Influence of arterial stiffness on cardiovascular outcome in patients without high blood pressure

ObjectiveAlthough blood pressure (BP) is a major determinant of arterial stiffness, whether high pulse wave velocity (PWV) adversely influences cardiac parameters and cardiovascular (CV) outcome in patients without high BP remains unclear.MethodsOutpatients without high BP (n=320), defined as systolic BP ≥140 mm Hg, were enrolled in this retrospective study. At baseline, all patients underwent echocardiography and multidetector CT to determine the coronary artery calcification (CAC) score. Arterial stiffness was assessed based on brachial-ankle PWV (baPWV), from which patients were classified into two groups: those with high (≥18 m/s, n=89) and low baPWV (<18 m/s, n=231). Cardiac parameters and CV event incidence during the follow-up period were compared between these groups.ResultsIn multivariable linear regression analysis, baPWV was significantly associated with CAC score and serum N-terminal pro-brain natriuretic peptide hormone level, after adjustment for confounding factors. In multivariable logistic regression analysis, baPWV ≥18 m/s was significantly associated with CAC score ≥400 (OR 2.466, 95% CI 1.012 to 6.009, p=0.0471). Kaplan-Meier analysis showed that the high-baPWV group experienced more CV events during the 575 days of follow-up (20% vs 6%, p=0.0003).ConclusionsHigh baPWV was associated with greater CAC and a high risk of a future CV event, especially coronary artery disease, even in patients without high BP.

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Vascular Overload Index Predicts Cerebral Small Vessel Disease in a Neurologically Healthy Population

Journal of Neurosonology and Neuroimaging ◽

10.31728/jnn.2021.00105 ◽

2021 ◽

Vol 13 (2) ◽

pp. 55-63

Author(s):

Ki-Woong Nam ◽

Hyung-Min Kwon ◽

Jin-Ho Park ◽

Hyuktae Kwon

Keyword(s):

Blood Pressure ◽

Regression Analysis ◽

Arterial Stiffness ◽

Confidence Interval ◽

Linear Regression Analysis ◽

University Hospital ◽

Small Vessel ◽

White Matter Hyperintensity ◽

Multivariable Logistic Regression Analysis ◽

Healthy Population

Background: Arterial stiffness has been suggested as one of the major pathological mechanisms of cerebral small vessel diseases (cSVDs). In this study, we confirmed this hypothesis by evaluating the association between vascular overload index (VOI), which is a physiologically good indicator of arterial stiffness, and cSVD.Methods: We evaluated participants who visited Seoul National University Hospital Health Promotion Center for health check-ups between 2006 and 2013. VOI was calculated by the following formula: VOI (mmHg)=1.33×systolic blood pressure -0.33×diastolic blood pressure-133.3. cSVDs were measured including white matter hyperintensity (WMH), lacunes, and cerebral microbleeds (CMBs). We quantitatively measured the WMH volume and rated the presence and number of lacunes and CMBs qualitatively.Results: A total of 3,231 participants were evaluated (mean age 57±9 years, male sex 53.9%). In multivariable linear regression analysis, VOI was significantly associated with WMH volume after adjusting confounders (β=0.004, 95% confidence interval=0.002–0.006). VOI also showed a close association with lacunes in multivariable logistic regression analysis (adjusted odds ratio=1.01, 95% confidence interval=1.00–1.02). There was no statistical association with CMBs. In subgroup analysis according to the presence of hypertension, VOI was closely associated with WMH volume/lacunes only in patients without hypertension. In patients with hypertension, these statistical associations disappeared.Conclusion: A high VOI was associated with cSVD in a neurologically healthy population, especially in patients without hypertension. This marker of arterial stiffness could be convenient and useful predictor of cSVD.

