. A., Yu S. Yudina, M. A. Ionov, N. G. Avdonina, I. V. Emelyanov, E. Yu Vasil`eva, E. A. Kitaeva, N. E. Zvartau, and A. O. Konradi. "Novel biomarkers of kidney injury and fibrosis in patients with different severity of hypertension: relation to vascular reactivity and stiffness." Russian Journal of Cardiology, no. 1 (February 9, 2019): 44–51. http://dx.doi.org/10.15829/1560-4071-2019-1-44-51.
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Aim. To compare the relationships between conventional and new potentially more early investigational biomarkers (urine and ultrasound) of kidney injury and central aortic blood pressure, vascular stiffness and reactivity, endothelial dysfunction in patients with different severity of hypertension.Material and methods. Urine levels NGAL, KIM-1, L-FABP, albuminuria and serum levels of сystatin C and creatinine were measured in 92 hypertensive patients with mild and severe hypertension, 46 male (mean age 50,7±12,2 years). Glomerular filtration rate was estimated by the level of serum creatinine and cystatin C by MDRD and CKD-EPI formulas. Instrumental examination included measuring office blood pressure, 24-hour ambulatory blood pressure monitoring (SpaceLabs 90207), applanation tonometry (SphygmoCor, Artcor Medical) with the calculation of central aortic blood pressure, pulse wave velocity and augmentation index and Doppler ultrasonography with assessment of intraparenchymal renal arterial resistance indices — resistive index and pulsatility index (Vivid 7 dimension). Endothelial function was assessed by reactive hyperemia index with EndoPAT device (Itamar Medicals).Results. There were no differences in conventional levels of biomarkers between patients, however, cystatin C level increased and serum cystatin C estimated GFR and serum creatinine and cystatin C estimated GFR (CKD EPI formula) (sCr,Cys-estimated GFR) levels decreased with the severity of hypertension. These novel biomarkers were associated with increased central aortic blood pressure, arterial stiffness and intraparenchymal renal arterial resistance indices. Decreased sCr,Cys-estimated GFR levels were associated with lower reactive hyperemia index. There were no differences in NGAL, KIM-1 and L-FABP levels in patients with hypertension. However, NGAL levels were associated with increased augmentation index, resistive index in intralobular and pulsatility index in arcuate arteries, KIM-1 and L-FABP levels were associated with increased systolic and diastolic central aortic blood pressure, pulse wave velocity only in patients with severe and resistant hypertension.Conclusion. Serum cystatin C, NGAL, KIM-1 and L-FABP levels seem to be biomarkers of increased systemic and intrarenal vascular stiffness in patients with different severity of hypertension.
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Figueroa, Arturo, Arun Maharaj, Sarah A. Johnson, Stephen M. Fischer, Bahram H. Arjmandi, and Salvador J. Jaime. "Exaggerated Aortic Pulse Pressure and Wave Amplitude During Muscle Metaboreflex Activation in Type 2 Diabetes Patients." American Journal of Hypertension 33, no. 1 (August 17, 2019): 70–76. http://dx.doi.org/10.1093/ajh/hpz135.
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Abstract Background Peripheral mean arterial pressure (MAP) responses to muscle metaboreflex activation using postexercise muscle ischemia (PEMI) in type 2 diabetes patients (T2D) are contradictory. Given that aortic pulse pressure (PP) and wave reflections are better indicators of cardiac load than peripheral MAP, we evaluated aortic blood pressure (BP) and wave amplitude during PEMI. METHODS Aortic BP and pressure wave amplitudes were measured at rest and during PEMI following isometric handgrip at 30% maximum voluntary contraction (MVC) in 16 T2D and 15 controls. Resting aortic stiffness (carotid-femoral pulse wave velocity, cfPWV) and fasting blood glucose (FBG) were measured. RESULTS Increases in aortic MAP (Δ26 ± 2 mmHg vs. Δ17 ± 2 mmHg), PP (Δ15 ± 2 mmHg vs. Δ10 ± 1 mmHg), augmentation index (AIx) (Δ8.2 ± 1.0% vs. Δ4.5 ± 1.3%), augmented pressure (AP) (Δ11 ± 1 mmHg vs. Δ5 ± 1 mmHg), forward (Pf) (Δ9 ± 1 mmHg vs. Δ5 ± 1 mmHg), and backward pressure waves (Pb) (Δ10 ± 1 mmHg vs. Δ5 ± 1 mmHg) responses to PEMI were greater in T2D than controls (P < 0.05). Aortic PP, but not MAP, response to PEMI was correlated to Pf (r = 0.63, P < 0.001) and Pb (r = 0.82, P < 0.001) responses and cfPWV (r = 0.37, P < 0.05). CONCLUSIONS Aortic BP and pressure wave responses to muscle metaboreflex activation are exaggerated in T2D. Aortic PP during PEMI was related to increased wave reflection, forward wave amplitude, and aortic stiffness in T2D patients.
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Doupis, John, Nikolaos Papanas, Alison Cohen, Lyndsay McFarlan, and Edward Horton. "Pulse Wave Analysis by Applanation Tonometry for the Measurement of Arterial Stiffness." Open Cardiovascular Medicine Journal 10, no. 1 (August 31, 2016): 188–95. http://dx.doi.org/10.2174/1874192401610010188.
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The aim of our study was to investigate the association between pulse wave velocity (PWV) and pulse wave analysis (PWA)-derived measurements for the evaluation of arterial stiffness. A total of 20 (7 male and 13 female) healthy, non-smoking individuals, with mean age 31 ± 12years were included. PWV and PWA measurements were performed using a SphygmoCor apparatus (Atcor Medical Blood Pressure Analysis System, Sydney Australia). PWV significantly correlated with all central aortic haemodynamic parameters, especially with pulse pressure (PP) (p < 0.0001), augmentation index corrected for 75 pulses/min (AI75) (p = 0.035) and augmentation pressure (AP) (p = 0.005). Male subjects presented significantly higher PWV compared with females (p = 0.03), while there were no differences in PP, AP and AI75. In conclusion, PWA is strongly correlated with PWV as a method for the evaluation of arterial stiffness.
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Segers, P., J. De Backer, D. Devos, S. I. Rabben, T. C. Gillebert, L. M. Van Bortel, J. De Sutter, A. De Paepe, and P. R. Verdonck. "Aortic reflection coefficients and their association with global indexes of wave reflection in healthy controls and patients with Marfan's syndrome." American Journal of Physiology-Heart and Circulatory Physiology 290, no. 6 (June 2006): H2385—H2392. http://dx.doi.org/10.1152/ajpheart.01207.2005.
