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Journal of Cardiothoracic and Vascular... Aug 2019Delta pulse pressure and delta down are used as dynamic preload indicators of fluid responsiveness during closed chest surgery. There are few data regarding their... (Clinical Trial)
Clinical Trial
OBJECTIVE
Delta pulse pressure and delta down are used as dynamic preload indicators of fluid responsiveness during closed chest surgery. There are few data regarding their accuracy in open chest surgery. The present study aimed to evaluate the influence of sternotomy on the accuracy of both delta pulse pressure and delta down.
DESIGN
Prospective study.
SETTING
Single institution, nonacademic hospital.
PARTICIPANTS
The study comprised 127 adult patients scheduled for elective open chest cardiac surgery.
INTERVENTIONS
Delta pulse pressure and delta down were calculated for all patients before and 10 minutes after sternotomy.
MEASUREMENTS AND MAIN RESULTS
Statistical analyses were performed to assess the influence of sternotomy on the accuracy of delta down and delta pulse pressure. Mann-Whitney and Bland-Altman analyses demonstrated a significant influence of sternotomy on delta pulse pressure values but not on delta down values. Among patients who had a positive delta down and/or delta pulse pressure before sternotomy, sternotomy significantly modified the delta pulse pressure value (p = 0.02), but not the delta down value (p = 0.22). The kappa coefficient indicated a very good agreement between delta down before and after sternotomy (0.83) and a fair agreement between delta pulse pressure before and after sternotomy (0.4). The difference between kappa coefficients was highly significant (p < 0.001).
CONCLUSIONS
Within the study population, sternotomy significantly influenced delta pulse pressure but not delta down. In this preliminary study, delta down appeared to be more accurate to evaluate fluid responsiveness during open chest surgery than did delta pulse pressure. Before promoting delta down in current practice, confirmation is needed on a larger scale.
Topics: Aged; Blood Pressure; Cardiac Surgical Procedures; Female; Hemodynamics; Humans; Male; Middle Aged; Prospective Studies; Sternotomy; Tidal Volume
PubMed: 30581108
DOI: 10.1053/j.jvca.2018.11.009 -
Therapeutic Advances in Cardiovascular... Feb 2008For many years, the cyclic blood pressure (BP) curve was described exclusively from two specific points of this curve, the highest, called systolic blood pressure, and... (Review)
Review
For many years, the cyclic blood pressure (BP) curve was described exclusively from two specific points of this curve, the highest, called systolic blood pressure, and the lowest, called diastolic blood pressure, both dominating the basis of cardiovascular (CV) hypertensive epidemiology. Nowadays, it is largely admitted that the BP curve should be characterized from pulsatile arterial hemodynamics, thus leading to the definition of novel indices in CV epidemiology. The present chapter details these new aspects.
Topics: Arteries; Blood Pressure; Humans; Hypertension; Pulsatile Flow; Risk Factors
PubMed: 19124404
DOI: 10.1177/1753944707086652 -
Journal of Translational Medicine Dec 2021Association between blood pressure (BP) and kidney function among the middle and old aged general population without hypertension remains unclear.
Association between pulse pressure, systolic blood pressure and the risk of rapid decline of kidney function among general population without hypertension: results from the China health and retirement longitudinal study (CHARLS).
BACKGROUND
Association between blood pressure (BP) and kidney function among the middle and old aged general population without hypertension remains unclear.
METHODS
Participants aged ≥ 45 years, with complete data in 2011 and 2015 interviews of the China Health and Retirement Longitudinal Study(CHARLS), and without pre-existing hypertension were included. Systolic BP (SBP) was categorized as low (< 120 mmHg), medium (120-129 mmHg), and high (120-139 mmHg). Diastolic BP (DBP) was categorized as low (< 60 mmHg), medium (60-74 mmHg), and high (75-89 mmHg). Pulse pressure (PP) was categorized as normal (< 60 mmHg) and high (≥ 60 mmHg). The outcome was defined as rapid decline of estimated glomerular filtration rate(eGFR, decline ≥ 4 ml/min/1.73 m/year). BP combination was designed according to the category of SBP and PP. The association between BP components, types of BP combination, and the risk of rapid decline of eGFR was analyzed using multivariate logistic regression models, respectively. Age-stratified analyses were conducted.