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Gender is a determinant of carotid artery stiffness independent of age and blood pressure

British Journal of Radiology ◽

10.1259/bjr.20200796 ◽

2021 ◽

Vol 94 (1119) ◽

pp. 20200796

Author(s):

Zhenzhen Wang ◽

Wei Li ◽

Wei Liu ◽

Jiawei Tian

Keyword(s):

Blood Pressure ◽

Regression Analysis ◽

Carotid Artery ◽

Linear Regression ◽

Arterial Stiffness ◽

Multiple Linear Regression ◽

Linear Regression Analysis ◽

Multiple Linear Regression Analysis ◽

Stiffness Index ◽

Males And Females

Objective: To identify the gender-specific differences in carotid artery structural and stiffening parameters by radiofrequency ultrasound (RFU) with an automatic arterial stiffness analyzing system. Methods: Seventy-two consecutive individuals (32 males and 40 females, age range from 36 to 62 years) with no history of significant cardiovascular diseases or carotid artery plaques were enrolled between September and December 2017. Quality intima-media thickness (QIMT) and quality arterial stiffness (QAS) parameters were automatically computed, including pulse wave velocity (PWV), vascular distension, compliance coefficient (CC), distensibility coefficient (DC), stiffness index α and β, augmentation pressure (AP), and augmentation index (AIx). Those parameters were compared between males and females. Multiple linear regression analysis was performed to assess the independent association between gender and RFU parameters. Results: The mean age had no difference between males and females (47.8 ± 3.3 vs 50.0 ± 8.5 years, p = 0.19). Females had higher systolic blood pressure (134.53 ± 9.65 vs 127.78 ± 6.12 mm Hg) and diastolic blood pressure (85.83 ± 3.94 vs 78.03 ± 5.22 mm Hg), greater carotid QIMT (598.73 ± 72.16 vs 550.84 ± 29.37 µm), advanced PWV (8.08 ± 1.60 vs 6.24 ± 0.70 m/s), higher stiffness index α (6.21 ± 1.94 vs 3.95 ± 0.78) and β (9.43 ± 3.17 vs 6.38 ± 0.78), higher AP (6.68 ± 2.24 vs 3.64 ± 1.22 mm Hg) and AIx (7.42 ± 2.08 vs 4.69 ± 1.26%), all p < 0.001. Multiple linear regression analysis demonstrated gender was independently associated with carotid structural and elastic parameters. Conclusion: Gender independently impacts carotid structure and function, with females more vulnerable to the progression of arterial aging. Awareness of the gender differences on the risk stratification of carotid artery disease will benefit reliable assessments and specific management recommendations in clinical practice. Advances in knowledge: (1) RFU provides an μm-unit quality IMT measurement and multiple quality arterial stiffness parameters. (2) Gender is an independent determinant in both the arterial structural and elastic aspects, with females of stiffer arteries in low CVD risk individuals.

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Burnout and resilience among Canadian palliative care physicians

BMC Palliative Care ◽

10.1186/s12904-020-00677-z ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Cindy Wang ◽

Pamela Grassau ◽

Peter G. Lawlor ◽

Colleen Webber ◽

Shirley H. Bush ◽

...

Keyword(s):

