Vascular Stiffness

IJCS

Original Article

The Association Between Presystolic Wave and Subclinical Left Ventricular Dysfunction in Asymptomatic Hypertensive Patients: Speckle-Tracking Echocardiographic Study

Mohamed Yahia et al. Mahmoud Soliman Mohamed Hashem

Abstract

Background

Presystolic waves are often found during Doppler evaluation of the left ventricular outflow tract (LVOT) in hypertensive individuals. LV stiffness and altered LV compliance are potential mechanisms for presystolic waves.

Objectives

This study’s objective was to examine the relationship between presystolic wave and subclinical left ventricular (LV) impairment in asymptomatic individuals with essential hypertension.

Methods

This observational research comprised 87 individuals with essential hypertension. All patients had two-dimensional and Doppler echocardiography performed. Based on the existence or absence of a presystolic wave, patients were separated into two groups. Using speckle-tracking echocardiography, subclinical LV systolic impairment was identified. Data were analyzed using IBM SPSS version 20.0. The significance level adopted in the statistical analysis was 5%.

Results

The mean age of the studied patients was 51 ± 9 years, with a male percentage of 57.4%. Among them, 57 patients (65%) had a presystolic wave, and 30 (35%) did not. Left ventricular mass index (LVMI) was greater in patients with a presystolic wave in comparison with patients without it (105.8 ± 16.1 g/m² versus 99.8 ± 9.47 g/m², p-value = 0.03). Left atrial volume index (LAVI) was higher in patients with a presystolic wave in comparison with patients without it (28.9 ± 5.25 ml/m² versus 26.3 ± 2.74 ml/m^2, p-value = 0.016). Patients with presystolic wave demonstrated LV diastolic dysfunction more than patients without it (p-value = 0.024). Left ventricular global longitudinal strain (LVGLS) was lower in patients with a presystolic wave in comparison with patients without it (-20.2 ± 2.55 versus -21.7 ± 2.27 % with p-value = 0.008). Patients with presystolic wave demonstrated more subclinical LV systolic dysfunction than patients without it (p-value = 0.025).

Conclusion

The presystolic wave was linked to subclinical LV impairment. The existence of a presystolic wave may indicate hypertensive people who are at risk of developing overt heart failure.

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IJCS

Original Article

Comparison of Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors in the Management of Arterial Stiffness and Target Organ Damage in Patients with Hypertension

Gilberto Campos Guimarães Filho et al. Reila Campos Guimarães de Araújo Karynne Borges Cabral Cácia Régia de Paula

Abstract

Background

Arterial stiffness and hypertension are strong predictors of cardiovascular disease and mortality. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are first-line antihypertensive agents in reducing blood pressure and arterial stiffness.

Objective

The objective of this study was to compare the effects of ACEI and ARB in reducing arterial stiffness and preventing target organ damage in patients with hypertension.

Methods

This observational study included 654 participants who attend routine consultations at an outpatient hypertension clinic in 2 university hospitals. Patients were interviewed, and they underwent central and peripheral blood pressure measurements. Doppler echocardiography, carotid ultrasound, biochemical tests, and anthropometric parameters were carried out. Shapiro-Wilk, chi-square, and Fisher’s exact test were used. A significance level of 5% was adopted.

Results

A total of 659 participants were evaluated in the study (398 from the ARB group and 256 from the ACEI group). Age, body mass index (BMI), central and peripheral blood pressure measurements, pulse wave velocity (PWV), left ventricular mass index, and carotid intima-media thickness did not show differences between the groups (p > 0.05). After linear regression analysis, the ACEI group had lower values of total vascular resistance (TVR) (p = 0.003) and augmentation pressure (p = 0.008), when compared to the ARB group.

Conclusion

This study showed that the ACEI group had a greater reduction in augmentation pressure and PWV. There were no differences between the groups regarding the improvement of outcomes related to central arterial pressure, PWV, and cardiac and vascular target organ damage.

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IJCS

Editorial

Study of Arterial Stiffness – Based on Scientific Evidence, What are the Current Tools for the Study of Arterial Stiffness?

Ronaldo Rodrigues

One of the biggest challenges in modern medicine is the early identification of patients with higher cardiovascular risks. The early identification of vascular damage in hypertensive patients is a challenge for cardiologists around the world in their attempt to reduce the risk of cardiovascular complications in patients.

