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Aim To characterize different patterns of variability of three repeated within-visit blood pressure (BP) readings and to determine the prevalence of specific variation trends in systolic (SBP), diastolic (DBP) blood pressure and pulse pressure (PP). Methods Data from 53 737 subjects from the National Health and Nutrition Examination Survey were analyzed. In each subject, three consecutive BP measurements were performed with a minimum time-interval of at least 30 s. We propose three patterns of within-visit BP variability (separately for SBP, DBP and PP): (1) increasing trend (BP3 > BP2 > BP1); (2) decreasing trend (BP1 > BP2 > BP3) and (3) no trend (BP3 ≈ BP2 ≈ BP1). A threshold of minimum change (ΔP > 3 mmHg) between BP1-BP2 and BP2-BP3 was also applied as a prerequisite for the definition of these trends. Results An increasing trend was observed among three consecutive measurements of SBP, DBP and PP in 7.4, 10.4 and 10.2%, respectively. When a minimum threshold of 3 mmHg was set the respective increasing trends were observed in 1.8, 2.9 and 4.4%, respectively. There was a higher prevalence of decreasing trend within three consecutive SBP, DBP and PP readings: 17, 13.1 and 16.2%, respectively, whereas using a threshold of ΔP >3 mmHg the respective prevalence was 6.3, 4.1 and 7.7%. A maximum absolute difference >10 mmHg within triplicate of SBP/DBP/PP readings was observed in 12.9, 13 and 29.4%, respectively. In the era of personalized medicine, these patterns are well worth further investigation concerning their pathophysiologic and clinical relevance.

Progressive arterial stiffening, as a marker of arterial aging, may reach a plateau in elderly patients and may thus lose its clinical utility. This phenomenon may be more prominent in high-risk patients. We aimed to investigate if carotid-to-femoral pulse wave velocity (cf-PWV) is related to coronary artery disease (CAD) and diastolic dysfunction in elderly high-risk patients as compared to a control group of younger individuals.One-hundred and ninety-two high-risk stable patients who underwent coronary artery angiography and assessment of cf-PWV were consecutively recruited. Indices of diastolic dysfunction were also measured by echocardiography, including the volume of the left atrium and the ratio of early transmitral peak velocity (E) to the mitral annular early diastolic velocity (E').Increased cf-PWV was associated with the presence of CAD [odds ratio (OR) 1.34, P = 0.02], number of diseased coronary vessels (OR 1.17, P = 0.029) and CAD severity (P = 0.023) as assessed by Gensini score, in patients less than 65 years old after adjustment for traditional risk factors. Moreover, cf-PWV correlated with E/E' (P = 0.019) and increased the odds by 16% (OR 1.16, P = 0.048) for more severe diastolic dysfunction in patients aged below 65 years old. None of these outcomes correlated with cf-PWV in the elderly.In high cardiovascular risk patients, an age-dependent association of cf-PWV with CAD and diastolic dysfunction was evinced. In contrast to younger patients, these results suggest that measuring arterial stiffness in elderly high-risk patients may lack clinical value.

BACKGROUND There is increasing evidence that the method of calibration directly influences the association between brachial systolic blood pressure (bSBP) and estimated aortic systolic blood pressure (aSBP) and subsequently affects prognostic and diagnostic differentiation power of the latter. OBJECTIVE The aim of this study was to investigate associations between different methods of systolic pressure assessment in a large cohort and its comparison with recently published evidence. PARTICIPANTS AND METHODS During a public health campaign, cardiovascular hemodynamic data were assessed using a validated oscillometric device in a pharmacy setting. The device measures bSBP, mean arterial pressure, and diastolic blood pressure (DBP), and records brachial waveforms at the DBP level. aSBP1 was derived using bSBP and DBP and aSBP2 using measured mean arterial pressure and DBP for waveform calibration. In addition to pressures, age, sex, and anthropometric data were recorded. Regression analysis was carried out to investigate associations. RESULTS A total of 7409 (5133/2276, female/male) individuals with a median age of 54 years were sampled. aSBPs differed significantly from bSBP (126.0 mmHg) for aSBP1 (117.0 mmHg) and aSBP2 (127.5 mmHg, both P