Palliative Care ◽

Regression Analysis ◽

Linear Regression Analysis ◽

Maslach Burnout Inventory ◽

Personal Accomplishment ◽

Multivariable Logistic Regression Analysis ◽

Individual Level ◽

Resilience Scale ◽

Multivariable Linear Regression Analysis ◽

High Degree

Abstract Background Physicians experience high rates of burnout, which may negatively impact patient care. Palliative care is an emotionally demanding specialty with high burnout rates reported in previous studies from other countries. We aimed to estimate the prevalence of burnout and degree of resilience among Canadian palliative care physicians and examine their associations with demographic and workplace factors in a national survey. Methods Physician members of the Canadian Society of Palliative Care Physicians and Société Québécoise des Médecins de Soins Palliatifs were invited to participate in an electronic survey about their demographic and practice arrangements and complete the Maslach Burnout Inventory for Medical Professionals (MBI-HSS (MP)), and Connor-Davidson Resilience Scale (CD-RISC). The association of categorical demographic and practice variables was examined in relation to burnout status, as defined by MBI-HSS (MP) score. In addition to bivariable analyses, a multivariable logistic regression analysis, reporting odds ratios (OR), was conducted. Mean CD-RISC score differences were examined in multivariable linear regression analysis. Results One hundred sixty five members (29%) completed the survey. On the MBI-HSS (MP), 36.4% of respondents reported high emotional exhaustion (EE), 15.1% reported high depersonalization (DP), and 7.9% reported low personal accomplishment (PA). Overall, 38.2% of respondents reported a high degree of burnout, based on having high EE or high DP. Median CD-RISC resilience score was 74, which falls in the 25th percentile of normative population. Age over 60 (OR = 0.05; CI, 0.01–0.38), compared to age ≤ 40, was independently associated with lower burnout. Mean CD-RISC resilience scores were lower in association with the presence of high burnout than when burnout was low (67.5 ± 11.8 vs 77.4 ± 11.2, respectively, p < 0.0001). Increased mean CD-RISC score differences (higher resilience) of 7.77 (95% CI, 1.97–13.57), 5.54 (CI, 0.81–10.28), and 8.26 (CI, 1.96–14.57) occurred in association with age > 60 as compared to ≤40, a predominantly palliative care focussed practice, and > 60 h worked per week as compared to ≤40 h worked, respectively. Conclusions One in three Canadian palliative care physicians demonstrate a high degree of burnout. Burnout prevention may benefit from increasing resilience skills on an individual level while also implementing systematic workplace interventions across organizational levels.

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Gender Difference of the Relationship between Arterial Stiffness and Blood Pressure Variability in Participants in Prehypertension

International Journal of Hypertension ◽

10.1155/2019/7457385 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Yang Lan ◽

Huan Liu ◽

Jinbo Liu ◽

Hongwei Zhao ◽

Hongyu Wang

Keyword(s):

Blood Pressure ◽

Arterial Stiffness ◽

Blood Pressure Variability ◽

Total Population ◽

Vascular System ◽

Blood Pressure Monitoring ◽

Linear Regression Analysis ◽

Multivariable Linear Regression Analysis ◽

Female Body Mass ◽

Traditional Risk Factors

Aim. The association of pressure load with elasticity in vascular system has not been studied fully. We proposed a hypothesis whether gender could modify the association of blood pressure variability (BPV) and arterial stiffness assessed by carotid-femoral pulse wave velocity (CF-PWV) in prehypertensive patients. Methods. 24h ambulatory blood pressure monitoring (24h-ABPM) and CF-PWV were measured in 723 participants with prehypertension. Univariate and multivariate regression analyses of these clinical and biological parameters were performed in total population, male and female. Results. A total of 723 participants (mean age 59.76 ± 12.37years, male 329 and female 394) were enrolled into the study. Compared with female, body mass index (BMI), fasting plasma glucose (FPG), uric acid (UA), and homocysteine (HCY) were significantly higher (all p < 0.05). Arterial stiffness (CF-PWV, male versus female, 10.89 ± 2.50 versus 10.33 ± 2.13 m/s, p=0.004) and BPVs (male versus female, 24 h SBPV 13.2 ± 5.11 versus 13.03 ± 5.20; 24 h DBPV 10.34 ± 3.87 versus 9.64 ± 3.59; N SBPV 11.90 ± 6.60 versus 10.94 ± 4.79; N DBPV 9.64 ± 5.87 versus 8.20 ± 4.48, all p<0.05) were higher in male. Multivariable linear regression analysis showed that 24 h BPV were linearly and positively related to CF-PWV in total population (24h SBPV, B=0.033; 24 h DBPV, B=0.035, both P<0.05) and female (24h SBPV, B=0.041; 24h DBPV, B=0.067, both P<0.05) independent of traditional risk factors and medications. Conclusion. BPV was independently associated with arterial stiffness in total population and the relation was modified by gender. 24 h BPVs in prehypertensive patients were useful to identify the early arterial stiffness. Clinical Trials Registration. This trial was registered with Clinical Trials.gov Identifier: NCT02569268.

