Influence of drugs and gender on the arterial pulse wave and natriuretic peptide secretion in untreated patients with essential hypertension

2002 ◽  
Vol 103 (5) ◽  
pp. 493-499 ◽  
Author(s):  
Alison J. DEARY ◽  
Anne L. SCHUMANN ◽  
Helen MURFET ◽  
Stephen HAYDOCK ◽  
Roger S. FOO ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Natriuretic Peptide ◽  
Pulse Wave ◽  
Antihypertensive Drugs ◽  
Augmentation Index ◽  
Systolic Pressure ◽  
Fold Increase ◽  
Paradoxical Response ◽  
Reflected Wave ◽  
And Gender

Recent studies have suggested a differential influence of mean pressure and pulse pressure on myocardial infarction and stroke, and differences among the major drugs in their efficacy at preventing these individual endpoints. We hypothesized that antihypertensive drugs have differing influences upon the pulse wave even when their effects on blood pressure are the same. We studied 30 untreated hypertensive patients, aged 28—55 years, who were rotated through six 6-week periods of daily treatment with amlodipine 5mg, doxazosin 4mg, lisinopril 10mg, bisoprolol 5mg, bendrofluazide 2.5mg or placebo. The best drug was repeated at the end of the rotation. Blood pressure readings and radial pulse tonometry (by Sphygmocor®) were performed at each visit, and blood was taken for measurement of levels of atrial natriuretic peptide and brain natriuretic peptide (BNP). The Sphygmocor derivation of the central aortic pulse wave was used to measure time for transmission of the reflected wave (TR) and the augmentation index (AI), which is the proportional increase in systolic pressure due to the reflected wave. There was a dissociation between the effects of the drugs on blood pressure and pulse wave analysis. Bisoprolol caused the greatest falls in blood pressure and TR, but was the only drug to increase AI. This paradoxical response to bisoprolol was associated with a 3-fold increase in plasma BNP levels. There was a smaller elevation of BNP in women compared with men, as described previously, and this elevation also was associated with significantly higher values of AI. Other drugs reduced AI, and this was associated with a significant decrease in BNP by amlodipine. In conclusion, antihypertensive drugs differ in their short-term effects on augmentation of the systolic pulse wave and secretion of BNP from the heart, regarded as a sensitive measure of strain on cardiomyocytes. These differences may help to explain cause-specific differences in outcome in recent trials.

scholarly journals Variation in carotid-femoral pulse wave velocity, augmentation pressure and augmentation index during different phases of menstrual cycle

2018 ◽  
Vol 2 (3) ◽  
pp. 27-32 ◽  
Author(s):  
Nudrath Kahkashan ◽  
Mehnaaz Sameera Arifuddin ◽  
Mohammed Abdul Hannan Hazari ◽  
Safia Sultana ◽  
Farah Fatima ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Menstrual Cycle ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Pulse Wave ◽  
Diastolic Pressure ◽  
Augmentation Index ◽  
Arterial Compliance ◽  
Systolic Pressure ◽  
Augmentation Pressure

Physiological variation of estrogen and progesterone during menstrual cycle is well known. They not only have an effect on blood pressure control, but also seem to have a role in regulating arterial compliance. This study was done to find out whether there are any changes in central arterial parameters during different phases of menstrual cycle. Thirty female subjects in the age group of 18-22 years with normal, regular menstrual cycles participated in this prospective observational study at our teaching hospital. Anthropometric parameters were recorded. Blood pressure in all 4 limbs was recorded using cardiovascular risk analyzer-Periscope™ on Day 3rd to 5th (follicular phase), Day 12th to 14th (ovulation phase), Day 22nd to 24th (luteal phase) of their menstrual cycle. We collected blood samples during these three phases for estimation of estradiol and progesterone by ELISA technique. Analysis of variance and correlation statistics were done using SPSS 17.0 statistical software. No significant statistical changes were observed in systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse pressure, aortic systolic pressure, aortic diastolic pressure, aortic augmentation pressure, aortic index and pulse wave velocity during the three recorded phases of the menstrual cycle. There are many studies which correlate changes in peripheral artery blood pressure with different phases of menstrual cycle. But there is scarcity in data available which correlates central arterial pressures and arterial stiffness with natural hormonal variations in different phases of menstrual cycle. However, our results show that although there are subtle changes in blood pressure parameters along with estrogen and progesterone levels throughout the menstrual cycle, yet these were not statistically significant.

