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Journal of Human Hypertension Oct 2023The study characterises vascular phenotypes of hypertensive patients utilising machine learning approaches. Newly diagnosed and treatment-naïve primary hypertensive...
The study characterises vascular phenotypes of hypertensive patients utilising machine learning approaches. Newly diagnosed and treatment-naïve primary hypertensive patients without co-morbidities (aged 18-55, n = 73), and matched normotensive controls (n = 79) were recruited (NCT04015635). Blood pressure (BP) and BP variability were determined using 24 h ambulatory monitoring. Vascular phenotyping included SphygmoCor® measurement of pulse wave velocity (PWV), pulse wave analysis-derived augmentation index (PWA-AIx), and central BP; EndoPAT™-2000® provided reactive hyperaemia index (LnRHI) and augmentation index adjusted to heart rate of 75bpm. Ultrasound was used to analyse flow mediated dilatation and carotid intima-media thickness (CIMT). In addition to standard statistical methods to compare normotensive and hypertensive groups, machine learning techniques including biclustering explored hypertensive phenotypic subgroups. We report that arterial stiffness (PWV, PWA-AIx, EndoPAT-2000-derived AI@75) and central pressures were greater in incident hypertension than normotension. Endothelial function, percent nocturnal dip, and CIMT did not differ between groups. The vascular phenotype of white-coat hypertension imitated sustained hypertension with elevated arterial stiffness and central pressure; masked hypertension demonstrating values similar to normotension. Machine learning revealed three distinct hypertension clusters, representing 'arterially stiffened', 'vaso-protected', and 'non-dipper' patients. Key clustering features were nocturnal- and central-BP, percent dipping, and arterial stiffness measures. We conclude that untreated patients with primary hypertension demonstrate early arterial stiffening rather than endothelial dysfunction or CIMT alterations. Phenotypic heterogeneity in nocturnal and central BP, percent dipping, and arterial stiffness observed early in the course of disease may have implications for risk stratification.
Topics: Humans; Carotid Intima-Media Thickness; Pulse Wave Analysis; Blood Pressure Monitoring, Ambulatory; Hypertension; Blood Pressure; Phenotype; Vascular Stiffness
PubMed: 36528682
DOI: 10.1038/s41371-022-00794-7 -
The Cochrane Database of Systematic... Nov 2021Hypertension is considered to be a serious health problem worldwide. Controlling and lowering blood pressure are of significant benefit to people with hypertension... (Review)
Review
BACKGROUND
Hypertension is considered to be a serious health problem worldwide. Controlling and lowering blood pressure are of significant benefit to people with hypertension because hypertension is a risk factor for stroke, heart disease, and cardiovascular disease. Roselle, the tropical plant Hibiscus sabdariffa, also commonly called sour tea or red tea, has been used as both a thirst-quenching drink and for medicinal purposes.
OBJECTIVES
To assess the effect of Roselle on blood pressure in people with primary hypertension.
SEARCH METHODS
For this update, the Cochrane Hypertension Information Specialist searched the following databases and trials registers for randomised controlled trials (RCTs): the Cochrane Hypertension Specialised Register (to 6 August 2021), Cochrane Central Register of Controlled Trials (CENTRAL; 2021, Issue 7), MEDLINE Ovid (1946 to 5 August 2021), Embase Ovid (1974 to 5 August 2021), ProQuest Dissertations & Theses (to 6 August 2021), Web of Science Clarivate (to 7 August 2021), Food Science and Technology Abstracts Clarivate (to 7 August 2021), the WHO International Clinical Trials Registry Platform (to 6 August 2021), and the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (to 6 August 2021). We searched Google Scholar and OpenSIGLE. We also handsearched local and regional Chinese databases: CBM, CMCC, TCMLARS, CNKI, CMAC, and the Index to Chinese Periodical Literature (to 14 September 2020), as well as Thai databases (ThaiJO, CUIR, TDC, CMU e-Theses, TCTR) (to 3 October 2020). There were no language or publication date restrictions.
