scholarly journals Large Artery Stiffness: A Companion to the 2015 AHA Science Statement on Arterial Stiffness

Pulse ◽  
2021 ◽  
pp. 1-10
Author(s):  
Jimena Rey-García ◽  
Raymond R. Townsend
Keyword(s):  
Target Organ Damage ◽  
Heart Association ◽  
Organ Damage ◽  
Large Artery ◽  
Dietary Interventions ◽  
Pharmacological Interventions ◽  
European Guidelines ◽  
Artery Stiffness ◽  
Risk Patients ◽  
Scientific Statement

Large artery stiffness (LAS) has proven to be an independent risk factor for cardiovascular disease and mortality. Nevertheless, the position of current hypertension guidelines regarding the usefulness of assessing LAS differs across different continents. In general, European Guidelines recognize pulse wave velocity (PWV) as a marker of target organ damage but do not recommend its systematic use in general population. Asian guidelines consider PWV as a recommended test at diagnosis of hypertension, in contrast to North American guidelines that do not state any position about its usefulness. However, PWV predicts cardiovascular events, and several studies have shown that it improves risk classification adjusting for established risk factors especially for intermediate-risk patients. Finally, some advances have been made related to treatments affecting LAS. Dietary interventions such as sodium restriction and exercise-based interventions have a modest effect in reducing LAS. Pharmacological interventions, such as statins, or more recent advances with mineralocorticoid blocker seem to have a beneficial effect. Last, controversial effects of renal denervation on LAS have been found. Our goal here is to update the reader on LAS on these areas since the 2015 American Heart Association Scientific Statement.

scholarly journals High ABCD2 Scores and In-Hospital Interventions following Transient Ischemic Attack

2016 ◽  
Vol 6 (3) ◽  
pp. 76-83 ◽  
Author(s):  
Shawna Cutting ◽  
Elizabeth Regan ◽  
Vivien H. Lee ◽  
Shyam Prabhakaran
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Heart Association ◽  
Reperfusion Therapy ◽  
Large Artery ◽  
Increased Risk ◽  
Risk Patients ◽  
Abcd2 Score ◽  
Ischemic Attack ◽  
Ischemic Events

Background and Purpose: Following transient ischemic attack (TIA), there is increased risk for ischemic stroke. The American Heart Association recommends admission of patients with ABCD2 scores ≥3 for observation, rapid performance of diagnostic tests, and potential acute intervention. We aimed to determine if there is a relationship between ABCD2 scores, in-hospital ischemic events, and in-hospital treatments after TIA admission. Methods: We reviewed consecutive patients admitted between 2006 and 2011 following a TIA, defined as transient focal neurological symptoms attributed to a specific vascular distribution and lasting <24 h. Three interventions were prespecified: anticoagulation for atrial fibrillation, carotid or intracranial revascularization, and intravenous or intra-arterial reperfusion therapies. We compared rates of in-hospital recurrent TIA or ischemic stroke and the receipt of interventions among patients with low (<3) versus high (≥3) ABCD2 scores. Results: Of 249 patients, 11 patients (4.4%) had recurrent TIAs or strokes during their stay (8 TIAs, 3 strokes). All 11 had ABCD2 scores ≥3, and no neurological events occurred in patients with lower scores (5.1 vs. 0%; p = 0.37). Twelve patients (4.8%) underwent revascularization for large artery stenosis, 16 (6.4%) were started on anticoagulants, and no patient received intravenous or intra-arterial reperfusion therapy. The ABCD2 score was not associated with anticoagulation (p = 0.59) or revascularization (p = 0.20). Conclusions: Higher ABCD2 scores may predict early ischemic events after TIA but do not predict the need for intervention. Outpatient evaluation for those with scores <3 would potentially have delayed revascularization or anticoagulant treatment in nearly one-fifth of ‘low-risk' patients.

scholarly journals European guidelines on the diagnostics, management and prevention of arterial hypertension 2018: opinion of the members of the Russian Society of cardiology

2019 ◽  
Vol 24 (6) ◽  
pp. 602-622
Author(s):  
D. V. Nebieridze ◽  
L. I. Gapon ◽  
O. P. Rotar ◽  
A. S. Alieva ◽  
L. S. Korostovtseva ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
European Society ◽  
European Heart Journal ◽  
Blood Pressure Measurement ◽  
Target Organ Damage ◽  
Heart Association ◽  
Organ Damage ◽  
Russian Society ◽  
Comprehensive Overview