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Early return of reflected pressure waves increases the load on central arteries and may increase the risk of aortic rupture in patients with Marfan's syndrome (MFS). To assess whether wave reflection is elevated in MFS, we used ultrasound and MRI to measure central pressure and flow waveforms in 26 patients (13–54 yr of age) and 26 age- and gender-matched controls. Aortic systolic and diastolic cross-sectional areas were measured at the ascending and descending aorta (AA and DA), diaphragm (DIA), and lower abdominal aorta (AB). From these measurements, local characteristic impedance ( Z0- xx) and local reflection coefficients (Γ xx-yy) were calculated. Calculated global wave reflection indexes were the augmentation index (AIx) and the ratio of backward to forward pressure wave (Pb/Pf). The aorta was wider in MFS patients at AA ( P < 0.01) and DA ( P < 0.01). Aortic pulse wave velocity was 42 cm/s higher in MFS patients ( P < 0.05). Z0- xx was not different between groups, except at DA, where it was lower in MFS patients. In controls, ΓAA-DA was 0.31 ± 0.08, ΓDA-DIA was 0.00 ± 0.11, and ΓDIA-AB was 0.31 ± 0.16. Mean values of Γ xx-yy were not different between MFS patients and controls. In controls, aging diminished ΓAA-DA but increased ΓDIA-AB. Clear age-related patterns were absent in MFS patients. AIx or Pb/Pf was not higher in MFS patients than in controls. There were indications for enhanced wave reflection in young MFS patients. Our data demonstrated that the major determinants of AIx were pulse wave velocity and the effective length of the arterial system and, to a lesser degree, HR and Pb/Pf.
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Tarumi, Takashi, Muhammad Ayaz Khan, Jie Liu, Benjamin M. Tseng, Rosemary Parker, Jonathan Riley, Cynthia Tinajero, and Rong Zhang. "Cerebral Hemodynamics in Normal Aging: Central Artery Stiffness, Wave Reflection, and Pressure Pulsatility." Journal of Cerebral Blood Flow & Metabolism 34, no. 6 (March 19, 2014): 971–78. http://dx.doi.org/10.1038/jcbfm.2014.44.
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Blood ejected from the left ventricle perfuses the brain via central elastic arteries, which stiffen with advancing age and may elevate the risk of end-organ damage. The purpose of this study was to determine the impact of central arterial aging on cerebral hemodynamics. Eighty-three healthy participants aged 22 to 80 years underwent the measurements of cerebral blood flow (CBF) and CBF velocity (CBFV) using magnetic resonance imaging (MRI) and transcranial Doppler, respectively. The CBF pulsatility was determined by the relative amplitude of CBFV to the mean value (CBFV%). Central arterial stiffness (carotid-femoral pulse wave velocity), wave reflection (carotid augmentation index), and pressure were measured using applanation tonometry. Total volume of white-matter hyperintensity (WMH) was quantified from MR images. Total CBF decreased with age while systolic and pulsatile CBFV% increased and diastolic CBFV% decreased. Women showed greater total CBF and lower cerebrovascular resistance than men. Diastolic CBFV% was lower in women than in men. Age- and sex-related differences in CBF pulsatility were independently associated with carotid pulse pressure and arterial wave reflection. In older participants, higher pulsatility of CBF was associated with the greater total volume of WMH. These findings indicate that central arterial aging has an important role in age-related differences in cerebral hemodynamics.
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Hope, Sarah A., David B. Tay, Ian T. Meredith, and James D. Cameron. "Waveform dispersion, not reflection, may be the major determinant of aortic pressure wave morphology." American Journal of Physiology-Heart and Circulatory Physiology 289, no. 6 (December 2005): H2497—H2502. http://dx.doi.org/10.1152/ajpheart.00411.2005.
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The objective of this study was to investigate the determinants of aortic pressure waveform morphology in the thoracoabdominal aorta with specific reference to features of potential prognostic value for cardiovascular disease. In particular, we aimed to determine the location of major pressure wave reflection sites within the aorta. Aortic pressure waveforms were acquired with 2-Fr Millar Mikro-tip catheter transducers in 40 subjects (26 men, 14 women), and repeated in 10 subjects, at five predetermined points within the aorta: aortic root, transverse arch, and at the levels of the diaphragm, renal arteries, and aortic bifurcation. Waveforms were analyzed for augmentation index (AI), time to inflection point ( Ti), and pressure parameters. AI decreased progressively between the aortic root and bifurcation ( P < 0.001), and Ti increased ( P < 0.01). There was the expected progressive peripheral amplification of systolic and pulse pressures and fall in time to peak pressure (all P < 0.001). There was no difference on repeat pullback or between sexes. These data are at variance with the concept that central AI results solely from pressure wave reflection, when Ti would be expected to decrease and AI increase with distal progression. Pressure wave propagation phenomena may contribute, and the potential role of frequency dispersion merits investigation.
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Schultz, Martin G., Alun D. Hughes, Justin E. Davies, and James E. Sharman. "Associations and clinical relevance of aortic-brachial artery stiffness mismatch, aortic reservoir function, and central pressure augmentation." American Journal of Physiology-Heart and Circulatory Physiology 309, no. 7 (October 2015): H1225—H1233. http://dx.doi.org/10.1152/ajpheart.00317.2015.
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Central augmentation pressure (AP) and index (AIx) predict cardiovascular events and mortality, but underlying physiological mechanisms remain disputed. While traditionally believed to relate to wave reflections arising from proximal arterial impedance (and stiffness) mismatching, recent evidence suggests aortic reservoir function may be a more dominant contributor to AP and AIx. Our aim was therefore to determine relationships among aortic-brachial stiffness mismatching, AP, AIx, aortic reservoir function, and end-organ disease. Aortic (aPWV) and brachial (bPWV) pulse wave velocity were measured in 359 individuals (aged 61 ± 9, 49% male). Central AP, AIx, and aortic reservoir indexes were derived from radial tonometry. Participants were stratified by positive (bPWV > aPWV), negligible (bPWV ≈ aPWV), or negative stiffness mismatch (bPWV < aPWV). Left-ventricular mass index (LVMI) was measured by two-dimensional-echocardiography. Central AP and AIx were higher with negative stiffness mismatch vs. negligible or positive stiffness mismatch (11 ± 6 vs. 10 ± 6 vs. 8 ± 6 mmHg, P < 0.001 and 24 ± 10 vs. 24 ± 11 vs. 21 ± 13%, P = 0.042). Stiffness mismatch (bPWV-aPWV) was negatively associated with AP ( r = −0.18, P = 0.001) but not AIx ( r = −0.06, P = 0.27). Aortic reservoir pressure strongly correlated to AP ( r = 0.81, P < 0.001) and AIx ( r = 0.62, P < 0.001) independent of age, sex, heart rate, mean arterial pressure, and height (standardized β = 0.61 and 0.12, P ≤ 0.001). Aortic reservoir pressure independently predicted abnormal LVMI (β = 0.13, P = 0.024). Positive aortic-brachial stiffness mismatch does not result in higher AP or AIx. Aortic reservoir function, rather than discrete wave reflection from proximal arterial stiffness mismatching, provides a better model description of AP and AIx and also has clinical relevance as evidenced by an independent association of aortic reservoir pressure with LVMI.