SELECTION CRITERIA
We sought RCTs evaluating the use of any forms of Roselle with placebo or no treatment in adults with hypertension. Our primary outcome was change in trough and/or peak systolic and diastolic blood pressure (SBP, DBP). Secondary outcomes were withdrawals due to adverse effects, change in pulse pressure, and change in heart rate.
DATA COLLECTION AND ANALYSIS
All search results were managed using Covidence and re-checked for the number of records, inclusion and exclusion of studies with Mendeley reference management software. We used standard methodological procedures expected by Cochrane. Two review authors worked independently in parallel for screening (titles and abstracts, and full reports), data extraction, risk of bias assessment, and assessment of the certainty of the evidence using the GRADE approach. Any disagreements were resolved by discussion or by consultation with the third review author if necessary. We presented mean difference (MD) of change in SBP and DBP with their corresponding 95% confidence interval (CI).
MAIN RESULTS
For this update, only one RCT with a parallel-group design involving 60 participants with type 2 diabetes mellitus fulfilled the inclusion criteria. This study investigated the effect of Roselle extract capsules (total dose of 5600 mg) compared with placebo (lactose) at eight weeks. The study was at low risk of selection bias, performance bias, and detection bias. Conversely, it was at high risk of attrition bias, reporting bias, and other bias (baseline imbalance). We have very little confidence in the effect estimate of Roselle on change-from-baseline in both SBP and DBP between the two groups. The MD of change in SBP was 1.65, 95% CI -7.89 to 11.19 mmHg, 52 participants, very low-certainty evidence. The MD of change in DBP was 4.60, 95% CI -1.38 to 10.58 mmHg, 52 participants, very low-certainty evidence. Our secondary outcomes of withdrawals due to adverse effects, change in pulse pressure, and change in heart rate were not reported. Due to the limited available data, no secondary analyses were performed (subgroup and sensitivity analysis).
AUTHORS' CONCLUSIONS
The evidence is currently insufficient to determine the effectiveness of Roselle compared to placebo for controlling or lowering blood pressure in people with hypertension. The certainty of evidence was very low due to methodological limitations, imprecision, and indirectness. There is a need for rigorous RCTs that address the review question.
Topics: Adult; Blood Pressure; Cardiovascular Diseases; Hibiscus; Humans; Hypertension; Systole
PubMed: 34837382
DOI: 10.1002/14651858.CD007894.pub3 -
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 -
Hypertension (Dallas, Tex. : 1979) Aug 2021
Topics: Blood Pressure; Diagnostic Techniques, Cardiovascular; Oscillometry; Pulse Wave Analysis
PubMed: 34232680
DOI: 10.1161/HYPERTENSIONAHA.121.17228 -
Korean Journal of Anesthesiology Oct 2019It is challenging to predict fluid responsiveness, that is, whether the cardiac index or stroke volume index would be increased by fluid administration, in the pediatric... (Review)
Review
It is challenging to predict fluid responsiveness, that is, whether the cardiac index or stroke volume index would be increased by fluid administration, in the pediatric population. Previous studies on fluid responsiveness have assessed several variables derived from pressure wave measurements, plethysmography (pulse oximeter plethysmograph amplitude variation), ultrasonography, bioreactance data, and various combined methods. However, only the respiratory variation of aortic blood flow peak velocity has consistently shown a predictive ability in pediatric patients. For the prediction of fluid responsiveness in children, flow- or volume-dependent, noninvasive variables are more promising than pressure-dependent, invasive variables. This article reviews various potential variables for the prediction of fluid responsiveness in the pediatric population. Differences in anatomic and physiologic characteristics between the pediatric and adult populations are covered. In addition, some important considerations are discussed for future studies on fluid responsiveness in the pediatric population.
