Abstract 410: Combination Therapy With Lercanidipine and Enalapril Improves Wave Reflection in Hypertensive Patients With Metabolic Sindrome

Arterial stiffness and wave reflection are independent predictors of cardiovascular events. This study compared the effect on arterial stiffness and wave reflection of a combination therapy with an ACE-inhibitor plus calcium channel blocker or thiazide diuretic in essential hypertensive patients with metabolic syndrome uncontrolled by ACE-inhibitor monotherapy. In a multicenter randomized, open, parallel group study, 76 hypertensive patients with metabolic syndrome, after 4 weeks run-in with Enalapril 20 mg, were randomized to a combination therapy with Lercanidipine (LER, 10-20 mg) or Hydrochlorothiazide (HCT, 12,5-25 mg) for 6 months. Applanation tonometry was used to measure aortic stiffness (carotid to femoral pulse wave velocity, PWV), central blood pressure (BP) and augmentation index (AI), a marker of wave reflection. At screening, office BP was 153±4/95±2 mmHg in both groups. After run in, BP was 139±18/84±12 and 142±17/84±10 mmHg, in the LER and HCT groups, respectively, and after 6-month it was 134±15/79±9 mmHg in the LER group and 134±14/79±10 mmHg in the HCT group. No significant difference between the two groups was observed. Central BP values had a similar behavior (6 months: LER 120±13/80±9 mmHg; HCT 122±13/79±9 mmHg). PWV was similar at baseline and was equally reduced by the two treatments (LER from 8.6±1.5 to 8.1±1.3 m/s; HCT from 8.5±1.2 to 8.2±1.0 m/s). Finally, both drugs reduced AI, but this reduction resulted significantly greater in LER than in HCT arm (LER from 26.8±10.9 to 20.6±9.1%; HCT from 28.2±9.0 to 24.7±8.7%). In conclusion, the addition of LER caused the same PWV reduction as compared to HCT but greater reduction in AI in hypertensive patients with metabolic syndrome not controlled with Enalapril alone. These results indicate a positive effect of the combination with LER on wave reflection, suggesting a potential role for cardiovascular protection.

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Parameters of arterial stiffness in hypertensive patients with and without subclinical carotid atherosclerosis

Arterial’naya Gipertenziya (Arterial Hypertension) ◽

10.18705/1607-419x-2021-27-4-427-435 ◽

2021 ◽

Vol 27 (4) ◽

pp. 427-435

Author(s):

V. E. Gumerova ◽

S. A. Sayganov ◽

V. V. Gomonova

Keyword(s):

Arterial Stiffness ◽

Pulse Pressure ◽

Augmentation Index ◽

Subclinical Atherosclerosis ◽

Stiffness Index ◽

Control Group ◽

Hypertensive Patients ◽

Significant Difference ◽

Arterial Stiffness Index ◽

Plaque Detection

Objective. To assess the relationship between arterial stiffness parameters in hypertensive patients with and without atherosclerotic lesions.Design and methods. We included 127 subjects who were divided into 3 groups: patients with hypertension (HTN) without atherosclerosis (n = 42); patients with HTN and subclinical atherosclerosis (SА) (n = 52) and control group which consisted of individuals without HTN, SA, or coronary artery disease (n = 33). All groups matched by age and gender. All subjects underwent following examinations: ultrasonography of extracranial segments of carotid arteries, 24-hour blood pressure monitoring with the assessment of arterial stiffness parameters.Results. In subjects with HTN compared to controls, pulse wave velocity in aorta (PWVao) was significantly higher (11,3 ± 1,5; 12,3 ± 1,8 vs 10,4 ± 1,3 m/s; p < 0,05), as well as pulse pressure (PP) (46,4 ± 9,8; 45,6 ± 10,6 vs 39,9 ± 6,5 mmHg; p < 0,05), central pulse pressure (PPао) (35,5 ± 8,5; 34,9 ± 8,5 vs 30,9 ± 5,4 mmHg; p < 0,05), and arterial stiffness index (ASI) (141 (127, 159); 139 (128,5, 160,5) vs 126 (118, 138) mmHg; p < 0,05). In subjects with HTN and SA, PWVao was significantly higher compared to other groups (p < 0,05). No significant difference in augmentation index was found (–32,5 (–45, –12); –22 (–36, –12); –37 (–50, –17); p = 0,25). Аmbulatory arterial stiffness index was higher in controls (0,5 ± 0,2) compared to HTN group (0,4 ± 0,2; p = 0,05), while HTN and SA group did not differ significantly (0,5 ± 0,2; p = 0,3). PWVao above 11,15 m/s is associated with 4,3 (2,3–8,2) times higher rate of atherosclerosis plaque detection.Conclusions. In HTN patients, arterial stiffness is changed compared to healthy individuals. PWVao above 11,15 m/s is associated with 4,3 (2,3–8,2) times higher rate of atherosclerosis plaque detection. In patients with HTN and SA arterial stiffness is higher, which might have additional predictive value in risk stratification.

