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Journal of Clinical Hypertension... Nov 2020Pulse pressure naturally increases over time as individuals' age due to arteriosclerosis and diffuse vascular stiffening. However, the differential for widened pulse... (Review)
Review
Pulse pressure naturally increases over time as individuals' age due to arteriosclerosis and diffuse vascular stiffening. However, the differential for widened pulse pressure is broad and includes causes of hyperdynamic circulation and high-output heart failure, such as aortic regurgitation and hyperthyroidism. In the absence of an underlying cause, wide pulse pressure is a sign of deteriorating cardiovascular health and carries increased risk for mortality, disease progression, and adverse clinical outcomes in chronic diseases including cardiovascular disease and chronic kidney disease. Current emphasis of antihypertensive treatment on systolic and diastolic blood pressure does not always address pulse pressure, thus subjecting many patients to an independent risk factor for poor outcomes. Pulse pressure control is more successfully achieved with thiazide diuretics and long-acting nitrates when compared to other antihypertensive agents, but further research is needed to quantify the additional benefits of pulse pressure control over conventional blood pressure therapy. This case review provides an overview of the pathogenesis, pathologic causes, and treatment of widened pulse pressure and evaluates current evidence for pulse pressure as a predictor of clinical outcomes.
Topics: Antihypertensive Agents; Blood Pressure; Cardiovascular Diseases; Humans; Sodium Chloride Symporter Inhibitors
PubMed: 32986936
DOI: 10.1111/jch.14051 -
Current Opinion in Nephrology and... May 2003Diastolic blood pressure has traditionally been considered the most important component of blood pressure and the primary target of antihypertensive therapy. However,... (Review)
Review
PURPOSE OF REVIEW
Diastolic blood pressure has traditionally been considered the most important component of blood pressure and the primary target of antihypertensive therapy. However, over 30 years ago important epidemiological studies pointed out the importance of systolic blood pressure, and research during the 1990s has strengthened this view. Unlike diastolic blood pressure, systolic blood pressure increases progressively with age, and in the ageing societies elevated systolic pressure is the most common form of hypertension. The characteristic changes of systolic and diastolic blood pressure with age lead to increases in pulse pressure (systolic minus diastolic), which has emerged as a new, potentially independent risk factor. In this review we compare the relative importance of various blood pressure components.
RECENT FINDINGS
Generally, in studies in which readings of systolic and diastolic blood pressure have been compared, systolic blood pressure has been a better predictor of risk. Moreover, isolated systolic hypertension predicts risk better than isolated diastolic hypertension, and the treatment of both isolated systolic hypertension and combined hypertension has reduced cardiovascular events. There are no treatment studies of isolated diastolic hypertension. Pulse pressure reflects stiffening of large arteries and is associated with several cardiovascular risk factors. Pulse pressure also predicts events in epidemiologic studies, but elucidation of an independent role is hampered by the close correlation between pulse pressure and systolic blood pressure.
SUMMARY
Epidemiological and treatment studies suggest that systolic blood pressure should be the primary target of antihypertensive therapy, although consideration of systolic and diastolic pressure together improves risk prediction. The greatest practical concern at the moment is the undertreatment of hypertension, especially systolic, and total cardiovascular risk.
Topics: Antihypertensive Agents; Blood Pressure; Cardiovascular Diseases; Diastole; Humans; Hypertension; Risk Factors; Systole; United States
PubMed: 12698068
DOI: 10.1097/00041552-200305000-00011 -
Journal of the American Heart... Apr 2019See Article Yamamoto et al.
See Article Yamamoto et al.