RESULTS
Of 4,534 participants included, 695(15.3%) individuals were recognized as having rapid decline of eGFR. High PP[odds ratio(OR) = 1.34, 95%confidence interval(CI) 1.02-1.75], low SBP (OR = 1.28, 95%CI 1.03-1.59), and high SBP (OR = 1.32, 95% CI 1.02-1.71) were significantly associated with the risk of eGFR decline. Low SBP were associated with 65% increment of the risk of eGFR decline among participants aged < 55 years. The combination of high SBP and high PP (OR = 1.79, 95% CI 1.27-2.54) and the combination of low SBP and high PP (OR = 3.07, 95% CI 1.24-7.58) were associated with the increased risk of eGFR decline among the middle and old aged general population.
CONCLUSION
Single and combination of high PP and high SBP could be the risk indicators of eGFR decline among the middle and old aged general population.
Topics: Aged; Blood Pressure; China; Humans; Hypertension; Kidney; Longitudinal Studies; Middle Aged; Renal Insufficiency, Chronic; Retirement
PubMed: 34930335
DOI: 10.1186/s12967-021-03176-8 -
Journal of the American College of... Jun 2019
Topics: Blood Pressure; Blood Pressure Determination; Humans; Hypertension; Percutaneous Coronary Intervention
PubMed: 31171091
DOI: 10.1016/j.jacc.2019.03.494 -
Psychophysiology Nov 2014Cerebrovascular support is crucial for healthy cognitive and brain aging. Arterial stiffening is a cause of reduced brain blood flow, a predictor of cognitive decline,...
Cerebrovascular support is crucial for healthy cognitive and brain aging. Arterial stiffening is a cause of reduced brain blood flow, a predictor of cognitive decline, and a risk factor for cerebrovascular accidents and Alzheimer's disease. Arterial health is influenced by lifestyle factors, such as cardiorespiratory fitness (CRF). We investigated new noninvasive optical measures of cerebrovascular health, which provide estimates of arterial pulse parameters (pulse pressure, transit time, and compliance/elasticity) within specific cerebral arteries and cortical regions, and low-resolution maps of large superficial cerebral arteries. We studied naturally occurring variability in these parameters in adults (aged 55-87), and found that these indices of cerebrovascular health are negatively correlated with age and positively with CRF and gray and white matter volumes. Further, regional pulse transit time predicts specific neuropsychological performance.
Topics: Aged; Aged, 80 and over; Aging; Blood Pressure; Cerebral Arteries; Cerebrovascular Disorders; Elasticity; Female; Humans; Male; Middle Aged; Optical Imaging
PubMed: 25100639
DOI: 10.1111/psyp.12288 -
Journal of Hypertension Jan 2021When assessing arterial stiffness, heart rate (HR) and blood pressure (BP) are potential confounders. It appears that the HR/BP dependences of pulse wave velocity (PWV)...
OBJECTIVES
When assessing arterial stiffness, heart rate (HR) and blood pressure (BP) are potential confounders. It appears that the HR/BP dependences of pulse wave velocity (PWV) and distensibility are different, even though both assess arterial stiffness. This study aims to compare aortic PWV as measured using pulse transit time (PWVTT) and as calculated from distensibility (PWVdist) at the same measurement site and propose a solution to the disparity in dependences of PWVTT and PWVdist.
METHODS
Adult anaesthetized rats (n = 24) were randomly paced at HRs 300-500 bpm, at 50 bpm steps. At each step, aortic PWVTT (two pressure-tip catheters) and PWVdist (pressure-tip catheter and ultrasound wall-tracking; abdominal aorta) were measured simultaneously while BP was varied pharmacologically.