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Relation between Oscillometric Measurement of Central Hemodynamics and Left Ventricular Hypertrophy in Hypertensive Patients

Pulse ◽

10.1159/000520006 ◽

2021 ◽

pp. 1-9

Author(s):

Masakazu Obayashi ◽

Shigeki Kobayashi ◽

Takuma Nanno ◽

Yoriomi Hamada ◽

Masafumi Yano

Keyword(s):

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Augmentation Index ◽

Characteristic Curve ◽

Left Ventricular ◽

Applanation Tonometry ◽

Central Hemodynamics ◽

Prognostic Information ◽

Hypertensive Patients ◽

Significant Difference

Introduction: The augmentation index (AIx) or central systolic blood pressure (SBP), measured by radial applanation tonometry, has been reported to be independently associated with left ventricular hypertrophy (LVH) in Japanese hypertensive patients. Cuff-based oscillometric measurement of the AIx using Mobil-O-Graph® showed a low or moderate agreement with the AIx measurement with other devices. Methods: The AIx measured using the Mobil-O-Graph was validated against the tonometric measurements of the radial AIx measured using HEM-9000AI in 110 normotensive healthy individuals (age, 21–76 years; 50 men). We investigated the relationship between the central hemodynamics assessed using the Mobil-O-Graph and LVH in 100 hypertensive patients (age, 54–75 years; 48 men), presenting a wall thickness of ≥11 mm and ≥10 mm in men and women, respectively. Results: Although the Mobil-O-Graph-measured central AIx showed no negative values, it correlated moderately with the HEM-9000AI-measured radial AIx (r = 0.602, p < 0.001) in the normotensive individuals. The hypertensive patients did not show a significant difference in the central SBP between the sexes, but the central AIx was lower in men than in women. The independent determinants influencing left ventricle (LV) mass index (LVMI) (R2 = 0.362; adjusted R2 = 0.329, p < 0.001) were heart rate (β = −0.568 ± 0.149, p < 0.001), central SBP (β = 0.290 ± 0.100, p = 0.005), and aortic root diameter (β = 1.355 ± 0.344, p = 0.001). Age (β = −0.025 ± 0.124, p = 0.841) and the central AIx (β = 0.120 ± 0.131, p = 0.361) were not independently associated with the LVMI. The area under the receiver operator characteristic curve to evaluate the diagnostic performance of the central AIx for the presence of LVH (LVMI >118 g/m2 in men or >108 g/m2 in women) was statistically significant in men (0.875, p < 0.001) but not in women (0.622, p = 0.132). In men, a central AIx of 28.06% had a sensitivity of 83.3% and specificity of 80.0% for detecting LVH. Conclusions: AIx measurement in men provided useful prognostic information for the presence of LVH. Pulse-wave analysis assessed using the Mobil-O-Graph may be a valuable tool for detecting LVH in hypertensive patients.

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Differential Effects in Cardiovascular Markers between High-Dose Angiotensin II Receptor Blocker Monotherapy and Combination Therapy of ARB with Calcium Channel Blocker in Hypertension (DEAR Trial)

International Journal of Hypertension ◽

10.4061/2011/284823 ◽

2011 ◽

Vol 2011 ◽

pp. 1-11 ◽

Cited By ~ 2

Author(s):

Kenichiro Kinouchi ◽

Atsuhiro Ichihara ◽

Kanako Bokuda ◽

Hideaki Kurosawa ◽

Hiroshi Itoh

Keyword(s):

