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Annals of Medicine Dec 2022Whether the association between pulse pressure (PP) and mortality varies with systolic blood pressure (SBP) in ischaemic heart failure (HF) with left ventricular...
BACKGROUND
Whether the association between pulse pressure (PP) and mortality varies with systolic blood pressure (SBP) in ischaemic heart failure (HF) with left ventricular systolic dysfunction (LVSD) is unknown.
OBJECTIVE
To evaluate the association between PP and all-cause mortality in ischaemic HF patients with SBP status at admission.
PATIENTS AND METHODS
This prospective cohort study included 1581 ischaemic HF patients with LVSD. A total of 23.3% ( = 368) and 22.2% ( = 351) of the participants had SBP <110 mmHg and SBP >140 mmHg, respectively, with more than 80% of participants being male. Restricted cubic spline was performed to determine whether a nonlinear relationship existed between PP and all-cause mortality risk. A multivariable Cox proportional hazards model was used to assess the association between PP and all-cause mortality.
RESULTS
After a median of follow-up of 3.0 years, 257 events (16.4%) were observed in the cohort. There was a J-shaped relationship between PP and all-cause mortality (P value for nonlinearity = 0.020), with a risk nadir of approximately 46-49 mmHg. All-cause mortality risk varied with SBP status. Higher PP was associated with worse prognosis when the SBP was ≥110 mmHg, whereas the relationship did not reach statistical significance when the SBP was <110 mmHg.
CONCLUSION
A J-shaped relationship between PP and all-cause mortality was observed in ischaemic HF patients with LVSD, and higher PP was associated with worse prognosis only in those with SBP ≥110 mmHg. Further studies are needed to corroborate these findings.KEY MESSAGESA J-shaped relationship between pulse pressure and all-cause mortality was observed in ischaemic heart failure patients with left ventricular systolic dysfunction, with a risk nadir of approximately 46-49 mmHg.All-cause mortality risk varied with systolic blood pressure status, and higher pulse pressure was associated with worse prognosis when systolic blood pressure was above 110 mmHg.
Topics: Blood Pressure; Cohort Studies; Female; Heart Failure; Humans; Hypertension; Male; Prognosis; Proportional Hazards Models; Prospective Studies; Ventricular Dysfunction, Left
PubMed: 36223284
DOI: 10.1080/07853890.2022.2128208 -
Journal of the American College of... Mar 2020
Topics: Arteries; Blood Pressure; Female; Humans; Male; Sex Characteristics; Vascular Stiffness
PubMed: 32130923
DOI: 10.1016/j.jacc.2019.12.041 -
Critical Care (London, England) Nov 2023Pulse pressure and stroke volume variation (PPV and SVV) have been widely used in surgical patients as predictors of fluid challenge (FC) response. Several factors may... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pulse pressure and stroke volume variation (PPV and SVV) have been widely used in surgical patients as predictors of fluid challenge (FC) response. Several factors may affect the reliability of these indices in predicting fluid responsiveness, such as the position of the patient, the use of laparoscopy and the opening of the abdomen or the chest, combined FC characteristics, the tidal volume (Vt) and the type of anesthesia.
METHODS
Systematic review and metanalysis of PPV and SVV use in surgical adult patients. The QUADAS-2 scale was used to assess the risk of bias of included studies. We adopted a metanalysis pooling of aggregate data from 5 subgroups of studies with random effects models using the common-effect inverse variance model. The area under the curve (AUC) of pooled receiving operating characteristics (ROC) curves was reported. A metaregression was performed using FC type, volume, and rate as independent variables.
RESULTS
We selected 59 studies enrolling 2,947 patients, with a median of fluid responders of 55% (46-63). The pooled AUC for the PPV was 0.77 (0.73-0.80), with a mean threshold of 10.8 (10.6-11.0). The pooled AUC for the SVV was 0.76 (0.72-0.80), with a mean threshold of 12.1 (11.6-12.7); 19 studies (32.2%) reported the grey zone of PPV or SVV, with a median of 56% (40-62) and 57% (46-83) of patients included, respectively. In the different subgroups, the AUC and the best thresholds ranged from 0.69 and 0.81 and from 6.9 to 11.5% for the PPV, and from 0.73 to 0.79 and 9.9 to 10.8% for the SVV. A high Vt and the choice of colloids positively impacted on PPV performance, especially among patients with closed chest and abdomen, or in prone position.