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Cheng, Chun-Yu, Hao-Min Cheng, Shih-Pin Chen, Chih-Ping Chung, Yung-Yang Lin, Han-Hwa Hu, Chen-Huan Chen, and Shuu-Jiun Wang. "White matter hyperintensities in migraine: Clinical significance and central pulsatile hemodynamic correlates." Cephalalgia 38, no. 7 (August 30, 2017): 1225–36. http://dx.doi.org/10.1177/0333102417728751.
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Background The role of central pulsatile hemodynamics in the pathogenesis of white matter hyperintensities in migraine patients has not been clarified. Methods Sixty patients with migraine (20–50 years old; women, 68%) without overt vascular risk factors and 30 demographically-matched healthy controls were recruited prospectively. Cerebral white matter hyperintensities volume was determined by T1-weighted magnetic resonance imaging with CUBE-fluid-attenuated-inversion-recovery sequences. Central systolic blood pressure, carotid-femoral pulse wave velocity, and carotid augmentation index were measured by applanation tonometry. Carotid pulsatility index was derived from Doppler ultrasound carotid artery flow analysis. Results Compared to the controls, the migraine patients had higher white matter hyperintensities frequency (odds ratio, 2.75; p = 0.04) and greater mean white matter hyperintensities volume (0.174 vs. 0.049, cm3, p = 0.04). Multivariable regression analysis showed that white matter hyperintensities volume in migraine patients was positively associated with central systolic blood pressure ( p = 0.04) and carotid-femoral pulse wave velocity ( p < 0.001), but negatively associated with carotid pulsatility index ( p = 0.04) after controlling for potential confounding factors. The interaction effects observed indicated that the influence of carotid-femoral pulse wave velocity ( p = 0.004) and central systolic blood pressure ( p = 0.03) on white matter hyperintensities formation was greater for the lower-carotid pulsatility index subgroup of migraine patients. White matter hyperintensities volume in migraine patients increased with decreasing carotid pulsatility index and with increasing central systolic blood pressure or carotid-femoral pulse wave velocity. Conclusions White matter hyperintensities are more common in patients with migraine than in healthy controls. Increased aortic stiffness or central systolic blood pressure in the presence of low intracranial artery resistance may predispose patients with migraine to white matter hyperintensities formation.
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Gurevich, A. P., I. V. Emelyanov, M. A. Boyarinova, E. V. Moguchaya, O. P. Rotar, Y. A. Kudaev, M. A. Chernyavskiy, and A. O. Konradi. "Arterial stiffness and central aortic blood pressure in patients with hypertension and abdominal aortic aneurysm." "Arterial’naya Gipertenziya" ("Arterial Hypertension") 28, no. 3 (March 2, 2022): 243–52. http://dx.doi.org/10.18705/1607-419x-2022-28-3-243-252.
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Objective. To assess the arterial stiffness, peripheral and central aortic blood pressure (PBP and CBP), and to determinate their relationships with indicators of structural changes of the affected aorta in patients with hypertension (HTN) and abdominal aortic aneurysms (AAA).Design and methods. We examined 75 patients with HTN and AAA and 75 controls with HTN without AAA. Groups matched by age and gender. A PBP was measured by OMRON (Japan). Noninvasive measurements of CBP, augmentation index (AIx), augmentation pressure (AP), carotid-femoral pulse wave velocity (cfPWV) were assessed by SphygmoCor (AtCorMedical, Australia).Results. There was no difference in cfPWV between patients with AAA and control group (10,3 (2,2) vs 9,7 (2,1) m/s; р = 0,102). Age, systolic PBP, and aortic diameter were independent predictors of cfPVV in patients with AAA (β = 0,271, р = 0,029; β = 0,272, р = 0,030 и β = –0,361, р = 0,004, respectively). Patients with large aortic diameter of AAA (> 60 mm) had decreased cfPWV compared with control group (8,8 (1,5) vs 9,7 (2,1) m/s; р < 0,05), patients with AAA diameter less than 60 mm, on the contrary, had increased cfPVV compared with the controls (11,8 (1,7) vs 9,7 (2,1) m/s; р < 0,001). Patients with AAA and patients of control group did not differ in systolic and pulse PBP (138,6 (16,4) vs 138,1 (13,6) mm Hg; р = 0,831 and 58,6 (11,8) vs 59,6 (10,2) mm Hg; р = 0,569, respectively). AIx and AP were higher in patients with AAA versus patients without AAA (27,6 (8,2) vs 21,3 (7,9)%; р < 0,001 and 17,3 (6,8) vs 13,9 (5,4) mm Hg; р = 0,001, respectively). Systolic and pulse CBP were higher in patients with AAA than in patients of control group (130,0 (16,4) vs 124,9 (13,9) mm Hg; р = 0,046 and 49,5 (11,7) vs 45,7 (9,9) mm Hg; р = 0,031, respectively).Conclusions. In patients with AAA cfPWV decreased with the expansion of the maximum aortic diameter. CfPWV is not suitable for accurate arterial stiffness assessment in patients with HTN and AAA due to the apparent confounding effect of aneurysm on the biomechanical properties of the aorta. Local assessment of the elastic properties of the aorta such as computed tomography angiography and magnetic resonance imaging is required for arterial stiffness evaluation in patients with AAA. Parameters of the reflected pulse wave such as AP and AIx are increased in patients with AAA. This might contribute to the increase in central aortic BP and target organ damage in patients with HTN combined with AAA.