Arterial Stiffness ◽

Combination Therapy ◽

Augmentation Index ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

High Dose ◽

Angiotensin Ii Receptor Blocker ◽

Angiotensin Ii Receptor ◽

Hypertensive Patients ◽

Cardiovascular Morbidity And Mortality

Background/Aims. Arterial stiffness is an independent risk factor for cardiovascular morbidity and mortality. This study was conducted to determine the effect of olmesartan (OLM) and azelnidipine (AZL) on arterial stiffness using the cardio-ankle vascular index (CAVI), which is a novel blood pressure (BP)-independent marker for arterial stiffness in hypertensive patients.Methods. Fifty-two consecutive hypertensive patients were randomly assigned either to a group treated with OLM monotherapy or to a group treated with OLM and AZL combination therapy. Clinical and biological parameters were measured before and 12 months after the start of this study.Results. Both therapies significantly and similarly reduced BP, augmentation index, and plasma aldosterone levels. The combination therapy significantly decreased CAVI and serum low-density lipoprotein (LDL-C) levels and these reductions were significantly greater than those produced with monotherapy. No significant differences in metabolic parameters were observed between the two therapies.Conclusion. The combination therapy with OLM and AZL had beneficial effects on arterial stiffness assessed by CAVI, LDL-C, and metabolism, despite the similar BP reduction, compared with OLM monotherapy. Since these markers are known to influence the future risk of cardiovascular events, combination therapy with OLM and AZL could be a useful choice for treating hypertensive patients.

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Maternal arterial stiffness in pregnancies affected by preeclampsia

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.01106.2008 ◽

2009 ◽

Vol 297 (2) ◽

pp. H759-H764 ◽

Cited By ~ 61

Author(s):

Christina Kaihura ◽

Makrina D. Savvidou ◽

James M. Anderson ◽

Carmel M. McEniery ◽

Kypros H. Nicolaides

Keyword(s):

Arterial Stiffness ◽

Pulse Wave Velocity ◽

Wave Velocity ◽

Wave Reflection ◽

Pulse Wave ◽

Augmentation Index ◽

Applanation Tonometry ◽

Control Group ◽

Arterial Tree ◽

Cross Sectional

Preeclampsia (PE) is characterized by an aberrant maternal cardiovascular adaptation to pregnancy and increased cardiovascular risk later on in life. The aim of this study was to compare the maternal wave reflections and arterial stiffness in women with established PE and those with normotensive pregnancies, after systematic adjustment for known confounders. This was a cross-sectional study involving 69 normotensive, pregnant women and 54 women with established PE. Maternal wave reflection (augmentation index) and pulse wave velocity of the carotid-radial and carotid-femoral parts of the arterial tree were assessed noninvasively using applanation tonometry. The measurements were adjusted for maternal age, heart rate, mean arterial pressure, and aortic time to wave reflection and expressed as multiples of the median (MoM) of the control group. In the PE group, compared with controls, there was an increase in the median pulse wave velocity of both the carotid to femoral [1.1, interquartile rage (IQR) 1.0–1.3 MoM vs. 0.9, IQR 0.9–1.0 MoM; P < 0.0001] and carotid to radial (1.0, IQR 0.9–1.1 MoM vs. 0.9, IQR 0.9–1.0 MoM; P = 0.01) parts of the arterial tree. In contrast, there were no significant differences between the two groups in the median augmentation index (0.9, IQR 0.7–1.1 MoM vs. 1.0, IQR 0.5–1.8 MoM; P = 0.46). In conclusion, we found that established PE is characterized by increased maternal arterial stiffness but not altered maternal wave reflection.

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Abstract P519: Arterial Stiffness is Associated With Lower Performance on the Cognitive Tests at Different Domains in Hypertensive Patients

Hypertension ◽

10.1161/hyp.70.suppl_1.p519 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Henrique Muela ◽

Valeria Costa-Hong ◽

Michel F Machado ◽

Natalia C Moraes ◽

Claudia M Memória ◽

...