Objective: Aortic (a) systolic blood pressure (SBP) is associated with arterial damage more consistently than brachial (b) SBP. However, it is unknown whether: (i) aSBP is normal in the presence of elevated bSBP, and vice versa; (ii) SBP classification on the basis of proposed bSBP and aSBP cut-off values, improves cardiovascular (CV) risk assessment. We tested (i) the frequency of 4 office SBP phenotypes: type I (both normal bSBP and aSBP); type II (high bSBP but normal aSBP); type III (normal bSBP but high aSBP), and type IV (both high bSBP and aSBP), (ii) the probability of each phenotype (using type I as reference) to be associated with increased arterial damage. Design and method: In a cohort study of 1861 participants (age: years 54 years, 49.1% males), we measured simultaneously bSBP, aSBP and carotid cross-sectional wall area (CSWA) with ultrasound. Results: Depending on the applied aSBP cut-off values, type II and type III phenotypes represented together 5–11 % of the studied population (0.9–3.4% and 1.8–10.3%, respectively). Subgroups with phenotypes II and III had significantly higher probability (by 2.3–3.3 and 3.3–8.9 times, respectively) as assessed by logistic regression analysis to present elevated carotid artery CSWA compared to the reference group, even after adjustment for diastolic blood pressure and other confounders. Conclusions: Defined on the basis of both bSBP and aSBP measurements, type II (i.e. isolated high bSBP) and type III (isolated high aSBP) are commonly observed and refine the detection of subgroups regarding the presence of arterial damage.

See related article, pp 148–157 The role of office and ambulatory 24-hour measurement of brachial blood pressure (BP) on the assessment and prediction of cardiovascular risk and mortality has been well established. In addition, the independent predictive value of office measurement of carotid-to-femoral pulse wave velocity (PWV), a surrogate of arterial stiffness, has been reported in longitudinal prospective studies and further confirmed by several meta-analyses. Indeed, the assessment of arterial stiffness at the office or clinical setting has gained a place in the latest (2013) European guidelines with an indication (Class IIa; Level of Evidence B) for evaluation of subclinical organ damage in hypertensive patients. Along with the growing clinical interest on the field, a variety of promising devices were introduced by the industry, which, however, led to known and new methodological concerns and debates thus resulting to the establishment of consensus reports and guidelines for their standardization.1 Several parallel studies have investigated the potential predictive value of central BP and aortic wave reflections, beyond and above peripheral (ie, brachial) BP values, but the provided evidence remains cloudy. With the advancement of technology, similarly to the ambulatory BP monitoring (ABPM) at the brachial artery, it is now feasible to monitor and evaluate the 24-hour (or longer) variation of arterial stiffness, wave reflections, and central BP at ambulatory conditions.2 Several commercially available devices exist for the above purposes as thoroughly described previously,3 providing a new tool to assess vascular function and properties at a circadian level. Numerous studies have demonstrated the prognostic value of ambulatory arterial stiffness in various populations and especially in hypertensive patients.3 Most commonly, the ambulatory arterial stiffness index, calculated using BP indices derived by brachial ABPM, has been applied for the assessment of 24-hour variation of arterial stiffness. Recently, the RENIS cohort investigated …

Reference EPFL-ARTICLE-227670doi:10.1097/Hjh.0000000000001247Afficher la publication dans Web of Science Notice creee le 2017-05-01, modifiee le 2017-05-07

