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Hypertension (Dallas, Tex. : 1979) Jun 2013Pulse pressure has been recognized as a risk factor for stroke. Moreover, it was shown that central pulse pressure relates more strongly to vascular disease and outcome... (Comparative Study)
Comparative Study
Pulse pressure has been recognized as a risk factor for stroke. Moreover, it was shown that central pulse pressure relates more strongly to vascular disease and outcome than (peripheral) brachial pulse pressure. Because vascular remodeling in the retinal circulation mirrors the 1 in the cerebral circulation and represents an easy, noninvasive possibility to assess microvascular changes in humans, we analyzed the impact of central pulse pressure on retinal vascular structure in humans. The study cohort comprised 135 nondiabetic patients across a wide range of blood pressure values. Parameter of retinal arteriolar remodeling (wall-to-lumen ratio) was assessed noninvasively and in vivo by scanning laser Doppler flowmetry. Central pulse pressure and augmentation index normalized to a heart rate of 75 beats per minute were assessed by pulse wave analysis. Central pulse pressure correlated with wall-to-lumen ratio (r=0.302; P<0.001), central augmentation index normalized to a heart rate of 75 beats per minute correlated with wall-to-lumen ratio (r=0.190; P=0.028), and in accordance pulse pressure amplification (peripheral pulse pressure/central pulse pressure) was negatively correlated with wall-to-lumen ratio (r=-0.223; P=0.009). In contrast, central mean arterial pressure was not correlated with wall-to-lumen ratio (r=0.110; P=0.203). Multiple regression analysis revealed an independent relationship between wall-to-lumen ratio and central pulse pressure (β=0.277; P=0.009), but not with other classical cardiovascular risk factors. Thus, central pulse pressure, indicative of changes in large conduit arteries is an independent determinant of vascular remodeling in small retinal arterioles. Such a relationship indicates a coupling and crosstalk between the microvascular and macrovascular changes attributable to hypertension.
Topics: Adolescent; Adult; Aged; Blood Pressure; Disease Progression; Female; Follow-Up Studies; Humans; Hypertension; Laser-Doppler Flowmetry; Male; Microcirculation; Middle Aged; Prognosis; Regional Blood Flow; Retinal Vessels; Risk Factors; Vascular Resistance; Young Adult
PubMed: 23569083
DOI: 10.1161/HYPERTENSIONAHA.111.00617 -
Annals of Internal Medicine Jan 2003Although hypertension is a principal precursor of congestive heart failure (CHF), the separate relations of systolic, diastolic, and pulse pressure with risk for heart...
BACKGROUND
Although hypertension is a principal precursor of congestive heart failure (CHF), the separate relations of systolic, diastolic, and pulse pressure with risk for heart failure have not been fully elucidated.
OBJECTIVE
To examine the value of blood pressure predictors of heart failure.
DESIGN
Community-based inception cohort study.
SETTING
Framingham, Massachusetts.
PATIENTS
2040 free-living Framingham Heart Study participants (mean age, 61 years [range, 50 to 79 years]).
MEASUREMENTS
The association of baseline systolic, diastolic, and pulse pressure with risk for incident CHF was examined in 894 men and 1146 women. Framingham Heart Study participants free of CHF at the baseline examination (performed from 1968 to 1973) were monitored for up to 24 years (mean, 17.4 years) for new-onset heart failure. Cox proportional hazards models were used to adjust for age, sex, smoking, left ventricular hypertrophy, body mass index, diabetes mellitus, high-density lipoprotein cholesterol level, and heart rate; hazard ratios and 95% CIs for blood pressure variables were estimated.
RESULTS
CHF developed in 234 participants (11.8%) during the follow-up period. All three blood pressure components were related to the risk for CHF, but the relation was strongest for systolic and pulse pressure. A 1-SD (20 mm Hg) increment in systolic pressure conferred a 56% increased risk for CHF (hazard ratio, 1.56 [95% CI, 1.37 to 1.77]); similarly, a 1-SD (16 mm Hg) increment in pulse pressure conferred a 55% increased risk for CHF (hazard ratio, 1.55 [CI, 1.37 to 1.75]). These associations were unrelated to age, duration of follow-up, and initiation of treatment for hypertension during follow-up; they were also observed in patients with systolic hypertension (systolic blood pressure > or = 140 mm Hg) at the baseline examination (hazard ratio, 1.41 [CI, 1.18 to 1.69] for pulse pressure and 1.42 [CI, 1.14 to 1.76] for systolic pressure).
