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Reviews in Cardiovascular Medicine Jan 2022Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting 0.5%-1% of people worldwide. Hemodynamic changes due to stiffening of the arteries may cause... (Review)
Review
Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting 0.5%-1% of people worldwide. Hemodynamic changes due to stiffening of the arteries may cause cardiac structural and electrical remodeling that induces AF.Pulse wave velocity (PWV) is a direct non-invasive method to measure arterial stiffness (AS). Central pulse pressure (PPc) describes oscillations around the mean arterial pressure and is increased in more rigid arteries. These two central variables can be considered markers of AF. Sympathetic activity has been reported to be directly relatedto PWV even in patients without comorbidities. Therefore, in patients with more rigid arteries, sudden changes in pressure could affect the activation of arterial baroreceptors, leading to an acute imbalance between the sympathetic and parasympathetic responses in the heart. The coexistence of AF and AS is common. This critical review aims to bring information about the role of AS in the pathophysiology of AF and discuss results of clinical studies on this topic. Althuogh discussed in the literature, further studies are needed to confirm the predictive role of these variables in AF, and their use in clinical practice.
Topics: Arterial Pressure; Atrial Fibrillation; Blood Pressure; Humans; Pulse Wave Analysis; Vascular Stiffness
PubMed: 35092224
DOI: 10.31083/j.rcm2301032 -
Journal of the American College of... Mar 2020
Topics: Arteries; Blood Pressure; Female; Humans; Male; Sex Characteristics; Vascular Stiffness
PubMed: 32130923
DOI: 10.1016/j.jacc.2019.12.041 -
Journal of Hypertension Sep 2023The aim was to study if children following preeclampsia (PE) develop alterations in blood pressure (BP) and arterial stiffness already early in life, and how this is... (Clinical Trial)
Clinical Trial
OBJECTIVES
The aim was to study if children following preeclampsia (PE) develop alterations in blood pressure (BP) and arterial stiffness already early in life, and how this is associated with gestational, perinatal and child cardiovascular risk profiles.
METHODS
One hundred eighty-two PE (46 early-onset with diagnosis before 34 gestational weeks, and 136 late-onset) and 85 non-PE children were assessed 8-12 years from delivery. Office and 24-h ambulatory BP, body composition, anthropometrics, lipids, glucose, inflammatory markers, and tonometry-derived pulse wave velocity (PWV) and central BPs were assessed.
RESULTS
Office BP, central BPs, 24-h systolic BP (SBP) and pulse pressure (PP) were higher in PE compared with non-PE. Early-onset PE children had the highest SBP, SBP-loads, and PP. SBP nondipping during night-time was common among PE. The higher child 24-h mean SBP among PE was explained by maternal SBP at first antenatal visit and prematurity (birth weight or gestational weeks), but child 24-h mean PP remained related with PE and child adiposity after adjustments. Central and peripheral PWVs were elevated in late-onset PE subgroup only and attributed to child age and anthropometrics, child and maternal office SBP at follow-up, but relations with maternal antenatal SBPs and prematurity were not found. There were no differences in body anthropometrics, composition, or blood parameters.
CONCLUSIONS
PE children develop an adverse BP profile and arterial stiffness early in life. PE-related BP is related with maternal gestational BP and prematurity, whereas arterial stiffness is determined by child characteristics at follow-up. The alterations in BP are pronounced in early-onset PE.Clinical Trial Registration information: https://clinicaltrials.gov/ct2/show/NCT04676295ClinicalTrials.gov Identifier: NCT04676295.
Topics: Child; Female; Humans; Pregnancy; Arterial Pressure; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cardiovascular Diseases; Heart Disease Risk Factors; Hypertension; Pre-Eclampsia; Pulse Wave Analysis; Risk Factors; Vascular Stiffness
PubMed: 37337860
DOI: 10.1097/HJH.0000000000003485 -
Menopause (New York, N.Y.) Dec 2022Postmenopausal women (post-MW) have greater risk of heart failure due to aortic pulsatile overload on the left ventricle associated with increased backward wave pressure...
OBJECTIVE
Postmenopausal women (post-MW) have greater risk of heart failure due to aortic pulsatile overload on the left ventricle associated with increased backward wave pressure (Pb). Post-MW have exaggerated peripheral blood pressure (BP) response to exercise mediated by metaboreflex (postexercise muscle ischemia [PEMI]) overactivation. Increased forward wave pressure (Pf) and Pb are determinants of aortic pulse pressure (PP) during isometric handgrip exercis (IHG) in young adults. We hypothesized that aortic PP and pressure wave responses to PEMI are augmented in nonhypertensive post-MW compared with premenopausal women (pre-MW).
