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Medicine Feb 2018Type 2 diabetes is associated with higher pulse pressure. In this study, we assessed and compared effects of classic diabetes treatments on pulse pressure (PP), systolic...
Type 2 diabetes is associated with higher pulse pressure. In this study, we assessed and compared effects of classic diabetes treatments on pulse pressure (PP), systolic blood pressure (SBP), and diastolic blood pressure (DBP) in patients with type 2 diabetes.In a retrospective cohort study, 718 non-hypertensive patients with type 2 diabetes were selected and divided into 4 groups including metformin, insulin, glibenclamide+metformin, and metformin+insulin. They were followed for 4 consecutive visits lasting about 45.5 months. Effects of drug regimens on pulse and blood pressure over time were assessed separately and compared in regression models with generalized estimating equation method and were adjusted for age, duration of diabetes, sex, smoking, and body mass index (BMI).Studied groups had no significant change in PP, SBP, and DBP over time. No significant difference in PP and DBP among studied groups was observed (PP:P = 0.090; DBP:P = 0.063). Pairwise comparisons of PP, SBP, and DBP showed no statistically significant contrast between any 2 studied groups. Interactions of time and treatment were not different among groups.Our results demonstrate patients using metformin got higher PP and SBP over time. Averagely, pulse and blood pressure among groups were not different. Trends of variation in pulse and blood pressure were not different among studied diabetes treatments.
Topics: Adult; Blood Pressure; Blood Pressure Determination; Cohort Studies; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Female; Glucose; Glyburide; Humans; Hypoglycemic Agents; Insulin; Iran; Male; Metformin; Middle Aged; Outcome and Process Assessment, Health Care; Retrospective Studies
PubMed: 29419672
DOI: 10.1097/MD.0000000000009791 -
Journal of the American Heart... Feb 2022Background Individuals of the same chronological age may exhibit diverse susceptibilities to death. However, few studies have investigated the associations between blood...
Background Individuals of the same chronological age may exhibit diverse susceptibilities to death. However, few studies have investigated the associations between blood pressure and the accelerated aging. Methods and Results A cross-sectional study was conducted in 288 adults aged ≥50 years. We assessed the DNA methylation-based measures of biological age using CpG sites on the Illumina HumanMethylationEPIC BeadChip. Epigenetic age acceleration metrics were derived by regressing residuals (ΔAge) and ratios (aging rate) of DNA methylation age on chronological age. Dose-response relationships between blood pressure and epigenetic age acceleration were quantified using multiple linear regression and restricted cubic regression models. We found that each 10-mm Hg increase in systolic blood pressure was associated with 0.608 (95% CI, 0.231-0.984) years increase in ΔAge and 0.007 (95% CI, 0.002-0.012) increase in aging rate; meanwhile, for pulse pressure, the increase was 1.12 (95% CI, 0.625-1.61) years for ΔAge and 0.013 (95% CI, 0.007-0.020) for aging rate. Subgroup analysis showed that the significant associations of systolic blood pressure and pulse pressure with epigenetic age acceleration appeared to be limited to women, although interactions between blood pressure and sex were not significant ( values for interaction >0.05). The combination of women and hypertension was associated with a much higher increase in ΔAge (β [95% CI], 4.05 [1.07-7.02]) and aging rate (β [95% CI], 0.047 [0.008-0.087]), compared with male participants without hypertension. Conclusions Our findings suggested that high systolic blood pressure and pulse pressure were associated with the epigenetic age acceleration, providing important clues for relationships between blood pressure and epigenetic aging.
Topics: Adult; Aging; Blood Pressure; Cross-Sectional Studies; DNA Methylation; Epigenesis, Genetic; Female; Humans; Hypertension; Male; Middle Aged
PubMed: 35001659
DOI: 10.1161/JAHA.121.022257 -
BioMed Research International 2014Arterial pulse pressure has been widely used as surrogate of stroke volume, for example, in the guidance of fluid therapy. However, recent experimental investigations...
Arterial pulse pressure has been widely used as surrogate of stroke volume, for example, in the guidance of fluid therapy. However, recent experimental investigations suggest that arterial pulse pressure is not linearly proportional to stroke volume. However, mechanisms underlying the relation between the two have not been clearly understood. The goal of this study was to elucidate how arterial pulse pressure and stroke volume respond to a perturbation in the left ventricular blood volume based on a systematic mathematical analysis. Both our mathematical analysis and experimental data showed that the relative change in arterial pulse pressure due to a left ventricular blood volume perturbation was consistently smaller than the corresponding relative change in stroke volume, due to the nonlinear left ventricular pressure-volume relation during diastole that reduces the sensitivity of arterial pulse pressure to perturbations in the left ventricular blood volume. Therefore, arterial pulse pressure must be used with care when used as surrogate of stroke volume in guiding fluid therapy.