scholarly journals Evaluation of 24-Hour Arterial Stiffness Indices and Central Hemodynamics in Healthy Normotensive Subjects versus Treated or Untreated Hypertensive Patients: A Feasibility Study

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Stefano Omboni ◽  
Igor N. Posokhov ◽  
Anatoly N. Rogoza
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Central Hemodynamics ◽  
Wave Analysis ◽  
Hypertensive Patients ◽  
Reflected Wave ◽  
Function Impairment ◽  
Normotensive Subjects

Objective. Central blood pressure (BP) and vascular indices estimated noninvasively over the 24 hours were compared between normotensive volunteers and hypertensive patients by a pulse wave analysis of ambulatory blood pressure recordings.Methods. Digitalized waveforms obtained during each brachial oscillometric BP measurement were stored in the device memory and analyzed by the validated Vasotens technology. Averages for the 24 hours and for the awake and asleep subperiods were computed.Results. 142 normotensives and 661 hypertensives were evaluated. 24-hour central BP, pulse wave velocity (PWV), and augmentation index (AI) were significantly higher in the hypertensive group than in the normotensive group (119.3 versus 105.6 mmHg for systolic BP, 75.6 versus 72.3 mmHg for diastolic BP, 10.3 versus 10.0 m/sec for aortic PWV, −9.7 versus −40.7% for peripheral AI, and 24.7 versus 11.0% for aortic AI), whereas reflected wave transit time (RWTT) was significantly lower in hypertensive patients (126.6 versus 139.0 ms). After adjusting for confounding factors a statistically significant between-group difference was still observed for central BP, RWTT, and peripheral AI. All estimates displayed a typical circadian rhythm.Conclusions. Noninvasive assessment of 24-hour arterial stiffness and central hemodynamics in daily life dynamic conditions may help in assessing the arterial function impairment in hypertensive patients.

Abstract P457: Hypertensive, Type II Diabetic and Obese Patients, Are Better Controlled and Reduce the Number of Drugs When Empagliflozin is Added to Standard Treatment Improving Also Arterial Stiffness and Central Blood Pressures

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Ricardo Cabrera-Sole ◽  
Caridad Turpin Lucas ◽  
Liliana Urrera Rivera ◽  
Santiago Garcia Ruiz ◽  
Manuel Aguilera
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Standard Treatment ◽  
Pulse Wave ◽  
Antihypertensive Drugs ◽  
Augmentation Index ◽  
P Value ◽  
Channel Blockers ◽  
Blood Pressures ◽  
Central Systolic Blood Pressure

Introduction: It is known the difficulty of adequate control of blood pressure (BP) with a single drug, being necessary in most use 2 or more antihypertensive drugs. If they are also obese and diabetic, require even more drugs so we present our experience of adding empagliflozin to the treatment of patients with these characteristics. Objectives: To assess the benefits of metabolic ,BP and arterial stiffness parameters introducing empagliflozin in obese ,hypertensive and diabetics patients (PHTAD). Material and Methods: we studied 32 PHTAD receiving at least 3 drugs (ACE inhibitors, calcium channel blockers, hydrochlorothiazide) and two or more anti diabetic drugs (metformin, glimepirina, sitagliptin, insulin and Statins) for controlling their pathologies). We checked number of drug, BP, glicosylated hemoglobin (A1cHb), BMI and arterial stiffness measured by augmentation index (AI) and pulse wave velocity (PWV) and central systolic blood pressure (SBPc). Patients were followed for 32 weeks, adding to the beginning of the study empagliflozina .Every two months we checked them . The beginning and the end results were compared and are set out in the following table. *means p value less than 0.05 Conclusions: According to our data, the introduction of empagliflozin to the treatment of PHTAD significantly improves metabolic parameters and helps to reduce the number of antihypertensive and antidiabetic drugs they are taking, improving the arterial stiffness indexes and the central pressure values, obtaining a clear improvement in the control of their cardiovascular risk . So it should be thought about this group of drugs when it comes to medicating PHTAD.

