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Critical Care (London, England) Mar 2017This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2017. Other selected articles can be found online at... (Review)
Review
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2017. Other selected articles can be found online at http://ccforum.com/series/annualupdate2017 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901 .
Topics: Blood Pressure; Critical Care; Hemodynamics; Humans; Respiration, Artificial; Tidal Volume
PubMed: 28320434
DOI: 10.1186/s13054-017-1637-x -
Mayo Clinic Proceedings May 2010The arterial pulse has historically been an essential source of information in the clinical assessment of health. With current sphygmomanometric and oscillometric... (Review)
Review
The arterial pulse has historically been an essential source of information in the clinical assessment of health. With current sphygmomanometric and oscillometric devices, only the peak and trough of the peripheral arterial pulse waveform are clinically used. Several limitations exist with peripheral blood pressure. First, central aortic pressure is a better predictor of cardiovascular outcome than peripheral pressure. Second, peripherally obtained blood pressure does not accurately reflect central pressure because of pressure amplification. Lastly, antihypertensive medications have differing effects on central pressures despite similar reductions in brachial blood pressure. Applanation tonometry can overcome the limitations of peripheral pressure by determining the shape of the aortic waveform from the radial artery. Waveform analysis not only indicates central systolic and diastolic pressure but also determines the influence of pulse wave reflection on the central pressure waveform. It can serve as a useful adjunct to brachial blood pressure measurements in initiating and monitoring hypertensive treatment, in observing the hemodynamic effects of atherosclerotic risk factors, and in predicting cardiovascular outcomes and events. Radial artery applanation tonometry is a noninvasive, reproducible, and affordable technology that can be used in conjunction with peripherally obtained blood pressure to guide patient management. Keywords for the PubMed search were applanation tonometry, radial artery, central pressure, cardiovascular risk, blood pressure, and arterial pulse. Articles published from January 1, 1995, to July 1, 2009, were included in the review if they measured central pressure using radial artery applanation tonometry.
Topics: Antihypertensive Agents; Arteries; Blood Flow Velocity; Blood Pressure; Blood Pressure Determination; Cardiovascular Diseases; Humans; Hypertension; Manometry; Radial Artery; Risk Factors; Veins
PubMed: 20435839
DOI: 10.4065/mcp.2009.0336 -
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 Clinical Hypertension... Nov 2022Blood pressure and pulse pressure (PP) had their own characteristics in the elderly population. This cross-sectional study including 5030 elderly participants was...
Blood pressure and pulse pressure (PP) had their own characteristics in the elderly population. This cross-sectional study including 5030 elderly participants was conducted to describe the distribution of blood pressure and wide PP in the elderly population and find influencing factors of wide PP. Wide PP was defined as PP equal to or more than 65 mmHg, and was classified three types as low systolic blood pressure (SBP) and low diastolic blood pressure (DBP) (LSLD), high SBP and low DBP (HSLD), and high SBP and high DBP (HSHD). Using multivariate logistic regression models to analyze the associations of demographic factors, health-related factors and lifestyle factors with different wide PP types. The associations of lifestyles with wide PP by gender were estimated by subgroup analyses. Among 5030 elderly participants, 2727 (54.2%) participants had wide PP. Logistic regression models showed older age (OR = 2.48, 95%CI: 2.14-2.88), female (OR = 1.31, 95%CI: 1.07-1.60), not married (OR = 1.26, 95%CI: 1.07-1.49), having chronic diseases (OR = 1.28, 95%CI: 1.09-1.50), current alcohol drinker (OR = 1.29, 95%CI: 1.11-1.50) were positively associated, and higher body height (OR = .78, 95%CI: .62-.99), higher education level (OR = .60, 95%CI: .43-.82), current smoker (OR = .79, 95%CI: .64-.97) were negatively associated with wide PP. Among three different types of wide PP including LSLD, HSLD, HSHD, these factors had different effects. Subgroup analyses found that only among male, current smoker was negatively associated and current alcohol drinker was positively associated with wide PP.
Topics: Male; Female; Aged; Humans; Blood Pressure; Cross-Sectional Studies; Hypertension; Asian People; Hypotension; China; Risk Factors
PubMed: 36259250
DOI: 10.1111/jch.14582 -
The American Journal of Medicine Jun 2019The efficacy and tolerability of intensive blood-pressure lowering may vary by pulse pressure (systolic minus diastolic blood pressure). (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The efficacy and tolerability of intensive blood-pressure lowering may vary by pulse pressure (systolic minus diastolic blood pressure).