RESULTS
HR dependence of PWVdist paradoxically decreased at higher levels of BP. In addition, BP dependence of PWVdist was much larger than that of PWVTT. These discrepancies are explained in that standard PWVdist uses an approximate derivative of pressure to diameter, which overestimates PWV with increasing pulse pressure (PP). In vivo, PP decreases as HR increases, potentially causing a PWVdist decrease with HR. Estimating the full pressure-diameter curve for each HR corrected for this effect by enabling calculation of the true derivative at diastolic BP. This correction yielded a PWVdist that shows HR and BP dependences similar to those of PWVTT. As expected, BP dependence of all PWV metrics was much larger than HR dependence.
CONCLUSION
Measured and calculated PWV have different dependences on HR and BP. These differences are, at least in part, because of approximations made in using systolic and diastolic values to calculate distensibility.
Topics: Animals; Aorta; Blood Pressure; Heart Rate; Pulse Wave Analysis; Rats; Vascular Stiffness
PubMed: 32784350
DOI: 10.1097/HJH.0000000000002608 -
PloS One 2023Delayed heart rate (HR) and blood pressure recovery after exercise test is known as the reliable indexes of autonomic dysfunction. Here we tried to evaluate the serial...
BACKGROUND
Delayed heart rate (HR) and blood pressure recovery after exercise test is known as the reliable indexes of autonomic dysfunction. Here we tried to evaluate the serial changes in various indicators during exercise test and correlations with recovery of HR and blood pressure in a normotensive healthy middle-aged group.
METHODS
A total of 122 patients without hypertension or diabetes was enrolled (mean age, 55.6 ± 11.0; male, 56.6%; mean blood pressure, 124.8 ± 16.6 / 81.5 ± 9.6 mmHg). Treadmill test was performed for evaluation of chest pain. Patients with coronary artery disease, positive treadmill test result, left ventricular dysfunction or renal failure were excluded. Heart rate recovery was calculated by subtracting the HR in the first or second minute of recovery period from the HR of peak exercise (HRR1 or HRR2). Systolic blood pressure in the 4th minute of recovery stage (SBPR4) was used to show delayed blood pressure recovery.
RESULTS
Metabolic equivalents (METs) and HR in stage 2 to 4 were significantly correlated with both HRR1 and HRR2. Multiple regression analysis of HRR revealed significant correlation of METs and SBPR4. SBPR4 was significantly correlated with both HRR1 and HRR2 (HRR1, r = -0.376, p<0.001; HRR2, r = -0.244, p = 0.008) as well as SBP in the baseline to stage 3 and pulse pressure (r = 0.406, p<0.001).
CONCLUSIONS
Delayed BP recovery after peak exercise test revealed significant association with autonomic dysfunction and increased pulse pressure in normotensive middle-aged healthy group. It can be a simple and useful marker of autonomic dysfunction and arterial stiffness.
Topics: Middle Aged; Humans; Male; Adult; Aged; Exercise Test; Blood Pressure; Heart Rate; Hypertension; Primary Dysautonomias
PubMed: 37788242
DOI: 10.1371/journal.pone.0285961 -
Korean Journal of Anesthesiology Oct 2019The assessment of intravascular volume status is very important especially in children during anesthesia. Pulse pressure variation (PPV) and pleth variability index... (Comparative Study)
Comparative Study
BACKGROUND
The assessment of intravascular volume status is very important especially in children during anesthesia. Pulse pressure variation (PPV) and pleth variability index (PVI) are well known parameters for assessing intravascular volume status and fluid responsiveness. We compared PPV and PVI for children aged less than two years who underwent surgery in the prone position.
METHODS
A total of 27 children were enrolled. We measured PPV and PVI at the same limb during surgery before and after changing the patients' position from supine to prone. We then compared PPV and PVI at each period using Bland-Altman plot for bias between the two parameters and for any correlation. We also examined the difference between before and after the position change for each parameter, along with peak inspiratory pressure, heart rate and mean blood pressure.
RESULTS
The bias between PPV and PVI was -2.2% with a 95% limits of agreement of -18.8% to 14.5%, not showing significant correlation at any period. Both PPV and PVI showed no significant difference before and after the position change.