METHODS
Aortic BP, Pf, Pb, and reflection magnitude were assessed at rest and during IHG and PEMI by applanation tonometry in 15 pre-MW and 16 post-MW.
RESULTS
Aortic systolic BP during PEMI similarly increased in both groups. The increase in diastolic BP was lower in post-MW (post-MW Δ6 ± 2 vs pre-MW Δ11 ± 2 mm Hg, P < 0.05). Aortic PP (post-MW Δ8 ± 2 vs pre-MW Δ3 ± 2), Pf (post-MW Δ6 ± 1 vs pre-MW Δ0 ± 1), and Pb (post-MW Δ5 ± 1 vs pre-MW Δ2 ± 1) augmented during PEMI in post-MW ( P < 0.05 for all), but not in pre-MW. Reflection magnitude increased during PEMI only in pre-MW (pre-MW Δ7 ± 2 vs post-MW Δ-1 ± 2, P < 0.05) due to concurrent increases in Pf and Pb in post-MW.
CONCLUSIONS
Even in nonhypertensive postmenopausal women, increases in Pf and Pb and decrease in aortic DBP are important factors that contribute to the augmented aortic PP response to PEMI.
Topics: Young Adult; Humans; Female; Arterial Pressure; Pulse Wave Analysis; Hand Strength; Lead; Blood Pressure; Menopause; Muscle, Skeletal
PubMed: 36194846
DOI: 10.1097/GME.0000000000002078 -
Blood Pressure Dec 2022Central blood pressure is a stronger predictor of cardiovascular prognosis rather than brachial blood pressure. The reflection wave reaches the abdominal aorta sooner...
PURPOSES
Central blood pressure is a stronger predictor of cardiovascular prognosis rather than brachial blood pressure. The reflection wave reaches the abdominal aorta sooner than ascending aorta. Thus, the contribution of central pulse pressure (cPP) to renal events may differ from that of cardiovascular events.
METHODS
The subanalysis of the ABC-J II study was performed. Subjects were 3434 treated hypertensive patients with a mean follow-up of 4.7 years. Left ventricular hypertrophy, an index of cardiovascular risk, correlated with cPP better than central systolic blood pressure in this cohort. The contribution of brachial pulse pressure (bPP) and cPP to cardiovascular and renal events was analysed.
RESULTS
Cox proportional-hazard analysis revealed that sex ( < 0.001), height ( < 0.05), history of cardiovascular diseases ( < 0.001), number of antihypertensive drugs ( < 0.05), and cPP ( < 0.05) contributed to cardiovascular events. However, Cox proportional-hazard analysis disclosed that baseline serum creatinine ( < 0.001) and bPP ( < 0.05) predicted renal events. After adjusting for the history of cardiovascular diseases, Cox regression demonstrated only sex as a significant predictor of cardiovascular events. After adjusting for baseline serum creatinine, no parameters were shown to predict renal events.
CONCLUSIONS
The present findings support our previous data that the absence of cardiovascular or renal diseases is an important determinant for event-free survival, and suggest that cPP and bPP contribute to cardiovascular and renal events in treated hypertensive patients.
Topics: Blood Pressure; Brachial Artery; Cardiovascular Diseases; Creatinine; Humans; Hypertension; Pulse Wave Analysis; Risk Factors
PubMed: 35438015
DOI: 10.1080/08037051.2022.2062295 -
Annals of Medicine Dec 2022Whether the association between pulse pressure (PP) and mortality varies with systolic blood pressure (SBP) in ischaemic heart failure (HF) with left ventricular...
BACKGROUND
Whether the association between pulse pressure (PP) and mortality varies with systolic blood pressure (SBP) in ischaemic heart failure (HF) with left ventricular systolic dysfunction (LVSD) is unknown.
OBJECTIVE
To evaluate the association between PP and all-cause mortality in ischaemic HF patients with SBP status at admission.
