-
Bone Aug 2023To investigate the association of the magnitude and direction of pulse pressure variability (PPV) with the incidence of fragility fracture in the general population.
OBJECTIVES
To investigate the association of the magnitude and direction of pulse pressure variability (PPV) with the incidence of fragility fracture in the general population.
METHODS
This prospective cohort study included current Kailuan Group employees and retirees who attended health checkups continuously from 2006 to 2010 and were followed up until December 31, 2021. A total of 56,129 individuals who completed the health checkups were selected and grouped according to coefficient of variation (CV) quartile for PPV. The standard deviation (SD) and variability independent of the mean were also calculated as measures of PPV. The cumulative incidence of fragility fracture in the four groups was calculated and the impact of PPV on the risk of fragility fracture was analyzed using a multivariate Cox regression model. The direction of the variation was also assessed.
RESULTS
There were 671 cases of fragility fracture (1.2%) during a median follow-up of 11 years. In the multivariable-adjusted model, the hazard ratio for fragility fracture was 1.37 (95% confidence interval 1.11-1.70) for the highest CV quartile for PPV versus the lowest CV quartile for PPV. There was a linear association between higher PPV and fragility fracture. Consistent results were noted for higher PPV and the risk of fragility fracture using other indices of variability and in various sensitivity and subgroup analyses.
CONCLUSIONS
High PPV was associated with a higher rate of fragility fracture independently of blood pressure. Reduction of PPV may help to prevent fragility fractures in the general population.
Topics: Humans; Blood Pressure; Prospective Studies; Risk Factors; Fractures, Bone; Proportional Hazards Models
PubMed: 37086777
DOI: 10.1016/j.bone.2023.116776 -
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 -
The Journal of Surgical Research Dec 2021The pulse pressure (PP) is the difference between systolic and diastolic blood pressures. Narrow PP in the Emergency Department (ED) has recently been shown to predict...
BACKGROUND
The pulse pressure (PP) is the difference between systolic and diastolic blood pressures. Narrow PP in the Emergency Department (ED) has recently been shown to predict hemorrhagic shock after trauma. This study examined the impact of prehospital narrow PP on outcomes after trauma.
METHODS
Patients presenting to our ACS-verified Level I trauma center (2008-2020) were retrospectively screened. Exclusions were unrecorded prehospital/ED vitals, age <16 or >60, transfers, on-scene cardiac arrest, and missing discharge disposition. Prehospital blood pressure defined study groups: Narrow PP (<30 mmHg) vs. Hypotensive (SBP<90 mmHg) vs. Others (herein referred to as Normotensive). Univariable/multivariable analyses compared outcomes and determined independent predictors of mortality; resuscitative thoracotomy; emergent intervention; and need for trauma intervention (NFTI), a contemporary measure of major trauma.
RESULTS
In total, 39,144 patients met inclusion/exclusion criteria: 5% (n=1,834) Narrow PP, 3% (n=1,062) Hypotensive, and 92% (n=36,248) Normotensive. Penetrating trauma was more frequent among Narrow PP and Hypotensive patients (23% vs. 32% vs. 14%, p<0.001). ISS was higher among Narrow PP and Hypotensive patients (5[1-14] vs. 10[2-21] vs. 4[1-9], p<0.001). Mortality was highest among the Hypotensive (n=130, 12%) followed by Narrow PP (n=92, 5%) and Normotensive patients (n=502, 1%) (p<0.001). On multivariable analysis, prehospital narrow PP was independently associated with resuscitative thoracotomy (OR 1.609, p=0.009), emergent intervention (OR 1.356, p=0.001), and NFTI (OR 1.237, p=0.009).
CONCLUSION
Prehospital narrow PP independently predicts severe trauma, resuscitative thoracotomy, and emergent intervention. Although prehospital narrow PP is not currently a TTA criterion, these patients have a mortality rate and ISS intermediate to those of hypotensive and normotensive patients. Prehospital narrow PP should be recognized as a proxy for major trauma in patients with heightened surgical and interventional needs so that appropriate in-hospital preparations may be made prior to patient arrival.
Topics: Blood Pressure; Emergency Medical Services; Humans; Injury Severity Score; Resuscitation; Retrospective Studies; Thoracotomy; Trauma Centers; Wounds and Injuries
PubMed: 34392182
DOI: 10.1016/j.jss.2021.06.051 -
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 Cardiothoracic and Vascular... Mar 2020To evaluate the association between preoperative pulse pressure (PP) and the incidences of renal, neurologic, cardiac, and mortality outcomes after surgery. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the association between preoperative pulse pressure (PP) and the incidences of renal, neurologic, cardiac, and mortality outcomes after surgery.
DESIGN
Systematic review and meta-analysis of cohort studies.
SETTING
Hospitals.
PARTICIPANTS
Patients who underwent cardiac or noncardiac surgeries.
INTERVENTION
The preoperative PP was measured.