Topics: Arteries; Baroreflex; Blood Pressure; Blood Volume; Computer Simulation; Elasticity; Humans; Models, Cardiovascular; Stroke Volume; Systole; Time Factors; Ventricular Function
PubMed: 25006577
DOI: 10.1155/2014/459269 -
BMC Pediatrics Apr 2023Increasing evidence suggests that reducing pulse pressure amplification (PPA) plays an important role in pathogenesis and progression of cardiovascular disease. This is... (Observational Study)
Observational Study
BACKGROUND
Increasing evidence suggests that reducing pulse pressure amplification (PPA) plays an important role in pathogenesis and progression of cardiovascular disease. This is a cross-sectional, observational, and analytical study in which we evaluated the associated factors with a greater chance of reducing PPA in 136 healthy children and adolescents aged 8 to 19 years old stratified by gender and age group.
METHODS
Arterial stiffness and vascular and hemodynamic parameters were non-invasively measured using Mobil-O-Graph® (IEM, Stolberg, Germany), a cuff-based oscillometric device. PPA was expressed as the peripheral-to-central pulse pressure ratio (PPp / PPc). Participants with PPA < 1.49 were considered as part of the arterial stiffness group.
RESULTS
In a univariate model, the increase in total vascular resistance, the reflection coefficient and the augmentation pressure were more likely to have arterial stiffness in all groups. The factors most likely to have arterial stiffness (as assessed by the reduction of the PPA) in the multivariate model were increasing age, the reflection coefficient and cardiac index in the total sample, male group and child and adolescent groups. In addition to age in the female group, cardiac output, stroke volume, and AIx@75 were the factors most likely to present arterial stiffness.
CONCLUSIONS
The results show for the first time in children and adolescents that the factors most likely to reduce PPA are related to the reflection wave, which determines aortic pressures and, therefore, left ventricular afterload.
Topics: Humans; Male; Child; Adolescent; Female; Young Adult; Adult; Blood Pressure; Cross-Sectional Studies; Vascular Stiffness; Hemodynamics; Heart Rate
PubMed: 37009891
DOI: 10.1186/s12887-023-03942-1 -
Minerva Cardiology and Angiology Jun 2021
Topics: Acute Coronary Syndrome; Blood Pressure; Humans; Hypertension; Systole
PubMed: 33427421
DOI: 10.23736/S2724-5683.20.05434-1 -
Journal of Hypertension Nov 2022The role of pulse pressure (PP) 'widening' at older and younger age as a cardiovascular risk factor is still controversial. Mean PP, as determined from repeated blood...
BACKGROUND
The role of pulse pressure (PP) 'widening' at older and younger age as a cardiovascular risk factor is still controversial. Mean PP, as determined from repeated blood pressure (BP) readings, can be expressed as a sum of two components: 'elastic PP' (elPP) and 'stiffening PP' (stPP) associated, respectively, with stiffness at the diastole and its relative change during the systole. We investigated the association of 24-h ambulatory PP, elPP, and stPP ('PP variables') with mortality and composite cardiovascular events in different age classes.
METHOD
Longitudinal population-based cohort study of adults with baseline observations that included 24-h ambulatory BP. Age classes were age 40 or less, 40-50, 50-60, 60-70, and over 70 years. Co-primary endpoints were total mortality and composite cardiovascular events. The relative risk expressed by hazard ratio per 1SD increase for each of the PP variables was calculated from multivariable-adjusted Cox regression models.
RESULTS
The 11 848 participants from 13 cohorts (age 53 ± 16 years, 50% men) were followed for up for 13.7 ± 6.7 years. A total of 2946 participants died (18.1 per 1000 person-years) and 2093 experienced a fatal or nonfatal cardiovascular event (12.9 per 1000 person-years). Mean PP, elPP, and stPP were, respectively, 49.7, 43.5, and 6.2 mmHg, and elPP and stPP were uncorrelated ( r = -0.07). At age 50-60 years, all PP variables displayed association with risk for almost all outcomes. From age over 60 years to age over 70 years, hazard ratios of of PP and elPP were similar and decreased gradually but differently for pulse rate lower than or higher than 70 bpm, whereas stPP lacked predictive power in most cases. For age 40 years or less, elPP showed protective power for coronary events, whereas stPP and PP predicted stroke events. Adjusted and unadjusted hazard ratio variations were similar over the entire age range.