CONCLUSIONS
Although each component of blood pressure was associated with risk for CHF, pulse and systolic pressure conferred greater risk than diastolic pressure. Increased pulse pressure may help identify hypertensive patients at high risk for overt CHF who are candidates for aggressive blood pressure control.
Topics: Aged; Blood Pressure; Diastole; Female; Follow-Up Studies; Heart Failure; Humans; Incidence; Male; Middle Aged; Proportional Hazards Models; Pulse; Risk Factors; Systole
PubMed: 12513039
DOI: 10.7326/0003-4819-138-1-200301070-00006 -
Jornal de Pediatria 2022In this study, the authors aimed to evaluate the effectiveness of the vena cava distensibility index and pulse pressure variation as dynamic parameters for estimating...
OBJECTIVE
In this study, the authors aimed to evaluate the effectiveness of the vena cava distensibility index and pulse pressure variation as dynamic parameters for estimating intravascular volume in critically ill children.
METHODS
Patients aged 1 month to 18 years, who were hospitalized in the present study's pediatric intensive care unit, were included in the study. The patients were divided into two groups according to central venous pressure: hypovolemic (< 8 mmHg) and non-hypovolemic (central venous pressure ≥ 8 mmHg) groups. In both groups, vena cava distensibility index was measured using bedside ultrasound and pulse pressure variation. Measurements were recorded and evaluated under arterial monitoring.
RESULTS
In total, 19 (47.5%) of the 40 subjects included in the study were assigned to the central venous pressure ≥ 8 mmHg group, and 21 (52.5%) to the central venous pressure < 8 mmHg group. A moderate positive correlation was found between pulse pressure variation and vena cava distensibility index (r = 0.475, p < 0.01), while there were strong negative correlations of central venous pressure with pulse pressure variation and vena cava distensibility index (r = -0.628, p < 0.001 and r = -0.760, p < 0.001, respectively). In terms of predicting hypovolemia, the predictive power for vena cava distensibility index was > 16% (sensitivity, 90.5%; specificity, 94.7%) and that for pulse pressure variation was > 14% (sensitivity, 71.4%; specificity, 89.5%).
CONCLUSION
Vena cava distensibility index has higher sensitivity and specificity than pulse pressure variation for estimating intravascular volume, along with the advantage of non-invasive bedside application.
Topics: Blood Pressure; Central Venous Pressure; Child; Critical Illness; Humans; Ultrasonography; Vena Cava, Inferior
PubMed: 34052225
DOI: 10.1016/j.jped.2021.04.005 -
Journal of Hypertension Jun 2022
Topics: Arterial Pressure; Blood Pressure; Exercise; Humans
PubMed: 35703890
DOI: 10.1097/HJH.0000000000003152 -
The American Journal of Cardiology Jun 2001
Topics: Antihypertensive Agents; Blood Pressure; Cardiovascular Diseases; Cause of Death; Diastole; Humans; Hypertension; Pulse; Risk Factors; Systole; Treatment Outcome
PubMed: 11377354
DOI: 10.1016/s0002-9149(01)01519-3 -
Blood Pressure Dec 2024Carotid-femoral pulse wave velocity (cfPWV) and central pulse pressure (PP) are recognised as significant indicators of vascular health and predictors of cardiovascular...
BACKGROUND
Carotid-femoral pulse wave velocity (cfPWV) and central pulse pressure (PP) are recognised as significant indicators of vascular health and predictors of cardiovascular outcomes. In this study, associations between central hemodynamics and left ventricular (LV) echocardiographic parameters were investigated in subjects with heart failure with reduced ejection fraction (HFrEF), comparing the results to healthy individuals.
METHODS AND RESULTS
This cross-sectional prospective controlled study included 50 subjects with HFrEF [mean LV ejection fraction (EF) 26 ± 6.5%] and 30 healthy controls (mean LVEF 65.9 ± 5.3%). Pulse wave analysis (PWA) and carotid-femoral pulse wave velocity (cfPWV) were used to measure central hemodynamics and arterial stiffness. The HFrEF group displayed higher cfPWV (8.2 vs. 7.2 m/s, = 0.007) and lower central (111.3 vs. 121.7 mmHg, = 0.001) and peripheral (120.1 vs. 131.5 mmHg, = 0.002) systolic blood pressure. Central pulse pressure (PP) was comparable between the two groups (37.6 vs. 40.4 mmHg, = 0.169). In the HFrEF group, cfPWV significantly correlated with left ventricular end-diastolic volume (LVEDV) index (mL/m) and LVEF, with LVEDV index being a significant independent predictor of cfPWV (R = 0.42, = 0.003). Central PP was significantly associated with heart rate, LVEF and LVEDV index, with the latter being a significant independent predictor of central PP (R = 0.41, < 0.001). These correlations were not observed in healthy controls.
