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Hypertension (Dallas, Tex. : 1979) Oct 2014High pulse pressure, a major cardiovascular risk factor, has been attributed to medial elastic fiber degeneration and aortic dilation, which transfers hemodynamic load...
High pulse pressure, a major cardiovascular risk factor, has been attributed to medial elastic fiber degeneration and aortic dilation, which transfers hemodynamic load to stiffer collagen. However, recent studies suggest higher pulse pressure is instead associated with smaller aortic diameter. Thus, we sought to elucidate relations of pulse pressure with aortic stiffness and aortic and cardiac dimensions. We used magnetic resonance imaging to examine relationships of pulse pressure with lumen area and wall stiffness and thickness in the thoracic aorta and left ventricular structure in 526 participants (72-94 years of age, 295 women) in the community-based Age, Gene/Environment Susceptibility-Reykjavik Study. In a multivariable model that adjusted for age, sex, height, weight, and standard vascular risk factors, central pulse pressure had a negative relationship with aortic lumen area (all effects expressed as mm Hg/SD; B=-8.1±1.2; P<0.001) and positive relationships with left ventricular end-diastolic volume (B=3.8±1.0; P<0.001), carotid-femoral pulse wave velocity (B=3.6±1.0; P<0.001), and aortic wall area (B=3.0±1.2; P=0.015). Higher pulse pressure in older people is associated with smaller aortic lumen area and greater aortic wall stiffness and thickness and left ventricular volume. Relationships of larger ventricular volume and smaller aortic lumen with higher pulse pressure suggest mismatch in hemodynamic load accommodation by the heart and aorta in older people.
Topics: Age Factors; Aged; Aged, 80 and over; Aorta, Thoracic; Blood Pressure; Female; Gene-Environment Interaction; Heart; Heart Ventricles; Humans; Linear Models; Magnetic Resonance Imaging; Male; Multivariate Analysis; Myocardium; Stroke Volume; Vascular Stiffness
PubMed: 25024287
DOI: 10.1161/HYPERTENSIONAHA.114.03870 -
Physiological Reports Feb 2016During positive pressure ventilation, arterial pressure variations, like the pulse pressure variation (PPV), are observed in neonates. However, the frequency of the PPV... (Observational Study)
Observational Study
During positive pressure ventilation, arterial pressure variations, like the pulse pressure variation (PPV), are observed in neonates. However, the frequency of the PPV does not always correspond with the respiratory rate. It is hypothesized that PPV is caused by cardiopulmonary interaction, but that this mismatch is related to the low respiratory rate/heart rate ratio. Therefore, the goal of this study is to investigate the relation between PPV and ventilation in neonates. A prospective observational cross-sectional study was carried out in a third-level neonatal intensive care unit in a university hospital. Neonates on synchronized intermittent mandatory ventilation (SIMV) or high-frequency ventilation (HFV) participated in the study. The arterial blood pressure was continuously monitored in 20 neonates on SIMV and 10 neonates on HFV. In neonates on SIMV the CO2 waveform and neonates on HFV the thorax impedance waveform were continuously monitored and defined as the respiratory signal. Correlation and coherence between the respiratory signal and pulse pressure were determined. The correlation between the respiratory signal and pulse pressure was -0.64 ± 0.18 and 0.55 ± 0.16 and coherence at the respiratory frequency was 0.95 ± 0.11 and 0.76 ± 0.4 for SIMV and HFV, respectively. The arterial pressure variations observed in neonates on SIMV or HFV are related to cardiopulmonary interaction. Despite this relation, it is not likely that PPV will reliably predict fluid responsiveness in neonates due to physiological aliasing.
Topics: Blood Pressure; Cross-Sectional Studies; Female; High-Frequency Ventilation; Humans; Infant, Newborn; Infant, Premature; Intermittent Positive-Pressure Ventilation; Male; Prospective Studies
PubMed: 26908715
DOI: 10.14814/phy2.12716 -
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 -
American Journal of Hypertension Jun 2021Aneurysmal subarachnoid hemorrhage (SAH) continues to be associated with significant morbidity and mortality despite treatment advancements. Although high blood pressure...
BACKGROUND
Aneurysmal subarachnoid hemorrhage (SAH) continues to be associated with significant morbidity and mortality despite treatment advancements. Although high blood pressure (BP) remains a significant risk factor in aneurysmal SAH and rerupture, the role of BP parameters and fluctuation in prognostication remains unclear. We sought to define how BP parameters and variability within 24 hours of hospitalization in acute-onset SAH affects patient discharge outcomes.
