Abstract P243: Endothelial Function, Arterial Stiffness and Central Blood Pressure are Not Affected by a Single Dose of Dietary Nitrate in Healthy Normotensive Females

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Katharine E Storo ◽  
Caleb D Harrison ◽  
Evan J Bockover ◽  
Brycen J Ratcliffe ◽  
Sierra Crowe ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Single Dose ◽  
Arterial Stiffness ◽  
Endothelial Function ◽  
Pulse Wave ◽  
Central Blood Pressure ◽  
Future Research ◽  
Dietary Nitrate ◽  
Nitrate Supplementation ◽  
Plasma Nitrite

Intro: Hypertension is a prominent risk factor for cardiovascular disease and arterial stiffness is a related predictor of both mortality and longitudinal onset of hypertension in normotensive individuals. Both vascular compliance and blood pressure have been shown to improve following dietary nitrate supplementation in some healthy and diseased individuals. Dietary nitrate supplementation increases plasma nitrite and may, therefore, enhance bioavailability of endothelium derived nitric oxide. Chronic increased flow mediated dilation (FMD) and reduction of pulse wave velocity (PWV) reduce a person’s long-term risk for developing endothelial dysfunction, atherosclerosis and hypertension. Hypothesis: We hypothesized that an acute dose of dietary nitrate would improve FMD, decrease PWV and reduce central blood pressure (cBP) in healthy, young females. Methods: Seven healthy, young (21 ± 2 years) females participated in a randomized, double blind, placebo controlled, crossover protocol. Participants had endothelial function measured via FMD, arterial stiffness via PWV and applanation tonometry, and cBP was determined non-invasively using pulse wave analysis following a 12-hour fasting period and 48-hour NIH approved low nitrate diet. Baseline values were measured the day before each treatment visit (placebo or nitrate-rich, separated by a 1-week washout period). Participants consumed either a placebo or nitrate-rich supplement (negligible and 6.2 mmol nitrate, respectively) 2 hours prior to their laboratory visit. Upon arrival, blood was drawn and participants assumed a supine position for 15 minutes. Then brachial artery FMD was assessed via high definition ultrasound imaging following 5 minutes of proximal forearm occlusion, followed by PWV and central blood pressure measurements. Results: Plasma nitrite was elevated following consumption of the nitrate rich supplement compared to placebo (26.33 ± 15.76 and 1.18 ± 0.96 arbitrary units, respectively; p<0.05). However, there was no difference between nitrate rich and placebo treatments for endothelial function as measured by FMD (10.33 ± 1.82 and 9.11 ± 5.43%, respectively; p=0.70). No difference was present between nitrate and placebo groups for PWV (5.99 ± 0.85 and 6.16 ± 0.80 m/s, respectively; p=0.90), systolic cBP (101.57 ± 9.29 and 96.90 ± 20.95 mmHg, respectively; p=0.40) and diastolic cBP (72.57 ± 7.67 and 73.20 ± 5.01 mmHg, respectively; p=0.97). Conclusion: While a single dose of dietary nitrate does increase plasma nitrite, supplementation has minimal effects on FMD, PWV and cBP in young healthy females. Future research should examine longer duration supplementation protocols as well as the changes in vascular health of patients with known disease such as hypertension or peripheral artery disease.

Abstract P216: Elevated Blood Glutathione Does Not Reduce Arterial Stiffness or Central Blood Pressure in Healthy Males and Females

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Brianna K Bruggeman ◽  
Katharine E Storo ◽  
Haley M Fair ◽  
Andrew J Wommack ◽  
James M Smoliga ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Antioxidant Capacity ◽  
Pulse Wave ◽  
Central Blood Pressure ◽  
Future Research ◽  
Double Blind ◽  
Mixed Effect ◽  
Males And Females ◽  
Healthy Males

