-
Nutrition, Metabolism, and... Oct 2014Aging leads to a multitude of changes in the cardiovascular system that include a rise in blood pressure. Age-related changes in blood pressure are mainly attributable... (Review)
Review
Aging leads to a multitude of changes in the cardiovascular system that include a rise in blood pressure. Age-related changes in blood pressure are mainly attributable to an increase in systolic blood pressure, generally associated with a slight decrease diastolic blood pressure. This leads to a widening in pulse pressure. Ambulatory blood pressure monitoring is a useful tool to understand these processes and to refine cardiovascular risk assessment. In the light of emerging data in this area, we reviewed the main features of ambulatory blood pressure in elderly and discussed the evidence showing that ambulatory blood pressure is superior to clinic blood pressure to reflect the true pattern of blood pressure over time. Furthermore, we discussed the role of weight control obtained by fitness programs to prevent an excessive rise in blood pressure with age. A thorough understanding of these concepts is of paramount importance and has therapeutic implications in the growing population of elderly subjects with increased blood pressure.
Topics: Aged; Aging; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cardiovascular Diseases; Humans; Hypertension; Risk Assessment; Risk Factors
PubMed: 24932538
DOI: 10.1016/j.numecd.2014.04.004 -
Journal of Hypertension Dec 2015
Topics: Black or African American; Aging; Blood Pressure; Female; Humans; Male; White People
PubMed: 26536088
DOI: 10.1097/HJH.0000000000000788 -
Current Hypertension Reviews 2021The relationship between the increases in pulse pressure (PP) and arterial stiffness determined by aging or systemic hypertension has been widely reported. These...
BACKGROUND
The relationship between the increases in pulse pressure (PP) and arterial stiffness determined by aging or systemic hypertension has been widely reported. These findings are supported by large-cohort analyzes conducted in well-known populations, such as Framingham Study. However, there is evidence that an age-PP curvilinear relationship may exist in hypertensive subjects. This study aimed to evaluate the age-related change in pulse pressure and arterial stiffness in a population-based study.
METHODS
Carotid-femoral Pulse Wave Velocity (cfPWV) were obtained in 2075 subjects.
RESULTS
Age-related changes of PP showed a curvilinear relationship (R=0.39, p<0.0001) in normotensive subjects, with a nadir at around 50 years of age. On the other hand, the age-cfPWV relationship showed a linear and positive correlation (R=0.72, p<0.0001). PP also showed a curvilinear relationship with age (R=0.36, p<0.0001) in hypertensive subjects, with a nadir around 50 years of age. The age-cfPWV relationship showed a linear and positive correlation (R=0.55, p<0.0001). Similar results were observed in the adult population (age≥16 years). Multivariate analysis showed that age, sex, cfPWV, and mean arterial pressure are determinants of PP values in the entire population; however, this result was not uniform when different subgroups were analyzed.
CONCLUSION
In conclusion, age-related changes in PP showed a curvilinear relationship and no parallelism with the age-cfPWV relationship for both normotensive and hypertensive subjects. The determinants of PP impact it differently depending on age and the pathological condition of the subject.
Topics: Adult; Arterial Pressure; Blood Pressure; Humans; Hypertension; Middle Aged; Pulse Wave Analysis; Vascular Stiffness
PubMed: 33305707
DOI: 10.2174/1573402116999201210195123 -
Journal of Clinical Monitoring and... Feb 2019To non-invasively predict fluid responsiveness, respiration-induced pulse amplitude variation (PAV) in the photoplethysmographic (PPG) signal has been proposed as an...