Topics: Blood Flow Velocity; Blood Pressure; Cardiac Output; Child; Fluid Therapy; Humans; Pediatrics; Plethysmography; Pulse Wave Analysis; Stroke Volume
PubMed: 31591858
DOI: 10.4097/kja.19305 -
Journal of Alzheimer's Disease : JAD 2022Studies have demonstrated that both tau and cardiovascular risk are associated with cognitive decline, but the possible synergistic effects of these pathologic markers...
BACKGROUND
Studies have demonstrated that both tau and cardiovascular risk are associated with cognitive decline, but the possible synergistic effects of these pathologic markers remain unclear.
OBJECTIVE
To explore the interaction of AD biomarkers with a specific vascular risk marker (pulse pressure) on longitudinal cognition.
METHODS
Participants included 139 older adults from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Biomarkers of tau, amyloid-β (Aβ), and vascular risk (pulse pressure) were assessed. Neuropsychological assessment provided memory, language, and executive function domain composite scores at baseline and 1-year follow-up. Multiple linear regression examined interactive effects of pulse pressure with tau PET independent of Aβ PET and Aβ PET independent of tau PET on baseline and 1-year cognitive outcomes.
RESULTS
The interaction between pulse pressure and tau PET significantly predicted 1-year memory performance such that the combined effect of high pulse pressure and high tau PET levels was associated with lower memory at follow-up but not at baseline. In contrast, Aβ PET did not significantly interact with pulse pressure to predict baseline or 1-year outcomes in any cognitive domain. Main effects revealed a significant effect of tau PET on memory, and no significant effects of Aβ PET or pulse pressure on any cognitive domain.
CONCLUSION
Results indicate that tau and an indirect marker of arterial stiffening (pulse pressure) may synergistically contribute to memory decline, whereas Aβ may have a lesser role in predicting cognitive progression. Tau and vascular pathology (particularly in combination) may represent valuable targets for interventions intended to slow cognitive decline.
Topics: Aged; Alzheimer Disease; Amyloid beta-Peptides; Biomarkers; Blood Pressure; Cognition; Cognitive Dysfunction; Humans; Positron-Emission Tomography; tau Proteins
PubMed: 35938247
DOI: 10.3233/JAD-220026 -
American Journal of Hypertension May 2023There are six different formulae for estimating mean arterial pressure (MAP) from systolic and diastolic pressure readings. This study is to determine the optimum...
BACKGROUND
There are six different formulae for estimating mean arterial pressure (MAP) from systolic and diastolic pressure readings. This study is to determine the optimum formula for calculating MAP when compared to the gold standard approach, which is the area under the curve of an invasively measured pulse waveform divided by the cardiac cycle duration.
METHODS
Eight live pigs were used as the experimental model for the invasive measurement of femoral artery pressure (AP) by a fluid filled catheter connected with a pressure transducer. In addition, intraocular pressure (IOP) and jugular vein pressure (JVP) were also recorded. The mean pressure (MP) was calculated from digital waveforms sampled at 1,000 points per second with the six formulae and area method for AP, IOP and JVP.
RESULTS
The absolute mean difference between the area MAP and each formula's MAP ranged from 0.98 to 3.23 mm Hg. Our study also found that even under physiological conditions, area MAP can vary between successive pulses by up to 5 mm Hg. For mean IOP and JVP, the mean difference between a formula's MP and the area method's was less than 1 mm Hg for most formulae. With the pooled data, there was excellent agreement amongst all formulae for MAP with the intra-class correlation coefficient (ICC) ranging from 0.97 to 0.99, while the ICC of most formulae for IOP and JVP was 1.0.
CONCLUSIONS
Our study suggests that all current formulae are adequate for estimating MAP, though some formulae are not suitable for mean IOP and JVP.
Topics: Swine; Animals; Blood Pressure; Intraocular Pressure; Arterial Pressure; Heart; Heart Rate
PubMed: 36945835
DOI: 10.1093/ajh/hpad026 -
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 -
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