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Current Cardiology Reports Oct 2021Isolated diastolic hypertension (IDH) is a frequent hypertension phenotype. We review IDH pathophysiology, risk stratification, and therapeutic decisions. (Review)
Review
PURPOSE OF REVIEW
Isolated diastolic hypertension (IDH) is a frequent hypertension phenotype. We review IDH pathophysiology, risk stratification, and therapeutic decisions.
RECENT FINDINGS
Recent guidelines lowering blood pressure cutoff levels have increased IDH prevalence and likely decreased associated cardiovascular risk. Long-term cardiovascular risk and pharmacological intervention in IDH are controversial. Narrow pulse pressure and other physiological and epidemiological characteristics are shared with a systodiastolic hypertension (SDH) subgroup. We propose that IDH be incorporated into a broader category, predominantly diastolic hypertension (PDH), defined by pulse pressure ≤ 45 mmHg and includes IDH and SDH with a narrow pulse pressure. IDH-PDH is associated with cardiovascular risk in the long term, especially in young patients. Standardization of the IDH definition and population may contribute to future research to understand genetics, pathophysiology, and eventually therapy in this important subgroup of hypertensive patients.
Topics: Blood Pressure; Humans; Hypertension; Phenotype; Prevalence; Risk Factors
PubMed: 34657205
DOI: 10.1007/s11886-021-01609-w -
JAMA Jun 2020
Topics: Blood Pressure; Blood Pressure Determination; Humans; Hypertension
PubMed: 32543678
DOI: 10.1001/jama.2020.5931 -
Advances in Clinical and Experimental... May 2022Pulse pressure (PP) is a pulsatile component of blood pressure (BP), strongly correlated with arterial stiffness (AS) and impacting prognosis. Disproportionally...
BACKGROUND
Pulse pressure (PP) is a pulsatile component of blood pressure (BP), strongly correlated with arterial stiffness (AS) and impacting prognosis. Disproportionally increased PP values in individuals with autosomal dominant polycystic kidney disease (ADPKD) should be expected, given the multifactorial cardiovascular involvement in the natural course of this disease.
OBJECTIVES
To investigate ambulatory PP in a group of ADPKD patients, and to examine the impact of age, sex, kidney function, hypertension, circadian rhythm, and antihypertensive drugs (AH) on studied parameters.
MATERIAL AND METHODS
A total of 130 ADPKD patients (median age 41 years, 35% men) who underwent 24-hour BP measurement with portable oscillometer Spacelabs 90217, were included in the study and their recordings were retrospectively analyzed. Demographic data and the medical history including antihypertensive treatment were collected, ADPKD was diagnosed based on the criteria by Pei et al., and estimated glomerular filtration rate (eGFR) was calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.
RESULTS
Pulse pressure in the whole group was 46 (IQR: 42-53) mm Hg and it was significantly higher in men than in women and during the day compared to nighttime. There was a negative correlation of PP with eGFR and a positive correlation with age. Pulse pressure was not different in ADPKD patients with or without a diagnosis of hypertension.
CONCLUSION
Ambulatory PP is not substantially increased in ADPKD patients across different stages of CKD. It follows a regular pattern of being increased with age, male sex, daytime, and decreasing eGFR, but not with the diagnosis of hypertension.
Topics: Adult; Blood Pressure; Female; Glomerular Filtration Rate; Humans; Hypertension; Kidney; Male; Polycystic Kidney, Autosomal Dominant; Renal Insufficiency, Chronic; Retrospective Studies
PubMed: 35543199
DOI: 10.17219/acem/149373 -
JMIR Public Health and Surveillance Jul 2023The causal relationship between blood pressure variability (BPV) and arterial stiffness remains debated.
BACKGROUND
The causal relationship between blood pressure variability (BPV) and arterial stiffness remains debated.
OBJECTIVE
This study aimed to explore the temporal and bidirectional associations between long-term BPV and arterial stiffness using a cohort design with multiple surveys.
METHODS
Participants from the Beijing Health Management Cohort who underwent health examinations from visit 1 (2010-2011) to visit 5 (2018-2019) were enrolled in this study. Long-term BPV was defined as intraindividual variation using the coefficient of variation (CV) and SD. Arterial stiffness was measured by brachial-ankle pulse wave velocity (baPWV). The bidirectional relationship between BPV and arterial stiffness was explored using cross-lagged analysis and linear regression models, with records before and after visit 3 categorized as phase 1 and phase 2, respectively.
RESULTS
Of the 1506 participants, who were a mean of 56.11 (SD 8.57) years old, 1148 (76.2%) were male. The cross-lagged analysis indicated that the standardized coefficients of BPV at phase 1 directing to the baPWV level at phase 2 were statistically significant but not vice-versa. The adjusted regression coefficients of the CV were 4.708 (95% CI 0.946-8.470) for systolic blood pressure, 3.119 (95% 0.166-6.073) for diastolic pressure, and 2.205 (95% CI 0.300-4.110) for pulse pressure. The coefficients of the SD were 4.208 (95% CI 0.177-8.239) for diastolic pressure and 4.247 (95% CI 0.448-8.046) for pulse pressure. The associations were predominant in the subgroup with hypertension, but we did not observe any significant association of baPWV level with subsequent BPV indices.
CONCLUSIONS
The findings supported a temporal relationship between long-term BPV and arterial stiffness level, especially among people with hypertension.
Topics: Humans; Male; Child; Female; Blood Pressure; Ankle Brachial Index; Cohort Studies; Vascular Stiffness; Pulse Wave Analysis; Hypertension
PubMed: 37402142
DOI: 10.2196/45324 -
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 -
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 -
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 -
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 -
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 -
Acta Neurochirurgica. Supplement 2021The slope of linear relationship between the amplitude of pulsations in intracranial pressure (ICP) versus mean ICP has recently been suggested as a useful guide for...
The slope of linear relationship between the amplitude of pulsations in intracranial pressure (ICP) versus mean ICP has recently been suggested as a useful guide for selecting patients for shunt surgery in normal pressure hydrocephalus (NPH). To better understand how the pathophysiology of cerebral circulation influences this parameter, we aimed to study the relationship between mean pressure and pulsation amplitude in a wide range of conditions affecting cerebrovascular tone and ICP in experimental conditions.We retrospectively analysed experimental material collected previously. Three physiological manoeuvres were studied in 29 New Zealand white rabbits: lumbar infusion with an infusion rate ≤0.2 mL/min to induce mild intracranial hypertension (n = 43), sympathetic blockade to induce arterial hypotension (n = 19), and modulation of the ventilator tidal volume, simultaneously influencing arterial carbon dioxide partial pressure (PaCO) to induce hypocapnia or hypercapnia (n = 17). We investigated whether the slope of the pulse amplitude (AMP)-ICP line depended on PaCO and arterial blood pressure (ABP) changes.We found a linear correlation between AMP-ICP and ICP with positive slope. Regression of slope against mean ABP showed a negative dependence (p = 0.03). In contrast, the relationship between slope and PaCO was positive, although not reaching statistical significance (p = 0.18).The slope of amplitude-pressure line is strongly modulated by systemic vascular variables and therefore should be taken as a descriptor of cerebrospinal fluid dynamics with great care.
Topics: Animals; Blood Pressure; Cerebrovascular Circulation; Hydrocephalus, Normal Pressure; Intracranial Hypertension; Intracranial Pressure; Rabbits; Retrospective Studies
PubMed: 33839858
DOI: 10.1007/978-3-030-59436-7_52