METHODS
We retrospectively analyzed a prospectively collected cohort of SAH patients. Hourly BP parameters, including systolic BP (SBP), diastolic BP, pulse pressure (PP), and their corresponding variability (delineated by SD), were collected to investigate associations with the primary endpoint of discharge disposition.
RESULTS
One hundred and seventy-four SAH patients were included in the study. On bivariate analysis, Hunt-Hess (HH) score, Fisher grade, intraventricular hemorrhage, external ventricular drain placement, and SBP and PP variability were significantly associated with a poor disposition. Poor disposition was significantly associated with age, HH score, intraventricular hemorrhage, and PP variability on multivariate analysis. PP variability remained an independent predictor for poor disposition (odds ratio 1.11, 95% confidence interval, 1.02-1.21, P = 0.02) when adjusting for potential confounders.
CONCLUSIONS
Increased BP and PP variability within the first 24 hours of admission portends a poor discharge disposition for aneurysmal SAH patients.
Topics: Blood Pressure; Humans; Prospective Studies; Retrospective Studies; Subarachnoid Hemorrhage; Time Factors; Treatment Outcome
PubMed: 33537749
DOI: 10.1093/ajh/hpab008 -
Journal of Hypertension. Supplement :... Jun 1999Hypertension is a cardiovascular risk factor classically attributed to a reduction in the calibre and/or number of small arteries and arterioles resulting in increased... (Review)
Review
Hypertension is a cardiovascular risk factor classically attributed to a reduction in the calibre and/or number of small arteries and arterioles resulting in increased peripheral vascular resistance. The definition of blood pressure as a product of total peripheral resistance (TPR) and cardiac output, however, does not take into account the fluctuation of blood pressure and flow during the cardiac cycle, with systolic and diastolic blood pressure representing the extremes of pulse pressure fluctuations. Diastolic blood pressure is closer to mean blood pressure (and therefore to TPR) than systolic blood pressure, and as such has been used as a marker for the diagnosis of hypertension. However, this approach has no rational basis and was challenged by the Framingham Heart Study which demonstrated that systolic rather than diastolic blood pressure is a better risk marker for stroke and coronary artery disease in subjects aged 45 years and older. This view has subsequently been confirmed by several epidemiological and interventional studies. Systolic blood pressure is closely associated with pulse pressure and is determined by the pattern of left ventricular ejection, arterial stiffness and timing of arterial wave reflections, i.e. the geometrical and viscoelastic properties of large conduit arteries. In humans, with ageing and hypertension, the arteries stiffen as a result of progressive degeneration of the arterial media, increased collagen and calcium content, and dilation and hypertrophy of large arteries and the aorta. Thus, the increase in systolic blood pressure (as a result of arterial damage) increases the fatigue of arterial walls and accelerates arterial damage, producing a self-perpetuating cycle.
Topics: Blood Pressure; Heart; Humans; Hypertension; Myocardial Contraction; Pulse; Systole; Vascular Resistance
PubMed: 10465060
DOI: No ID Found -
European Journal of Anaesthesiology Nov 2022The NICCI system (Getinge, Gothenburg, Sweden) is a new noninvasive haemodynamic monitoring system using a finger sensor.
A new noninvasive finger sensor (NICCI system) for continuous blood pressure and pulse pressure variation monitoring: A method comparison study in patients having neurosurgery.
BACKGROUND
The NICCI system (Getinge, Gothenburg, Sweden) is a new noninvasive haemodynamic monitoring system using a finger sensor.
OBJECTIVES
We aimed to investigate the performance of the NICCI system to measure blood pressure and pulse pressure variation compared with intra-arterial measurements.
DESIGN
A prospective method comparison study.
SETTING
University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
PATIENTS
Forty-seven neurosurgery patients.
MAIN OUTCOME MEASURES
We performed a method comparison study in 47 neurosurgery patients to compare NICCI blood pressure measurements (BP NICCI ) with intra-arterial blood pressure measurements (BP ART ) (Bland-Altman analysis, four-quadrant plot, error grid analysis) and NICCI pulse pressure variation measurements (PPV NICCI ) with pulse pressure variation calculated manually from the intra-arterial blood pressure waveform (PPV ART ) (Bland-Altman analysis, predictive agreement, Cohen's kappa).