Topics: Blood Pressure; Diabetes Mellitus, Type 1; Diabetic Angiopathies; Diabetic Retinopathy; Eye Diseases; Humans
PubMed: 30971161
DOI: 10.1161/JAHA.119.012491 -
Minerva Anestesiologica Apr 2013Fluid management is a crucial issue in patients with acute respiratory distress syndrome (ARDS). Assessment of preload responsiveness should help to define the best... (Review)
Review
Fluid management is a crucial issue in patients with acute respiratory distress syndrome (ARDS). Assessment of preload responsiveness should help to define the best fluid strategy. Arterial pulse pressure variation (PPV), which represents the amplitude of the respiratory changes in arterial pulse pressure, is considered as a marker of preload responsiveness in patients mechanically ventilated and fully adapted to their ventilator. The good ability of PPV to predict fluid responsiveness has been confirmed in various clinical situations (sepsis, operative and post-operative periods). However, there are a number of limits of using PPV (e.g., spontaneous breathing activity, cardiac arrhythmias, low tidal volume ventilation, low lung compliance), which are particularly important in ARDS. Clinical studies have confirmed the poor reliability of PPV in predicting fluid responsiveness in patients with ARDS, ventilated according to the currently recommended lung protective strategy. Although a PPV >10-12% still keeps its good predictive value, a lower PPV (<10%) is far to guarantee fluid unresponsiveness since many false-negative cases can be encountered in this setting. Thus, performance of alternative preload responsiveness tests such as passive leg raising or end-expiratory occlusion tests, is necessary when low PPV values are measured. This review addresses the meaning of PPV, its conditions of use and its limits in ARDS patients.
Topics: Blood Pressure; Fluid Therapy; Hemodynamics; Humans; Respiration, Artificial; Respiratory Distress Syndrome; Stroke Volume
PubMed: 23370121
DOI: No ID Found -
JAMA Jun 2020
Topics: Blood Pressure; Blood Pressure Determination; Humans; Hypertension
PubMed: 32543678
DOI: 10.1001/jama.2020.5931 -
BMC Neurology Apr 2022Growing evidence suggests that vascular risk factors, especially hypertension, relate not only to cardiovascular disease but also to cognitive impairment. However, the...
BACKGROUND
Growing evidence suggests that vascular risk factors, especially hypertension, relate not only to cardiovascular disease but also to cognitive impairment. However, the impact of pulse pressure on cognitive function remains controversial. In this study, we evaluated the associations between pulse pressure and cognitive function in a Japanese health examination cohort using propensity matching analysis.
METHODS
We examined 2,546 individuals with a mean age of 60.8 ± 10.3 years who voluntarily participated in health examination. Clinical variables included pulse pressure, and brain magnetic resonance imaging (MRI). We divided the participants into the high and low pulse pressure groups with a pre-defined cut-off value of 65 mmHg and evaluated their physical examination data, cognitive functions including Okabe's test, Kohs' test, and silent brain lesions using propensity matching. To clarify whether pulse pressure and blood pressure have different implications for cognitive function, a mediating analysis was also conducted.
RESULTS
From the 2,546 subjects, 439 (17.2%) were in the high PP group. The propensity matching algorithm produced 433 pairs of patients with similar propensities. Higher pulse pressure corresponded to lower Okabe and Kohs' scores (44.3 ± 7.1 vs 42.7 ± 7.5; p = 0.002, 97.9 ± 18.0 vs 95.0 ± 18.1 p = 0.019, respectively). The relationship between pulse pressure and cognitive impairment was not significantly mediated by systolic blood pressure. We observed no significant associations between silent brain lesions and pulse pressure.
CONCLUSION
High pulse pressure was associated with lower cognitive performance without systolic blood pressure mediation in Japanese subjects without dementia.
Topics: Aged; Blood Pressure; Cognition; Cross-Sectional Studies; Humans; Hypertension; Japan; Middle Aged
PubMed: 35410174
DOI: 10.1186/s12883-022-02666-6 -
American Journal of Hypertension May 2015Classical studies indicate that the contribution of kidneys to hypertension is almost exclusively related to the association between mean arterial pressure (MAP) and... (Review)
Review
Classical studies indicate that the contribution of kidneys to hypertension is almost exclusively related to the association between mean arterial pressure (MAP) and vascular resistance. Recent reports including estimates of glomerular filtration rate (GFR) have shown that pulse pressure (PP) and pulse wave velocity, 2 major indices of arterial stiffness, now emerge as significant predictors of cardiovascular risk and age-associated decline in GFR. Such findings are mainly observed in patients with hypertension and renal failure and in atherosclerotic subjects undergoing coronary angiography. In such patients, amplification of PP between ascending and terminal aorta at the renal site is constantly increased over 10mm Hg (P < 0.001), whereas MAP level remains continuously unmodified. This PP amplification is significantly associated with presence of proteinuria. Furthermore, increases in plasma creatinine and aortic stiffness are independently and positively correlated (P < 0.001) both in cross-sectional and longitudinal studies. All these relationships associating PP, arterial stiffness, and renal function are mainly observed in patients 60 years of age or older. Furthermore, in renal transplant patients and their donors, subjects have been recruited for evaluations of arterial stiffness and posttransplant decline in GFR. Determinants of GFR decline were evaluated 1 and 9 years after transplantation. The first year GFR decline was related to smoking and acute rejection, whereas the later was significantly and exclusively associated with donor age and aortic stiffness. Thus, in hypertensive humans, the observed association between PP and GFR suggests that the 2 parameters are substantially mediated by arterial stiffness, not exclusively by vascular resistance.