CONCLUSION
This study provides a new basis for associating PP components with outcome and arterial properties in different age groups and at different pulse rates for both old and young age. The similarity between adjusted and unadjusted hazard ratios supports the clinical usefulness of PP components but further studies are needed to assess the prognostic significance of the PP components, especially at the young age.
Topics: Adult; Aged; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cardiovascular Diseases; Cohort Studies; Female; Humans; Hypertension; Male; Middle Aged; Systole
PubMed: 35950994
DOI: 10.1097/HJH.0000000000003258 -
Alzheimer's Research & Therapy Mar 2018Substantial evidence indicates that the relationship between blood pressure (BP) measures and cognitive functioning is inconsistent, complex, and age-related. Pulse...
BACKGROUND
Substantial evidence indicates that the relationship between blood pressure (BP) measures and cognitive functioning is inconsistent, complex, and age-related. Pulse pressure (PP), which can not only reflect arterial stiffness and but also represent the chronic effects of hypertension other than BP itself, has been considered as a better predictor of cognitive impairment. However, evidence on the association of cognitive function with PP has not been investigated extensively. We examined this relationship in a longitudinal study based on the latent growth model (LGM).
METHODS
This study was based on a nationally representative sample of Chinese middle-aged and older participants from the China Health and Retirement Longitudinal Study (CHARLS), a prospective observational study conducted from 2011 to 2016. Cognitive performance was assessed on the basis of three measures of cognition. The PP was calculated as the difference of the average values of three systolic and diastolic BP readings. A series of potential confounders were collected in this research. The LGM was used to examine the effects of PP on cognitive performance at three time points. To test the independent effects of PP on the initial level and the subsequent development of cognition, unconditional and conditional models were compared sequentially.
RESULTS
After excluding respondents with missing key variables, we ultimately included 9750 participants in the analysis. Cognitive performance scores and PP showed significant differences across time. After adjustment for the confounders, the standardized coefficients of PP in the LGM indicated negative effects on cognitive performance in elderly Chinese participants at wave 2 and wave 3 (P < 0.01). The initial level of PP in the unconditional model was negatively associated with the initial level (β = - 0.25) and the slope (β = - 0.16) of cognition, whereas these effects were attenuated and the association between intercept of PP and slope of cognition became nonsignificant after controlling for the confounders.
CONCLUSIONS
The implications of these results demonstrate that a higher PP lowers the cognitive performance of middle-aged and elderly persons independent of a comprehensive set of covariates, but it is not a contributor to the rate of change in cognition.
Topics: Age Factors; Aged; Aged, 80 and over; Aging; Asian People; Blood Pressure; Cognition; Cohort Studies; Community Health Planning; Female; Humans; Male; Middle Aged; Models, Theoretical; Neuropsychological Tests; Statistics, Nonparametric
PubMed: 29530075
DOI: 10.1186/s13195-018-0355-1 -
Arquivos Brasileiros de Cardiologia Jun 2016Casual blood pressure measurements have been extensively questioned over the last five decades. A significant percentage of patients have different blood pressure... (Review)
Review
Casual blood pressure measurements have been extensively questioned over the last five decades. A significant percentage of patients have different blood pressure readings when examined in the office or outside it. For this reason, a change in the paradigm of the best manner to assess blood pressure has been observed. The method that has been most widely used is the Ambulatory Blood Pressure Monitoring - ABPM. The method allows recording blood pressure measures in 24 hours and evaluating various parameters such as mean BP, pressure loads, areas under the curve, variations between daytime and nighttime, pulse pressure variability etc. Blood pressure measurements obtained by ABPM are better correlated, for example, with the risks of hypertension. The main indications for ABPM are: suspected white coat hypertension and masked hypertension, evaluation of the efficacy of the antihypertensive therapy in 24 hours, and evaluation of symptoms. There is increasing evidence that the use of ABPM has contributed to the assessment of blood pressure behaviors, establishment of diagnoses, prognosis and the efficacy of antihypertensive therapy. There is no doubt that the study of 24-hour blood pressure behavior and its variations by ABPM has brought more light and less darkness to the field, which justifies the title of this review.
Topics: Antihypertensive Agents; Blood Pressure; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory; Brazil; Humans; Hypertension; Masked Hypertension; Practice Guidelines as Topic; Societies, Medical; Time Factors; White Coat Hypertension
PubMed: 27168473
DOI: 10.5935/abc.20160065 -
Journal of the American Heart... May 2014Somatic growth in childhood is accompanied by substantial remodeling of the aorta. Obesity is associated with increased aortic stiffness and flow and may interfere with...
