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Internal Medicine Journal Jan 2021Despite multiple studies, it has not been possible to account for the normal changes of blood pressure that occur from infancy to old age. We sought a comprehensive... (Review)
Review
Despite multiple studies, it has not been possible to account for the normal changes of blood pressure that occur from infancy to old age. We sought a comprehensive explanation, by linking brachial pressure with the well documented changes in the arterial pulse waveform, whose peak and nadir determine systolic, diastolic and pulse pressure in brachial arteries. Changes in humans arterial pulse wave contour from birth to old age can be readily explained on (i) growth, with increasing length of the body from birth to adolescence, and adult height maintained thereafter, and (ii) degeneration and dilation of the aorta from elastic fibre fracture throughout life, causing progressive increase in aortic pressure wave amplitude from early return of wave reflection, and summation of incident with reflected waves in systole. These changes throughout life complement arterial pulse waveform analysis and explain brachial cuff pressure values, with optimal pulse wave pattern for cardiac interaction apparent in adolescence.
Topics: Adult; Aorta; Arterial Pressure; Blood Pressure; Brachial Artery; Humans; Longevity; Systole
PubMed: 32175664
DOI: 10.1111/imj.14815 -
Annals of Palliative Medicine Jul 2021This study aims to evaluate the ability of stroke volume variation (SVV) and pulse pressure variation (PPV) to predict fluid responsiveness in mechanically ventilated...
BACKGROUND
This study aims to evaluate the ability of stroke volume variation (SVV) and pulse pressure variation (PPV) to predict fluid responsiveness in mechanically ventilated patients with thoracic kyphosis.
METHODS
A total of 35 patients diagnosed with thoracic kyphosis undergoing corrective surgery were studied. For all patients, the Vigileo/FloTrac system was used for analysis. Hemodynamic data such as mean arterial pressure (MAP), heart rate (HR), stroke volume (SV), stroke volume index (SVI), cardiac output (CO), cardiac output index (CI), SVV, and PPV were recorded before and after volume expansion (VE). Fluid responsiveness was defined as an increase in SVI ≥10% (ΔSVI ≥10%). Patients were divided into responders and non-responders as determined by changes in ΔSVI ≥10% and <10%. Nonparametric Wilcoxon rank sum test was used to compare the hemodynamic parameters of Responders and Non-responders before and after VE. Pearson correlation analysis was used to analyze the values of SVV, PPV and ΔSVI. The receiver operating characteristic (ROC) curve of each hemodynamic index was drawn to determine its accuracy and threshold.
RESULTS
Two patients were excluded. There was no significant difference in patients' characteristics between Responders and Non-responders. After VE, there were no significant changes in HR, MAP, and SV in both responders and non-responders, but CI were significantly changed in the two groups. SVI and CO increased significantly in responders before and after VE, but not in non-responders. VE also caused decreases of PPV and SVV in both responders and non-responders. Before VE, the SVV and PPV correlated with ΔSVI in responders (r=0.621, r=0.569, respectively, P<0.05), but neither the SVV nor PPV correlated with ΔSVI in non-responders (P>0.05). The areas under the ROC curves of patients with thoracic kyphosis were 0.872 (95% CI: 0.719-1.000) for SVV and 0.833 (95% CI: 0.667-1.000) for PPV. The threshold of the SVV of patients with thoracic kyphosis was 13.5%, and the threshold of PPV was 14.5%.
CONCLUSIONS
Both SVV and PPV can be used as effective indictors to monitor volume changes in patients with thoracic kyphosis.
Topics: Blood Pressure; Fluid Therapy; Hemodynamics; Humans; Kyphosis; Stroke Volume
PubMed: 34154341
DOI: 10.21037/apm-21-1211 -
PloS One 2017Cerebrovascular health is important for maintaining a high level of cognitive performance, not only in old age, but also throughout the lifespan. Recently, it was first...