We know how important it is today to measure the thickness of the carotid intima-media complex through ultrasound examination in order to identify a greater or lesser cardiovascular risk. Arterial stiffness has proven to be a marker of arterial disease, which is why it has become an important parameter for the assessment of cardiovascular risk. It is also well-known that ventricular ejection generates a pressure wave that travels through the heart at a certain speed, which is known as the pulse wave velocity (PWV). The study of PWV in the carotid and femoral arteries is considered the gold standard in the assessment of arterial stiffness.

[…]

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IJCS

Original Article

Carotid Intima and Media Thickness Correlation with Central Blood Pressure Measurements by Tonometric and Oscillometric Methods: A Proof of Concept

Weimar Kunz Sebba Barroso et al. Milena de Andrade Melo Priscila Valverde Vitorino Claudia Gonçalves … João Alexandre Berigó Ana Carolina Arantes Jeeziane Rezende Thiago Veiga Jardim Ana Luiza Lima Souza Paulo César Veiga Jardim

Abstract

Background

The early detection of vascular damage in subclinical stages of hypertensive disease may be the key point in the prevention of cardiovascular outcomes.

Objectives

to correlate parameters of structural vascular damage (measurement of the carotid intima-media thickness) with parameters of functional vascular damage (central hemodynamic measurements) in pre-hypertensive and hypertensive patients taking up to two classes of anti-hypertensive drugs.

Methods

This was a cross-sectional descriptive study conducted with a convenience sample of patients attending the Liga de Hipertensão Arterial , a multidisciplinary program for the diagnosis and treatment of systemic hypertension, of the Federal university of Goias. Patients with arrythmia, diabetes, previous cardiovascular or cerebrovascular diseases, and end-stage diseases were excluded. Carotid Doppler test, measurements of peripheral and central blood pressure by applanation tonometry (Sphygmocor®) and oscillometry (Mobil-O-Graph®) were performed. The t-test was used for comparisons and the Pearson correlation test for correlations, considering a p<0.05 statistically significant.

Results

twenty patients (12 women) were evaluated, mean age 53.8 ± 14.3 years. Higher values of central pulse pressure (42.9±13.9 vs. 34.7±9.6, p=0.01) and pulse wave velocity (PWV) (9.0±1.9 vs. 7.9±1.5, p=0.01) were obtained by applanation tonometry compared with oscillometry. No difference between the methods was observed for the other measures. A significant correlation was found between carotid artery intima-media thickness (CA-IMT) and PWV (r=0.659; p=0.002) by the oscillometric test, but not with applanation tonometry. No correlation was found between central hemodynamic variables and the presence of carotid artery plaques.

Conclusion

PWV, estimated by oscillometry, was the only central hemodynamic parameter that correlated significantly with CA-IMT in pre-hypertensive and hypertensive patients at low cardiovascular risk. International Journal of Cardiovascular Sciences. 2020; [online].ahead print, PP.0-0

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IJCS

Editorial

Vascular Aging and Arterial Stiffness in Older Adults

Erika Maria Gonçalves Campana et al. Sayuri Inuzuka

Deaths from cardiovascular disease, according to the WHO, are projected to reach around 14 million by 2030. The global population is aging at an accelerated rate and the prevalence of arterial hypertension (AH) increases with advancing age. Aging is the common denominator in several cardiovascular diseases. Arterial stiffness and increased pulse wave velocity (PWV), as well as central systolic pressure are major predictors of cardiovascular events. ( )

[…]

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IJCS

Original Article

Tonometric and Oscillometric Methods for Measurement of Central Blood Pressure Parameters: a Comparison in Patients with Borderline Hypertension or Stage 1 Hypertension

Weimar Kunz Sebba Barroso et al. Claudia Ferreira Gonçalves João Alexandre Costa Berigó Milena Andrade Melo … Ana Carolina Arantes Ellen De Souza Lelis Watila Moura Sousa Jeeziane Marcelino Rezende Thiago Jardim Paulo Cesar Jardim Ana Luiza Lima Sousa Priscila Valverde Oliveira Vitorino

Abstract

Background

Changes in arterial compliance are among the first changes detectable in hypertensive syndrome. Methods with good reproducibility as compared with the gold standard for identifying such changes are desirable in clinical practice.

