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Alzheimer Disease and Associated... 2016We investigated whether midlife pulse pressure is associated with brain atrophy and cognitive decline, and whether the association was modified by apolipoprotein-E ε4...
We investigated whether midlife pulse pressure is associated with brain atrophy and cognitive decline, and whether the association was modified by apolipoprotein-E ε4 (APOE-ε4) and hypertension. Participants (549 stroke-free and dementia-free Framingham Offspring Cohort Study participants, age range=55.0 to 64.9 y) underwent baseline neuropsychological and magnetic resonance imaging (subset, n=454) evaluations with 5- to 7-year follow-up. Regression analyses investigated associations between baseline pulse pressure (systolic-diastolic pressure) and cognition, total cerebral volume and temporal horn ventricular volume (as an index of smaller hippocampal volume) at follow-up, and longitudinal change in these measures. Interactions with APOE-ε4 and hypertension were assessed. Covariates included age, sex, education, assessment interval, and interim stroke. In the total sample, baseline pulse pressure was associated with worse executive ability, lower total cerebral volume, and greater temporal horn ventricular volume 5 to 7 years later, and longitudinal decline in executive ability and increase in temporal horn ventricular volume. Among APOE-ε4 carriers only, baseline pulse pressure was associated with longitudinal decline in visuospatial organization. Findings indicate arterial stiffening, indexed by pulse pressure, may play a role in early cognitive decline and brain atrophy in mid to late life, particularly among APOE-ε4 carriers.
Topics: Alleles; Apolipoprotein E4; Atrophy; Blood Pressure; Brain; Cognitive Dysfunction; Cohort Studies; Female; Genotype; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuropsychological Tests; Risk Factors
PubMed: 27556935
DOI: 10.1097/WAD.0000000000000127 -
Investigative Ophthalmology & Visual... Dec 2022To investigate the association of systemic blood pressure and incident primary open-angle glaucoma (POAG) using a large open-access database.
PURPOSE
To investigate the association of systemic blood pressure and incident primary open-angle glaucoma (POAG) using a large open-access database.
METHODS
Prospective cohort study included 484,268 participants from the UK Biobank without glaucoma at enrollment. Incident POAG events were recorded through assessment visits, hospital inpatient admissions, and primary care data. Blood pressure measures included systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP). Repeated measurements throughout the study period were analyzed as time-varying covariables. The parameters were modeled as both categorical and continuous nonlinear variables. The primary outcome measure was the relative hazard of incident POAG.
RESULTS
There were 2390 incident POAG events over 5,715,480 person-years of follow-up. Median follow-up was 12.08 years. In multivariable analyses, compared to SBP and PP in the normal range (SBP, 120-130 mmHg; PP, 40-50 mmHg), higher SBP and PP were associated with an increased risk of incident POAG (linear trend P = 0.038 for SBP, P < 0.001 for PP). Specifically, SBP of 130 to 140 mmHg or 140 to 150 mmHg was associated with a 1.16 higher hazard of incident POAG (95% CI, 1.01-1.32 and 1.01-1.33, respectively), whereas a PP of greater than 70 mmHg was associated with a 1.13 higher hazard of incident glaucoma (95% CI, 1.00-1.29). In multivariable models, no statistically significant associations were found for DBP or MAP with incident glaucoma. These findings were similar when blood pressure measures were modeled as continuous variables.
CONCLUSIONS
Higher SBP and PP were associated with an increased risk of incident POAG. Further studies are required to characterize these relationships better.
Topics: Humans; Blood Pressure; Glaucoma, Open-Angle; Prospective Studies; Arterial Pressure; Risk Factors
PubMed: 36469027
DOI: 10.1167/iovs.63.13.3 -
Critical Care (London, England) 2011The aim of this study was to evaluate dynamic indices of fluid responsiveness in a model of intra-abdominal hypertension.
INTRODUCTION
The aim of this study was to evaluate dynamic indices of fluid responsiveness in a model of intra-abdominal hypertension.