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P0235LOW SERUM 3-METHYL HISTIDINE LEVEL IS ASSOCIATED WITH AORTIC STIFFNESS IN HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0235 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Yu-Chi Chang ◽

Chi-Chong Tang ◽

Bang-Gee Hsu

Keyword(s):

Regression Analysis ◽

Arterial Stiffness ◽

Aortic Stiffness ◽

High Performance ◽

Independent Predictor ◽

Linear Regression Analysis ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Control Group ◽

Multivariable Logistic Regression Analysis

Abstract Background and Aims 3-methyl histidine (3MH) is a non-proteinogenic amino acid and an index of muscle breakdown. Subclinical protein malnutrition is an independent association with arterial stiffness. The aim of this study was to evaluate the relationship between serum 3MH levels and carotid-femoral pulse wave velocity (cfPWV) values in chronic hemodialysis patients. Method Fasting blood samples and baseline characteristics were obtained from 136 chronic hemodialysis patients. Serum 3MH was performed with high-performance liquid chromatography and mass spectrometry. Aortic arterial stiffness was defined as cfPWV values >10 m/s according to the ESH-ESC 2013 guidelines. Results Among 110 chronic hemodialysis patients, 45 patients (40.9%) were in the aortic arterial stiffness group. When compared to those in the control group, the aortic arterial stiffness group had high prevalence of diabetes mellitus (p < 0.001), hypertension (p = 0.006), older age (p = 0.002), higher systolic blood pressure (p = 0.016), and lower serum 3MH level (p = 0.001). Multivariable logistic regression analysis of the factors significantly associated with aortic arterial stiffness revealed that serum 3MH levels (odds ratio (OR): 0.791, 95% confidence interval (CI): 0.691–0.906, p = 0.001) was the independent predictor of aortic arterial stiffness in chronic hemodialysis patients. Multivariable forward stepwise linear regression analysis also showed that logarithmically transformed 3MH level (log-3MH, β = -0.322, adjusted R2 change = 0.127, p < 0.001) was an independent predictor of cfPWV values in chronic hemodialysis patients. The area under the receiver-operating characteristic (ROC) curve indicates the diagnostic power of 3MH at predicting aortic stiffness of chronic hemodialysis patients was 0.691 (95% CI: 0.595-0.775, p = 0.0002). Conclusion Serum-free 3MH level is negatively associated with aortic arterial stiffness in chronic hemodialysis patients.

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Determinants of change in arterial stiffness over 5 years in early chronic kidney disease

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz170 ◽

2019 ◽

Cited By ~ 2

Author(s):

Natasha J McIntyre ◽

Adam Shardlow ◽

Richard J Fluck ◽

Christopher W McIntyre ◽

Maarten W Taal

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Arterial Stiffness ◽

Linear Regression Analysis ◽

Arterial Disease ◽

Diabetes Status ◽

Ckd Stage ◽

Baseline Systolic Blood Pressure ◽

Multivariable Linear Regression Analysis

Abstract Background Arterial stiffness (AS) is an established and potentially modifiable risk factor for cardiovascular disease associated with chronic kidney disease (CKD). There have been few studies to evaluate the progression of AS over time or factors that contribute to this, particularly in early CKD. We therefore investigated AS over 5 years in an elderly population with CKD Stage 3 cared for in primary care. Methods A total of 1741 persons with an estimated glomerular filtration rate of 30–59 mL/min/1.73 m2 underwent detailed clinical and biochemical assessment at baseline and Years 1 and 5. Carotid to femoral pulse wave velocity (PWV) was measured to assess AS using a Vicorder device. Results 970 participants had PWV assessments at baseline and 5 years. PWV increased significantly by a mean of 1.1 m/s (from 9.7 ± 1.9 to 10.8 ± 2.1 m/s). Multivariable linear regression analysis identified the following independent determinants of ΔPWV at Year 5: baseline age, diabetes status, baseline systolic blood pressure (SBP) and diastolic blood pressure, baseline PWV, ΔPWV at 1 year, ΔSBP over 5 years and Δserum bicarbonate over 5 years (R2 = 0.38 for the equation). Conclusions We observed a clinically significant increase in PWV over 5 years in a cohort with early CKD despite reasonably well-controlled hypertension. Measures of BP were identified as the most important modifiable determinant of ΔPWV, suggesting that interventions to prevent arterial disease should focus on improved control of BP, particularly in those who evidence an early increase in PWV. These hypotheses should now be tested in prospective trials.