To non-invasively predict fluid responsiveness, respiration-induced pulse amplitude variation (PAV) in the photoplethysmographic (PPG) signal has been proposed as an alternative to pulse pressure variation (PPV) in the arterial blood pressure (ABP) signal. However, it is still unclear how the performance of the PPG-derived PAV is site-dependent during surgery. The aim of this study is to compare finger- and forehead-PPG derived PAV in their ability to approach the value and trend of ABP-derived PPV. Furthermore, this study investigates four potential confounding factors, (1) baseline variation, (2) PPV, (3) ratio of respiration and heart rate, and (4) perfusion index, which might affect the agreement between PPV and PAV. In this work, ABP, finger PPG, and forehead PPG were continuously recorded in 29 patients undergoing major surgery in the operating room. A total of 91.2 h data were used for analysis, from which PAV and PPV were calculated and compared. We analyzed the impact of the four factors using a multiple linear regression (MLR) analysis. The results show that compared with the ABP-derived PPV, finger-derived PAV had an agreement of 3.2 ± 5.1%, whereas forehead-PAV had an agreement of 12.0 ± 9.1%. From the MLR analysis, we found that baseline variation was a factor significantly affecting the agreement between PPV and PAV. After correcting for respiration-induced baseline variation, the agreements for finger- and forehead-derived PAV were improved to reach an agreement of - 1.2 ± 3.8% and 3.3 ± 4.8%, respectively. To conclude, finger-derived PAV showed better agreement with ABP-derived PPV compared to forehead-derived PAV. Baseline variation was a factor that significantly affected the agreement between PPV and PAV. By correcting for the baseline variation, improved agreements were obtained for both the finger and forehead, and the difference between these two agreements was diminished. The tracking abilities for both finger- and forehead-derived PAV still warrant improvement for wide use in clinical practice. Overall, our results show that baseline-corrected finger- and forehead-derived PAV may provide a non-invasive alternative for PPV.
Topics: Aged; Arterial Pressure; Blood Pressure; Female; Fingers; Forehead; Heart Rate; Humans; Male; Middle Aged; Operating Rooms; Photoplethysmography; Regression Analysis; Respiration; Signal Processing, Computer-Assisted; Time Factors
PubMed: 29644558
DOI: 10.1007/s10877-018-0140-5 -
Kidney & Blood Pressure Research 2023Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) are risk factors for cardiovascular mortality (CVM). Pulse pressure (PP)... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) are risk factors for cardiovascular mortality (CVM). Pulse pressure (PP) is an easily available parameter of vascular stiffness, but its impact on CVM in chronic dialysis patients with diabetes is unclear.
METHODS
Therefore, we have examined the predictive value of baseline, predialytic PP, SBP, DBP, and MAP in the German Diabetes and Dialysis (4D) study, a prospective, randomized, double-blind trial enrolling 1,255 patients with type 2 diabetes on hemodialysis in 178 German dialysis centers.
RESULTS
Mean age was 66.3 years, mean blood pressure 146/76 mm Hg, mean time suffering from diabetes 18.1 years, and mean time on maintenance dialysis 8.3 months. Considered as continuous variables, PP, MAP, SBP, and DBP could not provide a significant mortality prediction for either cardiovascular or all-cause mortality. After dividing the cohort into corresponding tertiles, we also did not detect any significant mortality prediction for PP, SBP, DBP, or MAP, both for all-cause mortality and CVM after adjusting for age and sex. Nevertheless, when comparing the HR plots of the corresponding blood pressure parameters, a pronounced U-curve was seen for PP for both all-cause mortality and CVM, with the trough range being 70-80 mm Hg.
DISCUSSION
In patients with end-stage renal disease and long-lasting diabetes mellitus predialytic blood pressure parameters at study entry are not predictive for mortality, presumably because there is a very high rate of competing mortality risk factors, resulting in overall very high rates of all-cause and CVM that may no longer be significantly modulated by blood pressure control.
Topics: Humans; Aged; Blood Pressure; Diabetes Mellitus, Type 2; Prospective Studies; Renal Dialysis; Risk Factors; Hypertension
PubMed: 37806305
DOI: 10.1159/000533136 -
Journal of Hypertension Apr 2021Aortic pulse pressure (PP) represents the hemodynamic cardiac and cerebral burden more directly than cuff PP. The objective of this study was to investigate whether...
OBJECTIVE
Aortic pulse pressure (PP) represents the hemodynamic cardiac and cerebral burden more directly than cuff PP. The objective of this study was to investigate whether invasively measured aortic PP confers additional prognostic value beyond cuff PP for cardiovascular events and death. With increasing age, cuff PP progressively underestimates aortic PP. Whether the prognostic association between cuff PP and outcomes is age-dependent remains to be elucidated.
METHODS
Cuff PP and invasively measured aortic PP were recorded in 21 908 patients (mean age 63 years, 58% men, 14% with diabetes) with stable angina pectoris undergoing elective coronary angiography during January 2001--December 2012. Multivariate Cox models were used to assess the association with incident myocardial infarction, stroke, and death. Discrimination was assessed using Harrell's C-index.