RESULTS
The mean of the differences ± standard deviation (95% limits of agreement) between BP NICCI and BP ART was 11 ± 10 mmHg (-8 to 30 mmHg) for mean blood pressure (MBP), 3 ± 12 mmHg (-21 to 26 mmHg) for systolic blood pressure (SBP) and 12 ± 10 mmHg (-8 to 31 mmHg) for diastolic blood pressure (DBP). In error grid analysis, 54% of BP NICCI and BP ART MBP measurement pairs were classified as 'no risk', 43% as 'low risk', 3% as 'moderate risk' and 0% as 'significant risk' or 'dangerous risk'. The mean of the differences between PPV NICCI and PPV ART was 1 ± 3% (-4 to 6%). The predictive agreement between PPV NICCI and PPV ART was 80% and Cohen's kappa was 0.55.
CONCLUSIONS
The absolute agreement between BP NICCI and BP ART was not clinically acceptable. We recommend not using the current version of the NICCI system for blood pressure monitoring during surgery. The absolute agreement between PPV NICCI and PPV ART was clinically acceptable with moderate predictive agreement regarding pulse pressure variation categories. The NICCI system needs to be further developed and re-evaluated when an improved version is available.
TRIAL REGISTRATION
The study was registered in the German Clinical Trials Register (DRKS00023188) on 2 October 2020.
Topics: Arterial Pressure; Blood Pressure; Blood Pressure Determination; Humans; Monitoring, Intraoperative; Neurosurgery
PubMed: 36155392
DOI: 10.1097/EJA.0000000000001754 -
Journal of the American Society of... Feb 2018The difference in pulse pressure (PP) between peripheral arteries and the aorta, called pulse pressure amplification (PPamp), is a well-described physiological... (Observational Study)
Observational Study
The difference in pulse pressure (PP) between peripheral arteries and the aorta, called pulse pressure amplification (PPamp), is a well-described physiological phenomenon independently associated with cardiovascular events. Recent studies suggest that it exhibits circadian variability. Our aim was to detect the factors associated with the circadian variability of PPamp. In 497 consecutive subjects (aged 54 years, 56.7% male, 79.7% hypertensives), we assessed the circadian pattern of peripheral and central arterial hemodynamics by 24-hour evaluation of brachial and aortic blood pressure (BP), augmentation index (AI), and pulse wave velocity (PWV) using a validated oscillometric device (Mobil-O-Graph). All parameters exhibited a circadian variation. Sleep dipping (decrease) pattern was observed for PPamp, brachial and aortic systolic BP, mean BP, and PWV, whereas a rising pattern (higher sleep than wake values) was observed for brachial PP, aortic PP, and AI. The factors independently associated with the less sleep dipping in PPamp were older age, lower height, the use of antihypertensive medication, and sleep decrease in arterial stiffness (PWV), whereas female gender, the presence of hypertension, sleep increase of pressure wave reflections (AI), sleep decrease in heart rate, and mean BP were associated with a greater sleep-dipping in PPamp. These data provide further pathophysiological understanding of the mechanisms leading to PPamp dipping. Several implications regarding the clinical use of the aortic and brachial BP, especially during sleep time, are raised that should be addressed in future research.
Topics: Adult; Aged; Antihypertensive Agents; Aorta; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Brachial Artery; Circadian Rhythm; Female; Heart Rate; Humans; Hypertension; Male; Middle Aged; Pulse Wave Analysis; Sex Factors; Sleep; Vascular Stiffness
PubMed: 29287945
DOI: 10.1016/j.jash.2017.12.005 -
The Journal of Invasive Cardiology Nov 2017Although the terms ventricularization and damping are commonly used in the cath lab and are widely recognized as indicating possible flow limitation due to catheter... (Review)
Review
Although the terms ventricularization and damping are commonly used in the cath lab and are widely recognized as indicating possible flow limitation due to catheter position, their hemodynamic origins and mechanism have not been well studied. Often, they are thought to be synonymous terms. Both patterns are due to distortion of the normal harmonic frequencies of wave conduction. Pressure damping is seen when the outer diameter of the catheter is larger than the ostial diameter or when the tip of the catheter is pressed against the vessel wall. It is characterized by an abrupt decline of mean coronary pressure with narrow pulse pressure and delayed upstroke and downstroke. Conversely, ventricularization is seen when the catheter tip is advanced into an ostial stenosis, partially obstructing flow, and is characterized by a steep decline of pressure in diastole with large pulse pressure, absence of the dicrotic notch, and appearance of presystolic positive deflection. A ventricularized pressure waveform can be considered a hybrid between coronary arterial pressure and coronary wedge pressure.
