Impaired perfusion modifies the relationship between blood pressure and stroke risk in major cerebral artery disease

Background: Identification and modification of cardiovascular risk factors is paramount to reducing cardiovascular disease morbidity and mortality. Hypertension is a major risk factor for cardiovascular disease, but its association with height remains largely underrecognized. Objectives: The objective of this manuscript is to review the evidence examining the association between blood pressure and human stature and to summarize the plausible pathophysiological mechanisms behind such an association. Methods: A systematic review of adult human height and its association with hypertension and coronary artery disease was undertaken. The literature evidence is summarized and tabulated, and an overview of the pathophysiological basis for this association is presented. Results: Shorter arterial lengths found in shorter individuals may predispose to hypertension in a complex hemodynamic interplay, which is explained predominantly by summated arterial wave reflections and an elevated augmentation index. Our systemic review suggests that an inverse relationship between adult height and blood pressure exists. However, differences in the studied populations and heterogeneity in the methods applied across the various studies limit the generalizability of these findings and their clinical application. Conclusion: Physiological studies and epidemiological data suggest a potential inverse association between adult height and blood pressure. Further research is required to define the relationship more clearly between adult height and blood pressure and to assess whether antihypertensive therapeutic approaches and goals should be modified according to patients’ heights.

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Plasma Catecholamine Responses to Dynamic Exercise in Patients with Coronary Artery Disease. The Relationship between Sympathetic Activity and Systolic Blood Pressure and Exercise-induced Ventricular Arrhythmias.

Japanese Circulation Journal ◽

10.1253/jcj.56.1115 ◽

1992 ◽

Vol 56 (11) ◽

pp. 1115-1123 ◽

Cited By ~ 2

Author(s):

HIROYUKI MIYAKODA ◽

NORIYASU NOGUCHI ◽

TATSUHIKO MATSUMOTO ◽

HIDEYUKI KITAMURA ◽

TORU KINUGAWA ◽

...

Keyword(s):

Blood Pressure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Sympathetic Activity ◽

Ventricular Arrhythmias ◽

Dynamic Exercise ◽

Plasma Catecholamine ◽

Artery Disease ◽

Exercise Induced ◽

The Relationship

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Selective neuronal damage and blood pressure in atherosclerotic major cerebral artery disease

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-320326 ◽

2019 ◽

Vol 90 (9) ◽

pp. 975-980 ◽

Cited By ~ 1

Author(s):

Hiroshi Yamauchi ◽

Shinya Kagawa ◽

Masaaki Takahashi ◽

Kuninori Kusano ◽

Chio Okuyama

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Systolic Blood Pressure ◽

Cerebral Artery ◽

Neuronal Damage ◽

Benzodiazepine Receptors ◽

Benzodiazepine Receptor ◽

Artery Disease

ObjectiveIn patients with atherosclerotic major cerebral artery disease, low blood pressure might impair cerebral perfusion, thereby exacerbate the risk of selective neuronal damage. The purpose of this retrospective study was to determine whether low blood pressure at follow-up is associated with increased selective neuronal damage.MethodsWe retrospectively analysed data from 76 medically treated patients with atherosclerotic internal carotid artery or middle cerebral artery disease with no ischaemic episodes on a follow-up of 6 months or more. All patients had measurements of the distribution of central benzodiazepine receptors twice using positron emission tomography and 11C-flumazenil. Using three-dimensional stereotactic surface projections, we quantified abnormal decreases in the benzodiazepine receptors of the cerebral cortex within the middle cerebral artery distribution and correlated these changes in the benzodiazepine receptors index with blood pressure values at follow-up examinations.ResultsThe changes in the benzodiazepine receptor index during follow-up (mean 27±21 months) were negatively correlated with systolic blood pressure at follow-up. The relationship between changes in benzodiazepine receptor index and systolic blood pressure was different among patients with and without decreased cerebral blood flow at baseline (interaction, p<0.005). Larger increases in benzodiazepine receptor index (neuronal damage) were observed at lower systolic blood pressure levels in patients with decreased cerebral blood flow than in patients without such decreases.ConclusionIn patients without ischaemic stroke episodes at follow-up but with decreased cerebral blood flow due to arterial disease, low systolic blood pressure at follow-up may be associated with increased selective neuronal damage.