Applanation Tonometry for Assessment of Left Ventricular Systolic Load

2019 ◽  
Vol 12 (2) ◽  
pp. 94-99
Author(s):  
Rene D. Mileva-Popova ◽  
Nina Y. Belova
Keyword(s):  
Arterial Stiffness ◽  
Augmentation Index ◽  
Age Groups ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Applanation Tonometry ◽  
Non Invasive ◽  
Pressure Area ◽  
Older Subjects ◽  
And Gender

Summary Vascular-ventricular coupling is a major determinant of left ventricular load. The aim of our study was to assess non- invasively left ventricular load and its dependency on central hemodynamics. Sixty-five healthy and gender-matched individuals were divided in two groups according to their age: 20y/o and 50y/o. Applanation tonometry was performed using the Sphygmocor device. Central pressures and pulse wave analysis indices were computed. Central systolic (120±3 vs. 98±2 mm Hg) and pulse pressures (43±3 vs. 29±1 mm Hg) as well as the augmentation index (AIx75) (23±3 vs. 6±2%) were significantly higher in the 50y/o group (p<0.01). These parameters are relevant markers of arterial stiffness and evidenced the development of central arterial morphological and functional alterations in the older subjects. The time-tension index (TTI) computed from the systolic pressure area was significantly higher in the 50y/o subjects as compared to the 20y/o group (2378±66 vs. 1954±73 mmHg×s, p<0.01). Moreover, we have shown the presence of significant correlation between TTI and AIx75 (p<0.01) in both age groups. This finding confirmed the contribution of arterial stiffness for the impaired vascular-ventricular coupling. In conclusion, applanation tonometry might be utilized for non-invasive evaluation of the left ventricular load, which is an important parameter of cardiovascular risk.

Determinants of central aortic pressure and pulse pressure amplification changes in patients with aortic aneurysm: the role of aortic diameter and aortic aneurysm location level

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Gurevich ◽  
I Emelyanov ◽  
N Zherdev ◽  
D Chernova ◽  
A Chernov ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Aneurysm ◽  
Pulse Pressure ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Aortic Pressure ◽  
Aortic Diameter ◽  
Maximum Diameter ◽  
Central Aortic Pressure ◽  
Abdominal Aortic

Abstract Background The presence of aortic aneurysm can alters pulse wave propagation and reflection, causing changes in central aortic pressure and pulse pressure amplification (PPA) between the aorta and the brachial artery that might be associated with unfavorable hemodynamic effects for the central arteries and the heart. However, the impact of the location of the aneurysm and increase of the aortic diameter on central blood pressure (CBP) is not fully understood. Objective To investigate central aortic pressure and PPA regarding to association with arterial stiffness and aortic diameter in patients with ascending aortic aneurysm (AA), descending thoracic and abdominal aortic aneurysm (TAA and AAA). Methods 122 patients (96 males, 65±11 years) with aortic aneurysm were enrolled before aortic repair. The parameters of the aorta were evaluated by MSCT angiography: 44 patients (30 males, 55±13 years) had AA (the maximum diameter: 59.9±14.2 mm), 13 patients (11 males, 62±11 years) had TAA (the maximum diameter: 62.8±8.0 mm) and 65 patients (54 males, 69±8 years) had AAA (the maximum diameter: 52.3±17.2 mm). Brachial blood pressure (BBP) was measured by OMRON. CBP, augmentation index (AIx), carotid-femoral pulse wave velocity (PWV) were assessed by SphygmoCor. PPA was calculated as a difference between the values of central and brachial pulse pressure (CPP and BPP). Results Patients of the three groups did not differ in BPP (AA: 59.2±17.6; TAA 56.8±12.8; AAA: 59.3±11.4 mm Hg; P=0.5). Intergroup comparison revealed a difference in CPP between the three patients groups: CPP was higher in patients with AA and AAA, lower in patients with TAA (AA: 50.3±16.2; TAA 43.8±10.8; AAA: 50.0±11.2 mm Hg; P=0.05). PPA was lower in patients with AA and AAA than in patients with TAA (9.6±6.7 and 9.3±4.2 vs. 13.0±6.5 mm Hg; P=0.05 and P=0.04, respectively). IAx was higher in patients with AA and AAA than in patients with TAA (25.2±8.1 and 27.6±8.2 vs. 17.2±8.2 mm Hg; P=0.008 and P=0.001, respectively). A decrease of PPA across all patients correlated with an increase of IAx (r = - 0.268; P=0.003). CPP decreased with an increase of the aortic diameter for each level of the aneurysm (AA: r = - 0.460, P=0.016; TAA: r = - 0.833, P=0.003; AAA: r = - 0.275, P=0.05). PWV decreased with the expansion of the maximum aortic diameter at the level of the AA, TAA and AAA: (r = - 0.389, P=0.03; r = - 0.827, P=0.02 and r = - 0.350, P=0.01, respectively). Conclusion In patients with aortic aneurysm measurements of lower central pulse pressure and reduced PWV indicate an association with increased diameter of the aneurysm. An increase in augmentation index, early return of reflected waves, thus smaller PP amplification and higher CPP were identified in patients with ascending and abdominal aortic aneurysm compared by patients with descending thoracic aortic aneurysm. Funding Acknowledgement Type of funding source: None