In 2018, at the annual congresses of the European Society of Hypertension and European Society of Cardiology, the updated guidelines on the diagnostics, management and prevention of arterial hypertension were announced, followed by their publication in the European Heart Journal. The guidelines present a comprehensive overview on the definition and classification of arterial hypertension, approaches to the blood pressure measurement, assessment of the target organ damage, special patient subgroups and other issues. Despite a detailed analysis of various issues of the diagnostics and treatment of hypertension, some of the statements appear to be disputable and raise discussion among specialists in hypertension field. The diagnostic criteria, threshold and target blood pressure levels are the most debatable issues involving comparisons with the guidelines of the American Heart Association (2017). This paper gathers a number of comments on the less discussed questions of the diagnostics, treatment and prevention of hypertension. This collection of letters of the specialists, members of the Russian Society of Cardiology includes both personal expert opinions and well-known facts, reflects the controversy of the available evidence and indicates the blanks and gaps in hypertensiology giving perspective for potential future studies.

scholarly journals Associations between measurements of central blood pressure and target organ damage in high-risk patients

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Ki-Hyun Jeon ◽  
Hack-Lyoung Kim ◽  
Woo-Hyun Lim ◽  
Jae-Bin Seo ◽  
Sang-Hyun Kim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Central Blood Pressure ◽  
Atherosclerotic Cardiovascular Disease ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background It is not well-known which components of central blood pressure (CBP) are more influential to target organ damage (TOD). This study aimed to determine the relationship between CBP measurements and various types of TOD in high-risk patients. Methods A total of 148 patients who had documented atherosclerotic cardiovascular disease or its multiple risk factors were prospectively enrolled. CBP was measured by using applanation tonometry of the radial artery. The following nine TOD parameters were evaluated: left ventricular mass index, relative wall thickness, septal e′ velocity, septal E/e′, brachial-ankle pulse wave velocity, ankle-brachial index, estimated glomerular filtration rate, urine protein and obstructive coronary artery disease. Results The mean age of the study population was 67.1 ± 9.0 years and 108 (73 %) were male. Among four CBP measurements (systolic, diastolic, mean, and pulse pressures), central pulse pressure (CPP) was associated with the largest number of TOD parameters. As CPP increased, the number of TOD increased (P = 0.010), but this association was not observed in other CBP measurements (P > 0.05 for each). Conclusions CPP had a stronger correlation with TOD than other CBP measurements. Non-invasive CPP could be a useful indicator for predicting TOD in patients at high coronary risk.

Mechanisms and consequences of large artery rigidity

2003 ◽  
Vol 81 (3) ◽  
pp. 205-211 ◽  
Author(s):  
Karima Et-Taouil ◽  
Michel Safar ◽  
Gérard E Plante
Keyword(s):  
Smooth Muscle ◽  
Pulse Wave Velocity ◽  
Smooth Muscle Cells ◽  
Wave Velocity ◽  
Pulse Wave ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ ◽  
Vasa Vasorum ◽  
Large Artery

In this review paper, the classical and more recently described mechanisms responsible for the structural and functional characteristics of large artery rigidity are described. Mostly important, these characteristics appear to be nonspecific to the primary disease process involved in arterial hypertension, diabetes mellitus, dyslipidemia, congestive heart failure, chronic uremia, and perhaps senescence, including vascular dementia. Nonspecific in terms of aetiology, the vasculopathy encountered in these diseases exhibits common structural and functional abnormalities. The identification of such abnormalities could well become the target of potent nonpharmacological and (or) pharmacological interventions capable of preventing or retarding morbidity and mortality. The structural characteristics responsible for large artery rigidity include smooth muscle cell hypertrophy, matrix collagen deposition, and recently described, dysfunction in proteoglycan metabolism. Functional abnormalities, such as bradykinin-dependent hyper-reactivity of smooth muscle cells and vasa vasorum microcirculation network disturbances, also appear to alter aortic wall rigidity. The physiopathology of target organ damage is then revisited, based on endothelial dysfunction, documented in large and resistance arteries, as well as in microcirculation networks, where altered permeability to macromolecules leads to interstitial matrix disorganization and cell damage. The clinical evaluation of large artery rigidity is described, and one of the noninvasive methods, evaluation of pulse-wave velocity, is validated in normal conditions and in disease processes. Finally, nonpharmacological and pharmacological therapeutic measures are presented, and includes physical exercise to reduce insulin resistance, and renin–angiotensin-II–aldosterone modulators.Key words: large artery compliance, aortic structure, collagen, elastin, proteoglycans, vascular smooth muscle cells, vasa vasorum, target organ damage, pulse wave velocity, vascular pharmacology.

scholarly journals Renal biomarkers reflect overall hypertensive organ damage: “one organ to rule them all”