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Figueroa, Arturo, Stacey Alvarez-Alvarado, Salvador J. Jaime, and Roy Kalfon. "l-Citrulline supplementation attenuates blood pressure, wave reflection and arterial stiffness responses to metaboreflex and cold stress in overweight men." British Journal of Nutrition 116, no. 2 (May 10, 2016): 279–85. http://dx.doi.org/10.1017/s0007114516001811.
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AbstractCombined isometric exercise or metaboreflex activation (post-exercise muscle ischaemia (PEMI)) and cold pressor test (CPT) increase cardiac afterload, which may lead to adverse cardiovascular events. l-Citrulline supplementation (l-CIT) reduces systemic arterial stiffness (brachial-ankle pulse wave velocity (baPWV)) at rest and aortic haemodynamic responses to CPT. The aim of this study was to determine the effect of l-CIT on aortic haemodynamic and baPWV responses to PEMI+CPT. In all, sixteen healthy, overweight/obese males (age 24 (sem 6) years; BMI 29·3 (sem 4·0) kg/m2) were randomly assigned to placebo or l-CIT (6 g/d) for 14 d in a cross-over design. Brachial and aortic systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP), aortic augmented pressure (AP), augmentation index (AIx), baPWV, reflection timing (Tr) and heart rate (HR) were evaluated at rest and during isometric handgrip exercise (IHG), PEMI and PEMI+CPT at baseline and after 14 d. No significant effects were evident after l-CIT at rest. l-CIT attenuated the increases in aortic SBP and wave reflection (AP and AIx) during IHG, aortic DBP, MAP and AIx during PEMI, and aortic SBP, DBP, MAP, AP, AIx and baPWV during PEMI+CPT compared with placebo. HR and Tr were unaffected by l-CIT in all conditions. Our findings demonstrate that l-CIT attenuates aortic blood pressure and wave reflection responses to exercise-related metabolites. Moreover, l-CIT attenuates the exaggerated arterial stiffness response to combined metaboreflex activation and cold exposure, suggesting a protective effect against increased cardiac afterload during physical stress.
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Heusinkveld, Maarten H. G., Tammo Delhaas, Joost Lumens, Wouter Huberts, Bart Spronck, Alun D. Hughes, and Koen D. Reesink. "Augmentation index is not a proxy for wave reflection magnitude: mechanistic analysis using a computational model." Journal of Applied Physiology 127, no. 2 (August 1, 2019): 491–500. http://dx.doi.org/10.1152/japplphysiol.00769.2018.
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The augmentation index (AIx) is deemed to capture the deleterious effect on left ventricular (LV) work of increased wave reflection associated with stiffer arteries. However, its validity as a proxy for wave reflection magnitude has been questioned. We hypothesized that, in addition to increased wave reflection due to increased pulse wave velocity, LV myocardial shortening velocity influences AIx. Using a computational model of the circulation, we investigated the isolated and combined influences of myocardial shortening velocity vs,LV and arterial stiffness on AIx. Aortic blood pressure waveforms were characterized using AIx and the reflected wave pressure amplitude ([Formula: see text], obtained using wave separation analysis). Our reference simulation (normal vs,LV and arterial stiffness) was characterized by an AIx of 21%. A realistic reduction in vs,LV caused AIx to increase from 21 to 42%. An arterial stiffness increase, characterized by a relevant 1.0 m/s increase in carotid-femoral pulse wave velocity, caused AIx to increase from 21 to 41%. Combining the reduced vs,LV and increased arterial stiffness resulted in an AIx of 54%. In a multistep parametric analysis, both vs,LV and arterial stiffness were about equal determinants of AIx, whereas [Formula: see text] was only determined by arterial stiffness. Furthermore, the relation between increased AIx and LV stroke work was only ≈50% explained by an increase in arterial stiffness, the other factor being vs,LV. The [Formula: see text], on the other hand, related less ambiguously to LV stroke work. We conclude that the AIx reflects both cardiac and vascular properties and should not be considered an exclusively vascular parameter. NEW & NOTEWORTHY We used a state-of-the-art computational model to mechanistically investigate the validity of the augmentation index (AIx) as a proxy for (changes in) wave reflection. In contrary to current belief, we found that LV contraction velocity influences AIx as much as increased arterial stiffness, and increased AIx does not necessarily relate to an increase in LV stroke work. Wave reflection magnitude derived from considering pressure, as well as flow, does qualify as a determinant of LV stroke work.
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Heffernan, Kevin S., James E. Sharman, Eun Sun Yoon, Eui Jin Kim, Su Jin Jung, and Sae Young Jae. "Effect of increased preload on the synthesized aortic blood pressure waveform." Journal of Applied Physiology 109, no. 2 (August 2010): 484–90. http://dx.doi.org/10.1152/japplphysiol.00196.2010.
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In the present study, we examined the influence of preload augmentation via passive leg elevation (PLE) on synthesized aortic blood pressure, aortic augmentation index (AIx), and aortic capacitance (a reflection of aortic reservoir function). Central and peripheral hemodynamics were measured via tonometry with a generalized transfer function in 14 young, healthy men (age = 24 yr). Aortic blood flow was calculated from the left ventricular outflow tract (LVOT) velocity-time integral (VTI) using standard two-dimensional echocardiographic-Doppler techniques. Measures were made in the supine position at rest (Pre), during PLE, and during recovery (Post). There was a significant increase in LVOT-VTI, synthesized aortic systolic blood pressure (BP) and AIx from Pre to PLE, with values returning to baseline Post ( P < 0.05). There was a reduction in aortic capacitance from Pre to PLE, with values returning to baseline Post ( P < 0.05). There was no change in heart rate, systemic arterial compliance, aortic elastance, aortic wave travel timing, or vascular resistance ( P > 0.05). Change in AIx from Pre to PLE was associated with change in LVOT-VTI ( r = 0.66, P < 0.05) and inversely associated with change in aortic capacitance ( r = −0.73, P < 0.05). These data suggest that in a setting of isolated augmented preload with minimal changes in other potential confounders, the morphology of the synthesized aortic BP waveform and AIx may be related to changes in aortic reservoir function.
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DEARY, Alison J., Anne L. SCHUMANN, Helen MURFET, Stephen HAYDOCK, Roger S. FOO, and Morris J. BROWN. "Influence of drugs and gender on the arterial pulse wave and natriuretic peptide secretion in untreated patients with essential hypertension." Clinical Science 103, no. 5 (October 10, 2002): 493–99. http://dx.doi.org/10.1042/cs1030493.