Intro: Glutathione is endogenous within human plasma, erythrocyte lysate and is also bound to the protein within plasma. Glutathione mediates redox chemistry and prevents oxidative damage within and around cellular components via reduction of reactive species (e.g. reactive oxygen, nitrogen, or sulfur species). Polyphenols and antioxidants have been shown to improve NO bioavailability which may reduce long term incidence of endothelial dysfunction. Less is known about whether changes in antioxidant capacity augments the risk of developing hypertension. Hypothesis: We hypothesized that acute glutathione supplementation would decrease arterial stiffness and reduce both brachial (bBP) and central blood pressure (cBP) in healthy male and female volunteers. Methods: Six males and six females (25 ± 3 and 22 ± 1 years, respectively) participated in a randomized, double blind, placebo controlled, crossover protocol. On two visits separated by 1 week, following a 12-hour fast, participants consumed either a placebo or glutathione (negligible and 200 mg, respectively) supplement via 90 second sublingual absorption which was then swallowed. Concentrations of oxidized (GSSG) and reduced glutathione (GSH) were spectrophotometrically measured in plasma (protein-bound) and erythrocyte lysate using a kinetic, enzymatic assay. Arterial stiffness was measured via pulse wave velocity (PWV) using applanation tonometry, and cBP was determined non-invasively using pulse wave analysis. All data were recorded before supplementation (baseline) and at 10, 30, 60 and 120 minutes post-consumption. Results: Linear mixed effect models revealed a significant (p<0.01) increase in total glutathione (GSH+GSSG) in the supplement group compared to placebo across all post-supplementation time points with the greatest increase occurring at 120 minutes (mean 99.0; 95%CI: 7.9,190.1). At 120 minutes post-consumption, no difference was present between glutathione and placebo groups for PWV (5.86 ± 1.19 and 6.08 ± 1.25 m/s, respectively; p=0.43), resting heart rate (52.95 ± 3.55 and 55.83 ± 6.36, respectively; p=0.16), systolic bBP (123.05 ± 12.75 and 123.13 ± 14.52 mmHg; p=0.22), diastolic bBP (71.81 ± 7.87 and 74.21 ± 6.53; p=0.48), systolic cBP (108.05 ± 10.45 and 108.68 ± 11.14 mmHg, respectively; p=0.11) and diastolic cBP (72.03 ± 7.82 and 74.94 ± 6.42 mmHg, respectively; p=0.46). Conclusion: Young healthy males and females experienced an increase in circulating humoral antioxidants in response to glutathione supplementation. However, supplementation had minimal effects on resting hemodynamics. Future research should examine glutathione supplementation’s effect in participants with decreased antioxidant capacity and increased oxidative stress including patients with known disease such as hypertension or peripheral artery disease.

scholarly journals Dietary saturated and unsaturated fats as determinants of blood pressure and vascular function

2009 ◽  
Vol 22 (1) ◽  
pp. 18-38 ◽  
Author(s):  
Wendy L. Hall
Keyword(s):  
Blood Pressure ◽  
Fatty Acid Composition ◽  
Fatty Acid ◽  
Endothelial Function ◽  
Acid Composition ◽  
Dietary Fat ◽  
Vascular Function ◽  
Pulse Wave ◽  
Arterial Compliance ◽  
Future Research

The amount and type of dietary fat have long been associated with the risk of CVD. Arterial stiffness and endothelial dysfunction are important risk factors in the aetiology of CHD. A range of methods exists to assess vascular function that may be used in nutritional science, including clinic and ambulatory blood pressure monitoring, pulse wave analysis, pulse wave velocity, flow-mediated dilatation and venous occlusion plethysmography. The present review focuses on the quantity and type of dietary fat and effects on blood pressure, arterial compliance and endothelial function. Concerning fat quantity, the amount of dietary fat consumed habitually appears to have little influence on vascular function independent of fatty acid composition, although single high-fat meals postprandially impair endothelial function compared with low-fat meals. The mechanism is related to increased circulating lipoproteins and NEFA which may induce pro-inflammatory pathways and increase oxidative stress. Regarding the type of fat, cross-sectional data suggest that saturated fat adversely affects vascular function whereas polyunsaturated fat (mainly linoleic acid (18 : 2n-6) and n-3 PUFA) are beneficial. EPA (20 : 5n-3) and DHA (22 : 6n-3) can reduce blood pressure, improve arterial compliance in type 2 diabetics and dyslipidaemics, and augment endothelium-dependent vasodilation. The mechanisms for this vascular protection, and the nature of the separate physiological effects induced by EPA and DHA, are priorities for future research. Since good-quality observational or interventional data on dietary fatty acid composition and vascular function are scarce, no further recommendations can be suggested in addition to current guidelines at the present time.