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Terentes-Printzios ◽  
K Aznaouridis ◽  
N Ioakeimidis ◽  
V Gardikioti ◽  
P Xaplanteris ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Target Organ Damage ◽  
Ankle Brachial Index ◽  
Predictive Ability ◽  
Organ Damage ◽  
Left Ventricular ◽  
European Guidelines ◽  
Close Relationship ◽  
Brachial Systolic Blood Pressure

Abstract Background/Introduction Hypertension is associated with higher cardiovascular risk as well as several markers of subclinical target organ damage (TOD). Albumin to creatinine ratio (ACR) in urine has been recognized as an independent risk factor for cardiovascular events. Purpose We hypothesized that there is a relationship between ACR and markers of TOD in never-treated hypertensives. Methods We enrolled 924 consecutive essential hypertensives (mean age 53±12 years, 486 males) without known cardiovascular disease (CVD). Markers of subclinical TOD [left ventricular mass index (LVMI), pulse wave velocity (PWV), ankle-brachial index (ABI) and estimated glomerular filtration rate (eGFR)] were evaluated in all patients. LVMI was assessed echocardiographically using the Devereux formula. Carotid-femoral PWV was estimated with the Complior device. eGFR was calculated by the Cockcroft-Gault formula. ABI was calculated by dividing the highest ankle systolic blood pressure by the highest brachial systolic blood pressure. Results ACR exhibited significant association with LVMI (r=0.277, p&lt;0.001, Figure), PWV (r=0.277, p&lt;0.001) ABI (r=−0.078, p=0.018) and eGFR (r=−0.100, p=0.002). In further analysis, ACR was associated with TOD as suggested by the 2018 European Guidelines for Hypertension [left ventricular hypertrophy (LVMI&gt;115 g/m2 in men and &gt;95 g/m2 in women), increased PWV (PWV&gt;10m/s), decreased ABI (ABI&lt;0.9) and decreased renal function (eGFR&lt;60ml/min)]. Specifically, ACR exhibited significant association with the number of TOD and this association was independent of age and gender (p&lt;0.05). Conclusions Our findings support the close relationship between ACR and TOD in hypertension, as well as, the predictive ability of ACR for TOD. FUNDunding Acknowledgement Type of funding sources: None. Association between LVMI and ACR

Abstract 346: Subcutaneous Resistance Artery Remodeling And Function In Chronic Kidney Disease Patients

Hypertension ◽  
2014 ◽  
Vol 64 (suppl_1) ◽  
Author(s):  
Julio C Fraulob-Aquino ◽  
Marie Briet ◽  
Tlili Barhoumi ◽  
Carmine Savoia ◽  
Pierre Paradis ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Target Organ Damage ◽  
Subcutaneous Fat ◽  
Organ Damage ◽  
Resistance Artery ◽  
Resistance Arteries ◽  
Artery Stiffness ◽  
Artery Remodeling ◽  
And Function

Background: Chronic kidney disease (CKD) is associated with cardiovascular (CV) complications. However, interventional trials targeting classical CV risks factors have been often unsuccessful in advanced stage CKD, which emphasizes the need to better understand CKD-associated vascular disorders. Resistance arteries are a key determinant of blood pressure (BP) and their changes in different CV conditions contribute to target organ damage. The aim of the present study was to characterize resistance artery remodeling and function in CKD patients, compared to vessels from hypertensive (HTN) subjects. Method: Twenty-two stage 4 CKD patients (aged 63.6±3.1 years) and 16 HTN subjects (45.6±16.1 years) were included in the present study. They all underwent a subcutaneous biopsy under local anaesthesia. Small artery remodeling and function were studied on a pressurized myograph, and subcutaneous fat CD3 infiltration and media fibronectin expression by immunostaining. Vascular smooth muscle cells (VSMCs) were counted after hematoxilin-eosin staining. Results: CKD systolic BP was similar to HTN (133±18 vs. 143±10 mmHg, respectively). Vasodilatory responses to acetylcholine were lower in CKD compared to HTN (maximal relaxation (%), 74.3±3.4 vs. 87.5±2.7, P<0.05). Media/lumen at 60 mmHg was lower in CKD than in HTN (6.7±0.5 vs 8.8±0.7, P<0.05). Resistance artery stiffness was lower in CKD compared to HTN (strain at 120 mmHg, 0.845±0.126 vs 0.585±0.099, P<0.05). Fibronectin staining in resistance arteries was lower in CKD than HTN (8.2±0.8 vs 23.3±1.7 RFU/μm2, P<0.001). Less VSMCs were present in the arterial wall of CKD compared to HTN (5.4±0.4 vs 7.2±0.5 cells/μm2, P<0.05). Subcutaneous fat presented fewer CD3+ cells in CKD than HTN (12.8±4.1 vs 23.7±12.8 cells/mm2, P<0.05). Conclusion: Despite higher levels of BP, resistance arteries isolated from CKD patients exhibited no vascular remodeling and lower arterial stiffness compared with HTN patients. These results are in line with the maladaptive hypotrophic remodeling observed in large vessels in CKD, suggesting a generalized vascular defect in mechanotransduction in CKD.