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Recent studies have suggested a differential influence of mean pressure and pulse pressure on myocardial infarction and stroke, and differences among the major drugs in their efficacy at preventing these individual endpoints. We hypothesized that antihypertensive drugs have differing influences upon the pulse wave even when their effects on blood pressure are the same. We studied 30 untreated hypertensive patients, aged 28—55 years, who were rotated through six 6-week periods of daily treatment with amlodipine 5mg, doxazosin 4mg, lisinopril 10mg, bisoprolol 5mg, bendrofluazide 2.5mg or placebo. The best drug was repeated at the end of the rotation. Blood pressure readings and radial pulse tonometry (by Sphygmocor®) were performed at each visit, and blood was taken for measurement of levels of atrial natriuretic peptide and brain natriuretic peptide (BNP). The Sphygmocor derivation of the central aortic pulse wave was used to measure time for transmission of the reflected wave (TR) and the augmentation index (AI), which is the proportional increase in systolic pressure due to the reflected wave. There was a dissociation between the effects of the drugs on blood pressure and pulse wave analysis. Bisoprolol caused the greatest falls in blood pressure and TR, but was the only drug to increase AI. This paradoxical response to bisoprolol was associated with a 3-fold increase in plasma BNP levels. There was a smaller elevation of BNP in women compared with men, as described previously, and this elevation also was associated with significantly higher values of AI. Other drugs reduced AI, and this was associated with a significant decrease in BNP by amlodipine. In conclusion, antihypertensive drugs differ in their short-term effects on augmentation of the systolic pulse wave and secretion of BNP from the heart, regarded as a sensitive measure of strain on cardiomyocytes. These differences may help to explain cause-specific differences in outcome in recent trials.
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Solanki, Jayesh Dalpatbhai, Sunil J. Panjwani, Ravi Kanubhai Patel, Devanshi Nishantbhai Bhatt, Param Jagdeep Kakadia, and Chinmay J. Shah. "Assessment of Arterial Stiffness, Brachial Haemodynamics, and Central Haemodynamics in Diabetic Hypertensives: A Pulse Wave Analysis-Based Case-Control Study from an Urban Area of West India." Pulse 9, no. 3-4 (2021): 89–98. http://dx.doi.org/10.1159/000519357.
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<b><i>Introduction:</i></b> Hypertension (HTN) and diabetes frequently coexist, imposing significant cardiovascular risk that is normally studied in terms of brachial blood pressure (bBP). Direct and superior parameters like central haemodynamics and arterial stiffness are studied scarcely. Pulse wave analysis (PWA) offers a non-invasive measurement of the same that we studied in diabetic hypertensives. <b><i>Materials and Methods:</i></b> We conducted a case-control study on 333 treated diabetic hypertensive cases and 333 euglycaemic normotensive controls. Oscillometric PWA was performed by Mobil-o-Graph (IEM, Aachen, Germany). Parameters were further analysed in relation to gender, physical activity, body mass index (BMI), glycaemic control, blood pressure control, and disease duration (cut-off 5 years). Multiple linear regressions were done to find significant associations. <b><i>Results:</i></b> Cases had significantly higher brachial haemodynamics (blood pressure, heart rate (HR), and rate pressure product); arterial stiffness measures (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, and pulse pressure amplification), and central haemodynamics (central blood pressure, cardiac output, stroke work) than controls. In the case group, female gender, BMI ≥23, and uncontrolled blood pressures were significant factors that affected the results while other factors such as glycaemic control, physical activity, and duration did not. HR was significantly associated with study parameters. Brachial pressures were not significantly associated with corresponding aortic pressures. <b><i>Conclusion:</i></b> Diabetic hypertensives had adverse profile of cardiovascular parameters beyond bBP, related to female gender, and HTN and its control, more than that of diabetes. This baseline work suggests further study on these potential parameters.
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Omboni, Stefano, Igor N. Posokhov, and Anatoly N. Rogoza. "Evaluation of 24-Hour Arterial Stiffness Indices and Central Hemodynamics in Healthy Normotensive Subjects versus Treated or Untreated Hypertensive Patients: A Feasibility Study." International Journal of Hypertension 2015 (2015): 1–10. http://dx.doi.org/10.1155/2015/601812.
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Objective. Central blood pressure (BP) and vascular indices estimated noninvasively over the 24 hours were compared between normotensive volunteers and hypertensive patients by a pulse wave analysis of ambulatory blood pressure recordings.Methods. Digitalized waveforms obtained during each brachial oscillometric BP measurement were stored in the device memory and analyzed by the validated Vasotens technology. Averages for the 24 hours and for the awake and asleep subperiods were computed.Results. 142 normotensives and 661 hypertensives were evaluated. 24-hour central BP, pulse wave velocity (PWV), and augmentation index (AI) were significantly higher in the hypertensive group than in the normotensive group (119.3 versus 105.6 mmHg for systolic BP, 75.6 versus 72.3 mmHg for diastolic BP, 10.3 versus 10.0 m/sec for aortic PWV, −9.7 versus −40.7% for peripheral AI, and 24.7 versus 11.0% for aortic AI), whereas reflected wave transit time (RWTT) was significantly lower in hypertensive patients (126.6 versus 139.0 ms). After adjusting for confounding factors a statistically significant between-group difference was still observed for central BP, RWTT, and peripheral AI. All estimates displayed a typical circadian rhythm.Conclusions. Noninvasive assessment of 24-hour arterial stiffness and central hemodynamics in daily life dynamic conditions may help in assessing the arterial function impairment in hypertensive patients.
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Papaioannou, T. G., J. P. Lekakis, A. G. Dagre, K. S. Stamatelopoulos, J. Terrovitis, E. J. Gialafos, J. Kanakakis, J. Nanas, S. F. Stamatelopoulos, and S. Moulopoulos. "Arterial Compliance is an Independent Factor Predicting Acute Hemodynamic Performance of Intra-aortic Balloon Counterpulsation." International Journal of Artificial Organs 24, no. 7 (July 2001): 478–83. http://dx.doi.org/10.1177/039139880102400710.
