The Effect of Antihypertensive Drugs on Arterial Stiffness and Central Hemodynamics: Not All Fingers are Made the Same

Arterial stiffness and central hemodynamics attract increasing scientific interest within the hypertensive community during the last decade. Accumulating evidence indicates that aortic stiffness is a strong and independent predictor of cardiovascular events and all-cause mortality in hypertensive patients, and its predictive value extends beyond traditional risk factors. The role of central hemodynamics and augmentation index (a marker of reflected waves), remains less established and requires further investigation. Several lines of evidence indicate that antihypertensive therapy results in significant reductions of pulse wave velocity and central hemodynamics. However, beta-blockers seem to be the only exception with significant within-class differences. Conventional beta-blockers, although equally effective in reducing pulse wave velocity, seem to be less beneficial on central hemodynamics and augmentation index than the other antihypertensive drug categories, whereas the newer vasodilating beta-blockers seem to share the benefits of the other antihypertensive drugs. In conclusion, aortic stiffness seems ready for ‘prime-time’ in the management of essential hypertension, while further research is needed for central hemodynamics and augmentation index.

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Augmentation index is not a proxy for wave reflection magnitude: mechanistic analysis using a computational model

Journal of Applied Physiology ◽

10.1152/japplphysiol.00769.2018 ◽

2019 ◽

Vol 127 (2) ◽

pp. 491-500 ◽

Cited By ~ 10

Author(s):

Maarten H. G. Heusinkveld ◽

Tammo Delhaas ◽

Joost Lumens ◽

Wouter Huberts ◽

Bart Spronck ◽

...

Keyword(s):

Arterial Stiffness ◽

Pulse Wave Velocity ◽

Computational Model ◽

Wave Velocity ◽

Wave Reflection ◽

Pulse Wave ◽

Augmentation Index ◽

The Other ◽

Stroke Work ◽

Shortening Velocity

The augmentation index (AIx) is deemed to capture the deleterious effect on left ventricular (LV) work of increased wave reflection associated with stiffer arteries. However, its validity as a proxy for wave reflection magnitude has been questioned. We hypothesized that, in addition to increased wave reflection due to increased pulse wave velocity, LV myocardial shortening velocity influences AIx. Using a computational model of the circulation, we investigated the isolated and combined influences of myocardial shortening velocity vs,LV and arterial stiffness on AIx. Aortic blood pressure waveforms were characterized using AIx and the reflected wave pressure amplitude ([Formula: see text], obtained using wave separation analysis). Our reference simulation (normal vs,LV and arterial stiffness) was characterized by an AIx of 21%. A realistic reduction in vs,LV caused AIx to increase from 21 to 42%. An arterial stiffness increase, characterized by a relevant 1.0 m/s increase in carotid-femoral pulse wave velocity, caused AIx to increase from 21 to 41%. Combining the reduced vs,LV and increased arterial stiffness resulted in an AIx of 54%. In a multistep parametric analysis, both vs,LV and arterial stiffness were about equal determinants of AIx, whereas [Formula: see text] was only determined by arterial stiffness. Furthermore, the relation between increased AIx and LV stroke work was only ≈50% explained by an increase in arterial stiffness, the other factor being vs,LV. The [Formula: see text], on the other hand, related less ambiguously to LV stroke work. We conclude that the AIx reflects both cardiac and vascular properties and should not be considered an exclusively vascular parameter. NEW & NOTEWORTHY We used a state-of-the-art computational model to mechanistically investigate the validity of the augmentation index (AIx) as a proxy for (changes in) wave reflection. In contrary to current belief, we found that LV contraction velocity influences AIx as much as increased arterial stiffness, and increased AIx does not necessarily relate to an increase in LV stroke work. Wave reflection magnitude derived from considering pressure, as well as flow, does qualify as a determinant of LV stroke work.

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Insulin Increases Central Aortic Stiffness in Response To Hyperglycemia in Healthy Humans: A Randomized Four-Way Crossover Study

10.21203/rs.3.rs-72339/v2 ◽

2020 ◽

Author(s):

William B Horton ◽

Linda A Jahn ◽

Lee M Hartline ◽

Kevin W Aylor ◽

Eugene J Barrett

Keyword(s):