Objectives

To compare central pressure measurements and arterial stiffness obtained by two non-invasive methods (tonometry and oscillometry).

Methods

This was a descriptive, cross-sectional study with a convenience sample of patients with borderline hypertension or stage 1 hypertension. Peripheral and central blood pressure measurements were obtained by tonometry (SphygmoCor®), considered the gold standard, and oscillometry (Mobil O´graph®). Comparisons of results were made by unpaired t-test, and p values < 0.05 were considered statistically significant.

Results

No difference was found in central pressure measurements obtained by SphygmoCor® (117 x 80.1 mmHg) compared with Mobil O’graph (112 x 81.4 mmHg). Mean augmentation index (AIx) was 26.1% and 21.3%, and mean pulse pressure (PP) amplification 10.7 mmHg and 10.0 mmHg by Sphygmocor® and Mobil O´graph®, respectively (p > 0.05). Mean pressure wave velocity (PWV), 8.4 m/s vs. 7.4 m/s (p = 0.013) and mean central pulse pressure, 37.7 mmmHg and 30.9 mmHg (p = 0.013) were significantly higher by SphygmoCor® than Mobil O´graph®.

Conclusion

Values of central systolic blood pressure, AIx and pulse pressure amplification obtained by oscillometry were not statistically different compared with tonometry; values of PWV and cPP, however, were underestimated by oscillometry. (Int J Cardiovasc Sci. 2020; 33(2):145-150)

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IJCS

Editorial

Arterial Stiffness: The New Frontier in Hypertension and Cardiovascular Disease

Erika Maria Gonçalves Campana

Vascular age is a reflection of cardiovascular and non-cardiovascular factors that contribute to accelerated vascular aging (AVA) and stiffness of large elastic arteries, leading to increased cardiovascular morbidity and mortality. Arterial stiffness has been regarded as an important biomarker in the assessment of subclinical atherosclerosis and cardiovascular risk.^– The addition of pulse wave velocity (PWV) measurements to traditional risk factors has improved the prediction of the ten-year risk of cardiovascular diseases in 13% of individuals at intermediate risk.

In addition, the altered behavior of central hemodynamic parameters, such as central systolic blood pressure (cSBP) and the (heart rate-corrected) augmentation index (AI), is influenced by arterial stiffness and plays a crucial role in the interface between the traditional cardiovascular continuum vascular aging continuum, which represents the current view of the pathophysiology of cardiovascular diseases.^– ()

[…]

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IJCS

Original Article

Determinants of Arterial Stiffness and Vascular Aging in the Older Adult

Telmo Pereira et al. Tatiana Costa

Abstract

Background:

Arterial stiffness (AS) is recognized as an important and independent risk factor for cardiovascular diseases (CVD).

Objective:

This study was aimed at identifying the main determinants of AS in the elderly.

Design and Methods:

This was an observational, cross-sectional study of elderly participants. Blood pressure (BP) and parameters of arterial function were measured using a validated device. Clinical and demographic data, global cardiovascular risk, health-related quality of life, dietary profile and cognition data were evaluated. Blood samples were collected for biochemical profiling of the participants. Handgrip strength test was performed. Student’s t-test and the χ² or Fisher exact tests were used for between-group comparisons as adequate. Correlational analysis was performed with the Pearson correlation coefficients and linear regression analysis. A two-tailed p < 0.05 was considered significant.

Results:

Fifty-four participants (81.8 ± 8.8 years; 65-94 years) were included in the study. Central BP was 132.7 ± 23.7 mmHg and 51.5 ± 15.7 mmHg, respectively, for aortic systolic and pulse pressures. Mean pulse wave velocity (PWV) was 12.9 ± 2.1 m/s and augmentation index 30.1 ± 12.9%. The proportion of participants with abnormal AS (increased PWV) was 27.8%. Participants with abnormal AS had higher brachial and central BP, higher BMI and higher abdominal fat. Functionality and nutritional status were worse in participants with abnormal AS. Regression analysis indicated age, brachial and central BP and vascular resistance as main determinants of AS.

Conclusions:

Abnormal AS is a common finding in the elderly and is highly associated with hypertension, functional decline and impairment of kidney function.

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