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Data concerning the effect of arterial compliance (AC) on hemodynamics during intra-aortic balloon counterpulsation (IABC) are lacking. This study examines the effect of AC on acute hemodynamics induced by IABC in 15 patients with post-infarction cardiogenic shock. AC was estimated by aortic pulse wave analysis using the reflection time index (RTI). Measurements were obtained once per day during IABC. The % reduction in systolic aortic pressure (ΔSAP), end-diastolic aortic pressure (ΔEDAP) and the peak aortic diastolic augmentation (PADA) were used as performance indices of IABC; 107 sets of measurements were obtained. Multivariate analysis indicated an independent association of each IABC performance index with AC (p<0.05). A high AC group (RTI≤20.6%, n=40) and a low AC group (RTI>20.6%, n=67) were obtained. ΔSAP, ΔEDAP and PADA were significantly higher in the low AC group by almost 75%, 54.6% and 11,3% (p<0.03), while arterial blood pressure did not significantly differ. Arterial compliance is an independent factor affecting hemodynamics during IABC. RTI values higher than 20.6% may predict a better acute hemodynamic response to IABC.
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Boutouyrie, P., A. Achouba, P. Trunet, Kt Ong, and S. Laurent. "CENTRAL BLOOD PRESSURE AND AUGMENTATION INDEX DECREASE ARE DEPENDENT ON AORTIC PULSE WAVE VELOCITY IMPROVEMENT: THE EXPLOR STUDY: PP.10.406." Journal of Hypertension 28 (June 2010): e171. http://dx.doi.org/10.1097/01.hjh.0000378730.88654.94.
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Horváth, Iván G., Ádám Németh, Zsófia Lenkey, Nicola Alessandri, Fabrizio Tufano, Pál Kis, Balázs Gaszner, and Attila Cziráki. "Invasive validation of a new oscillometric device (Arteriograph) for measuring augmentation index, central blood pressure and aortic pulse wave velocity." Journal of Hypertension 28, no. 10 (October 2010): 2068–75. http://dx.doi.org/10.1097/hjh.0b013e32833c8a1a.
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Wong, Alexei, Arturo Figueroa, Stephen M. Fischer, Reza Bagheri, and Song-Young Park. "The Effects of Mat Pilates Training on Vascular Function and Body Fatness in Obese Young Women With Elevated Blood Pressure." American Journal of Hypertension 33, no. 6 (April 1, 2020): 563–69. http://dx.doi.org/10.1093/ajh/hpaa026.
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Abstract BACKGROUND Effective nonpharmacological interventions targeting the enhancement of vascular function and decline of body fatness (BF) in obese individuals are indispensable for the prevention of hypertension and cardiovascular events in young adults. Mat Pilates training (MPT) has gained significant popularity worldwide, yet its effects on vascular function and body composition are understudied. We examined the effects of MPT on vascular function and BF in young obese women with elevated blood pressure (BP). METHODS Twenty-eight young obese women with elevated BP were randomized to an MPT (n = 14) or a nonexercising control (CON, n = 14) group for 12 weeks. Systemic arterial stiffness (brachial-ankle pulse wave velocity (baPWV)), brachial and aortic BP, wave reflection (augmentation index (AIx)), plasma nitric oxide (NO) levels, and BF percentage (BF%) were assessed before and after 12 weeks. RESULTS MPT significantly reduced (P ˂ 0.05) baPWV (−0.7 ± 0.2 m/s), AIx (−4 ± 1%), brachial systolic BP (−5 ± 1 mm Hg), aortic systolic BP (−6 ± 1 mm Hg), and BF% (−2 ± 1%), while significantly increasing plasma NO (6 ± 2 µM) (P ˂ 0.05) compared with CON. MPT improved systemic arterial stiffness, aortic BP, wave reflection, circulating plasma NO, and BF% in young obese women with elevated BP. CONCLUSIONS MPT may be an effective intervention for the improvement of vascular function and BF in young obese women with elevated BP, a population at risk for hypertension and early vascular complications. CLINICAL TRIALS REGISTRATION Trial Number NCT03907384.
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Zagidullin, N. Sh, R. Kh Zulkarneev, E. S. Scherbakova, Yu F. Safina, and Sh Z. Zagidullin. "Arterial stiffness as a cardiovascular events risk marker and possibilities for its downregulation by contemporary antihypertensive medications." Kazan medical journal 95, no. 4 (August 15, 2014): 575–81. http://dx.doi.org/10.17816/kmj1847.
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Arterial blood pressure measured by Korotkov’s method is a non-valid predictor for possible cardiovascular events, which requires introduction of new methods of arterial hypertension diagnostics. Recently, the effect on arterial stiffness has become a very important characteristic of antihypertensive drugs overall efficacy. Evaluation of arterial stiffness (central aortic pressure, augmentation index and pulse wave velocity) contributes to more precise cardiovascular risk stratification and reflects target organ damage and the effectiveness of antihypertensive treatment. In particular, pulse wave velocity exceeding 12 m/s is a significant risk factor of cardiovascular events. Arterial compliance can be determined by applanation tonometry, pulse wave shift at the carotid and femoral arteries, finger photoplethysmography, volume pulsoxymetry, echo-tracking, suprasystolic pulse waves recording method and cardio-ankle vascular index. Different effects of antihypertensive drugs on arterial stiffness at the same blood pressure reduction have been repeatedly shown. The article discusses the impact of the most commonly used antihypertensive drugs, including contemporary antihypertensive drugs combinations, on arterial stiffness. Effect of beta-blockers greatly varies depending on the characteristics of the drug, diuretics have neutral effect, calcium antagonists (especially amlodipine) decrease the pulse wave speed and arterial wall stiffness. Both angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers (more data for enalapril, perindopril and valsartan) were effective in decreasing arterial wall stiffness. A significant reduction in arterial wall stiffness was mainly found if antihypertensive drugs combinations were used, especially the combination of calcium antagonists and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers.
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Balal, Mehmet, Meltem Demirkiran, and Saime Paydas. "Central Aortic Pressure and Arterial Stiffness in Parkinson’s Disease: A Comparative Study." Parkinson's Disease 2022 (July 12, 2022): 1–8. http://dx.doi.org/10.1155/2022/6723950.