METHODS
Nine mechanically-ventilated pigs underwent increased intra-abdominal pressure (IAP) by abdominal banding up to 30 mmHg and then fluid loading (FL) at this IAP. The same protocol was carried out in the same animals made hypovolemic by blood withdrawal. In both volemic conditions, dynamic indices of preload dependence were measured at baseline IAP, at 30 mmHg of IAP, and after FL. Dynamic indices involved respiratory variations in stroke volume (SVV), pulse pressure (PPV), and systolic pressure (SPV, %SPV and Δdown). Stroke volume (SV) was measured using an ultrasound transit-time flow probe placed around the aortic root. Pigs were considered to be fluid responders if their SV increased by 15% or more with FL. Indices of fluid responsiveness were compared with a Mann-Whitney U test. Then, receiver operating characteristic (ROC) curves were generated for these parameters, allowing determination of the cut-off values by using Youden's method.
RESULTS
Five animals before blood withdrawal and all animals after blood withdrawal were fluid responders. Before FL, SVV (78 ± 19 vs 42 ± 17%), PPV (64 ± 18 vs 37 ± 15%), SPV (24 ± 5 vs 18 ± 3 mmHg), %SPV (24 ± 4 vs 17 ± 3%) and Δdown (13 ± 5 vs 6 ± 4 mmHg) were higher in responders than in non-responders (P < 0.05). Areas under ROC curves were 0.93 (95% confidence interval: 0.80 to 1.06), 0.89 (0.70 to 1.07), 0.90 (0.74 to 1.05), 0.92 (0.78 to 1.06), and 0.86 (0.67 to 1.06), respectively. Threshold values discriminating responders and non-responders were 67% for SVV and 41% for PPV.
CONCLUSIONS
In intra-abdominal hypertension, respiratory variations in stroke volume and arterial pressure remain indicative of fluid responsiveness, even if threshold values identifying responders and non-responders might be higher than during normal intra-abdominal pressure. Further studies are required in humans to determine these thresholds in intra-abdominal hypertension.
Topics: Animals; Blood Pressure; Disease Models, Animal; Fluid Therapy; Hydrodynamics; Intra-Abdominal Hypertension; Pressure; Respiration, Artificial; Stroke Volume; Swine; Treatment Outcome
PubMed: 21247472
DOI: 10.1186/cc9980 -
Genetics and Molecular Research : GMR Feb 2014The aim of this study was to analyze the association between pulse pressure and a novel type of phospholipid with solubility similar to that of lysophosphatidic acid...
The aim of this study was to analyze the association between pulse pressure and a novel type of phospholipid with solubility similar to that of lysophosphatidic acid (LPA), designated as AP, which was reported to be elevated during ischemia. In this cross-sectional study, 416 hypertensive patients and 252 controls aged between 35 and 70 years were enrolled consecutively. Fasting blood samples were extracted for assays of phospholipids and other biomarkers. Compared to controls, the hypertensive patients had higher levels of both LPA [odds ratio (OR) = 3.83] and AP (OR = 4.30). Changes in blood pressure did not affect the levels of LPA or AP. However AP, but not LPA, levels were significantly higher in patients with lower or higher pulse pressure (Pearson χ(2) = 11.239, P = 0.001). For patients whose pulse pressure was ≤60 mmHg, plasma levels of AP were significantly negatively correlated with pulse pressure. However, this was not observed for LPA and nine other biomarkers, including lipoproteins. Plasma levels of AP increased in hypertensive patients with higher or lower pulse pressure. Thus, attention should be paid to the possibility of cerebral ischemia in hypertensive patients when they have abnormal pulse pressure, especially for those with relatively low pulse pressure.