scholarly journals Effects of aerobic, resistance and concurrent exercise on pulse wave reflection and autonomic modulation in men with elevated blood pressure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Paulo Farinatti ◽  
Alex da Silva Itaborahy ◽  
Tainah de Paula ◽  
Walace David Monteiro ◽  
Mário F. Neves
Keyword(s):  
Blood Pressure ◽  
Wave Reflection ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Aortic Pressure ◽  
Elevated Blood Pressure ◽  
Autonomic Modulation ◽  
Elevated Blood ◽  
Pulse Wave Reflection ◽  
Concurrent Exercise

AbstractThe acute effects of exercise modes on pulse wave reflection (PWR) and their relationship with autonomic control remain undefined, particularly in individuals with elevated blood pressure (BP). We compared PWR and autonomic modulation after acute aerobic (AE), resistance (RE), and concurrent exercise (CE) in 15 men with stage-1 hypertension (mean ± SE: 34.7 ± 2.5 years, 28.4 ± 0.6 kg/m2, 133 ± 1/82 ± 2 mmHg). Participants underwent AE, RE, and CE on different days in counterbalanced order. Applanation tonometry and heart rate variability assessments were performed before and 30-min postexercise. Aortic pressure decreased after AE (− 2.4 ± 0.7 mmHg; P = 0.01), RE (− 2.2 ± 0.6 mmHg; P = 0.03), and CE (− 3.1 ± 0.5 mmHg; P = 0.003). Augmentation index remained stable after RE, but lowered after AE (− 5.1 ± 1.7%; P = 0.03) and CE (− 7.6 ± 2.4% P = 0.002). Systolic BP reduction occurred after CE (− 5.3 ± 1.9 mmHg). RR-intervals and parasympathetic modulation lowered after all conditions (~ 30–40%; P < 0.05), while the sympathovagal balance increased after RE (1.2 ± 0.3–1.3 ± 0.3 n.u., P < 0.05). Changes in PWR correlated inversely with sympathetic and directly with vagal modulation in CE. In conclusion, AE, RE, and CE lowered central aortic pressure, but only AE and CE reduced PWR. Overall, those reductions related to decreased parasympathetic and increased sympathetic outflows. Autonomic fluctuations seemed to represent more a consequence than a cause of reduced PWR.

Cardiovascular Effects of Aerobic Exercise With Self-Selected or Predetermined Intensity in Adolescents With Obesity

2021 ◽  
pp. 1-7
Author(s):  
Tércio A.R. Barros ◽  
Wagner L. do Prado ◽  
Thiago R.S. Tenório ◽  
Raphael M. Ritti-Dias ◽  
Antônio H. Germano-Soares ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Body Mass Index ◽  
Heart Rate ◽  
Pulse Pressure ◽  
Exercise Intensity ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Cardiovascular Effects ◽  
Heart Rate Reserve ◽  
Central Pulse Pressure

This study compared the effects of self-selected exercise intensity (SEI) versus predetermined exercise intensity (PEI) on blood pressure (BP) and arterial stiffness in adolescents with obesity. A total of 37 adolescents, 14.7 (1.6) years old, body mass index ≥95th percentile were randomly allocated into SEI (n = 18; 12 boys) or PEI (n = 19; 13 boys). Both groups exercised for 35 minutes on a treadmill, 3 times per week, for 12 weeks. The SEI could set the speed at the beginning of the sessions and make changes every 5 minutes. The PEI adolescents were trained at an intensity set at 60% to 70% of heart rate reserve. Brachial and central BP, pulse pressure, augmentation index, and carotid–femoral pulse wave were determined at baseline and after 12 weeks. Both groups reduced brachial systolic BP (SEI, Δ = −9 mm Hg; PEI, Δ = −4 mm Hg; P < .01), central systolic BP (SEI, Δ = −4 mm Hg; PEI, Δ = −4 mm Hg; P = .01), and central pulse pressure (SEI, Δ = −4 mm Hg; PEI, Δ = −3 mm Hg; P = .02) without differences between groups. No changes in the augmentation index and carotid–femoral pulse wave were observed in either group. The SEI induced similar changes in various cardiovascular outcomes compared with PEI in adolescents with obesity.

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