Topics: Blood Pressure; Female; Glomerular Filtration Rate; Humans; Hypertension; Kidney; Male; Pulse Wave Analysis; Vascular Stiffness
PubMed: 25480804
DOI: 10.1093/ajh/hpu206 -
Heart (British Cardiac Society) May 2001
Topics: Blood Pressure; Cardiovascular Diseases; Humans; Hypertension; Prognosis; Pulsatile Flow; Ventricular Dysfunction, Left
PubMed: 11302985
DOI: 10.1136/heart.85.5.484 -
Journal of Hypertension May 2021Hypertension leads to aortic stiffening and dilatation but unexpected data from the Framingham Heart Study showed an inverse relationship between brachial pulse pressure...
OBJECTIVES
Hypertension leads to aortic stiffening and dilatation but unexpected data from the Framingham Heart Study showed an inverse relationship between brachial pulse pressure and aortic diameter. Aortic dilatation would not only lead to lower pulse pressure but also to a worse prognosis (cardiac events, heart failure). Invasive pressure may be more informative but data are lacking.
AIM
This study evaluated the relationship between invasively measured central blood pressure and proximal aortic diameter.
METHODS
In 71 consecutive patients referred to invasive haemodynamic study, proximal aortic remodelling was evaluated in terms of Z-score, comparing diameters measured at the sinus of Valsalva to the diameter expected according to patients' age, sex and body height. Pressures were recorded directly in the proximal aorta by means of a catheter before coronary assessment.
RESULTS
The mean invasive aortic SBPs and DBPs were 146 ± 23 and 78 ± 13 mmHg, respectively, giving a central pulse pressure (cPP inv) of 68 ± 21 mmHg. Proximal aortic diameter was 34.9 ± 19.4 mm, whereas Z-score was -0.3 ± 1.7. Patients with higher cPPinv showed a significantly lower Z-score (-0.789 vs. 0.155, P = 0.001). cPPinv was inversely related to Z-score (R = -0.271, P = 0.022) independently from age, mean blood pressure and heart rate (β = -0.241, P = 0.011).
CONCLUSION
Aortic root Z-score is inversely associated with invasively measured central pulse pressure in a cohort of patients undergoing invasive coronary assessment. Remodelling at the sinuses of Valsalva may be a compensatory mechanism to limit pulse pressure.
Topics: Aorta; Arterial Pressure; Blood Pressure; Dilatation, Pathologic; Humans; Hypertension
PubMed: 33710165
DOI: 10.1097/HJH.0000000000002730 -
American Journal of Hypertension Dec 2014This critique is intended to provide background for the reader to evaluate the relative clinical utilities of brachial cuff systolic blood pressure (SBP) and its... (Review)
Review
This critique is intended to provide background for the reader to evaluate the relative clinical utilities of brachial cuff systolic blood pressure (SBP) and its derivatives, including pulse pressure, central systolic pressure, central augmentation index (AI), and pulse pressure amplification (PPA). The critical question is whether the newer indicators add sufficient information to justify replacing or augmenting brachial cuff blood pressure (BP) data in research and patient care. Historical context, pathophysiology of variations in pulse wave transmission and reflection, issues related to measurement and model errors, statistical limitations, and clinical correlations are presented, along with new comparative data. Based on this overview, there is no compelling scientific or practical reason to replace cuff SBP with any of the newer indicators in the vast majority of clinical situations. Supplemental value for central SBP may exist in defining patients with exaggerated PPA ("spurious systolic hypertension"), managing cardiac and aortic diseases, and in studies of cardiovascular drugs, but there are no current standards for these possibilities.
Topics: Arterial Pressure; Blood Pressure Determination; Brachial Artery; Humans; Hypertension; Systole; Vascular Resistance
PubMed: 25233859
DOI: 10.1093/ajh/hpu135