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The Relationship between Inter-Arm Blood Pressure Difference and Coronary Artery Disease Severity Calculated by the SYNTAX Score

International Journal of Hypertension ◽

10.1155/2018/9370417 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Gündüz Durmuş ◽

Erdal Belen ◽

Akif Bayyigit ◽

Muhsin Kalyoncuoğlu ◽

Mehmet Mustafa Can

Keyword(s):

Blood Pressure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Pressure Difference ◽

Syntax Score ◽

Pressure Measurements ◽

Blood Pressure Difference ◽

Artery Disease ◽

The Relationship

Objectives. The inter-arm systolic blood pressure difference (IASBPD) is closely related to cardiovascular mortality and morbidity. The SYNTAX score indicates the extent and complexity of coronary artery disease, which are determined by coronary angiography. The aim of our study is to examine the relationship between the IASBPD (which is easily calculated in routine practice) and the SYNTAX score. Methods. 104 patients were included in this cross-sectional study. The IASBPD was calculated by blood pressure measurements obtained simultaneously from both arms. The SYNTAX score was calculated by coronary angiography. Results. Patients were divided into two groups: those with a high SYNTAX score (≥20) and those with a low SYNTAX score (<20). The mean IASBPD values were significantly higher in the group with a high SYNTAX score (≥20) (p<0.001). The patients with IASBPD≥10 were more likely to have a high SYNTAX score compared to the patients with IASBPD<10 (p<0.001). Multiple logistic regression analysis revealed that only the IASBPD values were found to be independently associated with high SYNTAX score (OR: 1.717 (CI: 1.307-2.257), p<0.001). Conclusion. The IASBPD values obtained by only blood pressure measurements are closely related to the extent of coronary artery disease.

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P1944Relationship between the duration of hypertension and cerebral and cardiovascular disease in the adult Korean population

European Heart Journal ◽

10.1093/eurheartj/ehz748.0691 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S W Rha ◽

B G Choi ◽

S Y Choi ◽

J K Byun ◽

J A Cha

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Life Expectancy ◽

Stroke Risk ◽

Pressure Control ◽

The Republic ◽

Optimal Blood Pressure ◽

The Impact ◽

The Relationship ◽

Nutritional Examination Survey

Abstract Background Although advances in medical technology and health care have led to increased life expectancy, the prevalence of chronic diseases such as hypertension, diabetes, stroke and cardiovascular events has increased. Purpose This study evaluated the prevalence of hypertension, treatment, and the impact of hypertension on cardiovascular disease (CVD) and stroke risk in Koreans. Methods The Korean National Health and Nutritional Examination Survey (KNHANES) database, which is a stratified random sampling to assess the health and nutritional status of Koreans (https://knhanes.cdc.go.kr), was analyzed for this study. The subjects of the survey were sampled to represent the entire population of the Republic of Korea. The endpoints of the study are the risk of CVD and stroke due to the prevalence of hypertension. We also examined the relationship between the control of hypertension and the risk of CVD and stroke. Results The prevalence of hypertension has increased rapidly as with longer life expectancy of the population. As the duration of hypertension increases, CVD and stroke risks are increased. Achieving a target goal blood pressure below 140/90 mmHg can reduce the risk of all CVD and stroke by nearly half. Korea-HTN Conclusion The risk of CVD and stroke in hypertensive patients can be significantly reduced by achieving optimal blood pressure control.

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Long-term hemodynamic changes and blood pressure in atherosclerotic major cerebral artery disease

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x17727385 ◽

2017 ◽

Vol 39 (2) ◽

pp. 324-331 ◽

Cited By ~ 3

Author(s):

Hiroshi Yamauchi ◽

Shinya Kagawa ◽

Masaaki Takahashi ◽

Tatsuya Higashi

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Systolic Blood Pressure ◽

Cerebral Artery ◽

Internal Carotid ◽

Hemodynamic Improvement ◽

The Mean ◽

Artery Disease

In patients with major cerebral artery disease, lower blood pressure might reduce blood flow in the collateral pathways, thereby impairing the growth of cerebral collaterals, inhibiting hemodynamic improvement. We evaluated the hemodynamic status twice using positron emission tomography and 15O-gas, over time, in 89 medically treated patients with atherosclerotic internal carotid artery or middle cerebral artery disease that had no ischemic episodes during follow-up (mean, 28 ± 23 months). Changes in the mean hemispheric values of hemodynamic parameters in the territory of the diseased artery at follow-up were correlated with the mean blood pressure values at the baseline and follow-up examinations. There was a positive linear relationship between the degree of hemodynamic improvement and systolic blood pressure. Patients with low systolic blood pressure (<130 mmHg) ( n = 18) showed hemodynamic deterioration as indicated by significant decreases in cerebral blood flow, cerebral blood flow/cerebral blood volume ratio, and increases in oxygen extraction fraction during follow-up. In contrast, there were no significant changes in patients without low systolic blood pressure. In patients with atherosclerotic internal carotid artery or middle cerebral artery disease and no ischemic episodes of stroke during follow-up, lower systolic blood pressure was associated with lesser hemodynamic improvement.