PATIENTS AND METHODS
This prospective cohort study included 1581 ischaemic HF patients with LVSD. A total of 23.3% ( = 368) and 22.2% ( = 351) of the participants had SBP <110 mmHg and SBP >140 mmHg, respectively, with more than 80% of participants being male. Restricted cubic spline was performed to determine whether a nonlinear relationship existed between PP and all-cause mortality risk. A multivariable Cox proportional hazards model was used to assess the association between PP and all-cause mortality.
RESULTS
After a median of follow-up of 3.0 years, 257 events (16.4%) were observed in the cohort. There was a J-shaped relationship between PP and all-cause mortality (P value for nonlinearity = 0.020), with a risk nadir of approximately 46-49 mmHg. All-cause mortality risk varied with SBP status. Higher PP was associated with worse prognosis when the SBP was ≥110 mmHg, whereas the relationship did not reach statistical significance when the SBP was <110 mmHg.
CONCLUSION
A J-shaped relationship between PP and all-cause mortality was observed in ischaemic HF patients with LVSD, and higher PP was associated with worse prognosis only in those with SBP ≥110 mmHg. Further studies are needed to corroborate these findings.KEY MESSAGESA J-shaped relationship between pulse pressure and all-cause mortality was observed in ischaemic heart failure patients with left ventricular systolic dysfunction, with a risk nadir of approximately 46-49 mmHg.All-cause mortality risk varied with systolic blood pressure status, and higher pulse pressure was associated with worse prognosis when systolic blood pressure was above 110 mmHg.
Topics: Blood Pressure; Cohort Studies; Female; Heart Failure; Humans; Hypertension; Male; Prognosis; Proportional Hazards Models; Prospective Studies; Ventricular Dysfunction, Left
PubMed: 36223284
DOI: 10.1080/07853890.2022.2128208 -
Annual International Conference of the... Jul 2019Many individuals suffer from ailments such hypertension that require frequent health monitoring. Unfortunately, current technology does not possess the ability for...
Many individuals suffer from ailments such hypertension that require frequent health monitoring. Unfortunately, current technology does not possess the ability for unobtrusive, continuous monitoring. This paper proposes estimation of pulse pressure based on pulse transient time determined from one non-contact, and one contact sensor: Doppler radar for non-contact detection of heart beat, and piezoelectric finger pulse sensor. The time delay between heart beat and finger pulse was determined using MATLAB software, and pulse wave velocity (PWV) was calculated. Finally, subjects' pulse pressure estimated using PWV was found to be in good agreement with pulse pressure measured using an off the shelf sphygmomanometer by reading and taking difference of systolic and diastolic blood pressure.
Topics: Blood Pressure; Blood Pressure Determination; Heart Rate; Humans; Pulse; Pulse Wave Analysis
PubMed: 31947348
DOI: 10.1109/EMBC.2019.8857439 -
European Heart Journal May 2024Few studies have compared arm and ankle blood pressures (BPs) with regard to peripheral artery disease (PAD) and mortality. These relationships were assessed using data...
BACKGROUND AND AIMS
Few studies have compared arm and ankle blood pressures (BPs) with regard to peripheral artery disease (PAD) and mortality. These relationships were assessed using data from three large prospective clinical trials.
METHODS
Baseline BP indices included arm systolic BP (SBP), diastolic BP (DBP), pulse pressure (arm SBP minus DBP), ankle SBP, ankle-brachial index (ABI, ankle SBP divided by arm SBP), and ankle-pulse pressure difference (APPD, ankle SBP minus arm pulse pressure). These measurements were categorized into four groups using quartiles. The outcomes were PAD (the first occurrence of either peripheral revascularization or lower-limb amputation for vascular disease), the composite of PAD or death, and all-cause death.
RESULTS
Among 40 747 participants without baseline PAD (age 65.6 years, men 68.3%, diabetes 50.2%) from 53 countries, 1071 (2.6%) developed PAD, and 4955 (12.2%) died during 5 years of follow-up. Incident PAD progressively rose with higher arm BP indices and fell with ankle BP indices. The strongest relationships were noted for ankle BP indices. Compared with people whose ankle BP indices were in the highest fourth, adjusted hazard ratios (95% confidence interval) for each lower fourth were 1.64 (1.31-2.04), 2.59 (2.10-3.20), and 4.23 (3.44-5.21) for ankle SBP; 1.19 (0.95-1.50), 1.66 (1.34-2.05), and 3.34 (2.75-4.06) for ABI; and 1.41 (1.11-1.78), 2.04 (1.64-2.54), and 3.63 (2.96-4.45) for APPD. Similar patterns were observed for mortality. Ankle BP indices provided the highest c-statistics and classification indices in predicting future PAD beyond established risk factors.