Cerebrovascular health is important for maintaining a high level of cognitive performance, not only in old age, but also throughout the lifespan. Recently, it was first demonstrated that diffuse optical imaging measures of pulse amplitude and arterial compliance can provide estimates of cerebral arterial health throughout the cortex, and were associated with age, estimated cardiorespiratory fitness (eCRF), neuroanatomy and cognitive function in older adults (aged 55-87). The current study replicates and extends the original findings using a broader age range (a new adult sample aged 18-75), longer recording periods (360 s), and a more extensive optical montage (1536 channels). These methodological improvements represent a 5-fold increase in recording time and a 4-fold increase in coverage compared to the initial study. Results show that reliability for both pulse amplitude and compliance measures across recording blocks was very high (r(45) = .99 and .75, respectively). Pulse amplitude and pulse pressure were shown to correlate with age across the broader age range. We also found correlations between arterial health and both cortical and subcortical gray matter volumes. Additionally, we replicated the correlations between arterial compliance and age, eCRF, global brain atrophy, and cognitive flexibility. New regional analyses revealed that higher performance on the operation span (OSPAN) working memory task was associated with greater localized arterial compliance in frontoparietal cortex, but not with global arterial compliance. Further, greater arterial compliance in frontoparietal regions was associated with younger age and higher eCRF. These associations were not present in the visual cortex. The current study not only replicates the initial one in a sample including a much wider age range, but also provides new evidence showing that frontoparietal regions may be especially vulnerable to vascular degeneration during brain aging, with potential functional consequences in cognition.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aging; Blood Pressure; Central Nervous System; Cerebrovascular Circulation; Cognition; Cognitive Dysfunction; Female; Humans; Intracranial Pressure; Magnetic Resonance Imaging; Male; Memory, Short-Term; Middle Aged; Vascular Stiffness
PubMed: 28234912
DOI: 10.1371/journal.pone.0171305 -
Nutrients Jan 2023Even though coffee consumption has been clearly related to a number of benefits to the cardiovascular system, its effect on blood pressure (BP) has not been fully...
Even though coffee consumption has been clearly related to a number of benefits to the cardiovascular system, its effect on blood pressure (BP) has not been fully elucidated. In this sub-analysis of the Brisighella Heart Study (BHS), we compared central and peripheral BP values in a sub-cohort of 720 men (47.9%) and 783 women (52.1%) reporting the drinking of different amounts of coffee each day, for whom a full set of clinical, laboratory and hemodynamic parameters was available. According to our observations, moderate coffee drinking was associated to either higher levels of systolic BP (SBP) compared to those with heavy coffee consumption or lower SBP than that in the non-coffee drinking group (p-value for trend <0.05). In particular, people who drank 2 cups of coffee per day and people who drank >3 cups per day had lower SBP than non-coffee drinkers by 5.2 ± 1.6 mmHg (p = 0.010) and 9.7 ± 3.2 mmHg, respectively (p = 0.007). Similar trends were also observed for peripheral pulse pressure (PP), aortic BP and aortic PP. In the age-adjusted multiple linear regression model, negative predictors of SBP, PP, aortic BP and aortic PP were the estimated glomerular filtration rate (eGFR), female sex and coffee consumption. Positive predictors included body mass index (BMI) and low-density lipoprotein cholesterol (LDL-C). Then, our findings show that regular coffee drinking is associated with lower SBP, PP, aortic BP and aortic PP, but with similar arterial stiffness.
Topics: Male; Humans; Female; Blood Pressure; Self Report; Arterial Pressure; Body Mass Index; Vascular Stiffness
PubMed: 36678184
DOI: 10.3390/nu15020312 -
Annals of African Medicine 2020Proportional Pulse Pressure (PPP) is a significant risk indicator in heart failure. PPP is a simple, inexpensive and easily measurable clinical index. This non-invasive...
INTRODUCTION
Proportional Pulse Pressure (PPP) is a significant risk indicator in heart failure. PPP is a simple, inexpensive and easily measurable clinical index. This non-invasive test provides useful prognostic information for patients with heart failure with reduced ejection fraction (EF) particularly in those with an EF < 30% where lower proportional pulse pressure independently predicts mortality.
METHODS
A prospective observational study involving 150 patients with reduced ejection fraction was done. Detailed history, clinical examination and parameters like pulse pressure, proportional pulse pressure were evaluated and correlated with ejection fraction.
RESULTS
The mean age of the patients was 58.99 ± 11.03 years and the majority of the study participants (57.33 %) were between 45 and 65 years of age. The most common etiology of heart failure (HF) was coronary heart disease in this study (76%). Proportional Pulse pressure showed significant association with ejection fraction. The specificity for detecting heart failure was more for proportional pulse pressure and systolic blood pressure (95 % each).
CONCLUSION
Proportional Pulse Pressure may help to identify HF patients who present with low cardiac output, low ejection fraction, and worse prognosis. Our current observations reinforce the importance of clinically based skills that must not be forgotten when managing HF.
Topics: Aged; Aged, 80 and over; Blood Pressure; Cardiac Output; Female; Heart Failure; Humans; Male; Middle Aged; Predictive Value of Tests; Prognosis; Prospective Studies; Risk Factors; Severity of Illness Index; Stroke Volume
PubMed: 32820731
DOI: 10.4103/aam.aam_43_19 -
Journal of Human Hypertension Mar 2022The cardiovascular disease (CVD) process may begin early in life when accompanied by atherosclerotic risk factors. CVD risk factors in children are associated with...