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Anemia increases long-term mortality in patients undergoing conventional coronary angiography – the ECAT registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.1508 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

B Balcer ◽

I Dykun ◽

S Hendricks ◽

F Al-Rashid ◽

M Totzeck ◽

...

Keyword(s):

Coronary Artery Disease ◽

Regression Analysis ◽

Coronary Artery ◽

Coronary Angiography ◽

Conventional Coronary Angiography ◽

Term Survival ◽

Coronary Syndrome ◽

Artery Disease

Abstract Background Anemia is a frequent comorbidity in patients with coronary artery disease (CAD). Besides a complemental effect on myocardial oxygen undersupply of CAD and anemia, available data suggests that it may independently impact the prognosis in CAD patients. We aimed to determine the association of anemia with long-term survival in a longitudinal registry of patients undergoing conventional coronary angiography. Methods The present analysis is based on the ECAD registry of patients undergoing conventional coronary angiography at the Department of Cardiology and Vascular Medicine at the University Clinic Essen between 2004 and 2019. For this analysis, we excluded all patients with missing hemoglobin levels at baseline admission or missing follow-up information. Anemia was defined as a hemoglobin level of <13.0g/dl for male and <12.0g/dl for female patients according to the world health organization's definition. Cox regression analysis was used to determine the association of anemia with morality, stratifying by clinical presentation of patients. Hazard ratio and 95% confidence interval are depicted for presence vs. absence of anemia. Results Overall, data from 28,917 patient admissions (mean age: 65.3±13.2 years, 69% male) were included in our analysis (22,570 patients without and 6,347 patients with anemia). Prevalence of anemia increased by age group (age <50 years: 16.0%, age ≥80 years: 27.7%). During a mean follow-up of 3.2±3.4 years, 4,792 deaths of any cause occurred (16.6%). In patients with anemia, mortality was relevantly higher as compared to patients without anemia (13.4% vs. 28.0% for patients without and with anemia, respectively, p<0.0001, figure 1). In univariate regression analysis, anemia was associated with 2.4-fold increased mortality risk (2.27–2.55, p<0.0001). Effect sizes remained stable upon adjustment for traditional risk factors (2.38 [2.18–2.61], p<0.0001). Mortality risk accountable to anemia was significantly higher for patients receiving coronary interventions (2.62 [2.35–2.92], p<0.0001) as compared to purely diagnostic coronary angiography examinations (2.31 [2.15–2.47], p<0.0001). Likewise, survival probability was slightly worse for patients with anemia in acute coronary syndrome (2.70 [2.29–3.12], p<0.0001) compared to chronic coronary syndrome (2.60 [2.17–3.12], p<0.0001). Interestingly, within the ACS entity, association of anemia with mortality was relevantly lower in STEMI patients (1.64 [1.10–2.44], p=0.014) as compared to NSTEMI and IAP (NSTEMI: 2.68 [2.09–3.44], p<0.0001; IAP: 2.67 [2.06–3.47], p<0.0001). Conclusion In this large registry of patients undergoing conventional coronary angiography, anemia was a frequent comorbidity. Anemia relevantly influences log-term survival, especially in patients receiving percutaneous coronary interventions. Our results confirm the important role of anemia for prognosis in patients with coronary artery disease, demonstrating the need for specific treatment options. Figure 1. Kaplan Meier analysis Funding Acknowledgement Type of funding source: None

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Comparing differences and correlation between 24-hour ambulatory blood pressure and office blood pressure monitoring in patients with untreated hypertension

Journal of International Medical Research ◽

10.1177/03000605211016144 ◽

2021 ◽

Vol 49 (6) ◽

pp. 030006052110161

Author(s):

Zhenhong Zhang ◽

Shunyin Wang ◽

Junru Yan ◽

Zhiwen Xu ◽

Dongliang Liang ◽

...