Topics: Adult; Aged; Blood Pressure; Brain Ischemia; Female; Genetic Association Studies; Humans; Hypertension; Lipids; Lysophospholipids; Male; Middle Aged; Phospholipids
PubMed: 24634302
DOI: 10.4238/2014.February.21.16 -
Canadian Journal of Anaesthesia =... Apr 2023There is lack of consensus regarding the minimum arterial pulse pressure required for confirming permanent cessation of circulation for death determination by... (Review)
Review
PURPOSE
There is lack of consensus regarding the minimum arterial pulse pressure required for confirming permanent cessation of circulation for death determination by circulatory criteria in organ donors. We assessed direct and indirect evidence supporting whether one should use an arterial pulse pressure of 0 mm Hg vs more than 0 (5, 10, 20, 40) mm Hg to confirm permanent cessation of circulation.
SOURCE
We conducted this systematic review as part of a larger project to develop a clinical practice guideline for death determination by circulatory or neurologic criteria. We systematically searched Ovid MEDLINE, Ovid Embase, Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Library, and Web of Science for articles published from inception until August 2021. We included all types of peer-reviewed original research publications related to arterial pulse pressure as monitored by an indwelling arterial pressure transducer around circulatory arrest or determination of death with either direct context-specific (organ donation) or indirect (outside of organ donation context) data.
PRINCIPAL FINDINGS
A total of 3,289 abstracts were identified and screened for eligibility. Fourteen studies were included; three from personal libraries. Five studies were of sufficient quality for inclusion in the evidence profile for the clinical practice guideline. One study measured cessation of cortical scalp electroencephalogram (EEG) activity after withdrawal of life-sustaining measures and showed that EEG activity fell below 2 μV when the pulse pressure reached 8 mm Hg. This indirect evidence suggests there is a possibility of persistent cerebral activity at arterial pulse pressures > 5 mm Hg.
CONCLUSION
Indirect evidence suggests that clinicians may incorrectly diagnose death by circulatory criteria if they apply any arterial pulse pressure threshold of greater than 5 mm Hg. Moreover, there is insufficient evidence to determine that any pulse pressure threshold greater than 0 and less than 5 can safely determine circulatory death.
STUDY REGISTRATION
PROSPERO (CRD42021275763); first submitted 28 August 2021.
Topics: Humans; Blood Pressure; Brain; Tissue and Organ Procurement; Tissue Donors; Heart Arrest; Death
PubMed: 37138154
DOI: 10.1007/s12630-023-02425-2 -
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 -
Nihon Ronen Igakkai Zasshi. Japanese... 2023Although the number of deaths in bathtubs in homes and residential facilities for the elderly has been decreasing slightly since 2017, it is still 4,900 (2019), which is...
INTRODUCTION
Although the number of deaths in bathtubs in homes and residential facilities for the elderly has been decreasing slightly since 2017, it is still 4,900 (2019), which is almost twice the number of traffic accident deaths.
PURPOSE
The purpose of this study was to investigate blood pressure and pulse fluctuations in community-dwelling elderly people during bathing, and to examine the alert range to determine when heat shock occurs.
METHODS
Ten elderly men (72.6±3.4/67-78) living in the community were subjected to a 6-minute full-body bath in a bath with a temperature of 41°C, and their blood pressure (SBP, DBP) and pulse (PR) were measured.
RESULTS
The SBP of the group whose PR increased by 15/min or more from before bathing to 30 seconds after bathing increased by about 30 mmHg. In the group where PR increased by 15/min or more, the pulse pressure (PP) increased by about 30 mmHg, and in the double product (DP), the abnormal increase of 5,000 DP or more was observed from before bathing to 30 seconds after bathing.
DISCUSSION
In the group where PR increased by 15/min or more from before bathing to 30 seconds after bathing, there is a possibility of cerebral hemorrhage immediately after bathing, dizziness, and falls. Analysis of pulse pressure (PP) and double product (DP) also suggests that the burden on the heart is applied 30 seconds after bathing, and sufficient attention is required.
