In very elderly individuals living in nursing homes, low PPA from central to peripheral arteries strongly predicts mortality and adverse effects. Assessment of this parameter could help in risk estimation and improve diagnostic and therapeutic strategies in very old, polymedicated persons. In contrast, high BP is not associated with higher risk of mortality or major CV events in this population. (Predictive Values of Blood Pressure and Arterial Stiffness in Institutionalized Very Aged Population [PARTAGE]; NCT00901355).

Arterial stiffness, estimated by pulse wave velocity (PWV), is an independent predictor of cardiovascular mortality and morbidity. However, the clinical applicability of these measurements and the elaboration of reference PWV values are difficult due to differences between the various devices used. In a population of 50 subjects aged 20-84 years, we compared PWV measurements with three frequently used devices: the Complior and the PulsePen, both of which determine aortic PWV as the delay between carotid and femoral pressure wave and the PulseTrace, which estimates the Stiffness Index (SI) by analyzing photoplethysmographic waves acquired on the fingertip. PWV was measured twice by each device. Coefficient of variation of PWV was 12.3, 12.4 and 14.5% for PulsePen, Complior and PulseTrace, respectively. These measurements were compared with the reference method, that is, a simultaneous acquisition of pressure waves using two tonometers. High correlation coefficients with the reference method were observed for PulsePen (r ¼ 0.99) and Complior (r ¼ 0.83), whereas for PulseTrace correlation with the reference method was much lower (r ¼ 0.55). Upon Bland-Altman analysis, mean differences of values ± 2s.d. versus the reference method were À0.15 ± 0.62 m/s, 2.09 ± 2.68 m/s and À1.12±4.92 m/s, for PulsePen, Complior and PulseTrace, respectively. This study confirms the reliability of Complior and PulsePen devices in estimating PWV, while the SI determined by the PulseTrace device was found to be inappropriate as a surrogate of PWV. The present results indicate the urgent need for evaluation and comparison of the different devices to standardize PWV measurements and establish reference values.

This study has shown a possible independent role of NAFLD in determining arterial stiffness.

Abstract-To investigate the effect of different antihypertensive agents on blood pressure (BP) variability (BPV) and the underlying mechanism, we analyzed the ambulatory BP monitoring data of 577 patients before and after 3-month antihypertensive treatment, in the Natrilix SR Versus Candesartan and Amlodipine in the Reduction of Systolic Blood Pressure in Hypertensive Patients (X-CELLENT) Study, a multicenter, multinational, randomized, double-blind, placebo-controlled study with 4 parallel treatment arms (placebo, candesartan, indapamide sustained release, and amlodipine). Within-subject mean and SD of 24-hour BP, weighted by time interval between consecutive readings, were calculated in 3 time frames (daytime, nighttime, and 24 hours) to evaluate BP and BPV. The mean 24-hour heart rate (HR) and HR variability were calculated with the same algorithms. We found that the 3 antihypertensive drugs had a similar BP-lowering effect (PϽ0.001 for all), but amlodipine (PϽ0.007) and indapamide sustained release (PϽ0.04) were the only agents associated with a significantly decreased BPV after 3-month treatment. On the other hand, the major determinants of BPV at baseline were age, mean BP, and the corresponding HR variability. However, the reduction in BPV by amlodipine was significantly associated with the reduction in BP (PϽ0.006) and the reduction in HR variability (PϽ0.02), whereas the corresponding reduction by indapamide sustained release was only associated with the reduction in HR variability at night (Pϭ0.004). In summary, 3-month amlodipine or indapamide sustained release treatment was associated with a significant reduction in BPV, and the mechanism of those reductions was possibly attributable to lowering BP or ameliorating the autonomic nervous system regulation or both. The combination of the 2 agents might help to optimize such properties. (Hypertension. 2011;58:155-160.)Key Words: ambulatory blood pressure monitoring Ⅲ calcium channel blocker Ⅲ diuretics Ⅲ blood pressure variability Ⅲ heart rate variability F or many decades, the main goal of antihypertensive treatment was to lower blood pressure (BP) to a defined level. Recently, several investigators have shown that BP variability (BPV) is another critical cardiovascular risk factor, which should also be emphasized in the treatment of hypertension. Mancia et al 1 were the first to report a close association of BPV, assessed by 24-hour ambulatory BP monitoring (ABPM), with target-organ damage in hypertensive patients. Carotid artery damage 1 and increased left ventricular mass index 2 were, therefore, investigated in the first instance. However, the predictive value of BPV concerning cardiovascular and all-cause mortality has long been a matter of debate. 3-9 More recently, nighttime BPV was considered to be a more pronounced risk factor than daytime BPV. 10,11 Finally, Rothwell 12 showed that visit-to-visit BPV was an independent and strong predictor of cardiovascular events, such as stroke and coronary heart disease, and calcium channel blockers and no...

Abstract-In old individuals, regulation of blood pressure during postural changes is impaired. Several studies have assessed the clinical impact of orthostatic hypotension (OHypoT) during the aging process. By contrast, the prevalence and prognostic role of the increase in blood pressure in upright position (orthostatic hypertension, OHyperT) in old adults remain unknown. We investigated the association of OHyperT with cardiovascular morbidity and mortality in a population of old institutionalized subjects. A 2-year follow-up longitudinal study was conducted on 972 subjects ( In conclusion, in a old frail population, the increase in systolic blood pressure during upright position occurs frequently and is associated with higher cardiovascular morbidity and mortality independently of sitting blood pressure levels and major comorbidities. Health professional should take into account not only the decrease but also the increase in blood pressure when standing up. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00901355.

Arterial stiffness in elastic arteries, but not in muscular arteries, increased significantly and progressively with age, and was more closely correlated to BP, plasma glucose and arterial thickness.

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