CONCLUSION
The overall performance of PPV and SVV in operating room in predicting fluid responsiveness is moderate, ranging close to an AUC of 0.80 only some subgroups of surgical patients. The grey zone of these dynamic indices is wide and should be carefully considered during the assessment of fluid responsiveness. A high Vt and the choice of colloids for the FC are factors potentially influencing PPV reliability.
TRIAL REGISTRATION
PROSPERO (CRD42022379120), December 2022. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=379120.
Topics: Adult; Humans; Blood Pressure; Hemodynamics; Stroke Volume; Operating Rooms; Reproducibility of Results; Colloids; Fluid Therapy; ROC Curve
PubMed: 37940953
DOI: 10.1186/s13054-023-04706-0 -
Journal of the American College of... Jul 2016
Topics: Blood Pressure; Cardiovascular Diseases; Cardiovascular System; Humans; Hypertension; Risk Factors
PubMed: 27364058
DOI: 10.1016/j.jacc.2016.03.586 -
Hypertension (Dallas, Tex. : 1979) May 2024This study focused on circulating plasma protein profiles to identify mediators of hypertension-driven myocardial remodeling and heart failure.
BACKGROUND
This study focused on circulating plasma protein profiles to identify mediators of hypertension-driven myocardial remodeling and heart failure.
METHODS
A Mendelian randomization design was used to investigate the causal impact of systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure on 82 cardiac magnetic resonance traits and heart failure risk. Mediation analyses were also conducted to identify potential plasma proteins mediating these effects.
RESULTS
Genetically proxied higher SBP, DBP, and pulse pressure were causally associated with increased left ventricular myocardial mass and alterations in global myocardial wall thickness at end diastole. Elevated SBP and DBP were linked to increased regional myocardial radial strain of the left ventricle (basal anterior, mid, and apical walls), while higher SBP was associated with reduced circumferential strain in specific left ventricular segments (apical, mid-anteroseptal, mid-inferoseptal, and mid-inferolateral walls). Specific plasma proteins mediated the impact of blood pressure on cardiac remodeling, with FGF5 (fibroblast growth factor 5) contributing 2.96% (=0.024) and 4.15% (=0.046) to the total effect of SBP and DBP on myocardial wall thickness at end diastole in the apical anterior segment and leptin explaining 15.21% (=0.042) and 23.24% (=0.022) of the total effect of SBP and DBP on radial strain in the mid-anteroseptal segment. Additionally, FGF5 was the only mediator, explaining 4.19% (=0.013) and 4.54% (=0.032) of the total effect of SBP and DBP on heart failure susceptibility.
CONCLUSIONS
This mediation Mendelian randomization study provides evidence supporting specific circulating plasma proteins as mediators of hypertension-driven cardiac remodeling and heart failure.
Topics: Humans; Mendelian Randomization Analysis; Ventricular Remodeling; Hypertension; Heart; Blood Pressure; Heart Failure
PubMed: 38487880
DOI: 10.1161/HYPERTENSIONAHA.123.22504 -
Journal of Clinical Hypertension... Sep 2014This study aimed to quantitatively evaluate the predictive value of brachial pulse pressure and cardiovascular or all-cause mortality in the general population based on... (Meta-Analysis)
Meta-Analysis Review
This study aimed to quantitatively evaluate the predictive value of brachial pulse pressure and cardiovascular or all-cause mortality in the general population based on prospective observational studies by conducting a meta-analysis. Only prospective observational studies investigating baseline brachial pulse pressure and cardiovascular or all-cause mortality risk were selected from PubMed and Embase databases until July 2013. Fourteen studies involving 510,456 participants were analyzed. Pooled risk ratio (RR) of cardiovascular and all-cause mortality for the highest vs lowest brachial pulse pressure category was 1.80 (95% confidence interval [CI], 1.49-2.17) and 1.32 (95% CI, 1.23-1.41), respectively. Pooled RR of cardiovascular and all-cause mortality per 10 mm Hg pulse pressure increment was 1.13 (95% CI, 1.10-1.17) and 1.09 (95% CI, 1.07-1.11), respectively. Wide brachial pulse pressure is associated with greater risk of cardiovascular and all-cause mortality. However, more well-designed studies specifically on age and sex are needed to further confirm these findings.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Blood Pressure; Brachial Artery; Cardiovascular Diseases; Female; Humans; Hypertension; Male; Middle Aged; Observational Studies as Topic; Predictive Value of Tests; Prospective Studies; Risk Factors; Sex Factors
PubMed: 25052820
DOI: 10.1111/jch.12375 -
Stroke Apr 2022Increased cerebral arterial pulsatility is associated with cerebral small vessel disease, recurrent stroke, and dementia despite the best medical treatment. However, no...