Background The usefulness of the hypertensive retinopathy classification by Keith-Wagener-Barker (KWB) in clinical practice remains controversial. The simplified Mitchell-Wong grading, combining the two initial KWB' grades in one stage, is proposed as an alternative method; both systems are poorly validated regarding their association with target organ damage. Objective In a population free of cardiovascular disease and diabetes, we aimed to investigate the interobserver and intraobserver agreement of both grading systems, their association with aortic stiffness, carotid hypertrophy or plaques and the role of age and sex on this association. Methods Digital retinal images were obtained and graded - according to both classifications - by two independent and blinded observers; aortic stiffness (carotid-femoral pulse wave velocity, m/s) and common carotid hypertrophy (cross-sectional area, mm) or plaques were assessed by tonometry and ultrasound, respectively. Results From the gradable retinal photos obtained by 200 eyes of 107 consecutive patients (age: 54 ± 13 years, 51% men, 79% hypertensive patients) and after adjustments for confounders, the intraobserver and interobserver level of agreement was as following: KWB 88/64% and Mitchell-Wong 91/71%, respectively; exclusively in younger, not older, individuals aortic stiffness, carotid hypertrophy, but not plaques, were significantly associated with both systems, independently from confounders; no differences regarding target organ damage were found between stages 1 and 2 of KWB. Conclusion Detecting early signs of hypertensive retinopathy may be of value in young individuals; the Mitchell-Wong seems preferable to the KWB classification system only for reasons of simplifying clinical practice.

BACKGROUND: Over 100 million women currently use oral contraceptive pills (OCPs) worldwide. However little is known about the effects of OCPs on arterial stiffness and hemodynamics. Furthermore whether arterial stiffness and hemodynamics vary throughout the natural menstrual cycle remains controversial. Herein we estimated the effect of the natural menstrual cycle and OCP use on arterial stiffness and hemodynamics. METHODS: Healthy nonsmoking women aged 18-30 years were recruited if they had regular menstrual cycles and never used OCPs (OCP nonuser group) or were using low-dose OCPs for at least 6 months (OCP user group). Using applanation tonometry three assessments of arterial stiffness and central and peripheral hemodynamics were performed in a randomized order: during the early follicular (days 3-6) late follicular (days 14-16) and luteal (days 22-26) phases. Within group and between group comparisons were performed using general linear models. RESULTS: Sixty women (21.7 +/- 2.8 years) were recruited. Compared with OCP nonusers OCP users had significantly increased aortic and peripheral SBPs during the active OCP use but not during the inert tablet phase. No differences in arterial stiffness were noted. CONCLUSION: OCP use was associated with significant increases in aortic and peripheral blood pressures but not with increased arterial stiffness. Given the widespread OCP use future longitudinal studies are needed to confirm our findings and assess the long-term effect of OCPs on arterial stiffness and hemodynamics.

Increased wave reflection is an independent factor associated with cardiovascular diseases, risk, and mortality. The influence of the menstrual cycle on wave reflections and particularly on the reproducibility of their measurement has never been examined. The aim of the present study was to examine the reproducibility and variability of wave reflection indices in premenopausal healthy women during their menstrual cycle. Thirty-two women were examined at 3 phases of their menstrual cycle: days 1 to 2 (menstrual phase), days 6 to 14 (late follicular), and days 4 to 7 after ovulation (early luteal phase). Applanation tonometry of the radial artery and aortic pulse wave analysis were performed for the calculation of augmentation pressure, augmentation index, and timing of reflected waves. Reproducibility of these measures was evaluated by intraclass correlation coefficient and Bland-Altman analysis, whereas ANOVA was performed to assess their variability during the menstrual cycle. The SD of augmentation index differences between repeated measurements within the menstrual cycle ranged from 7.6% to 9.9%. Bland-Altman analysis indicated no evidence of systemic bias and no trend for the reproducibility of measurements to vary with their underlying mean value. Intraclass correlation coefficient indicated a moderate reproducibility of augmentation index and augmentation pressure (>0.80) and a rather low reproducibility for timing of reflected waves (0.43). Mean augmentation pressure, augmentation index, and timing of reflected waves did not vary significantly during the menstrual cycle (ANOVA). Measurement of wave reflections at the same phase of the menstrual cycle or statistical adjustment could be suggested for optimal study design and data interpretation.