scholarly journals Correlation arterial stiffness and central blood pressure with obstructive sleep apnea in patients with resistant arterial hypertension

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
O Rekovets ◽  
Y Sirenko ◽  
N Krushynska ◽  
O Torbas ◽  
S Kushnir ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Arterial Stiffness ◽  
Arterial Hypertension ◽  
Aortic Stiffness ◽  
Pulse Wave ◽  
Central Blood Pressure ◽  
Nocturnal Hypoxemia ◽  
Obstructive Sleep ◽  
Resistant Arterial Hypertension

Abstract   The aim assess correlation the arterial stiffness in patients with resistant arterial hypertension (AH) and obstructive sleep apnea (OSA) Design 185 patients with AH were enrolled into the study. They were divided on 2 groups: OSA group – 148 patients were found to have OSA, indicated by at mean AHI of 38.1±2.5 h–1, and control group – 37 patients without OSA, mean AHI 3.02±0.25 h–1 (P&lt;0.001). Patients of both groups were comparable on age, growth, total cholesterol level and office systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results Patients with RAH and OSA (mean apnea-hypopnea index (AHI) 36.5±2.7 event/h) in comparison with patients with RAH without OSA (mean AHI 3.4±0.2 event/h) had significantly higher body mass index (34.2±0.7 vs 31.6±0.7 kg/m2, P&lt;0.05), uric acid level (6.7±0.1 vs 5.6±0.4 mg/dl, P&lt;0,05), higher carotid-femoral pulse wave velocity (PWVcf) (12.1±0.5 vs 10.2 m/s, P&lt;0,05) and central systolic blood pressure (CSBP) (143.8±2.7 vs 136.2±3.4 mm Hg, P&lt;0,05). Patients of both groups had comparable office blood pressure (SBP 145.6±1.67 vs 138.4±3.66 mm Hg, P=0.057 and DBP 93.6+±1.18 vs 89.1±2.11 mm Hg, P=0.073), but significantly higher 24-h systolic and diastolic blood pressure. We suggest that in the study some patients with OSA had masked arterial hypertension. Daytime sleepiness in OSA patients was associated with structural remodeling of the left ventricle myocardium and more expressed arterial stiffness: ESS score was independently correlated with snoring duration (β=−0.008; P=0.021), interventricular septum thickness (β=0.023; P=0.026), LVMI (β=−0.037; P=0.039) and indexes of central pulse wave: ejection duration (ED) (β=−0.020; P&lt;0.001) and subendocardial viability ratio (SEVR) (β=−0.224; P=0.012). Nocturnal hypoxemia in OSA patients was associated with increased aortic stiffness and higher central blood pressure: desaturation index was independently correlated with Aix (β=4.167; P=0.009), Aix75 (β=−3.929; P=0.006) and central DBP (β=0.151; P=0.004). Conclusion In patients with RH and OSA nocturnal hypoxemia correlation with increased aortic stiffness and higher central blood pressure. FUNDunding Acknowledgement Type of funding sources: None.

Effects of short-term dietary nitrate supplementation on blood pressure, O2 uptake kinetics, and muscle and cognitive function in older adults

2013 ◽  
Vol 304 (2) ◽  
pp. R73-R83 ◽  
Author(s):  
James Kelly ◽  
Jonathan Fulford ◽  
Anni Vanhatalo ◽  
Jamie R. Blackwell ◽  
Olivia French ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Cognitive Function ◽  
Metabolic Response ◽  
Treadmill Walking ◽  
Beetroot Juice ◽  
Dietary Nitrate ◽  
Resting Blood Pressure ◽  
Nitrate Supplementation ◽  
Plasma Nitrite