RESULTS
During a median follow-up period of 3.7 years (range 0.1-10.8 years), 422 strokes, 511 myocardial infarctions, and 1530 deaths occurred. Both cuff and aortic PP were associated with stroke, myocardial infarction, and death in crude analyses. However, only cuff PP remained associated with stroke (hazard ratio per 10 mmHg, 1.06 (95% confidence interval (CI) 1.01--1.12)] and myocardial infarction [hazard ratio per 10 mmHg 1.05 (95% CI 1.01--1.11)] in multivariate Cox models. Both cuff and aortic PP lost significance as predictors of death in multivariate models. Age did not modify the prognostic association between cuff PP and stroke, myocardial infarction, and death.
CONCLUSION
Invasively measured aortic PP did not add prognostic information about cardiovascular outcomes and death beyond cuff PP in patients with stable angina pectoris.
Topics: Arterial Pressure; Blood Pressure; Cardiovascular Diseases; Female; Heart Disease Risk Factors; Humans; Male; Middle Aged; Risk Factors
PubMed: 33201052
DOI: 10.1097/HJH.0000000000002694 -
Hypertension (Dallas, Tex. : 1979) Jan 2022It remains debated whether pulse pressure is associated with left ventricular traits and adverse outcomes over and beyond mean arterial pressure (MAP) in patients with...
It remains debated whether pulse pressure is associated with left ventricular traits and adverse outcomes over and beyond mean arterial pressure (MAP) in patients with heart failure (HF) with preserved ejection fraction. We investigated these associations in 3428 patients with HF with preserved ejection fraction (51.5% women; mean age, 68.6 years) enrolled in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist). We computed association sizes and hazards ratios with 1-SD increase in MAP and pulse pressure. In multivariable-adjusted analyses, association sizes (≤0.039) for MAP were 0.016 cm and 0.014 cm for septal and posterior wall thickness, -0.15 for E/A ratio, -0.66 for E/e', and -0.64% for ejection fraction, independent of pulse pressure. With adjustment additionally applied for MAP, E/A ratio and longitudinal strain increased with higher pulse pressure with association sizes amounting to 0.067 (=0.026) and 0.40% (=0.023). In multivariable-adjusted analyses of both placebo and spironolactone groups, lower MAP and higher pulse pressure predicted the primary composite end point (≤0.028) and hospitalized HF (≤0.002), whereas MAP was also significantly associated with total mortality (≤0.007). Sensitivity analyses stratified by sex, median age, and region generated confirmatory results with exception for the association of adverse outcomes with pulse pressure in patients with age ≥69 years. In conclusion, the clinical application of MAP and pulse pressure may refine risk estimates in patients with HF with preserved ejection fraction. This finding may help further investigation for the development of HF with preserved ejection fraction preventive strategies targeting pulsatility and blood pressure control.
Topics: Aged; Blood Pressure; Echocardiography; Female; Heart Failure; Humans; Male; Middle Aged; Stroke Volume
PubMed: 34739763
DOI: 10.1161/HYPERTENSIONAHA.121.17782 -
Journal of the American Heart... Feb 2022Background Individuals of the same chronological age may exhibit diverse susceptibilities to death. However, few studies have investigated the associations between blood...
Background Individuals of the same chronological age may exhibit diverse susceptibilities to death. However, few studies have investigated the associations between blood pressure and the accelerated aging. Methods and Results A cross-sectional study was conducted in 288 adults aged ≥50 years. We assessed the DNA methylation-based measures of biological age using CpG sites on the Illumina HumanMethylationEPIC BeadChip. Epigenetic age acceleration metrics were derived by regressing residuals (ΔAge) and ratios (aging rate) of DNA methylation age on chronological age. Dose-response relationships between blood pressure and epigenetic age acceleration were quantified using multiple linear regression and restricted cubic regression models. We found that each 10-mm Hg increase in systolic blood pressure was associated with 0.608 (95% CI, 0.231-0.984) years increase in ΔAge and 0.007 (95% CI, 0.002-0.012) increase in aging rate; meanwhile, for pulse pressure, the increase was 1.12 (95% CI, 0.625-1.61) years for ΔAge and 0.013 (95% CI, 0.007-0.020) for aging rate. Subgroup analysis showed that the significant associations of systolic blood pressure and pulse pressure with epigenetic age acceleration appeared to be limited to women, although interactions between blood pressure and sex were not significant ( values for interaction >0.05). The combination of women and hypertension was associated with a much higher increase in ΔAge (β [95% CI], 4.05 [1.07-7.02]) and aging rate (β [95% CI], 0.047 [0.008-0.087]), compared with male participants without hypertension. Conclusions Our findings suggested that high systolic blood pressure and pulse pressure were associated with the epigenetic age acceleration, providing important clues for relationships between blood pressure and epigenetic aging.