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Lack of Association between Interarm Systolic Blood Pressure Difference and Coronary Artery Disease in Patients Undergoing Elective Coronary Angiography

International Journal of Hypertension ◽

10.1155/2021/6665039 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Mohammad Hosein Mohamadi ◽

Alireza Rai ◽

Mansour Rezaei ◽

Alireza Khatony

Keyword(s):

Blood Pressure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Coronary Artery Stenosis ◽

Artery Stenosis ◽

Peripheral Vascular ◽

Blood Pressure Difference ◽

Artery Disease ◽

The Relationship

Aim. Peripheral vascular disease (PVD) and coronary artery disease (CAD) are, in many cases, asymptomatic and not usually diagnosed. The timely diagnosis of peripheral vascular diseases can act as an indicator or practical evidence of CAD. Therefore, this study was conducted to determine the relationship between interarm systolic blood pressure difference (IASBPD) and severity and number of coronary artery stenosis. Methods. The samples in this cross-sectional study consisted of 578 patients who were candidates for coronary angiography, with an average age of 57.5 ± 10.5 years. Patients were classified according to CAD and number and severity of coronary artery stenosis. The relationship between IASBPD and presence or lack of CAD as well as the number and severity of coronary artery stenosis was studied. The sensitivity, specificity, and positive predictive value of IASBPD index were calculated for the detection of CAD using the Kappa coefficient. Results. There was no statistically significant relationship between IASBPD, CAD, and severity and number of coronary artery stenosis. This index had low sensitivity and predictive value in the diagnosis of CAD and stenosis in coronary arteries in comparison with angiography. Conclusion. The results showed that the IASBPD index cannot be a valid criterion for the diagnosis of CAD as well as the number and severity of coronary artery stenosis. More studies with larger sample sizes and different designs are needed in this regard to achieve more conclusive results.

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Blood pressure management based on hemodynamic measurements in major cerebral artery disease

Nosotchu ◽

10.3995/jstroke.10292 ◽

2015 ◽

Vol 37 (4) ◽

pp. 248-252

Author(s):

Hiroshi Yamauchi

Keyword(s):

Blood Pressure ◽

Cerebral Artery ◽

Pressure Management ◽

Blood Pressure Management ◽

Artery Disease ◽

Hemodynamic Measurements

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Alternative Graphical Causal Models and the Identification of Direct Effects

Causality and Psychopathology ◽

10.1093/oso/9780199754649.003.0011 ◽

2011 ◽

Author(s):

James M. Robins ◽

Thomas S. Richardson

Keyword(s):

Blood Pressure ◽

Population Distribution ◽

Causal Models ◽

Computer Algorithms ◽

Causal Inferences ◽

Full Compliance ◽

Computer Calculations ◽

Artery Disease ◽

The Relationship ◽

Counterfactual Approach

The subject-specific data from either an observational or experimental study consist of a string of numbers. These numbers represent a series of empirical measurements. Calculations are performed on these strings and causal inferences are drawn. For example, an investigator might conclude that the analysis provides strong evidence for ‘‘both an indirect effect of cigarette smoking on coronary artery disease through its effect on blood pressure and a direct effect not mediated by blood pressure.’’ The nature of the relationship between the sentence expressing these causal conclusions and the statistical computer calculations performed on the strings of numbers has been obscure. Since the computer algorithms are well-defined mathematical objects, it is crucial to provide formal causal models for the English sentences expressing the investigator’s causal inferences. In this chapter we restrict ourselves to causal models that can be represented by a directed acyclic graph. There are two common approaches to the construction of causal models. The first approach posits unobserved fixed ‘potential’ or ‘counterfactual’ outcomes for each unit under different possible joint treatments or exposures. The second approach posits relationships between the population distribution of outcomes under experimental interventions (with full compliance) to the set of (conditional) distributions that would be observed under passive observation (i.e., from observational data). We will refer to the former as ‘counterfactual’ causal models and the latter as ‘agnostic’ causal models (Spirtes, Glymour, & Scheines, 1993) as the second approach is agnostic as to whether unit-specific counterfactual outcomes exist, be they fixed or stochastic. The primary difference between the two approaches is ontological: The counterfactual approach assumes that counterfactual variables exist, while the agnostic approach does not require this. In fact, the counterfactual theory logically subsumes the agnostic theory in the sense that the counterfactual approach is logically an extension of the latter approach. In particular, for a given graph the causal contrasts (i.e. parameters) that are well-defined under the agnostic approach are also well-defined under the counterfactual approach.

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