BACKGROUND
Increased cerebral arterial pulsatility is associated with cerebral small vessel disease, recurrent stroke, and dementia despite the best medical treatment. However, no study has identified the rates and determinants of progression of arterial stiffness and pulsatility.
METHODS
In consecutive patients within 6 weeks of transient ischemic attack or nondisabling stroke (OXVASC [Oxford Vascular Study]), arterial stiffness (pulse wave velocity [PWV]) and aortic systolic, aortic diastolic, and aortic pulse pressures (aoPP) were measured by applanation tonometry (Sphygmocor), while middle cerebral artery (MCA) peak (MCA-PSV) and trough (MCA-EDV) flow velocity and Gosling pulsatility index (PI; MCA-PI) were measured by transcranial ultrasound (transcranial Doppler, DWL Doppler Box). Repeat assessments were performed at the 5-year follow-up visit after intensive medical treatment and agreement determined by intraclass correlation coefficients. Rates of progression and their determinants, stratified by age and sex, were determined by mixed-effects linear models, adjusted for age, sex, and cardiovascular risk factors.
RESULTS
In 188 surviving, eligible patients with repeat assessments after a median of 5.8 years. PWV, aoPP, and MCA-PI were highly reproducible (intraclass correlation coefficients, 0.71, 0.59, and 0.65, respectively), with progression of PWV (2.4%; <0.0001) and aoPP (3.5%; <0.0001) but not significantly for MCA-PI overall (0.93; =0.22). However, PWV increased at a faster rate with increasing age (0.009 m/s per y/y; <0.0001), while aoPP and MCA-PI increased significantly above the age of 55 years (aoPP, <0.0001; MCA-PI, =0.009). Higher aortic systolic blood pressure and diastolic blood pressure predicted a greater rate of progression of PWV and aoPP, but not MCA-PI, although current MCA-PI was particularly strongly associated with concurrent aoPP (<0.001).
CONCLUSIONS
Arterial pulsatility and aortic stiffness progressed significantly after 55 years of age despite the best medical treatment. Progression of stiffness and aoPP was determined by high blood pressure, but MCA-PI predominantly reflected current aoPP. Treatments targetting cerebral pulsatility may need to principally target aortic stiffness and pulse pressure to have the potential to prevent cerebral small vessel disease.
Topics: Animals; Blood Pressure; Geese; Humans; Middle Aged; Middle Cerebral Artery; Pulse Wave Analysis; Vascular Stiffness
PubMed: 34852644
DOI: 10.1161/STROKEAHA.121.035560 -
Current Cardiology Reports Oct 2021Isolated diastolic hypertension (IDH) is a frequent hypertension phenotype. We review IDH pathophysiology, risk stratification, and therapeutic decisions. (Review)
Review
PURPOSE OF REVIEW
Isolated diastolic hypertension (IDH) is a frequent hypertension phenotype. We review IDH pathophysiology, risk stratification, and therapeutic decisions.
RECENT FINDINGS
Recent guidelines lowering blood pressure cutoff levels have increased IDH prevalence and likely decreased associated cardiovascular risk. Long-term cardiovascular risk and pharmacological intervention in IDH are controversial. Narrow pulse pressure and other physiological and epidemiological characteristics are shared with a systodiastolic hypertension (SDH) subgroup. We propose that IDH be incorporated into a broader category, predominantly diastolic hypertension (PDH), defined by pulse pressure ≤ 45 mmHg and includes IDH and SDH with a narrow pulse pressure. IDH-PDH is associated with cardiovascular risk in the long term, especially in young patients. Standardization of the IDH definition and population may contribute to future research to understand genetics, pathophysiology, and eventually therapy in this important subgroup of hypertensive patients.