Dietary nitrate (NO3−) supplementation has been shown to reduce resting blood pressure and alter the physiological response to exercise in young adults. We investigated whether these effects might also be evident in older adults. In a double-blind, randomized, crossover study, 12 healthy, older (60–70 yr) adults supplemented their diet for 3 days with either nitrate-rich concentrated beetroot juice (BR; 2 × 70 ml/day, ∼9.6 mmol/day NO3−) or a nitrate-depleted beetroot juice placebo (PL; 2 × 70 ml/day, ∼0.01 mmol/day NO3−). Before and after the intervention periods, resting blood pressure and plasma [nitrite] were measured, and subjects completed a battery of physiological and cognitive tests. Nitrate supplementation significantly increased plasma [nitrite] and reduced resting systolic (BR: 115 ± 9 vs. PL: 120 ± 6 mmHg; P < 0.05) and diastolic (BR: 70 ± 5 vs. PL: 73 ± 5 mmHg; P < 0.05) blood pressure. Nitrate supplementation resulted in a speeding of the V̇o2 mean response time (BR: 25 ± 7 vs. PL: 28 ± 7 s; P < 0.05) in the transition from standing rest to treadmill walking, although in contrast to our hypothesis, the O2 cost of exercise remained unchanged. Functional capacity (6-min walk test), the muscle metabolic response to low-intensity exercise, brain metabolite concentrations, and cognitive function were also not altered. Dietary nitrate supplementation reduced resting blood pressure and improved V̇o2 kinetics during treadmill walking in healthy older adults but did not improve walking or cognitive performance. These results may have implications for the enhancement of cardiovascular health in older age.

scholarly journals No Effect of Beetroot Juice Supplementation on 100-m and 200-m Swimming Performance in Moderately Trained Swimmers

2019 ◽  
Vol 14 (6) ◽  
pp. 706-710 ◽  
Author(s):  
Ozcan Esen ◽  
Ceri Nicholas ◽  
Mike Morris ◽  
Stephen J. Bailey
Keyword(s):  
Blood Pressure ◽  
Swimming Performance ◽  
Time Trial ◽  
Upper Body ◽  
Beetroot Juice ◽  
Nitrite Concentration ◽  
Double Blind ◽  
Dietary Nitrate ◽  
Nitrate Supplementation ◽  
Plasma Nitrite

Purpose: Dietary nitrate supplementation has been reported to improve performance in kayaking and rowing exercise, which mandate significant recruitment of the upper-body musculature. Because the effect of dietary nitrate supplementation on swimming performance is unclear, the purpose of this study was to assess the effect of dietary nitrate supplementation on 100-m and 200-m swimming freestyle time-trial (TT) performance. Methods: In a double-blind, randomized crossover design, 10 moderately trained swimmers underwent 2 separate 3-d supplementation periods, with a daily dose of either 140 mL nitrate-rich (∼800 mg/d nitrate) or nitrate-depleted (PLA) beetroot juice (BRJ). After blood sampling on day 3, the swimmers performed both 200-m and 100-m freestyle swimming TTs, with 30 min recovery between trials. Results: Plasma nitrite concentration was greater after BRJ relative to PLA consumption (432 [203] nmol/L, 111 [56] nmol/L, respectively, P = .001). Systolic blood pressure was lowered after BRJ compared with PLA supplementation (114 [10], 120 [10] mm Hg, respectively P = .001), but time to complete the 200-m (BRJ 152.6 [14.1] s, PLA 152.5 [14.1] s) and 100-m (BRJ 69.5 [7.2] s, PLA 69.4 [7.4] s) freestyle swimming TTs was not different between BRJ and PLA (P > .05). Conclusions: Although 3 d of BRJ supplementation increased plasma nitrite concentration and lowered blood pressure, it did not improve 100-m and 200-m swimming TT performance. These results do not support an ergogenic effect of nitrate supplementation in moderately trained swimmers, at least for 100-m and 200-m freestyle swimming performance.

scholarly journals Development of an optimal protocol for assessing of peripheral and central blood pressure, pulse wave and arterial stiffness using a single-cuff volumetric sphygmograph in patients with cardiovascular diseases