Keyword(s):

Cognitive Impairment ◽

Executive Function ◽

Cognitive Function ◽

Arterial Stiffness ◽

Neuropsychological Tests ◽

Augmentation Index ◽

Multivariate Regression Analysis ◽

Applanation Tonometry ◽

Hypertensive Patients ◽

Stage 1

Background: Cognitive impairment and elevated arterial stiffness are described in patients with arterial hypertension(AH), but its correlations are not well studied. Objectives: To study the cognitive function at different domains and arterial properties in patients with AH stage 1 to 3 compared to normotensives and to evaluate the correlations between these variables. Methods: We evaluated 221 subjects, 71 normotensives (52±14yrs,47%male,65%white) and 150 patients with stage 1-3 AH (52±12yrs,45%male,70%white) under treatment. The global cognitive function was assessed by Mini Mental State Examination(MMSE) and Montreal Cognitive Assessment(MoCA). There was done a validated comprehensive battery of neuropsychological tests(NPE) assessed the following main cognitive areas: memory, language, visuospatial ability, executive function, attention. Pulse wave velocity(PWV) was measured by Complior® device. Carotid properties were assessed by radiofrequency ultrasound(WTS®). Central arterial pressure and augmentation index (AIx) were obtained using applanation tonometry(Sphygmocor®). Results: Mean BP of the normotensive group (122.1±8/76.7±7mmHg) was significantly lower than hypertensive patients (135.2±13/83.3±10 and 149.9±29/91.5±16mmHg). Severe HTN group had worse performance in cognitive evaluation either by MMSE (26.8±2.1 vs 27.4±2.1 vs. 28.0±2.0, p=0.004) or MoCA test (23.4±3.7 vs. 24.9±2.8 vs. 25.5±3.2, p<0.001). On the neuropsychological tests hypertensive patients had worse performance mainly in visuoperceptual and visuospatial capacities and executive function. On the multivariate regression analysis, the following independent associations were observed: Aix-language, executive function, visuospatial and attention; cSBP-MoCA; IMT-memory and attention; PWV-memory, executive function, visuospatial and attention. Higher PWV group had more cognitive dysfunction. Conclusions: Cognitive impairment at different domains was more frequent in patients with different stages of AH. Arterial functional and structural properties were diversely associated with cognitive performance at different domains

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Applanation Tonometry for Assessment of Left Ventricular Systolic Load

Journal of Biomedical and Clinical Research ◽

10.2478/jbcr-2019-0014 ◽

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.

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Wave reflection augments central systolic and pulse pressures during facial cooling

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.01369.2007 ◽

2008 ◽

Vol 294 (6) ◽

pp. H2535-H2539 ◽

Cited By ~ 21

Author(s):

David G. Edwards ◽

Matthew S. Roy ◽

Raju Y. Prasad

Keyword(s):

Cardiovascular Events ◽

Wave Reflection ◽

Augmentation Index ◽

Systolic Pressure ◽

Aortic Pressure ◽

Applanation Tonometry ◽

Pressure Waveform ◽

Central Aortic Pressure ◽

Facial Cooling ◽

Change In Mean

Cardiovascular events are more common in the winter months, possibly because of hemodynamic alterations in response to cold exposure. The purpose of this study was to determine the effect of acute facial cooling on central aortic pressure, arterial stiffness, and wave reflection. Twelve healthy subjects (age 23 ± 3 yr; 6 men, 6 women) underwent supine measurements of carotid-femoral pulse wave velocity (PWV), brachial artery blood pressure, and central aortic pressure (via the synthesis of a central aortic pressure waveform by radial artery applanation tonometry and generalized transfer function) during a control trial (supine rest) and a facial cooling trial (0°C gel pack). Aortic augmentation index (AI), an index of wave reflection, was calculated from the aortic pressure waveform. Measurements were made at baseline, 2 min, and 7 min during each trial. Facial cooling increased ( P < 0.05) peripheral and central diastolic and systolic pressures. Central systolic pressure increased more than peripheral systolic pressure (22 ± 3 vs. 15 ± 2 mmHg; P < 0.05), resulting in decreased pulse pressure amplification ratio. Facial cooling resulted in a robust increase in AI and a modest increase in PWV (AI: −1.4 ± 3.8 vs. 21.2 ± 3.0 and 19.9 ± 3.6%; PWV: 5.6 ± 0.2 vs. 6.5 ± 0.3 and 6.2 ± 0.2 m/s; P < 0.05). Change in mean arterial pressure but not PWV predicted the change in AI, suggesting that facial cooling may increase AI independent of aortic PWV. Facial cooling and the resulting peripheral vasoconstriction are associated with an increase in wave reflection and augmentation of central systolic pressure, potentially explaining ischemia and cardiovascular events in the cold.