Heart Rate ◽

Arterial Stiffness ◽

Pulse Wave Velocity ◽

Crossover Study ◽

Wave Velocity ◽

Aortic Stiffness ◽

Pulse Wave ◽

Augmentation Index ◽

Healthy Humans ◽

Peripheral Arterial

Abstract Increasing arterial stiffness is a feature of vascular aging that is accelerated by conditions that enhance cardiovascular risk, including diabetes mellitus. Emerging evidence demonstrates that reversal of the normal lower central to higher peripheral arterial stiffness gradient predicts adverse cardiovascular consequences, including target organ damage. Preferential stiffening of central over peripheral arteries has been reported in type 2 diabetes, though mechanisms for this remain unclear. We tested the effect of acutely increasing plasma glucose, plasma insulin, or both on hemodynamic function, central aortic stiffness (carotid-femoral pulse wave velocity), and peripheral arterial stiffness (augmentation index) in a randomized, four-way, crossover study of 19 healthy young adults. Carotid-femoral pulse wave velocity increased only during hyperglycemic-hyperinsulinemia (+0.4 m/s; p=0.02), while augmentation index did not change significantly within any intervention (all p>0.05). Heart rate significantly increased only during hyperglycemic-hyperinsulinemia (+3.62 bpm; p=0.02). There was a significant inverse correlation between the changes of central and peripheral arterial stiffness only during hyperglycemic-hyperinsulinemia. We conclude that combined hyperglycemia and hyperinsulinemia acutely increased aortic stiffness, changed the normal central-to-peripheral arterial stiffness gradient, and increased heart rate in healthy humans. (ClinicalTrials.gov number NCT03520569; registered 9 May 2018).

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Evaluation of Arterial Stiffness Using Pulse Wave Velocity and Augmentation Index in Patients with Chronic Venous Insufficiency

International Journal of Vascular Medicine ◽

10.1155/2018/5437678 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Mustafa Dogdus ◽

Onur Akhan ◽

Mehmet Ozyasar ◽

Ahmet Yilmaz ◽

Mehmet Sait Altintas

Keyword(s):

Arterial Stiffness ◽

Pulse Wave Velocity ◽

Wave Velocity ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Pulse Wave ◽

Augmentation Index ◽

Chronic Venous Disease ◽

Venous Disease ◽

High Morbidity

Background and Objectives. Chronic venous insufficiency (CVI) is a common pathology of the circulatory system and is associated with a high morbidity for the patients and causes high costs for the healthcare systems. Arterial stiffness has been shown to be a predictor of cardiovascular events and mortality. The relationship between CVI and arterial stiffness using pulse wave velocity (PWV) and augmentation index (Aix) was evaluated in this study. Methods. Sixty-two patients with the stage of C3-C5 chronic venous disease (CVD) and 48 healthy subjects were enrolled in the study. To assess arterial stiffness, all cases were evaluated with I.E.M. Mobil-O-Graph brand ambulatory blood pressure monitor device. PWV and Aix were used to assess arterial stiffness in this study. Results. The mean age was 61.9±11.05 years and 54 % of the patient population was females. PWV and Aix were significantly higher in CVI patients than controls (8.92±1.65 vs. 8.03±1.43, p=0.001; 25.51±8.14 vs. 20.15±9.49, p=0.003, respectively) and also positive linear correlation was observed between CVI and all measured arterial stiffness parameters (r=0.675 for CVI and PWV, r=0.659 for CVI and Aix, respectively). A PWV value of > 9.2 has 88.9 % sensitivity and 71.4 % specificity to predict the presence of CVI. Conclusions. PWV and Aix are the most commonly used, easy, reproducible, reliable methods in the clinic to assess arterial stiffness. Logistic regression analysis showed that PWV and Aix were the independent predictors of CVI. PWV has the sensitivity of 88.9 % and specificity of 71.4 % to detect the presence of CVI.

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Volume status and arterial blood pressures are associated with arterial stiffness in hemodialysis patients

The International Journal of Artificial Organs ◽

10.1177/0391398818778212 ◽

2018 ◽

Vol 41 (7) ◽

pp. 378-384 ◽

Cited By ~ 2

Author(s):

Alper Erdan ◽

Abdullah Ozkok ◽

Nadir Alpay ◽

Vakur Akkaya ◽

Alaattin Yildiz

Keyword(s):