Topics: Blood Pressure; Humans; Hypertension; Phenotype; Prevalence; Risk Factors
PubMed: 34657205
DOI: 10.1007/s11886-021-01609-w -
European Heart Journal Nov 2018Due to the cyclic function of the human heart, pressure and flow in the circulation are pulsatile rather than continuous. Addressing pulsatile haemodynamics starts with... (Review)
Review
Due to the cyclic function of the human heart, pressure and flow in the circulation are pulsatile rather than continuous. Addressing pulsatile haemodynamics starts with the most convenient measurement, brachial pulse pressure, which is widely available, related to development and treatment of heart failure (HF), but often confounded in patients with established HF. The next level of analysis consists of central (rather than brachial) pressures and, more importantly, of wave reflections. The latter are closely related to left ventricular late systolic afterload, ventricular remodelling, diastolic dysfunction, exercise capacity, and, in the long-term, the risk of new-onset HF. Wave reflection may also represent a suitable therapeutic target. Treatments for HF with preserved and reduced ejection fraction, based on a reduction of wave reflection, are emerging. A full understanding of ventricular-arterial coupling, however, requires dedicated analysis of time-resolved pressure and flow signals, which can be readily accomplished with contemporary non-invasive imaging and modelling techniques. This review provides a summary of our current understanding of pulsatile haemodynamics in HF.
Topics: Aged; Blood Pressure; Female; Heart Failure; Hemodynamics; Humans; Male; Models, Cardiovascular; Pulsatile Flow
PubMed: 29947746
DOI: 10.1093/eurheartj/ehy346 -
BMC Cardiovascular Disorders Jul 2023Elevated pulse pressure (PP) is a robust independent predictor of cardiovascular diseases. The relationship between PP and body mass index (BMI) was presented in a few...
BACKGROUND
Elevated pulse pressure (PP) is a robust independent predictor of cardiovascular diseases. The relationship between PP and body mass index (BMI) was presented in a few studies. However, the findings were inconsistent. Therefore, the aim of the present study is to identify the association between elevated PP and BMI using a large sample of active-duty Royal Thai Army (RTA) personnel.
METHODS
A cross-sectional study was conducted through the use of the dataset obtained from the annual health examination database of RTA personnel in Thailand in 2022. BMI 25.0-29.9 kg/m was classified as obesity I, whereas BMI ≥ 30.0 kg/m was classified as obesity II. Elevated PP was defined as PP ≥ 50 mmHg. Multivariable linear regression and log-binomial regression models were utilized for determining the association between elevated PP and BMI.
RESULTS
A total of 62,113 active-duty RTA personnel were included in the study. The average BMI was 25.4 ± 3.8 kg/m, while the average PP was 50.1 ± 11.2 mmHg. Compared to individuals with normal weight, the [Formula: see text] coefficients of PP and BMI were 1.38 (95% CI: 1.15-1.60) and 2.57 (95% CI: 2.25-2.88) in individuals with obesity I and obesity II, respectively. Effect modification by high blood pressure (BP) on the association between elevated PP and BMI was observed. Among participants with normal BP, in comparison with BMI of 18.5-22.9 kg/m, the adjusted prevalence ratio (PR) for elevated PP was 1.23 (95% CI: 1.19-1.28) and 1.41 (95% CI: 1.35-1.48) in those with obesity I and obesity II, respectively. Meanwhile, among individuals with high BP, the adjusted PR for elevated PP was 1.05 (95% CI: 1.01-1.08) and 1.09 (95% CI: 1.06-1.13) in those with obesity I and obesity II, respectively.
CONCLUSION
PP was positively associated with BMI in active-duty RTA personnel. High BP was the modifier of the association between PP and BMI. A weaker association between elevated PP and BMI was observed among RTA personnel with high BP.
Topics: Humans; Body Mass Index; Blood Pressure; Thailand; Military Personnel; Cross-Sectional Studies; Southeast Asian People; Obesity; Hypertension
PubMed: 37464282
DOI: 10.1186/s12872-023-03390-w