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Combination Therapy of Calcium Channel Blocker and Angiotensin II Receptor Blocker Reduces Augmentation Index in Hypertensive Patients

The American Journal of the Medical Sciences ◽

10.1097/maj.0b013e3181d658c4 ◽

2010 ◽

Vol 339 (5) ◽

pp. 433-439 ◽

Cited By ~ 16

Author(s):

Masayuki Doi ◽

Toru Miyoshi ◽

Satoshi Hirohata ◽

Shigeshi Kamikawa ◽

Hiroko Ogawa ◽

...

Keyword(s):

Angiotensin Ii ◽

Combination Therapy ◽

Calcium Channel ◽

Calcium Channel Blocker ◽

Channel Blocker ◽

Augmentation Index ◽

Receptor Blocker ◽

Angiotensin Ii Receptor Blocker ◽

Angiotensin Ii Receptor ◽

Hypertensive Patients

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Abstract 2994: Gender-Related Differences in the Central Arterial Pressure Waveform Begin in Childhood and are Independent of Height

Circulation ◽

10.1161/circ.118.suppl_18.s_802 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Julian G Ayer ◽

Albert Avolio ◽

Guy Marks ◽

Jason A Harmer ◽

David S Celermajer

Keyword(s):

Arterial Pressure ◽

Wave Reflection ◽

Augmentation Index ◽

Systolic Pressure ◽

Pressure Rise ◽

Radial Pressure ◽

Applanation Tonometry ◽

Stiffness Index ◽

Reflected Wave ◽

Age Related

Introduction Women develop age-related LV hypertrophy and symptomatic heart failure to a greater extent than men. Contributing to this may be a higher pulsatile afterload in women, with a higher central arterial systolic augmentation pressure (AP, peak pressure minus pressure at systolic shoulder) and augmentation index (AIx, ratio of AP to pulse pressure). It is unclear if these differences are due to gender per se or shorter female stature. We studied 8-year old children to determine if gender-related differences in carotid pressure augmentation are present in early life and if so, whether they are independent of height (Ht). Methods 406 children (age 8.0 ± 0.1, 49% girls) had anthropometry, brachial systolic and diastolic BP (SBP, DBP), heart rate (HR) and carotid and radial pressure waveforms (by applanation tonometry, calibrated to mean BP and DBP) assessed. Carotid ultrasound evaluated arterial elasticity [Carotid Artery Compliance (CAC), Stiffness Index (SI) and Young’s Elastic Modulus (YEM)]. Results Boys and girls had a similar Ht (129 ± 6 v 128 ± 6 cm), BMI (17.6 ± 3.1 v 17.5 ± 3.0), SBP (100 ± 7 v 101 ± 5 mmHg), DBP (59 ± 6 v 60 ± 5 mmHg) and HR (80 ± 10 v 82 ± 10 bpm). The carotid AP and AIx were significantly higher in girls (−4 ± 3 v −6 ± 4 mmHg and −12 ± 8 v −16 ± 9 respectively, p < 0.001), indicating greater systolic pressure augmentation. Time to onset of the reflected wave ( Tr ) and time to peak of the reflected wave were shorter in girls (154 ± 19 v 163 ± 18 msec, p < 0.001 and 206 ± 23 v 212 ± 22 msec, p = 0.03 respectively), indicating earlier wave reflection. Girls had a higher velocity index (Vr) estimated from Ht ( Vr = Ht /Tr , 8.4 ± 1.0 v 8.0 ± 0.9 m/sec, p = 0.001). Ejection duration, maximum rate of pressure rise and time to systolic peak (indicating effect of ventricular ejection on the carotid waveform) were not significantly different between genders. Boys, however, had stiffer carotid arteries than girls [lower CAC (5.8 ± 1.5 v 6.2 ± 1.8 %/10 mmHg, p = 0.016), higher SI (2.7 ± 0.7 v 2.5 ± 0.7, p = 0.012) and YEM (735 ± 217 v 681 ± 237, p = 0.021)]. Conclusion Even in the first decade of life, girls demonstrate greater central arterial pressure augmentation than boys, with earlier wave reflection. This is independent of height and may contribute to cardiovascular morbidity in females, later in life.

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