CONCLUSIONS
Significant associations between central hemodynamic measures and LV echocardiographic parameters were identified, suggesting the potential to use PWA and cfPWV as possible tools for managing HFrEF.
Topics: Humans; Heart Failure; Male; Female; Cross-Sectional Studies; Middle Aged; Pulse Wave Analysis; Blood Pressure; Stroke Volume; Prospective Studies; Vascular Stiffness; Aged; Echocardiography
PubMed: 38819846
DOI: 10.1080/08037051.2024.2359932 -
Age and Ageing Nov 2021Blood pressure measurement with a cuff in patients with stiff arteries can be misleading, with false elevation of the diastolic pressure. Coronary flow, and most of the...
Blood pressure measurement with a cuff in patients with stiff arteries can be misleading, with false elevation of the diastolic pressure. Coronary flow, and most of the cerebral blood flow occur during diastole. There is a marked diastolic J curve in patients with diastolic pressure <60 mmHg and pulse pressure >60 mmHg. Aiming for a systolic target of 120 mmHg is not safe in some frail older patients.
Topics: Aged; Blood Pressure; Blood Pressure Determination; Diastole; Frail Elderly; Humans; Hypotension; Systole
PubMed: 32520996
DOI: 10.1093/ageing/afaa084 -
Pulse Pressure Response to Inotrope Therapy in Cardiogenic Shock: A Subanalysis of the DOREMI Trial.JACC. Heart Failure Jun 2024
Topics: Humans; Shock, Cardiogenic; Blood Pressure; Cardiotonic Agents; Male; Female
PubMed: 38839155
DOI: 10.1016/j.jchf.2024.03.013 -
American Journal of Physiology.... Sep 2016Aortic pulse pressure arises from the interaction of the heart, the systemic arterial system, and peripheral microcirculations. The complex interaction between...
Aortic pulse pressure arises from the interaction of the heart, the systemic arterial system, and peripheral microcirculations. The complex interaction between hemodynamics and arterial remodeling precludes the ability to experimentally ascribe changes in aortic pulse pressure to particular adaptive responses. Therefore, the purpose of the present work was to use a human systemic arterial system model to test the hypothesis that pulse pressure homeostasis can emerge from physiological adaptation of systemic arteries to local mechanical stresses. First, we assumed a systemic arterial system that had a realistic topology consisting of 121 arterial segments. Then the relationships of pulsatile blood pressures and flows in arterial segments were characterized by standard pulse transmission equations. Finally, each arterial segment was assumed to remodel to local stresses following three simple rules: 1) increases in endothelial shear stress increases radius, 2) increases in wall circumferential stress increases wall thickness, and 3) increases in wall circumferential stress decreases wall stiffness. Simulation of adaptation by iteratively calculating pulsatile hemodynamics, mechanical stresses, and vascular remodeling led to a general behavior in response to mechanical perturbations: initial increases in pulse pressure led to increased arterial compliances, and decreases in pulse pressure led to decreased compliances. Consequently, vascular adaptation returned pulse pressures back toward baseline conditions. This behavior manifested when modeling physiological adaptive responses to changes in cardiac output, changes in peripheral resistances, and changes in local arterial radii. The present work, thus, revealed that pulse pressure homeostasis emerges from physiological adaptation of systemic arteries to local mechanical stresses.
Topics: Adaptation, Physiological; Arterial Pressure; Arteries; Blood Flow Velocity; Blood Pressure; Computer Simulation; Homeostasis; Humans; Mechanotransduction, Cellular; Models, Cardiovascular; Pulsatile Flow; Stress, Mechanical; Vascular Resistance; Vascular Stiffness
PubMed: 27306830
DOI: 10.1152/ajpregu.00402.2015 -
International Journal of Cardiology Aug 2014
Topics: Adult; Aged; Blood Flow Velocity; Blood Pressure; Cardiovascular Diseases; Female; Humans; Male; Middle Aged; Risk Factors; Vascular Stiffness; Vasodilation
PubMed: 24953869
DOI: 10.1016/j.ijcard.2014.06.002