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Background. Cardiovascular autonomic dysfunction, which leads to hemodynamic disorders, is commonly observed in patients with Parkinson’s disease (PD). Central aortic pressure (CAP) is the systolic blood pressure (SBP) at the root of the aorta. In young people, CAP is lower than peripheral arterial blood pressure. In older people, the difference between CAP and peripheral arterial blood pressure decreases depending on the extent of arterial stiffness (AS). In patients with AS, CAP increases. CAP is thus regarded as an indicator of AS. Objective. To compare CAP and other hemodynamic parameters for AS between patients with Parkinson’s disease and control group. We also aimed to evaluate changes in these hemodynamic parameters after the levodopa (LD) intake. Methods. We included 82 patients with PD and 76 healthy controls. Age, sex, disease duration, disease subtype, Hoehn–Yahr stage (H&Y), and nonmotor symptoms (NMS) were documented. TensioMed Software v.3.0.0.1 was used to measure CAP, peripheral arterial blood pressure, pulse pressure (PP), heart rate (HR), mean arterial pressure (MAP), augmentation index (AI), pulse wave velocity, and ejection time. All patients were being treated with LD, and measurements were performed 1 h before and 1 h after LD intake. Results. Baseline peripheral arterial blood pressure and CAP values were significantly higher in the PD group than in the control group ( p < 0.001 and p = 0.02 , respectively). Most cardiac hemodynamic parameters, including peripheral arterial blood pressure and CAP, decreased significantly ( p < 0.02 and p < 0.001 , respectively) after LD intake in the PD group. Disease subtype, duration, and severity did not affect any of the hemodynamic parameters. When NMS were evaluated, patients with psychosis and dementia showed higher baseline parameters. Conclusion. Loss of postganglionic noradrenergic innervation is well-known with PD. Several cardiac hemodynamic parameters were affected, suggesting cardiac autonomic dysfunction in these patients. The data obtained were independent of disease severity, duration, and subtype. After LD intake, most of these parameters decreased, which might have a positive effect on the vascular burden.
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Boardman, Henry, Katherine Birse, Esther F. Davis, Polly Whitworth, Veena Aggarwal, Adam J. Lewandowski, and Paul Leeson. "Comprehensive multi-modality assessment of regional and global arterial structure and function in adults born preterm." Hypertension Research 39, no. 1 (September 24, 2015): 39–45. http://dx.doi.org/10.1038/hr.2015.102.
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Abstract Preterm birth is associated with higher blood pressure, which could be because preterm birth alters early aortic elastin and collagen development to cause increased arterial stiffness. We measured central and conduit artery size and multiple indices of arterial stiffness to define the extent and severity of macrovascular changes in individuals born preterm. A total of 102 young adults born preterm and 102 controls who were born after an uncomplicated pregnancy underwent cardiovascular magnetic resonance on a Siemens 1.5 T scanner to measure the aortic cross-sectional area in multiple locations. Ultrasound imaging with a Philips CX50 and linear array probe was used to measure carotid and brachial artery diameters. Carotid-femoral pulse wave velocity and the augmentation index were measured by SphygmoCor, brachial-femoral pulse wave velocity by Vicorder and aortic pulse wave velocity by cardiovascular magnetic resonance. The cardio-ankle vascular index (CAVI) was used as a measurement of global stiffness, and ultrasound was used to assess peripheral vessel distensibility. Adults born preterm had 20% smaller thoracic and abdominal aortic lumens (2.19±0.44 vs. 2.69±0.60 cm2, P<0.001; 1.25±0.36 vs. 1.94±0.45 cm2, P<0.001, respectively) but similar carotid and brachial diameters to adults born at term. Pulse wave velocity was increased (5.82±0.80 vs. 5.47±0.59 m s−1, P<0.01, 9.06±1.25 vs. 8.33±1.28 m s−1, P=0.01, 5.23±1.19 vs. 4.75±0.91 m s−1, P<0.01) and carotid distensibility was decreased (4.75±1.31 vs. 5.60±1.48 mm Hg−1103, P<0.001) in this group compared with the group born at term. However, the global and peripheral arterial stiffness measured by CAVI and brachial ultrasound did not differ (5.95±0.72 vs. 5.98±0.60, P=0.80 and 1.07±0.48 vs. 1.19±0.54 mm Hg−1103, P=0.12, respectively). Adults who are born preterm have significant differences in their aortic structure from adults born at term, but they have relatively small differences in central arterial stiffness that may be partially explained by blood pressure variations.
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Bhuva, Anish N., A. D’Silva, C. Torlasco, N. Nadarajan, S. Jones, R. Boubertakh, J. Van Zalen, et al. "Non-invasive assessment of ventriculo-arterial coupling using aortic wave intensity analysis combining central blood pressure and phase-contrast cardiovascular magnetic resonance." European Heart Journal - Cardiovascular Imaging 21, no. 7 (September 9, 2019): 805–13. http://dx.doi.org/10.1093/ehjci/jez227.
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Abstract Background Wave intensity analysis (WIA) in the aorta offers important clinical and mechanistic insight into ventriculo-arterial coupling, but is difficult to measure non-invasively. We performed WIA by combining standard cardiovascular magnetic resonance (CMR) flow-velocity and non-invasive central blood pressure (cBP) waveforms. Methods and results Two hundred and six healthy volunteers (age range 21–73 years, 47% male) underwent sequential phase contrast CMR (Siemens Aera 1.5 T, 1.97 × 1.77 mm2, 9.2 ms temporal resolution) and supra-systolic oscillometric cBP measurement (200 Hz). Velocity (U) and central pressure (P) waveforms were aligned using the waveform foot, and local wave speed was calculated both from the PU-loop (c) and the sum of squares method (cSS). These were compared with CMR transit time derived aortic arch pulse wave velocity (PWVtt). Associations were examined using multivariable regression. The peak intensity of the initial compression wave, backward compression wave, and forward decompression wave were 69.5 ± 28, −6.6 ± 4.2, and 6.2 ± 2.5 × 104 W/m2/cycle2, respectively; reflection index was 0.10 ± 0.06. PWVtt correlated with c or cSS (r = 0.60 and 0.68, respectively, P < 0.01 for both). Increasing age decade and female sex were independently associated with decreased forward compression wave (−8.6 and −20.7 W/m2/cycle2, respectively, P < 0.01) and greater wave reflection index (0.02 and 0.03, respectively, P < 0.001). Conclusion This novel non-invasive technique permits straightforward measurement of wave intensity at scale. Local wave speed showed good agreement with PWVtt, and correlation was stronger using the cSS than the PU-loop. Ageing and female sex were associated with poorer ventriculo-arterial coupling in healthy individuals.
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Agnoletti, Gabriella, Caroline Bonnet, Damien Bonnet, Daniel Sidi, and Yacine Aggoun. "Mid-term effects of implanting stents for relief of aortic recoarctation on systemic hypertension, carotid mechanical properties, intimal medial thickness and reflection of the pulse wave." Cardiology in the Young 15, no. 3 (May 3, 2005): 245–50. http://dx.doi.org/10.1017/s1047951105000521.