Topics: Adult; Aging; Blood Pressure; Cross-Sectional Studies; DNA Methylation; Epigenesis, Genetic; Female; Humans; Hypertension; Male; Middle Aged
PubMed: 35001659
DOI: 10.1161/JAHA.121.022257 -
BMC Cardiovascular Disorders Jul 2023Elevated pulse pressure (PP) is a robust independent predictor of cardiovascular diseases. The relationship between PP and body mass index (BMI) was presented in a few...
BACKGROUND
Elevated pulse pressure (PP) is a robust independent predictor of cardiovascular diseases. The relationship between PP and body mass index (BMI) was presented in a few studies. However, the findings were inconsistent. Therefore, the aim of the present study is to identify the association between elevated PP and BMI using a large sample of active-duty Royal Thai Army (RTA) personnel.
METHODS
A cross-sectional study was conducted through the use of the dataset obtained from the annual health examination database of RTA personnel in Thailand in 2022. BMI 25.0-29.9 kg/m was classified as obesity I, whereas BMI ≥ 30.0 kg/m was classified as obesity II. Elevated PP was defined as PP ≥ 50 mmHg. Multivariable linear regression and log-binomial regression models were utilized for determining the association between elevated PP and BMI.
RESULTS
A total of 62,113 active-duty RTA personnel were included in the study. The average BMI was 25.4 ± 3.8 kg/m, while the average PP was 50.1 ± 11.2 mmHg. Compared to individuals with normal weight, the [Formula: see text] coefficients of PP and BMI were 1.38 (95% CI: 1.15-1.60) and 2.57 (95% CI: 2.25-2.88) in individuals with obesity I and obesity II, respectively. Effect modification by high blood pressure (BP) on the association between elevated PP and BMI was observed. Among participants with normal BP, in comparison with BMI of 18.5-22.9 kg/m, the adjusted prevalence ratio (PR) for elevated PP was 1.23 (95% CI: 1.19-1.28) and 1.41 (95% CI: 1.35-1.48) in those with obesity I and obesity II, respectively. Meanwhile, among individuals with high BP, the adjusted PR for elevated PP was 1.05 (95% CI: 1.01-1.08) and 1.09 (95% CI: 1.06-1.13) in those with obesity I and obesity II, respectively.
CONCLUSION
PP was positively associated with BMI in active-duty RTA personnel. High BP was the modifier of the association between PP and BMI. A weaker association between elevated PP and BMI was observed among RTA personnel with high BP.
Topics: Humans; Body Mass Index; Blood Pressure; Thailand; Military Personnel; Cross-Sectional Studies; Southeast Asian People; Obesity; Hypertension
PubMed: 37464282
DOI: 10.1186/s12872-023-03390-w -
Medicine Dec 2023Sarcopenia is characterized by a loss of muscle mass and strength and is associated with a high risk of cardiovascular events and increased mortality. Pulse pressure...
Sarcopenia is characterized by a loss of muscle mass and strength and is associated with a high risk of cardiovascular events and increased mortality. Pulse pressure (PP) serves as a marker for changes in heart structure and function, as well as arterial stiffness. A high PP also increases the risk of cardiovascular disease and all-cause mortality. However, the relationship between PP and sarcopenia is poorly understood. We used the data of participants of the Korea National Health and Nutrition Examination Survey (KNHANES) of 2008 to 2011. Participants were divided into a control group (PP < 40 mm Hg) and a high-PP group (PP ≥ 40 mm Hg). PP was calculated by subtracting the diastolic blood pressure (DBP) from the systolic blood pressure (SBP), and the low muscle index was assessed using appendicular skeletal muscle mass (ASM) normalized by body mass index (BMI). Multiple logistic regression analyses were performed to examine the association between PP and the prevalence of low muscle mass, adjusting for potential confounders. The high-PP group had a higher age, SBP, DBP, and prevalence of hypertension, diabetes and hyperlipidemia than the control group. The high-PP group had a higher prevalence of low muscle mass than the control group in all models. A high PP is significantly associated with a higher prevalence of low muscle mass. Therefore, PP monitoring may help identify individuals at risk of sarcopenia and guide interventions to improve health outcomes.
Topics: Adult; Humans; Blood Pressure; Sarcopenia; Cross-Sectional Studies; Nutrition Surveys; Muscles; Republic of Korea; Risk Factors
PubMed: 38206714
DOI: 10.1097/MD.0000000000036644