Blood Pressure ◽

Arterial Stiffness ◽

Pulse Wave Velocity ◽

Wave Velocity ◽

Pulse Pressure ◽

Pulse Wave ◽

Augmentation Index ◽

Mean Blood Pressure ◽

Aortic Blood ◽

Aortic Blood Pressure

Background: Arterial stiffness is a strong predictor of mortality in hemodialysis patients. In this study, we aimed to investigate possible relations of arterial stiffness with volume status determined by bioimpedance analysis and aortic blood pressure parameters. Also, effects of a single hemodialysis session on these parameters were studied. Methods: A total of 75 hemodialysis patients (M/F: 43/32; mean age: 53 ± 17) were enrolled. Carotid-femoral pulse wave velocity, augmentation index, and aortic pulse pressure were measured by applanation tonometry before and after hemodialysis. Extracellular fluid and total body fluid volumes were determined by bioimpedance analysis. Results: Carotid-femoral pulse wave velocity (9.30 ± 3.30 vs 7.59 ± 2.66 m/s, p < 0.001), augmentation index (24.52 ± 9.42 vs 20.28 ± 10.19, p < 0.001), and aortic pulse pressure (38 ± 14 vs 29 ± 8 mmHg, p < 0.001) significantly decreased after hemodialysis. Pre-dialysis carotid-femoral pulse wave velocity was associated with age (r2 = 0.15, p = 0.01), total cholesterol (r2 = 0.06, p = 0.02), peripheral mean blood pressure (r2 = 0.10, p = 0.005), aortic-mean blood pressure (r2 = 0.06, p = 0.02), aortic pulse pressure (r2 = 0.14, p = 0.001), and extracellular fluid/total body fluid (r2 = 0.30, p < 0.0001). Pre-dialysis augmentation index was associated with total cholesterol (r2 = 0.06, p = 0,02), aortic-mean blood pressure (r2 = 0.16, p < 0.001), and aortic pulse pressure (r2 = 0.22, p < 0.001). Δcarotid-femoral pulse wave velocity was associated with Δaortic-mean blood pressure (r2 = 0.06, p = 0.02) and inversely correlated with baseline carotid-femoral pulse wave velocity (r2 = 0.29, p < 0.001). Pre-dialysis Δaugmentation index was significantly associated with Δaortic-mean blood pressure (r2 = 0.09, p = 0.009) and Δaortic pulse pressure (r2 = 0.06, p = 0.03) and inversely associated with baseline augmentation index (r2 = 0.14, p = 0.001). In multiple linear regression analysis (adjusted R2 = 0.46, p < 0.001) to determine the factors predicting Log carotid-femoral pulse wave velocity, extracellular fluid/total body fluid and peripheral mean blood pressure significantly predicted Log carotid-femoral pulse wave velocity (p = 0.001 and p = 0.006, respectively). Conclusion: Carotid-femoral pulse wave velocity, augmentation index, and aortic pulse pressure significantly decreased after hemodialysis. Arterial stiffness was associated with both peripheral and aortic blood pressure. Furthermore, reduction in arterial stiffness parameters was related to reduction in aortic blood pressure. Pre-dialysis carotid-femoral pulse wave velocity was associated with volume status determined by bioimpedance analysis. Volume control may improve not only the aortic blood pressure measurements but also arterial stiffness in hemodialysis patients.

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Abstract 17389: The Role of Arterial Stiffness in Mediating the Association Between Grip Strength and Cardiovascular Events: The Korean Genome and Epidemiology Study

Circulation ◽

10.1161/circ.138.suppl_1.17389 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Cheol Ung Choi ◽

Woohyeun Kim ◽

Chol Shin ◽

Jong-il Choi ◽

Seong Hwan Kim ◽

...

Keyword(s):

Arterial Stiffness ◽

Pulse Wave Velocity ◽

Grip Strength ◽

Wave Velocity ◽

Cardiovascular Events ◽

Pulse Wave ◽

Augmentation Index ◽

Epidemiology Study ◽

Intima Medial Thickness ◽

Carotid Intima Medial Thickness

Introduction: Grip strength has been associated with cardiovascular events. However, there have been no exact mechanisms explaining the association between grip strength and cardiovascular events. Hypothesis: The aim of this study was to assess whether arterial stiffness or endothelial function could mediate the association between grip strength and cardiovascular events. Methods: We studied 1508 participants (Age; 60 ± 7, Men; 47.5 %) from the Ansan cohort of the Korean Genome Epidemiology Study. Participants were assessed for grip strength, measured using a Jamar dynamometer. The central blood pressure, the augmentation index, and the pulse wave velocity were evaluated by using an applanation tonometer. Intima medial thickness was measured by B-mode ultrasonogram with a 7.5 MHz linear array transducer. Results: With increasing the grip strength, augmentation index decreased (r= -0.445, p<0.001). Pulse wave velocity (r= -0.044, p=0.109) and carotid intima medial thickness (r= -0.004, p=0.881) had no significant correlation with grip strength. Conclusions: Grip strength was inversely correlated with augmentation index. This result suggests that systemic arterial stiffness could mediate the association between grip strength and cardiovascular events.