METHODS
SPRINT randomized 9361 high-risk adults without diabetes and who were ≥50 years with systolic blood pressure 130-180 mm Hg to intensive or standard antihypertensive treatment. The primary efficacy end point was the composite of acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. The primary safety end point was composite serious adverse events. We examined the prognostic implications of baseline pulse pressure and the effects of intensive blood-pressure lowering on clinical outcomes across the spectrum of pulse-pressure values using restricted cubic splines.
RESULTS
Mean baseline pulse pressure was similar between the 2 study groups (intensive treatment 61±14 mm Hg vs standard treatment 62±14 mm Hg; P = 0.59). Except stroke, for which the association with pulse pressure was best defined as linear, pulse pressure displayed a nonlinear U-shaped relationship with the risk of all tested clinical end points (P <0.05), though no association remained significant upon multivariable adjustment (P >0.05). The benefit of intensive blood-pressure management on mortality appeared greatest in patients with a pulse pressure ∼60 mm Hg (P = 0.03 for interaction). Pulse pressure did not modify the effect of intensive blood-pressure lowering for other clinical end points (P >0.05 for interaction).
CONCLUSION
In a large randomized clinical trial of patients with a high risk of cardiovascular events, risks and benefits of intensive blood-pressure lowering did not appear to be modified by baseline pulse pressure. Selection of appropriate candidates for intensive blood-pressure lowering should not be limited by this parameter.
Topics: Aged; Aged, 80 and over; Antihypertensive Agents; Blood Pressure; Female; Humans; Hypertension; Male; Middle Aged
PubMed: 30659811
DOI: 10.1016/j.amjmed.2019.01.001 -
The Korean Journal of Internal Medicine Jul 2021Maintaining a mean arterial pressure (MAP) ≥ 65 mmHg during septic shock should be based on individual circumstances, but specific target is poorly understood. We...
BACKGROUND/AIMS
Maintaining a mean arterial pressure (MAP) ≥ 65 mmHg during septic shock should be based on individual circumstances, but specific target is poorly understood. We investigated associations between time-weighted average (TWA) hemodynamic parameters during the initial resuscitative period and 28-day mortality.
METHODS
Prospectively collected data were obtained from a septic shock patient registry, according to the Sepsis-3 definition, between 2016 and 2018. The TWA systolic blood pressure, diastolic blood pressure, MAP, shock index, and pulse pressure (PP) during the first 6 hours after shock recognition were compared. Multivariable regression analysis was performed to assess associations between these parameters and 28-day mortality.
RESULTS
Of 340 patients with septic shock, 92 died. Only the median TWA PP differed between the survivors and non-survivors (39.2 mmHg vs. 43.0 mmHg, p = 0.020), whereas the other indexes did not. When PP was divided into quartiles (< 34, 34 to 40, 40 to 48, and > 48 mmHg), the mortality rate was higher in the highest quartile (41.2%). Multivariable logistic analysis revealed that PP (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.012 to 1.622; p = 0.039) and PP of > 48 mmHg (OR, 2.25; 95% CI, 1.272 to 3.981; p = 0.005) were independently associated with 28-day mortality.
CONCLUSION
PP was significantly associated with 28-day mortality in patients with septic shock and MAP maintained at > 65 mmHg during the first 6 hours. Further studies are warranted to optimize strategies for maintaining PP and MAP at > 65 mmHg during the early resuscitative period.
Topics: Arterial Pressure; Blood Pressure; Fluid Therapy; Humans; Resuscitation; Shock, Septic
PubMed: 32811131
DOI: 10.3904/kjim.2020.056 -
Journal of Hypertension Jun 2022
Topics: Arterial Pressure; Blood Pressure; Exercise; Humans; Pulse
PubMed: 35703889
DOI: 10.1097/HJH.0000000000003126 -
Expert Review of Neurotherapeutics Feb 2008
Topics: Blood Pressure; Humans; Predictive Value of Tests; Risk Factors; Stroke
PubMed: 18271702
DOI: 10.1586/14737175.8.2.165 -
Japan Journal of Nursing Science : JJNS Apr 2023Although systolic and diastolic blood pressures as well as blood glucose are monitored when nurses care for patients with type 2 diabetes, the same is not true for pulse... (Observational Study)
Observational Study
AIM
Although systolic and diastolic blood pressures as well as blood glucose are monitored when nurses care for patients with type 2 diabetes, the same is not true for pulse pressure. We aimed to determine the association between pulse pressure and all-cause mortality.