Keyword(s):

Blood Pressure ◽

Regression Analysis ◽

Linear Regression ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Linear Regression Analysis ◽

Fasting Blood Glucose ◽

Left Ventricular ◽

Office Blood Pressure ◽

Pressure Index

Objective We assessed differences and correlations between 24-hour ambulatory blood pressure (ABP) and office blood pressure (OBP) monitoring. Methods We conducted an observational study among 85 untreated patients with essential hypertension and measured 24-hour ABP, OBP, target organ damage (TOD) markers, and metabolism indexes. Variance analysis and the Pearson method were used to compare differences and correlation between the two methods. The Spearman or Pearson method was applied to compare the correlation between TOD markers, blood pressure index, and metabolism index. Linear regression analysis was applied to estimate the quantitative relationship between the blood pressure index and TOD markers. Results There were significant differences in the mean and variance of systolic blood pressure (SBP) and diastolic blood pressure and a positive correlation between ABP and OBP. Correlations between the left ventricular mass index (LVMI) and average ambulatory SBP, daytime ambulatory SBP, nighttime ambulatory SBP, and fasting blood glucose were significant. Correlations between left intima-media thickness (IMT) and average ambulatory SBP, nighttime ambulatory SBP, right IMT, and nighttime ambulatory SBP were significant. In linear regression analysis of the LVMI (y) and ambulatory SBP (x), the equation was expressed as y = 0.637*x. Conclusion Nighttime ambulatory SBP may be an optimal predictor of TOD.

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Abstract P262: Spot Urine Sodium to Potassium Ratio Predicts Increasing Blood Pressure Levels in a General Population: The Nagahama Study

Hypertension ◽

10.1161/hyp.68.suppl_1.p262 ◽

2016 ◽

Vol 68 (suppl_1) ◽

Author(s):

Yasuharu Tabara ◽

Yoshimitsu Takahashi ◽

Takeo Nakayama ◽

Fumihiko Matsuda

Keyword(s):

Blood Pressure ◽

Salt Intake ◽

Linear Regression Analysis ◽

Prognostic Significance ◽

Reverse Causality ◽

Cross Sectional ◽

Salt Loading ◽

Available N ◽

Spot Urine

Excessive salt intake is a risk factor for hypertension. The most reliable method for estimating daily salt intake is measurement of 24-h urinary sodium excretion, while it is inconvenient. Sodium-to-potassium ratio (Na/K) of a urine sample is another index of salt loading. We previously reported that a simple measure of spot urine Na/K might be a representative of salt loading in a cross-sectional setting. Here, we conducted a longitudinal study aiming to clarify a prognostic significance of spot urine Na/K for increasing blood pressure (BP) levels. Study subjects consists of 9,769 general individuals. Among them, individuals whose baseline Na/K was available (n=9,328), who were normotensive at baseline (n=6,392), and who participated in the follow-up measurement (n=5,209) were included in this analysis (51.8±12.9 years old, male: 29.2%). Mean follow-up duration was 5.0±0.5 years. Mean Na/K at baseline was 3.1±1.7, and showed step-wise increase with BP levels (optimal: 3.0±1.6, normal: 3.3±1.8, high normal: 3.4±1.8, P<0.001). Other major factors that were significantly associated with Na/K was fasting time (r=-0.220, P<0.001), and CKD (CKD (n=694): 2.7±1.6, control: 3.2±1.7, P<0.001). Mean SBP was significantly increased during follow-up period (baseline: 116±12, follow-up: 119±15 mmHg), and 805 individuals (15.5%) were newly diagnosed as hypertension (HT). These individuals were significantly older (HT: 60.3±9.9, NT: 50.3±12.8 years), were frequently male (36.4%, 27.9%), and had higher SBP (127±9, 115±11 mmHg) at baseline (P<0.001). In contrast, baseline spot urine Na/K was slightly lower in individuals who developed HT (3.0±1.6, 3.1±1.8, P=0.013), while that measured at follow-up investigation was oppositely higher in hypertensives (3.1±1.8, 2.8±1.5, P<0.001). Multiple linear regression analysis adjusted for the covariates identified baseline Na/K (β=0.108, P<0.001) and changes in Na/K during follow-up period (β=0.222, P<0.001) as independent determinants for future SBP levels. Higher spot urine Na/K, as well as increases in the Na/K levels, was significant determinant for future BP levels. The apparently lower baseline Na/K levels in individuals who developed HT might be due to reverse causality.