2020 ◽  
pp. 40-47
Author(s):  
А.Р. Заирова ◽  
А.Н. Рогоза ◽  
Г.И. Хеймец ◽  
В.И. Каминная ◽  
В.В. Кухарчук
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Diseases ◽  
Arterial Stiffness ◽  
Pulse Wave ◽  
Screening Tests ◽  
Central Blood Pressure ◽  
Accurate Estimation ◽  
Left Shoulder ◽  
Wide Range ◽  
The Right

Введение. Объемные сфигмографы рекомендованы МЗ РФ в документе «Стандарт оснащения отделения функциональной диагностики». Од- нако отсутствуют общепринятые протоколы обследования и рекомендации по интерпретации получаемых данных. Цель исследования. Изучить особенности оценки периферического и центрального артериального давления (АД), пульсовой волны (ПВ) и арте- риальной жесткости (АЖ) с использованием одноманжеточного объемного сфигмографа (ООС) у больных сердечно-сосудистыми заболеваниями (ССЗ) и определить возможный вариант протокола обследования и алгоритм интерпретации получаемых данных для скрининговых исследований. Материал и методы. Обследовано 42 пациента в возрасте от 25 до 76 (56,8 ± 13,9) лет с гиперхолестеринемией (ГХС) (22 мужчины (52%), 20 женщин (48%)). Атеросклероз коронарных артерий выявлен у 48%, периферических артерий — у 76%, артериальная гипертония (АГ) — у 45% пациентов. Оценка показателей периферического и центрального АД, ПВ и АЖ проводилась с использованием ООС BPLab Vasotens® Office (ООО «Петр Телегин», г. Нижний Новгород) с регистрацией данных поочередно с правого и левого плеча по двум протоколам. Результаты. Продемонстрирован широкий диапазон изучаемых показателей у больных ССЗ, их нестабильность, «эффект первого измерения» для систолического АД (САД) и пульсового АД, необходимость серийных измерений для точной оценки значений с определением наличия или отсутствия асимметрии. Показано, что протокол с сокращенным временем исследования может быть использован в качестве оптимального без потери точности результатов. Заключение. Для оптимальной оценки устойчивых показателей периферического и центрального АД, ПВ и АЖ с использованием ООС у боль- ных ССЗ предложен протокол, заключающийся в поочередной регистрации данных с правого и левого плеча (всего 5–6 раз) без дополнитель- ной паузы между измерениями, с последующим исключением из анализа данных первого измерения, расчетом разницы значений перифери- ческого САД между измерениями для определения наличия устойчивой асимметрии и ее значимости и выбором алгоритма итоговой оценки всех изучаемых показателей. Introduction. Volumetric sphygmographs are recommended by the Ministry of Healthcare of the Russian Federation in the document “Equipment Standard for the Department of Functional Diagnostics”. However, there are no generally accepted examination protocols and recommendations on the interpretation of the data obtained. Aim. To study the features of the assessment of peripheral and central blood pressure (BP), pulse wave (PW) and arterial stiffness (AS) using a single-cuff volumetric sphygmograph (SCS) in patients with cardiovascular diseases (CVDs) and to determine a possible variant of the protocol and algorithm for interpreting the received datafor screening tests. Material and methods. 42 patients with hypercholesterolemia from 25 to 76 (56.8 ± 13.9) years old were examined – men 22 (52%), women 20 (48 %): coronary atherosclerosis was detected in 48%, peripheral arteries atherosclerosis in 76%, arterial hypertension (AH) in 45%. The peripheral and central BP, PW, AS indices were evaluated using the BPLabVasotens® Office (Petr Telegin LLC, Nizhny Novgorod) with registration of data alternately from the right and left shoulder according to two protocols. Results. А wide range of studied parameters in patients with CVDs, instability of these parameters, the "effect of the first measurement" for systolic and pulse BP (SBP and PBP), the need for "serial" measurements for accurate estimation of values and the determination of the presence or absence of asymmetry were demonstrated. It was shown that a protocol with reduced study time can be used as optimal without loss of accuracy of the results. Conclusion. The protocol for assessing stable indicators of peripheral and central BP, PW and AS using SCS in CVDs patients was proposed. It consists in alternate registration of data from the right and left shoulder (total 5 or 6) without an additional pause between measurements, with the subsequent exclusion from analysis the data of the first measurement, by calculating the difference in the values of the peripheral SBP between the measurements to determine the presence of stable asymmetry and its significance and the choice of the algorithm for the final assessment of all studied parameters

scholarly journals Effects of hormone replacement therapy on arterial stiffness, endothelial function and myocardial deformation in women with Turner syndrome