Relationship between circulating serum omentin-1 levels and nascent metabolic syndrome in patients with hypertension

2021 ◽  
pp. jim-2021-002071
Author(s):  
Sara Cetin Sanlialp ◽  
Gokay Nar ◽  
Rukiye Nar
Keyword(s):  
Metabolic Syndrome ◽  
Characteristic Curve ◽  
Target Organ Damage ◽  
Venous Blood ◽  
Multivariate Logistic Regression Analysis ◽  
Area Under The Curve ◽  
Heart Association ◽  
Organ Damage ◽  
Tyg Index ◽  
Increased Risk

The prevalence of metabolic syndrome (MetS) is more common in patients with hypertension and is associated with an increased risk of target organ damage and/or cardiovascular disease (CVD). Omentin-1 is a beneficial adipokine considered to play a role in MetS and MetS-related states such as obesity, diabetes, and coronary artery disease. The aim of this study was to determine the relationship between circulating omentin-1 levels and MetS uncomplicated by diabetes or CVD (nascent MetS) in patients with hypertension. In this study, 110 patients (54 men, 49%; average age: 49.72±11.32 years) treated for hypertension but without overt diabetes and/or CVD were enrolled. 66 patients were stratified into MetS (+) (group 1) and 44 patients into MetS (−) (group 2) according to the American Heart Association/National Heart, Lung, and Blood Institute criteria. The triglyceride glucose (TyG) index was used to assess insulin resistance. Circulating omentin-1 levels in venous blood samples were measured by an ELISA kit. Circulating omentin-1 levels in patients with MetS were significantly lower than in patients without MetS (46.35 ng/mL (42.70–57.70 ng/mL) vs 130.95 ng/mL (62.83–236.48 ng/mL), p<0.001). Omentin-1 was inversely correlated with TyG index (r=−0.204, p=0.033). In a multivariate logistic regression analysis, omentin-1, TyG index, and body mass index were independent predictors of MetS. A receiver operating characteristic curve analysis determined that the best cut-off value for omentin-1 in predicting MetS was 62.20 ng/mL and the area under the curve was 0.880 (95% CI 0.817 to 0.942, p<0.001). The findings of this study suggest that circulating omentin-1 levels are inversely related to the presence of MetS and may be a reliable marker to predict the development of MetS in patients with hypertension.

scholarly journals Weight-Loss Strategies for Prevention and Treatment of Hypertension: A Scientific Statement From the American Heart Association

Hypertension ◽  
2021 ◽  
Author(s):  
Michael E. Hall ◽  
Jordana B. Cohen ◽  
Jamy D. Ard ◽  
Brent M. Egan ◽  
John E. Hall ◽  
...  
Keyword(s):  
Weight Loss ◽  
Lifestyle Modification ◽  
Kidney Diseases ◽  
Target Organ Damage ◽  
Heart Association ◽  
Organ Damage ◽  
The United States ◽  
Target Organ ◽  
Renal Diseases

Hypertension is a major risk factor for cardiovascular and renal diseases in the United States and worldwide. Obesity accounts for much of the risk for primary hypertension through several mechanisms, including neurohormonal activation, inflammation, and kidney dysfunction. As the prevalence of obesity continues to increase, hypertension and associated cardiorenal diseases will also increase unless more effective strategies to prevent and treat obesity are developed. Lifestyle modification, including diet, reduced sedentariness, and increased physical activity, is usually recommended for patients with obesity; however, the long-term success of these strategies for reducing adiposity, maintaining weight loss, and reducing blood pressure has been limited. Effective pharmacotherapeutic and procedural strategies, including metabolic surgeries, are additional options to treat obesity and prevent or attenuate obesity hypertension, target organ damage, and subsequent disease. Medications can be useful for short- and long-term obesity treatment; however, prescription of these drugs is limited. Metabolic surgery is effective for producing sustained weight loss and for treating hypertension and metabolic disorders in many patients with severe obesity. Unanswered questions remain related to the mechanisms of obesity-related diseases, long-term efficacy of different treatment and prevention strategies, and timing of these interventions to prevent obesity and hypertension-mediated target organ damage. Further investigation, including randomized controlled trials, is essential to addressing these questions, and emphasis should be placed on the prevention of obesity to reduce the burden of hypertensive cardiovascular and kidney diseases and subsequent mortality.

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