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Single Pill Indapamide and Perindopril Arginine Combination: Optimal Coupling of Vascular Protection and Hemodynamic Risk Factors Reduction in Patients with Essential Arterial Hypertension

Kardiologiia ◽

10.18087/cardio.2019.3.10236 ◽

2019 ◽

Vol 59 (3) ◽

pp. 18-26 ◽

Cited By ~ 1

Author(s):

E. V. Borisova ◽

A. I. Kochetkov ◽

O. D. Ostroumova

Keyword(s):

Blood Pressure ◽

Arterial Stiffness ◽

Arterial Hypertension ◽

Arterial Compliance ◽

Stage Ii ◽

Stiffness Index ◽

Single Pill ◽

Essential Arterial Hypertension ◽

The Impact

Objective: to investigate the impact of indapamide / perindopril single-pill combination (I / P SPC) on arterial stiffness parameters, blood pressure (BP) level and BP variability (BPV) in middle-aged patients with stage II grade 1–2 essential arterial hypertension (EAH). Materials and methods. We retrospectively formed a group of patients with stage II grade 1–2 EAH who had not previously received regular antihypertensive therapy (AHT) (n=52, mean age 52.9±6.0 years). All patients were treated with I / P SPC and all of them achieved target office BP level (less than 140 / 90 mm Hg). After 12 weeks of follow-up (from the time of reaching the target BP) assessment of AHT effectiveness (general clinical data, ambulatory blood pressure monitoring [ABPM], volume sphygmography, echocardiography), and vascular stiffness evaluation were performed.Results. At the end of follow-up office systolic BP (SBP), diastolic BP (DBP), pulse BP, day-time, night-time and 24‑hour SBP and DBP significantly (p<0.001 for all) decreased. According to the ABPM data day-time, nighttime, and 24‑hour systolic BPV significantly decreased (p=0.029, p=0.006 and p<0.001, respectively); day-time and 24‑hour diastolic BPV also significantly decreased (p=0.001 and p<0.001, respectively). Day-night standard deviation (SDdn) significantly decreased too (p=0.002 and p<0.001, respectively). Volumetric sphygmography showed significant decrease of right cardio-ankle vascular index (CAVI) (from 8.20±1.29 to 7.58±1.44, p=0.001) and of left CAVI (from 8.13±1.40 to 7.46±1.43, p<0.001), as well as reduction of the number o f patients with a right- and / or left-CAVI >9.0 (from 32.7 to 11.5 %, p=0.018). According to assessment of arterial stiffness using the Vasotens24 software package, the arterial stiffness index (ASI) significantly (p<0.001) decreased from 153.5±29.9 to 138.3±20.0 (by –9.2±13.1 %). Transthoracic echocardiography data demonstrated significant decrease (p<0.001) in effective arterial elastance (from 1.82±0.43 to 1.58±0.36 mm Hg; by –11.85±16.29 %) and significant (p<0.001) increase in the arterial compliance – from 1.27±0.34 to 1.54±0.38 mm Hg / ml (+26.95±38.06 %).Conclusion. In AHT naive patients 40–65 years old with stage II grade 1–2 EAH therapy with I / P SPC provided effective 24‑hour BP control, reduced BPV and improved arterial stiffness parameters.

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