CONCLUSIONS
No significant correlation between PVI and PPV was observed in children undergoing surgery in the prone position. Further studies relating PVI, PPV, and fluid responsiveness via adequate cardiac output estimation in children aged less than 2 years are required.
Topics: Anesthesia; Bias; Blood Pressure; Cardiac Output; Female; Fluid Therapy; Humans; Infant; Male; Pilot Projects; Plethysmography; Prone Position
PubMed: 31216847
DOI: 10.4097/kja.19128 -
BMC Research Notes Mar 2021To determine the correlation between anthropometric indices and the selected hemodynamic parameters among secondary adolescents aged 12-17 years.
OBJECTIVES
To determine the correlation between anthropometric indices and the selected hemodynamic parameters among secondary adolescents aged 12-17 years.
RESULTS
Our findings showed weak positive correlation between generally body surface area, neck circumference and conicity index with the hemodynamic parameters (systolic blood pressure, diastolic blood pressure, resting pulse rate, mean arterial pressure, rate pressure product and pulse pressure). However, the ponderosity index, body mass index and waist hip ratio showed negative weak correlations with the hemodynamic parameters. There was a significant difference in pulse pressure among the BMI categories. All parameters showed significant (p < 0.05) differences across the categories of neck circumference and waist hip ratio. Generally, in multivariate regression analysis, anthropometric indices showed significant prediction of the hemodynamic parameters.
Topics: Adolescent; Anthropometry; Arterial Pressure; Blood Pressure; Body Mass Index; Child; Cross-Sectional Studies; Humans; Obesity; Risk Factors; Waist Circumference; Waist-Hip Ratio
PubMed: 33731195
DOI: 10.1186/s13104-021-05515-w -
The Journals of Gerontology. Series A,... Jul 2023Dysfunction in blood vessel dynamics may contribute to changes in muscle measures. Therefore, we examined associations of vascular health measures with grip strength and...
BACKGROUND
Dysfunction in blood vessel dynamics may contribute to changes in muscle measures. Therefore, we examined associations of vascular health measures with grip strength and gait speed in adults from the Framingham Heart Study.
METHODS
The cross-sectional study (1998-2001) included participants with 1 measure of grip strength (kg, dynamometer) or gait speed (4-m walk, m/s) and at least 1 measure of aortic stiffness (carotid-femoral pulse wave velocity, brachial pulse pressure, and brachial flow pulsatility index) or brachial artery structure and function (resting flow velocity, resting brachial artery diameter, flow-mediated dilation %, hyperemic brachial blood flow velocity, and mean arterial pressure [MAP]) assessed by tonometry and brachial artery ultrasound. The longitudinal study included participants with ≥1 follow-up measurement of gait speed or grip strength. Multivariable linear regression estimated the association of 1 standard deviation (SD) higher level of each vascular measure with annualized percent change in grip strength and gait speed, adjusting for covariates.
RESULTS
In cross-sectional analyses (n = 2 498, age 61 ± 10 years; 56% women), higher resting brachial artery diameter (β ± standard error [SE] per 1 SD: 0.59 ± 0.24, p = .01) and MAP (β ± SE: 0.39 ± 0.17, p = .02) were associated with higher grip strength. Higher brachial pulse pressure (β ± SE: -0.02 ± 0.01, p = .07) was marginally associated with slower gait speed. In longitudinal analyses (n = 2 157), higher brachial pulse pressure (β ± SE: -0.19 ± 0.07, p = .005), was associated with slowing of gait speed but not with grip strength.
CONCLUSIONS
Higher brachial artery pulse pressure (measure of aortic stiffness) was associated with loss of physical function over ~11 years, although we found no evidence that microvascular function contributed to the relation.
Topics: Humans; Female; Aged; Male; Longitudinal Studies; Cross-Sectional Studies; Pulse Wave Analysis; Blood Pressure; Vascular Stiffness; Brachial Artery
PubMed: 37183502
DOI: 10.1093/gerona/glad097