The cardiovascular disease (CVD) process may begin early in life when accompanied by atherosclerotic risk factors. CVD risk factors in children are associated with stiffening of the large elastic arteries, a reflection of subclinical atherosclerosis. Physical activity is a preventative lifestyle strategy that may benefit arterial stiffness by attenuating the hemodynamic stress on the artery wall. This study examined the relations between physical activity, carotid pulsatile stress, and carotid stiffness in children. One hundred and forty children (9-11 yrs; 50.0% male, 57.9% African-American, 42.10% Caucasian, body mass index (BMI) 20.1 ± 4.7 kg/m) participated in this study. Physical activity counts were measured using a wrist-worn accelerometer and averaged over 7 days. Carotid artery β-stiffness and pulse pressure (calibrated to brachial mean and diastolic pressure) were assessed as via ultrasound and tonometry, respectively. Pulsatile stress was calculated as the product of carotid pulse pressure and heart rate. Physical activity counts were correlated with pulsatile stress (r = -0.27), and BMI (r = -0.23), but were unrelated to carotid stiffness. In multivariate models, associations between physical activity counts and pulsatile stress remained (B = -1.3 [95%CI, -2.4, -0.2], β = -0.20, p < 0.05) after covariate adjustment for age, race, sex, pubertal stage, and BMI. Carotid pulsatile stress was related to regional carotid stiffness (r = 0.45, p < 0.05). These data suggest that higher levels of physical activity at young age are associated with lower hemodynamic stress in the carotid artery. Findings are discussed in the context of an inverse relationship between hemodynamic pulsatile stress and carotid stiffness in children.
Topics: Atherosclerosis; Blood Pressure; Carotid Arteries; Child; Exercise; Female; Humans; Male; Pulsatile Flow; Vascular Stiffness
PubMed: 33712711
DOI: 10.1038/s41371-021-00506-7 -
International Journal of Environmental... Apr 2021The current study aimed to investigate the normative data for blood pressure. From 2017 to 2020, 2032 men and women classified as 'war veterans' were recruited (mean...
The current study aimed to investigate the normative data for blood pressure. From 2017 to 2020, 2032 men and women classified as 'war veterans' were recruited (mean age ± standard deviation (SD): 60.97 ± 7.98 years; mean stature: 172.50 ± 9.10 cm; mean body mass: 90.25 ± 36.45 kg; mean body-mass index: 29.66 ± 5.59 kg/m; 29.9% women). Their systolic and diastolic blood pressures were measured three times. The procedure was carried out according to the American Heart Organization. The sex-specific and age-specific normative data for the 5th, 25th, 50th (median), 75th, and 90th percentiles for systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (measured as SBP-DBP) and mid-BP (the average of SBP and DBP) were presented. The men had higher SBP ( < 0.001), DBP ( < 0.001), pulse pressure ( < 0.001) and mid-BP ( < 0.001) compared to the women. The age-specific differences showed that older individuals had higher values of SBP ( < 0.001), pulse pressure ( < 0.001), and mid-BP ( < 0.001), while no significant differences for DBP ( = 0.496) were observed. This is the first study providing sex-specific and age-specific normative data for blood pressure in war veterans.
Topics: Blood Pressure; Blood Pressure Determination; Body Height; Female; Humans; Hypertension; Male; Veterans
PubMed: 33920854
DOI: 10.3390/ijerph18084175 -
Singapore Medical Journal Dec 2022Optimal intraoperative fluid management guided by central venous pressure (CVP), a traditional intravascular volume status indicator, has improved transplanted graft...
INTRODUCTION
Optimal intraoperative fluid management guided by central venous pressure (CVP), a traditional intravascular volume status indicator, has improved transplanted graft function during kidney transplantation (KT). Pulse pressure variation (PPV) and stroke volume variation (SVV) - dynamic preload indexes - are robust predictors of fluid responsiveness. This study aimed to compare the accuracy of PPV and CVP against SVV in predicting fluid responsiveness in terms of cost-effectiveness after a standardised empiric volume challenge in KT patients.
METHODS
36 patients undergoing living-donor KT were analysed. PPV, SVV, CVP and cardiac index (CI) were measured before and after fluid loading with a hydroxyethyl starch solution (7 mL/kg of ideal body weight). Patients were classified as responders (n = 12) or non-responders (n = 24) to fluid loading when CI increases were ≥10% or <10%, respectively. The ability of PPV, SVV and CVP to predict fluid responsiveness was assessed using receiver operating characteristic (ROC) curves.