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Effect of Second hand Smoke on Arterial Stiffness among Healthy Women

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v18i2.40706 ◽

2019 ◽

Vol 18 (2) ◽

pp. 340-346

Author(s):

Suriyati Sariban ◽

Siti Suhaila Mohd Yusoff ◽

Juwita Shaaban ◽

Norhayati Mohd Noor ◽

Harmy Mohamed Yusoff

Keyword(s):

Arterial Stiffness ◽

Pulse Wave Velocity ◽

Cigarette Smoke ◽

Wave Velocity ◽

Pulse Wave ◽

Augmentation Index ◽

Pulse Wave Analysis ◽

Second Hand Smoke ◽

Wave Analysis ◽

The Mean

Introduction: Arterial stiffness is recognised as a significant cardiovascular risk factor and an independent predictor of all causes of cardiovascular death. Women are the largest population exposed to cigarette smoke either at work or from their partner. The objectives of this study are to compare the arterial stiffness (augmentation index and pulse wave velocity) between second hand smoke (SHS) and non second hand smoke (non-SHS). Designs and method: Comparative cross-sectional study was conducted among 118 healthy female subjects (64 SHS and 54 non- SHS). The women were in the SHS group if their spouse is a smoker and they had an exposure to cigarette smoke for at least three years, minimum of15 minutes two days a week. Pulse wave analysis and pulse wave velocity was used to study the arterial stiffness. Pulse wave analysis reported as percentage of augmentation index. Pulse wave velocity equal to carotid femoral distance (meter) divided by time (second) Results: The mean augmentation index (AIx) for SHS groups was 17.9 (SD7.06) and for non SHS groups was 20.7(SD6.11). The mean of Pulse wave velocity was 8.94 (SD1.36) in SHS groups and 9.02 (SD8.68) in non SHS groups. ANOVA and ANCOVA shown significance difference in crude mean (p = 0.047) and estimated marginal mean (p = 0.028) of augmentation index between SHS and non - SHS after controlling for age and BMI. However, there was no significant difference in crude mean (p = 0.795) and estimated marginal mean (p = 0.716) pulse wave velocity between SHS and non - SHS after controlling for age and BMI. Conclusion: An increase in augmentation index amongst non SHS in this study most probably due to exposure to environmental tobacco at work compared to exposure to spouse’s smoke Bangladesh Journal of Medical Science Vol.18(2) 2019 p.340-346

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P.064 AMBULATORY ARTERIAL STIFFNESS INDEX, PULSE WAVE VELOCITY AND AUGMENTATION INDEX–INTERCHANGEABLE OR MUTUALLY EXCLUSIVE MEASURES

Artery Research ◽

10.1016/j.artres.2007.07.121 ◽

2007 ◽

Vol 1 (2) ◽

pp. 67

Author(s):

A. Mahmud ◽

P. Jerrard-Dunne ◽

J. Feely

Keyword(s):

Arterial Stiffness ◽

Pulse Wave Velocity ◽

Wave Velocity ◽

Pulse Wave ◽

Augmentation Index ◽

Stiffness Index ◽

Arterial Stiffness Index

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Normal Pregnancy Is Associated with Changes in Central Hemodynamics and Enhanced Recruitable, but Not Resting, Endothelial Function

International Journal of Reproductive Medicine ◽

10.1155/2015/250951 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Juan Torrado ◽

Yanina Zócalo ◽

Ignacio Farro ◽

Federico Farro ◽

Claudio Sosa ◽

...

Keyword(s):

Pulse Wave Velocity ◽

Endothelial Function ◽

Wave Velocity ◽

Aortic Stiffness ◽

Pulse Wave ◽

Reactive Hyperemia ◽

Intima Media Thickness ◽

Normal Pregnancy ◽

Low Flow ◽

Central Hemodynamics

Introduction.Flow-mediated dilation (FMD), low flow-mediated constriction (L-FMC), and reactive hyperemia-related changes in carotid-to-radial pulse wave velocity (ΔPWVcr%) could offer complementary information about both “recruitability” and “resting” endothelial function (EF). Carotid-to-femoral pulse wave velocity (PWVcf) and pulse wave analysis-derived parameters (i.e., AIx@75) are the gold standard methods for noninvasive evaluation of aortic stiffness and central hemodynamics. If healthy pregnancy is associated with both changes in resting and recruitable EF, as well as in several arterial parameters, it remains unknown and/or controversial.Objectives.To simultaneously and noninvasively assess in healthy pregnant (HP) and nonpregnant (NP) women central parameters in conjunction with “basal and recruitable” EF, employing new complementary approaches.Methods.HP (n=11, 34.2 ± 3.3 weeks of gestation) and age- and cardiovascular risk factors-matched NP (n=22) were included. Aortic blood pressure (BP), AIx@75, PWVcf, common carotid stiffness, and intima-media thickness, as well as FMD, L-FMC, and ΔPWVcr %, were measured.Results.Aortic BP, stiffness, and AIx@75 were reduced in HP. ΔPWVcr% and FMD were enhanced in HP in comparison to NP. No differences were found in L-FMC between groups.Conclusion.HP is associated with reduced aortic stiffness, central BP, wave reflections, and enhanced recruitable, but not resting, EF.

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