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Blood Pressure Feb 2014The influence of chronological ageing on the components of the cardiovascular system is of fundamental importance for understanding how hemodynamics change and the... (Review)
Review
The influence of chronological ageing on the components of the cardiovascular system is of fundamental importance for understanding how hemodynamics change and the cardiovascular risk increases with age, the most important risk marker. An increase in peripheral vascular resistance associated with increased stiffness of central elastic arteries represents hallmarks of this ageing effect on the vasculature, referred to as early vascular ageing (EVA). In clinical practice, it translates into increased brachial and central systolic blood pressure and corresponding pulse pressure in subjects above 50 years of age, as well as increased carotid-femoral pulse wave velocity (c-f PWV)--a marker of arterial stiffness. A c-f PWV value ≥ 10 m/s is threshold for increased risk according. Improved lifestyle and control of risk factors via appropriate drug therapy are of importance in providing vascular protection related to EVA. One target group might be members of risk families including subjects with early onset cardiovascular disease.
Topics: Age Factors; Blood Pressure; Cardiovascular Diseases; Humans; Hypertension; Pulse Wave Analysis
PubMed: 23750722
DOI: 10.3109/08037051.2013.796142 -
Therapeutic Advances in Cardiovascular... Feb 2008For many years, the cyclic blood pressure (BP) curve was described exclusively from two specific points of this curve, the highest, called systolic blood pressure, and... (Review)
Review
For many years, the cyclic blood pressure (BP) curve was described exclusively from two specific points of this curve, the highest, called systolic blood pressure, and the lowest, called diastolic blood pressure, both dominating the basis of cardiovascular (CV) hypertensive epidemiology. Nowadays, it is largely admitted that the BP curve should be characterized from pulsatile arterial hemodynamics, thus leading to the definition of novel indices in CV epidemiology. The present chapter details these new aspects.
Topics: Arteries; Blood Pressure; Humans; Hypertension; Pulsatile Flow; Risk Factors
PubMed: 19124404
DOI: 10.1177/1753944707086652 -
Maturitas Jul 2024This study examined the associations between pulse pressure, hypertension, and the decline in physical function in a prospective framework.
OBJECTIVES
This study examined the associations between pulse pressure, hypertension, and the decline in physical function in a prospective framework.
STUDY DESIGN
The Healthy Aging Longitudinal Study tracked a group of Taiwanese adults aged 55 or more over an average of 6.19 years to assess pulse pressure and decline in physical function, including in handgrip strength, gait speed, and 6-min walking distance, at baseline (2009-2013) and in the second phase of assessments (2013-2020).
MAIN OUTCOME MEASURES
Pulse pressure was calculated as the difference between systolic and diastolic blood pressure values. Weakness, slowness, and low endurance were defined as decreases of ≥0.23 m/s (one standard deviation) in gait speed, ≥5.08 kg in handgrip strength, and ≥ 57.73 m in a 6-min walk, as determined from baseline to the second phase of assessment. Linear and logistic regressions were employed to evaluate the associations between pulse pressure, hypertension, and decline in physical function.
RESULTS
Baseline pulse pressure was associated with future handgrip strength (beta = -0.017, p = 0.0362), gait speed (beta = -0.001, p < 0.0001), and 6-min walking distance (beta = -0.470, p < 0001). In multivariable models, only handgrip strength (beta = -0.016, p = 0.0135) and walking speed (beta = -0.001, p = 0.0042) remained significantly associated with future pulse pressure. Older adults with high systolic blood pressure (≥140 mmHg) and elevated pulse pressure (≥60 mmHg) exhibited a significantly increased risk of weakness (odds ratio: 1.30, 95 % confidence interval: 1.08-1.58), slowness (1.29, 1.04-1.59), and diminished endurance (1.25, 1.04-1.50) compared with the reference group, who exhibited systolic blood pressure of <140 mmHg and pulse pressure of <60 mmHg.
CONCLUSIONS
Among older adults, pulse pressure is associated with a decline in physical function, especially in terms of strength and locomotion.
Topics: Humans; Aged; Male; Female; Hand Strength; Blood Pressure; Longitudinal Studies; Middle Aged; Hypertension; Taiwan; Prospective Studies; Walking Speed; Walking; Aged, 80 and over
PubMed: 38669896
DOI: 10.1016/j.maturitas.2024.108000 -
Clinical and Experimental Pharmacology... Dec 20011. The aim of the present brief review is to show that the pulsatile component of blood pressure is a stronger determinant of large artery remodelling than the steady... (Review)
Review
1. The aim of the present brief review is to show that the pulsatile component of blood pressure is a stronger determinant of large artery remodelling than the steady component (i.e. mean blood pressure). 2. Pulse pressure, which is a strong determinant of cardiovascular events, including coronary heart disease and stroke, is increased when large arteries stiffen. Local pulse pressure, measured with applanation tonometry in normotensives and patients with essential hypertension, explains a significant part of the variance of intima-media thickness at the site of the carotid artery, a proximal elastic artery, whereas mean blood pressure does not contribute. Local pulse pressure has no influence on intima-media thickness at the site of the radial artery, a distal muscular artery that undergoes very little stroke change in diameter. 3. The decrease in carotid pulse pressure is also a major determinant of the regression of carotid intima-media thickness after antihypertensive treatment. Local pulse pressure can influence not only intima-media thickness, but also internal diameter. Indeed, there is a significant association between the lumen enlargement of the ascending aorta in patients with Marfan syndrome and pulse pressure. In addition, carotid pulse pressure is positively correlated with carotid internal diameter in normotensives and hypertensives, and the decrease in carotid internal diameter during long-term antihypertensive treatment is influenced by the decrease in carotid pulse pressure and not by the reduction in mean blood pressure. 4. We suggest that the effects of pulse pressure on large artery remodelling may explain part of its predictive value on cardiovascular events.