Topics: Blood Pressure; Cardiac Catheterization; Coronary Circulation; Coronary Vessels; Humans
PubMed: 29086728
DOI: No ID Found -
Critical Care (London, England) Sep 2020Veno-arterial extracorporeal life support (VA-ECLS) results in cardiopulmonary shunting with reduced native cardiac output (NCO). Low NCO occurrence is common and... (Observational Study)
Observational Study
BACKGROUND
Veno-arterial extracorporeal life support (VA-ECLS) results in cardiopulmonary shunting with reduced native cardiac output (NCO). Low NCO occurrence is common and associated with risk of thromboembolic and pulmonary complications. Practical tools for monitoring NCO during VA-ECLS would therefore be valuable. Pulse pressure (PP) and end-tidal carbon dioxide (EtCO) are known to be related to cardiac output. We have designed a study to test whether PP and EtCO were efficient for the monitoring of NCO during VA-ECLS.
METHODS
In this prospective single-center observational study, patients who underwent a VA-ECLS for cardiogenic shock from January 2016 to October 2017 were included, provided low NCO was suspected by a PP < 20 mmHg. NCO was measured with pulmonary artery catheter or echocardiography and compared to PP and EtCO. The ability of PP and EtCO to predict NCO < 1 L/min was evaluated with receiver operating characteristics (ROC) curves.
RESULTS
Among the 106 patients treated with VA-ECLS for cardiogenic shock during the study period, 26 were studied, allowing the collection of 196 study points. PP and EtCO relationships with NCO were nonlinear and showed strong correlations for NCO < 2 L/min (r = 0.69 and r = 0.78 respectively). A PP < 15 mmHg and EtCO < 14 mmHg had good predictive values for detecting NCO < 1 L/min (area under ROC curve 0.93 [95% CI 0.89-0.96] and 0.97 [95% CI 0.94-0.99] respectively, p = 0.058).
CONCLUSIONS
PP and EtCO may offer an accurate real-time monitoring of low NCO events during VA-ECLS support. Further studies are needed to show if their utilization may help to implement therapeutic strategies in order to prevent thromboembolic and respiratory complications associated with VA-ECLS, and to improve patients' prognosis.
TRIAL REGISTRATION
NCT03323268 , July 12, 2016.
Topics: Aged; Blood Pressure; Carbon Dioxide; Cardiac Output; Extracorporeal Membrane Oxygenation; Female; Humans; Male; Middle Aged; Prognosis; Prospective Studies; Tidal Volume
PubMed: 32962727
DOI: 10.1186/s13054-020-03280-z -
Current Hypertension Reviews 2021The relationship between the increases in pulse pressure (PP) and arterial stiffness determined by aging or systemic hypertension has been widely reported. These...
BACKGROUND
The relationship between the increases in pulse pressure (PP) and arterial stiffness determined by aging or systemic hypertension has been widely reported. These findings are supported by large-cohort analyzes conducted in well-known populations, such as Framingham Study. However, there is evidence that an age-PP curvilinear relationship may exist in hypertensive subjects. This study aimed to evaluate the age-related change in pulse pressure and arterial stiffness in a population-based study.
METHODS
Carotid-femoral Pulse Wave Velocity (cfPWV) were obtained in 2075 subjects.
RESULTS
Age-related changes of PP showed a curvilinear relationship (R=0.39, p<0.0001) in normotensive subjects, with a nadir at around 50 years of age. On the other hand, the age-cfPWV relationship showed a linear and positive correlation (R=0.72, p<0.0001). PP also showed a curvilinear relationship with age (R=0.36, p<0.0001) in hypertensive subjects, with a nadir around 50 years of age. The age-cfPWV relationship showed a linear and positive correlation (R=0.55, p<0.0001). Similar results were observed in the adult population (age≥16 years). Multivariate analysis showed that age, sex, cfPWV, and mean arterial pressure are determinants of PP values in the entire population; however, this result was not uniform when different subgroups were analyzed.
CONCLUSION
In conclusion, age-related changes in PP showed a curvilinear relationship and no parallelism with the age-cfPWV relationship for both normotensive and hypertensive subjects. The determinants of PP impact it differently depending on age and the pathological condition of the subject.
Topics: Adult; Arterial Pressure; Blood Pressure; Humans; Hypertension; Middle Aged; Pulse Wave Analysis; Vascular Stiffness
PubMed: 33305707
DOI: 10.2174/1573402116999201210195123