CONCLUSIONS
Ankle BP indices including the ankle SBP and the APPD best predicted PAD and mortality.
Topics: Humans; Male; Female; Peripheral Arterial Disease; Aged; Ankle Brachial Index; Blood Pressure; Arm; Middle Aged; Prospective Studies; Risk Factors
PubMed: 38426892
DOI: 10.1093/eurheartj/ehae087 -
American Journal of Hypertension Dec 2014This critique is intended to provide background for the reader to evaluate the relative clinical utilities of brachial cuff systolic blood pressure (SBP) and its... (Review)
Review
This critique is intended to provide background for the reader to evaluate the relative clinical utilities of brachial cuff systolic blood pressure (SBP) and its derivatives, including pulse pressure, central systolic pressure, central augmentation index (AI), and pulse pressure amplification (PPA). The critical question is whether the newer indicators add sufficient information to justify replacing or augmenting brachial cuff blood pressure (BP) data in research and patient care. Historical context, pathophysiology of variations in pulse wave transmission and reflection, issues related to measurement and model errors, statistical limitations, and clinical correlations are presented, along with new comparative data. Based on this overview, there is no compelling scientific or practical reason to replace cuff SBP with any of the newer indicators in the vast majority of clinical situations. Supplemental value for central SBP may exist in defining patients with exaggerated PPA ("spurious systolic hypertension"), managing cardiac and aortic diseases, and in studies of cardiovascular drugs, but there are no current standards for these possibilities.
Topics: Arterial Pressure; Blood Pressure Determination; Brachial Artery; Humans; Hypertension; Systole; Vascular Resistance
PubMed: 25233859
DOI: 10.1093/ajh/hpu135 -
Critical Care (London, England) Nov 2023Pulse pressure and stroke volume variation (PPV and SVV) have been widely used in surgical patients as predictors of fluid challenge (FC) response. Several factors may... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pulse pressure and stroke volume variation (PPV and SVV) have been widely used in surgical patients as predictors of fluid challenge (FC) response. Several factors may affect the reliability of these indices in predicting fluid responsiveness, such as the position of the patient, the use of laparoscopy and the opening of the abdomen or the chest, combined FC characteristics, the tidal volume (Vt) and the type of anesthesia.
METHODS
Systematic review and metanalysis of PPV and SVV use in surgical adult patients. The QUADAS-2 scale was used to assess the risk of bias of included studies. We adopted a metanalysis pooling of aggregate data from 5 subgroups of studies with random effects models using the common-effect inverse variance model. The area under the curve (AUC) of pooled receiving operating characteristics (ROC) curves was reported. A metaregression was performed using FC type, volume, and rate as independent variables.
RESULTS
We selected 59 studies enrolling 2,947 patients, with a median of fluid responders of 55% (46-63). The pooled AUC for the PPV was 0.77 (0.73-0.80), with a mean threshold of 10.8 (10.6-11.0). The pooled AUC for the SVV was 0.76 (0.72-0.80), with a mean threshold of 12.1 (11.6-12.7); 19 studies (32.2%) reported the grey zone of PPV or SVV, with a median of 56% (40-62) and 57% (46-83) of patients included, respectively. In the different subgroups, the AUC and the best thresholds ranged from 0.69 and 0.81 and from 6.9 to 11.5% for the PPV, and from 0.73 to 0.79 and 9.9 to 10.8% for the SVV. A high Vt and the choice of colloids positively impacted on PPV performance, especially among patients with closed chest and abdomen, or in prone position.
CONCLUSION
The overall performance of PPV and SVV in operating room in predicting fluid responsiveness is moderate, ranging close to an AUC of 0.80 only some subgroups of surgical patients. The grey zone of these dynamic indices is wide and should be carefully considered during the assessment of fluid responsiveness. A high Vt and the choice of colloids for the FC are factors potentially influencing PPV reliability.
TRIAL REGISTRATION
PROSPERO (CRD42022379120), December 2022. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=379120.
Topics: Adult; Humans; Blood Pressure; Hemodynamics; Stroke Volume; Operating Rooms; Reproducibility of Results; Colloids; Fluid Therapy; ROC Curve
PubMed: 37940953
DOI: 10.1186/s13054-023-04706-0