Topics: Antihypertensive Agents; Arteries; Blood Pressure; Humans; Hypertension; Marfan Syndrome; Tunica Intima
PubMed: 11903305
DOI: 10.1046/j.1440-1681.2001.03569.x -
American Journal of Physiology. Heart... Oct 2003
Comparative Study Review
Topics: Animals; Arteries; Biological Factors; Blood Pressure; Elasticity; Humans; Hypertension; Rats; Systole
PubMed: 12969878
DOI: 10.1152/ajpheart.00513.2003 -
Journal of Hypertension. Supplement :... May 2006Brachial pulse pressure (PP) is now a well-established cardiovascular risk factor. Central rather than peripheral PP should be measured to determine the 'true'... (Review)
Review
Brachial pulse pressure (PP) is now a well-established cardiovascular risk factor. Central rather than peripheral PP should be measured to determine the 'true' haemodynamic effects of antihypertensive agents on target organs. Peripheral PP, measured at the brachial artery, does not reflect central PP (either carotid or ascending aorta), because their determinants are different and pathophysiological conditions and drugs may change central PP without changing peripheral PP. Central PP (i.e. carotid artery or ascending aorta) has shown an independent predictive value for all-cause mortality in patients with end-stage renal disease and in the hypertensive patients of the CAFE study. Antihypertensive treatment has repeatedly demonstrated its ability to prevent cardiovascular events. Whether the effect on cardiovascular events in clinical trials comparing two pharmacological classes or two therapeutic strategies is, at least partly, the result of differential effects on PP remains to be demonstrated. It is therefore of major importance to determine which therapeutic strategies may differentially lower central PP, and in turn reduce cardiovascular events. In clinical practice, lowering PP is often a difficult task, particularly in diabetic hypertensive individuals. In the PARADIS study, we aimed to determine, in a population of hypertensive patients with both type 2 diabetes and PP greater than 60 mmHg, which clinical characteristics predict the fall in PP on treatment and a reduction in cardiovascular events. The reinforcement of therapeutic measures, including a fixed low-dose perindopril/indapamide combination, made possible the effective lowering of PP and cardiovascular events in type 2 diabetic hypertensive patients, under conditions of usual care by general practitioners and specialists.
Topics: Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Blood Pressure; Cardiovascular Diseases; Clinical Trials as Topic; Diuretics; Drug Combinations; Humans; Hypertension; Indapamide; Perindopril
PubMed: 16723861
DOI: 10.1097/01.hjh.0000229464.09610.ff -
Atherosclerosis Sep 2012Obtaining pulse pressure non-invasively from applanation tonometry requires the calibration of pressure waveform with brachial systolic and diastolic blood pressure. In... (Comparative Study)
Comparative Study
Obtaining pulse pressure non-invasively from applanation tonometry requires the calibration of pressure waveform with brachial systolic and diastolic blood pressure. In the literature, several calibration methodologies are applied, and clinical studies disagree about the predictive value of central hemodynamic parameters. Our aim was to compare 4 calibration methodologies and assess the usefulness of pulse pressure amplification as an index independent of calibration. We investigated 108 subjects with tonometry in carotid, femoral, brachial, radial and dorsalis-pedis arteries; pulse pressure amplification between arterial waveforms was calculated. Four methods to calibrate the waveforms were compared: the 1/3 rule, the 40% rule, the integral of radial and brachial waveforms. Pulse pressure amplification in 5 arterial territories (carotid-femoral, carotid-brachial, carotid-radial and carotid-pedis amplifications; femoral-pedis amplification) was studied. Pulse pressure was successfully measured non-invasively at the 5 arterial sites. Pulse pressure was markedly dependent on calibration, with differences up to 18 mmHg between methods. Calculation of pulse pressure amplification eliminated effects of calibration method. Furthermore, pulse pressure amplifications in the 5 arterial sites presented a distinct pattern of clinical/biological determinants: heart rate and body height were common determinants of carotid to brachial, radial and femoral amplifications; diabetes was related to carotid to brachial amplification and pulse wave velocity to femoral to pedis amplification. In conclusion, the calibration of pulse pressure will influence results of clinical trials, but calculation of pulse pressure amplification can avoid this. We also suggest that the alteration of amplification in each arterial territory might be considered as a signal of clinical/subclinical damage.
Topics: Adult; Aged; Aged, 80 and over; Arteries; Blood Pressure; Blood Pressure Determination; Body Height; Brachial Artery; Calibration; Carotid Arteries; Female; Heart Rate; Humans; Male; Manometry; Middle Aged; Pulse Wave Analysis; Radial Artery
PubMed: 22832004
DOI: 10.1016/j.atherosclerosis.2012.06.055 -
Journal of Hypertension Sep 2000Drug treatment of hypertension reduces systolic and diastolic blood pressure according to a well-established dose-response curve. Whether there is a parallel decrease in... (Review)
Review
Drug treatment of hypertension reduces systolic and diastolic blood pressure according to a well-established dose-response curve. Whether there is a parallel decrease in mean blood pressure and pulse pressure has not been investigated in the past Recent analysis of the literature and personal work indicates that, during drug treatment of hypertension, a significant decrease in systolic and diastolic blood pressure may be associated with an unchanged pulse pressure, a situation that might contribute to maintaining cardiovascular risk.
Topics: Antihypertensive Agents; Blood Pressure; Diastole; Humans; Hypertension; Risk Factors; Systole; Treatment Failure
PubMed: 10994746
DOI: 10.1097/00004872-200018090-00001 -
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 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