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
I Ikonomidis ◽  
G Pavlidis ◽  
I Mavroidi ◽  
M Varoudi ◽  
J Thymis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Hormone Replacement Therapy ◽  
Arterial Stiffness ◽  
Endothelial Function ◽  
Replacement Therapy ◽  
Turner Syndrome ◽  
Pulse Wave ◽  
Hormone Replacement ◽  
Volume Index ◽  
Percent Decrease

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction: Turner syndrome (TS) is associated with congenital or acquired cardiovascular diseases. Purpose We investigated whether hormone replacement therapy (HRT) affects arterial elastic properties, endothelial function and myocardial deformation in women with TS. Methods In 25 women with TS (age: 29 ± 9years) we measured  in the oestrogen phase of HRT cycle and 1 month after discontinuation of HRT: a)Pulse wave velocity (PWV-Complior), central systolic blood pressure (cSBP) and augmentation index (AI) of the aortic pulse wave, b)perfused boundary region (PBR) of the sublingual arterial microvessels, as a marker of endothelial glycocalyx thickness, c)carotid intima-media thickness (cIMT), d)flow-mediated dilatation (FMD) of the brachial artery and percentage difference of FMD (FMD%), and e)global LV longitudinal strain (GLS) and left atrium (LA) strain using speckle tracking echocardiography. Ten healthy subjects of similar sex, age and BMI served as control group. Results Compared to controls, women with TS under HRT had higher PWV (9.1 ± 2.4 vs. 7.5 ± 0.5m/s), AI (18 [7 to 27] vs. 5.8 [-10 to 19]%), cSBP (130 ± 15 vs. 121 ± 6mmHg), cIMT (0.66 ± 0.06 vs. 0.55 ± 0.05mm), FMD (7.2 ± 4 vs. 10 ± 2.3%) and lower LA volume index (14.3 ± 4 vs. 24 ± 13 mL/m²) and GLS (-18.8 ± 2.7 vs. -21.9 ± 1.5) (p &lt; 0.05 for all comparisons). PBR was negatively related with FMD% (r=-0.58, p = 0.022) in women with TS under HRT. One month after discontinuation of HRT, all women reduced PWV, AI, cSBP and increased FMD. There were no statistically significant changes in BMI, PBR, cIMT, LA volume index, LA strain and LV GLS (p &gt; 0.05 for all comparisons) (Table). The percent decrease of cSBP was associated with the percent decrease of PWV (r = 0.54) and inversely related with the percent increase of FMD (r=-0.57) (p &lt; 0.05 for all comparisons). Conclusions Hormone replacement treatment in women with TS deteriorates arterial stiffness and endothelial function probably due to increased central arterial blood pressure. Women with Turner syndrome under HRT (n = 25) Women with Turner syndrome one month after discontinuation of HRT (n = 25) p-value PWV, m/s 9.1 ± 2.4 7.8 ± 1.7 0.028 Central SBP, mmHg 130 ± 15 123 ± 14 0.007 PBR, 5-25μm 2.11 ± 0.3 2.12 ± 0.2 0.983 cIMT, mm 0.66 ± 0.06 0.67 ± 0.06 0.947 FMD, % 7.2 ± 4 11.7 ± 6 0.042 LA strain, % 51 ± 12 54 ± 15 0.400 LV GLS, % -18.8 ± 2.7 -19.3 ± 2.3 0.594 Table

scholarly journals Feasibility of non‐invasive measurement of central blood pressure and arterial stiffness in shock

2021 ◽  
Author(s):  
Konstantinos Markakis ◽  
Nikolaos Pagonas ◽  
Eleni Georgianou ◽  
Panagiota Zgoura ◽  
Benjamin J. Rohn ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Central Blood Pressure ◽  
Non Invasive ◽  
Invasive Measurement
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