MEASUREMENT AND MAIN RESULTS
Relevant cohort studies were obtained by systematic search of PubMed and Embase databases. A randomized effect model was used to pool the results. The multivariate adjusted risk ratio (RR) and its 95% confidence intervals (CI) were calculated to reflect the association between preoperative PP and adverse postoperative outcomes. Twelve cohort studies that included 40,143 patients who had undergone cardiac, vascular, or noncardiac surgery were included in the meta-analysis. The results showed that above a threshold of 40 mmHg, an increase in preoperative PP of 10 mmHg was independently associated with increased risk for renal events (adjusted RR: 1.13, 95% CI 1.08-1.19, p < 0.001; I = 0%), neurologic events (adjusted RR: 1.75, 95% CI 1.01-3.02, p = 0.04; I = 70%), cardiac events (adjusted RR: 1.19, 95% CI 1.03-1.37, p = 0.01; I = 0%), major cardiovascular adverse events (adjusted RR: 1.62, 95% CI 1.10-2.41, p = 0.02; I = 0%), and overall mortality (adjusted RR: 1.13, 95% CI 1.07-1.20, p < 0.001; I = 0%) after surgery.
CONCLUSIONS
Patients with higher-than-normal preoperative PP are at increased risk for adverse postoperative outcomes.
Topics: Blood Pressure; Cohort Studies; Humans; Kidney; Postoperative Period
PubMed: 31986286
DOI: 10.1053/j.jvca.2019.09.036 -
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 -
Annual International Conference of the... Jul 2022Pulse pressure (PP) is defined as the difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP). The metric PP is not unique, as numerous...
Pulse pressure (PP) is defined as the difference between systolic blood pressure (SBP) and diastolic blood pressure (DBP). The metric PP is not unique, as numerous combinations of SBP and DBP yield the same value for PP. Therefore, we introduced the PP companion (PPC) which is calculated using the Pythagorean theorem. Only the combination of PP and PPC offers unique characterization. Interestingly, PPCwas found to be associated with mean arterial pressure (MAP). Another mathematical construct frequently used in hemodynamic studies refers to the ratio of DBP and SBP, or DBP/SBP, denoted as Prat. As Prat and PP share the same companion (C), we investigated the association between PratC and MAP, as well as the connection between PP and Prat. Various patient cohorts were included: A) 52 heart failure patients (16 women), B) 88 patients (11 women) with acute cardiac syndromes, C) 257 patients (68 men) diagnosed with atherosclerosis or any of various types of autoimmune disease, and D) 106 hypertensives (51 men). Linear regression analysis resulted in the following correlations: A: R (PratC, MAP) = 0.94, R (PP, Prat) = -0.91 B: R (PratC, MAP) = 0.98, R (PP, Prat) = -0.85 C: R (PratC, MAP) = 0.97, R (PP, Prat) = -0.86 D: R (PratC, MAP) = 0.92, R (PP, Prat) = -0.82 We conclude that Prat carries no substantial incremental value beyond PP, while both Prat and PP are incomplete metrics, requiring simultaneous consideration of MAP. Clinical Relevance- Various ratio-based metrics have been introduced in hemodynamic studies without paying attention to missing components or even redundant candidates. Here we present a uniform method to provide comprehensive insight.
Topics: Arterial Pressure; Blood Pressure; Diastole; Female; Hemodynamics; Humans; Hypertension; Male
PubMed: 36086169
DOI: 10.1109/EMBC48229.2022.9871478 -
Experimental Gerontology Mar 2022Augmented aortic systolic blood pressure (SBP) and wave reflection via sympathetic-mediated vasoconstriction elevates the risk for adverse cardiovascular events in older... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND AND AIMS
Augmented aortic systolic blood pressure (SBP) and wave reflection via sympathetic-mediated vasoconstriction elevates the risk for adverse cardiovascular events in older adults. L-citrulline (L-CIT) supplementation has shown to reduce aortic SBP and pulse pressure (PP) responses to cold pressor test (CPT) induced sympathoactivation in young men. The aim of this study was to elucidate the efficacy of L-CIT supplementation to attenuate aortic hemodynamic responses to CPT in older adults.
METHODS AND RESULTS
Sixteen older adults were randomly assigned to placebo or L-CIT (6 g/day) for 14-days in a crossover, double-blind, placebo-controlled design. Brachial SBP and aortic SBP, PP, augmented pressure (AP), augmentation index standardized at 75 bpm (AIx@75), and pressure of the forward (Pf) and reflected (Pb) waves were evaluated at rest and during CPT pre- and post-intervention. Although no hemodynamic changes at rest, brachial SBP (Δ-12 ± 18 vs. Δ4 ± 14 mmHg; P = 0.008) and aortic SBP (Δ-10 ± 14 vs. Δ4 ± 12 mmHg; P = 0.005), PP (Δ-10 ± 12 vs. Δ4 ± 11 mmHg; P = 0.002), AP (Δ-4 ± 4 vs. Δ2 ± 7 mmHg; P = 0.004), AIx@75 (Δ-3.2 ± 7.2 vs. Δ2.2 ± 6.9%; P = 0.038), Pf (Δ-6 ± 10 vs. Δ3 ± 9 mmHg; P = 0.019), and Pb (Δ-4 ± 6 vs. Δ2 ± 6 mmHg; P = 0.008) responses to the CPT were significantly attenuated following L-CIT supplementation vs. placebo.
CONCLUSIONS
L-CIT supplementation attenuated aortic pulsatile pressure and pressure wave reflection responses to CPT in older adults, providing possible cardioprotection during cold-induced sympathoactivation in older adults.
Topics: Aged; Arterial Pressure; Blood Pressure; Citrulline; Cold-Shock Response; Dietary Supplements; Humans; Male; Pulse Wave Analysis; Vascular Stiffness
PubMed: 34990772
DOI: 10.1016/j.exger.2021.111685