The present experimental study compared the effectiveness of counterpulsation provided by the intra-aortic balloon pump (IABP) versus that of a nonpulsatile, radial-flow centrifugal pump (CFP) in rapidly worsening acute heart failure (HF). Eighteen pigs were included in the study. After the induction of acute moderate HF, circulatory support was randomly provided with either the IABP or CFP. No significant change in cardiac output (CO) and mean aortic pressure (MAP) was observed with either pump. The IABP caused a significantly greater decrease than the CFP in 1) double product (13.138 +/- 2.476 mm Hg/min vs. 14.217 +/- 2.673 mm Hg/min, p = 0.023), 2) left ventricular systolic pressure (LVSP, 100 +/- 8 mm Hg vs. 106 +/- 10 mm Hg, p = 0.046), and 3) end-diastolic aortic pressure (EDAP, 70 +/- 6 mm Hg vs. 86 +/- 6 mm Hg, p = 0.000). The effects of both pumps on total tension time index and LAD flow were similar. After the induction of severe HF, the IABP had its main effects on afterload and decreased LVSP from 88 +/- 6 mm Hg to 78 +/- 9 mm Hg, (p = 0.008), and EDAP from 57 +/- 9 mm Hg to 49 +/- 14 mm Hg, (p = 0.044), whereas the CFP exerted its effects mainly on preload, lowering LV end-diastolic pressure from 19 +/- 5 mm Hg to 11 +/- 4 mm Hg, (p = 0.002). CO and MAP were similarly increased by both assist systems. The IABP (by lowering afterload) and CFP (by lowering preload) both offered significant mechanical support in acute HF. However, afterload reduction offered principally by the IABP seems preferable for the recovery of the acutely failing heart.

Combined consumption of olive oil and wine is common in the Mediterranean diet, but there are no data concerning their synergistic haemodynamic response. We sought to determine the combined postprandial effects of wine and olive oil on wave reflections and central haemodynamics.Fifteen healthy subjects consumed four standard meals on different days, containing 50 g of olive oil and 250 ml of wine, in a randomized cross-over study design. Two types of wine [red (R) and white (W)] and two types of olive oil [green (G) and refined (O) (rich and poor in antioxidants, respectively)] were used in all possible combinations (RO, RG, WO and WG). Applanation tonometry and aortic pulse wave analysis were performed when fasting and 1, 2 and 3 h postprandially. A second group of 15 healthy individuals matched for age, gender and body mass index served as the control group.All meals decreased AIx (RO and RG, P0.001; WO, P = 0.007; and WG, P = 0.039). The AIx reduction after RG, RO, WO and WG was significantly different from the respective AIx response of the control group. No difference was observed in the reduction of AIx between sessions, but a significantly earlier peak decrease in AIx, as well as a more prolonged decreasing effect, was observed after RG and RO consumption compared to WO and WG. Central systolic and diastolic pressures were diminished after all four combinations of wine and olive oil (P0.05).Combined consumption of wine and olive oil provided beneficial postprandial effects on haemodynamics. These findings reveal an additional favourable effect of components of the Mediterranean diet on haemodynamics in the postprandial state.

Wave reflections are implicated increasingly in clinical research.The purpose of the present study was to investigate whether wave reflection indices are reproducible when measured repeatedly (more than twice) at longer time intervals, namely hour-to-hour and week-to-week, in healthy subjects; something that has not yet been examined.Bland-Altman plots, the interclass correlation coefficients (ICC) and coefficient of variation were used for this purpose. Two series, with measurements repeated in triplicate, were performed in 22 healthy subjects: the first at intervals of 1 h and the second at 1-week time intervals. Augmentation index (AIx), heart rate-corrected AIx (AI@75) and arrival time of reflected waves at the central aorta (tr) were calculated by aortic pulse wave analysis.AIx and AI@75 presented very good to excellent reproducibility (ICC = 0.86) for hour-to-hour repeated measurements, while tr was also highly reproducible (ICC = 0.79). AIx, AI@75 and tr were substantially reproducible when measured repeatedly with 1-week intervals, providing ICCs greater than 0.70. Bland-Altman plots confirmed these results, indicating that more than 90% of AIx, AI@75 and tr measurements fell within two standard deviations of the mean difference.Wave reflections are substantially reproducible even when measurements repeated in triplicate are performed at longer time intervals (hours and weeks). A quantifiable amount of variation was reported, which should be taken carefully into consideration in interventional studies with repeated measurements and in observational studies investigating differences or correlations of these indices.