BACKGROUND
Somatic growth in childhood is accompanied by substantial remodeling of the aorta. Obesity is associated with increased aortic stiffness and flow and may interfere with aortic remodeling during growth. Wide pulse pressure (PP) indicates mismatch between aortic impedance and pulsatile flow and increases risk for future systolic hypertension and cardiovascular disease (CVD). We hypothesized that the rise of pediatric obesity would be associated with a temporal trend to higher PP.
METHODS AND RESULTS
We analyzed demographic, anthropometric, and blood pressure (BP) data for 8- to 17-year-old children (N=16 457) from the cross-sectional National Health and Nutrition Examination Surveys (NHANES) for 1976 through 2008. Multivariable adjusted survey regression was used to examine temporal trends in PP and mean arterial pressure (MAP) and the relation to obesity. Across this period, unadjusted PP was higher (0.29 mm Hg/y, 95% CI 0.26 to 0.33 mm Hg/y; P<0.0001), while MAP was lower (-0.24 mm Hg/y, 95% CI -0.27 to -0.20 mm Hg/y; P<0.0001) across examinations. Adjusting for body mass index partially attenuated the temporal trend for PP by 32% (P<0.0001). Obesity amplified the relation between taller height and higher PP (from 0.23 [95% CI 0.19 to 0.28] to 0.27 [95% CI 0.21 to 0.34] mm Hg/cm height in boys and from 0.08 [95% CI 0.04 to 0.13] to 0.22 [95% CI 0.13 to 0.31] mm Hg/cm height in girls; P<0.01 for both).
CONCLUSIONS
PP has increased during the rise of pediatric obesity. Higher PP may indicate mismatch between aortic diameter, wall stiffness, and flow in obese children during a period of rapid somatic growth when the aorta is already under considerable remodeling stress.
Topics: Adolescent; Blood Pressure; Body Mass Index; Child; Cross-Sectional Studies; Female; Humans; Male; Nutrition Surveys; Obesity; Sex Factors; United States; Vascular Remodeling
PubMed: 24811611
DOI: 10.1161/JAHA.113.000725 -
British Journal of Anaesthesia Sep 2015Dynamic indices, such as pulse pressure variation (PPV), are inaccurate predictors of fluid responsiveness in mechanically ventilated patients with low tidal volume.... (Observational Study)
Observational Study
BACKGROUND
Dynamic indices, such as pulse pressure variation (PPV), are inaccurate predictors of fluid responsiveness in mechanically ventilated patients with low tidal volume. This study aimed to test whether changes in continuous cardiac index (CCI), PPV, and stroke volume variation (SVV) after a mini-fluid challenge (100 ml of fluid during 1 min) could predict fluid responsiveness in these patients.
METHODS
We prospectively studied 49 critically ill, deeply sedated, and mechanically ventilated patients (tidal volume <8 ml kg(-1) of ideal body weight) without cardiac arrhythmias, in whom a fluid challenge was indicated because of circulatory failure. The CCI, SVV (PiCCO™; Pulsion), and PPV (MP70™; Philips) were measured before and after 100 ml of colloid infusion during 1 min, and then after the additional infusion of 400 ml during 14 min. Responders were defined as subjects with a ≥15% increase in cardiac index (transpulmonary thermodilution) after the full (500 ml) fluid challenge. Areas under the receiver operating characteristic curves (AUCs) and the grey zones were determined for changes in CCI (ΔCCI100), SVV (ΔSVV100), and PPV (ΔPPV100) after 100 ml fluid challenge.
RESULTS
Twenty-two subjects were responders. The ΔCCI100 predicted fluid responsiveness with an AUC of 0.78. The grey zone was large and included 67% of subjects. The ΔSVV100 and ΔPPV100 predicted fluid responsiveness with AUCs of 0.91 and 0.92, respectively. Grey zones were small, including ≤12% of subjects for both indices.
CONCLUSIONS
The ΔSVV100 and ΔPPV100 predict fluid responsiveness accurately and better than ΔCCI100 (PiCCO™; Pulsion) in patients with circulatory failure and ventilated with low volumes.
Topics: Adult; Aged; Area Under Curve; Blood Pressure; Cardiac Output; Critical Illness; Female; Fluid Therapy; Humans; Male; Middle Aged; Prospective Studies; ROC Curve; Reproducibility of Results; Respiration, Artificial; Stroke Volume; Tidal Volume
PubMed: 26152341
DOI: 10.1093/bja/aev222