RESULTS
SVV and CVP measured before fluid loading were correlated with changes in CI caused by fluid expansion (ρ = 0.33, P = 0.049 and ρ = -0.37, P = 0.026) in contrast to PPV (ρ = 0.14, P = 0.429). The ROC analysis showed that SVV and CVP predicted response to volume loading (area under the ROC curve = 0.781 and 0.727, respectively; P < 0.05).
CONCLUSION
Under the conditions of our study, SVV and CVP exhibited similar performance in predicting fluid responsiveness and could inform fluid management during KT as compared with PPV.
Topics: Humans; Blood Pressure; Stroke Volume; Kidney Transplantation; Central Venous Pressure; Fluid Therapy; ROC Curve; Hemodynamics
PubMed: 34911180
DOI: 10.11622/smedj.2021221 -
European Review For Medical and... Jan 2023Growing evidence shows that pulse pressure (PP) is a strong risk factor for cardiovascular disease and is closely associated with cardiovascular events, strokes, and...
OBJECTIVE
Growing evidence shows that pulse pressure (PP) is a strong risk factor for cardiovascular disease and is closely associated with cardiovascular events, strokes, and mortality. However, currently, data on the relationship between body mass index (BMI) and PP are still limited.
SUBJECTS AND METHODS
Here, a cross-sectional study was conducted based on 211,809 non-diabetic adults in 11 cities in China from 2010 to 2016. Raw data were obtained from a public database (www.datadryad.org). According to the BMI level, they are classified into "underweight", "normal", "overweight", and "obesity" groups. Two groups of continuous variables were measured by the Mann-Whitney test, while the differences between multiple groups were tested by Kruskal-Wallis' One-Way ANOVA and Dunn's test. Besides, multiple linear regression analyses were performed to assess the linear relationship between BMI and PP. In addition, multivariate logistic regression was carried out to further confirm the relationship between different BMI levels and the prevalence of high PP.
RESULTS
In the total population, BMI was linearly positively related to PP regardless of gender and age, but it was not observed in the elevated blood pressure group. Multiple linear regression analysis showed that after fully adjusting for the maximum covariates, compared to the normal group, PP in the overall population decreased by 2.19 mmHg in the underweight group and increased by 1.426 and 2.919 mmHg in the overweight and obese groups, respectively. Similar results were observed in men, women, age <60 years, and normotensive groups. However, there was no significantly linear relationship between BMI and PP at the age of ≥60 years and elevated blood pressure groups. Besides, from multiple logistic regression analysis, the similar results were obtained, with no obvious association between BMI and high PP prevalence in those aged ≥60 years or with elevated blood pressure.
CONCLUSIONS
PP increased with rising BMI in the overall population. However, stratified analysis demonstrated no significant association between BMI and PP in individuals aged over 60 years or with elevated blood pressure.
Topics: Male; Adult; Humans; Female; Middle Aged; Aged; Blood Pressure; Body Mass Index; Cross-Sectional Studies; Obesity; Overweight; Hypertension; Thinness; Autonomic Nervous System Diseases
PubMed: 36647868
DOI: 10.26355/eurrev_202301_30871 -
Journal of Healthcare Engineering 2018Arterial pressure waves have been described in one dimension using several approaches, such as lumped (Windkessel) or distributed (using Navier-Stokes equations) models....
Arterial pressure waves have been described in one dimension using several approaches, such as lumped (Windkessel) or distributed (using Navier-Stokes equations) models. An alternative approach consists of modeling blood pressure waves using a Korteweg-de Vries (KdV) equation and representing pressure waves as combinations of solitons. This model captures many key features of wave propagation in the systemic network and, in particular, pulse pressure amplification (PPA), which is a mechanical biomarker of cardiovascular risk. The main objective of this work is to compare the propagation dynamics described by a KdV equation in a human-like arterial tree using acquired pressure waves. Furthermore, we analyzed the ability of our model to reproduce induced elastic changes in PPA due to different pathological conditions. To this end, numerical simulations were performed using acquired central pressure signals from different subject groups (young, adults, and hypertensive) as input and then comparing the output of the model with measured radial artery pressure waveforms. Pathological conditions were modeled as changes in arterial elasticity (). Numerical results showed that the model was able to propagate acquired pressure waveforms and to reproduce PPA variations as a consequence of elastic changes. Calculated elasticity for each group was in accordance with the existing literature.
Topics: Adult; Aged; Blood Pressure; Blood Pressure Determination; Female; Humans; Hypertension; Male; Middle Aged; Models, Cardiovascular; Signal Processing, Computer-Assisted; Young Adult
PubMed: 29599937
DOI: 10.1155/2018/1364185