It is well established that in young and healthy individuals central (aortic or carotid) systolic and pulse pressures are different from peripheral (brachial) corresponding pressures as a consequence of progressive changes in arterial stiffness and pressure wave reflections along the arterial tree. There is evidence indicating that in interventions with pharmaceutical and non-pharmaceutical agents, central pressures are subjected to greater changes than peripheral pressures, and they are more closely related to the pathophysiology of end-organ damage or cardiovascular risk. Therefore central blood pressures may be of higher clinical importance than peripheral pressures. The present review aims to provide an insight into the (patho)physiology of central blood pressures, to present the most accurate techniques for their estimation, and to discuss the available experimental and epidemiological data that support the emerging need for the evaluation of central blood pressures in clinical practice.

We would like to congratulate Milne et al,1 because they conducted this study, which covers a great gap about the validity and feasibility of devices for noninvasive estimation of central blood pressure (c-BP) in children. This will be a reference article and thus it is critical to clarify a few issues. Both ART.LAB and SphygmoCor apparatuses are used for the noninvasive estimation of c-BP. In clinical practice, the pulse waves recorded by these devices are calibrated using BP values noninvasively measured at the brachial artery. Thus, a great emphasis should be given on the fact that in this study the recorded pulses by ART.LAB were validated by mean arterial pressure and diastolic BP values which were measured by invasive intra-arterial BP recordings. Because the errors of noninvasive brachial BP measurement (ie, by cuff sphygmomanometers) are expected to be transferred to the c-BP estimation, it would be enlightening if the authors provide (if possible) the respective error in c-BP estimation by the ART.LAB system when it is calibrated using mean and diastolic brachial BP values measured noninvasively, similar to the procedure followed …

OBJECTIVE Red wine seems to improve haemodynamic variables, while smoking provokes adverse effects. The haemodynamic effects of their combined use is unknown. The purpose of the present study was to examine the acute effects of red wine and its constituents, in combination with the smoking of one cigarette, on haemodynamic parameters, such as blood pressure and wave reflections, in a group of smokers. METHODS Twenty smokers (12 males, eight females) participated in a double-blind, crossover study comprised of 3 study days. All subjects either smoked one cigarette, or smoked and drank 250 ml of red wine, or 250 ml of de-alcoholized red wine (containing the same type and similar concentration of antioxidants). Applanation tonometry and generalized transfer functions were used to estimate aortic pressure waveforms at baseline and 30, 60 and 90 min after each trial. The augmentation index (AIx) was used to express wave reflections. RESULTS Smoking increased peripheral systolic blood pressure (P < 0.005) 30 min later, but simultaneous consumption of either type of red wine caused no such effect. Additionally, smoking caused no overall effect on AIx, while smoking and drinking either regular or de-alcoholized red wine reduced AIx (P < 0.001). The reduction of AIx after red wine consumption was significantly greater than the respective reduction after de-alcoholized red wine (P = 0.004). CONCLUSION Antioxidant substances in red wine counteracted the smoking-induced increase in peripheral systolic blood pressure. Both alcohol and antioxidants in red wine decrease wave reflections in uncomplicated habitual smokers postprandially, indicating an additional favourable effect of red wine.

The intraaortic balloon pump (IABP) is the single most effective and widely used device for temporary mechanical assistance of the failing heart. Although the principles underlying IABP function are simple, various biologic factors often determine its performance in a particularly complicated way. We briefly describe the basic disciplines of counterpulsation by IABP and the induced hemodynamic changes while clarifying the biologic mechanisms that play a crucial role in the modification of IABP acute hemodynamic performance.

We read with great interest the study of Lurbe et al1 It is remarkable that noninvasive assessment of aortic blood pressures (BPs) and pulse wave velocity (PWV) was achieved in a large population of children including obese subjects. The reported findings are very relevant but we would like to comment on a few methodological issues and technological limitations. It must be noted that the methodology of the SphygmoCor software has not been validated in children. The transfer function used to derive the aortic pressure wave has been validated only in adults using directly measured aortic and radial pressure waves. Because …