METHODS
We conducted a longitudinal study of outpatients with type 2 diabetes aged 65 years and older at diabetes-specialized hospitals in Japan from September 2004 to December 2016. Descriptive data, blood pressure measurements, blood analysis data, and information on life and death were obtained from medical records. Cox proportional hazards models were used to estimate the relative risks with 95% confidence intervals for all-cause mortality.
RESULTS
We analyzed 357 of the 383 recruited patients (mean age, 74.9 years; 175 men and 182 women; average follow-up, 7.7 years), and 50 patients died. After adjusting for covariates, the relative risks for pulse pressures of 55 to <65, 65 to <75, and ≥75 mmHg (reference: <55 mmHg) were 1.77 (95% confidence interval: [0.59, 5.28]), 2.66 (95% confidence interval: [0.93, 7.56]), and 3.23 (95% confidence interval: [1.16, 8.99]), respectively. The relative risk for the 65 mmHg or higher group (reference: <65 mmHg) was 2.08 (95% confidence interval: [1.11, 3.92]). Neither systolic blood pressure nor diastolic blood pressure alone were significantly associated with mortality.
CONCLUSIONS
In older patients with type 2 diabetes, a wide pulse pressure was associated with a higher risk of all-cause mortality. Nurses caring for older people with diabetes should also monitor pulse pressure.
Topics: Male; Humans; Female; Aged; Blood Pressure; Diabetes Mellitus, Type 2; Longitudinal Studies; East Asian People; Cohort Studies; Proportional Hazards Models; Hypertension; Risk Factors
PubMed: 36254581
DOI: 10.1111/jjns.12517 -
Journal of Clinical Monitoring and... Apr 2022The finger-cuff system CNAP (CNSystems Medizintechnik, Graz, Austria) allows non-invasive automated measurement of pulse pressure variation (PPV). We sought to validate...
The finger-cuff system CNAP (CNSystems Medizintechnik, Graz, Austria) allows non-invasive automated measurement of pulse pressure variation (PPV). We sought to validate the PPV-algorithm and investigate the agreement between PPV and arterial catheter-derived manually calculated pulse pressure variation (PPV). This was a prospective method comparison study in patients having neurosurgery. PPV was the reference method. We applied the PPV-algorithm to arterial catheter-derived blood pressure waveforms (PPV) and to CNAP finger-cuff-derived blood pressure waveforms (PPV). To validate the PPV-algorithm, we compared PPV to PPV. To investigate the clinical performance of PPV, we compared PPV to PPV. We used Bland-Altman analysis (absolute agreement), Deming regression, concordance, and Cohen's kappa (predictive agreement for three pulse pressure variation categories). We analyzed 360 measurements from 36 patients. The mean of the differences between PPV and PPV was -0.1% (95% limits of agreement (95%-LoA) -2.5 to 2.3%). Deming regression showed a slope of 0.99 (95% confidence interval (95%-CI) 0.91 to 1.06) and intercept of -0.02 (95%-CI -0.52 to 0.47). The predictive agreement between PPV and PPV was 92% and Cohen's kappa was 0.79. The mean of the differences between PPV and PPV was -1.0% (95%-LoA-6.3 to 4.3%). Deming regression showed a slope of 0.85 (95%-CI 0.78 to 0.91) and intercept of 0.10 (95%-CI -0.34 to 0.55). The predictive agreement between PPV and PPV was 82% and Cohen's kappa was 0.48. The PPV-algorithm reliably calculates pulse pressure variation compared to manual offline pulse pressure variation calculation when applied on the same arterial blood pressure waveform. The absolute and predictive agreement between PPV and PPV are moderate.
Topics: Arterial Pressure; Blood Pressure; Blood Pressure Determination; Humans; Neurosurgery; Prospective Studies
PubMed: 33630220
DOI: 10.1007/s10877-021-00669-1