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Objective:Primary implantation of stents is an accepted technique for treating aortic recoarctation, albeit that the effects of stenting on pressure profiles, carotid mechanical properties, intimal medial thickness, and reflection of the pulse wave have not been systematically investigated.Methods:Over the period from 1 January, 1999, to 31 December, 2002, we implanted stents to relieve aortic recoarctation in 15 patients, with a median age of 17 years, and a range from 7 to 29 years, with a median weight of 56 kilograms, ranging from 20 to 96 kilograms. Indications were a gradient of 20 millimetres of mercury or more measured in all, systemic hypertension at rest in 8, and systemic hypertension at exercise in all. Of the patients, 5 were receiving anti-hypertensive treatment. Before implantation of the stents, and after a mean follow-up of 22 months, all patients underwent an exercise test, vascular echography, and examination of the common carotid artery so as to determine its cross sectional compliance and distensibility, and the augmentation index.Results:The stents were implanted successfully in all patients. The mean gradient was reduced from 27 to 4 millimetres of mercury (p < 0.001). Systolic blood pressure at rest diminished from 140 to 131 millimetres of mercury (p = 0.04), while hypertension at rest regressed in 4 patients. Systolic blood pressure at exercise diminished from 245 to 222 millimetres of mercury (p = 0.018), and hypertension at exercise regressed in 1 patient. Anti-hypertensive treatment is still required for 4 patients. A correlation was found between systolic blood pressure at rest and initial peak-to-peak gradient (r = 0.8), and between initial gradient and percentage reduction of systolic blood pressure at rest at follow-up (r = −0.73). Compliance and distensibility of the common carotid artery were not significantly modified, albeit that the intimal medial thickness diminished from 0.64 to 0.57 millimetres (p = 0.04), and the augmentation index decreased from 5 to −1 (p = 0.012).Conclusions:Primary implantation of stents is effective in mid-term repair of aortic recoarctation. Although there is an improvement in systemic hypertension, the tensional profile and vascular sonography are not normalized. At long term follow-up, the suppression of an early reflection site of the pulse wave could decrease the wall stress of the great elastic vessels, reducing the thickness of the arterial walls.
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Sergey A., Pribylov, Yakovleva Margarita V., Pribylov Vladislav S., Barbashina Tatiana A., Leonidova Kristina O., and Pribylova Nadezda N. "Arterial stiffness in patients with acute coronary syndrome without persistent ST segment elevation combined with chronic kidney disease and arterial hypertension and its correction with antihypertensive therapy." Человек и его здоровье 25, no. 1 (2022): 19–27. http://dx.doi.org/10.21626/vestnik/2022-1/03.
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Objective: to study arterial stiffness in patients with acute coronary syndrome without ST elevation, who have hypertension (AH) and stage 2-3A chronic kidney disease (CKD) and to assess the ability of angiotensin-converting enzyme inhibitor perindopril and angiotensin receptor antagonist losartan to reduce arterial stiffness in these patients. Materials and Methods. We studied 44 patients with ACS without ST elevation combined with CKD stage 2-3A, AH (the 1st group). The comparison groups were the ACS without ST segment elevation, AH patients with normal renal function (the 2nd group, n=27) and the 3rd group (n=44) of patients with chronic CHD, AH and CKD. Group 1 patients were divided into 2 subgroups taking perindopril or losartan. The parameters of vascular wall stiffness (pulse wave velocity (PWV), cardio-ankle vascular index (CAVI), ankle brachial index (ABI), aortic augmentation index (AI), central systolic and pulse aortic pressure, peripheral blood pressure (BP), estimated glomerular filtration rate (GFR) were assessed.) Results. The patients with ACS without ST elevation combined with 2-3A stages of CKD and AH had a significantly higher cPAP, AI, PWV, and CAVI than the patients of the 2nd group. During 3 months of complex therapy with perindopril, a decrease in PWV, cSAP, cPAP, AI was observed. There were no significant differences in the effects of perindopril and losartan on peripheral and central blood pressure, on renal function, on arterial stiffness parameters. Conclusion. Patients with AH and CKD stage 2-3A have more pronounced arterial stiffness compared to similar patients with normal GFR. Antihypertensive therapy with perindopril and losartan allows to reach target levels of peripheral BP, significantly reduce central aortic pressure and improve elastic properties of the arterial vascular wall.
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Pradhan, Akshyaya, Pravesh Vishwakarma, Monika Bhandari, Rishi Sethi, and Varun Shankar Narain. "Differential Effects of Combination of Renin-Angiotensin-Aldosterone System Inhibitors on Central Aortic Blood Pressure: A Cross-Sectional Observational Study in Hypertensive Outpatients." Cardiovascular Therapeutics 2020 (September 8, 2020): 1–8. http://dx.doi.org/10.1155/2020/4349612.
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Background. Central aortic blood pressure (CABP) indices, central hemodynamics, and arterial stiffness are better predictors of cardiovascular events as compared with brachial cuff pressure measurements alone. The present study is aimed at assessing the effects of different antihypertensive drug combination regimens involving renin-angiotensin-aldosterone system (RAAS) inhibitors on CABP indices in Indian patients with hypertension. Methods. This was a cross-sectional, single-center study conducted in patients treated for hypertension for >6 weeks using different treatment regimens involving the combination of RAAS inhibitors with drugs from other classes. CABP indices, vascular age, arterial stiffness, and central hemodynamics were measured in patients using the noninvasive Agedio B900 device (IEM, Stolberg, Germany) and compared between different treatment regimens. Results. A total of 199 patients with a mean age of 54.22±10.15 years were enrolled, where 68.8% had hypertension for over three years and 50.25% had their systolic blood pressure SBP<140 mmHg. Combination treatment with angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) was given to 77.9% and to 20.1% patients, respectively. The mean vascular age was higher than the actual age (58.13±12.43 vs. 54.22±10.15, p=0.001). The SBP and diastolic blood pressure (DBP) levels in patients treated with ACEI-based combinations were lower than those in patients treated with ARB-based combinations (p<0.05). The mean central pulse pressure amplification, augmentation pressure, and augmentation index were lower in patients treated with ACEI-based combinations than those treated with other treatments (p=0.001). In a subgroup analysis, patients given perindopril and calcium channel blockers (CCBs) or diuretics had significantly lower CABP and pulse wave velocity than those given other treatments (p<0.05). A total of 6.5% patients experienced any side effects. Conclusion. The majority of central hemodynamic parameters, including vascular age, were found to improve more effectively in patients treated with ACEIs than with ARBs. Our results indicate a gap between routine clinical practice and evidence-based guidelines in Indian settings and identify a need to reevaluate the current antihypertensive prescription strategy.