Topics: Male; Humans; Aged; Blood Pressure; Heart Rate; Baths
PubMed: 38171761
DOI: 10.3143/geriatrics.60.434 -
Kidney & Blood Pressure Research 2023Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) are risk factors for cardiovascular mortality (CVM). Pulse pressure (PP)... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) are risk factors for cardiovascular mortality (CVM). Pulse pressure (PP) is an easily available parameter of vascular stiffness, but its impact on CVM in chronic dialysis patients with diabetes is unclear.
METHODS
Therefore, we have examined the predictive value of baseline, predialytic PP, SBP, DBP, and MAP in the German Diabetes and Dialysis (4D) study, a prospective, randomized, double-blind trial enrolling 1,255 patients with type 2 diabetes on hemodialysis in 178 German dialysis centers.
RESULTS
Mean age was 66.3 years, mean blood pressure 146/76 mm Hg, mean time suffering from diabetes 18.1 years, and mean time on maintenance dialysis 8.3 months. Considered as continuous variables, PP, MAP, SBP, and DBP could not provide a significant mortality prediction for either cardiovascular or all-cause mortality. After dividing the cohort into corresponding tertiles, we also did not detect any significant mortality prediction for PP, SBP, DBP, or MAP, both for all-cause mortality and CVM after adjusting for age and sex. Nevertheless, when comparing the HR plots of the corresponding blood pressure parameters, a pronounced U-curve was seen for PP for both all-cause mortality and CVM, with the trough range being 70-80 mm Hg.
DISCUSSION
In patients with end-stage renal disease and long-lasting diabetes mellitus predialytic blood pressure parameters at study entry are not predictive for mortality, presumably because there is a very high rate of competing mortality risk factors, resulting in overall very high rates of all-cause and CVM that may no longer be significantly modulated by blood pressure control.
Topics: Humans; Aged; Blood Pressure; Diabetes Mellitus, Type 2; Prospective Studies; Renal Dialysis; Risk Factors; Hypertension
PubMed: 37806305
DOI: 10.1159/000533136 -
Hypertension Research : Official... Nov 2021High leptin levels are associated with an unfavorable cardiometabolic risk profile. A number of studies found a positive association between leptin and vascular damage,...
High leptin levels are associated with an unfavorable cardiometabolic risk profile. A number of studies found a positive association between leptin and vascular damage, but to date, no observational study has evaluated a potential predictive role of leptin for arterial stiffening. Therefore, the aim of this study was to estimate the role of leptin in the incidence of arterial stiffening (pulse pressure >60 mmHg) and changes in pulse pressure in an 8-year follow-up of a sample of adult men (The Olivetti Heart Study). The analysis included 460 men without baseline arterial stiffening and antihypertensive treatment at baseline and at follow-up (age: 50.0 years, BMI: 26.5 kg/m). At the end of the follow-up period, the incidence of arterial stiffening was 8%. Baseline leptin was significantly greater in the group that developed arterial stiffening and was significantly correlated with pulse pressure changes over time (p < 0.05). According to the median plasma leptin distribution of the whole population, the sample was stratified into two groups: one with leptin levels above the median and the other with leptin levels below the median. Those who had baseline leptin levels above the median had a greater risk of developing arterial stiffening (odds ratio: 2.5, p < 0.05) and a greater increase in pulse pressure over time (beta: 2.1, p < 0.05), also after adjustment for confounders. The results of this prospective study indicate a predictive role of circulating leptin levels for vascular damage, independent of body weight and blood pressure.
Topics: Adult; Blood Pressure; Follow-Up Studies; Humans; Leptin; Male; Middle Aged; Prospective Studies; Risk Factors; Vascular Stiffness
PubMed: 34385686
DOI: 10.1038/s41440-021-00718-x -
Journal of the American College of... Jul 2016
Topics: Blood Pressure; Cardiovascular Diseases; Cardiovascular System; Humans; Hypertension; Risk Factors
PubMed: 27364059
DOI: 10.1016/j.jacc.2016.04.020