Pulsatile blood pressure (BP) confers cardiovascular risk. Whether associations of cardiovascular endpoints are tighter for central than peripheral systolic or pulse pressure (cSBP, pSBP, cPP, pPP) is uncertain. Among 5608 participants (54.1% women; mean age, 54.2 years) enrolled in nine studies, median follow-up was 4.1 years. cSBP and cPP, estimated tonometrically from the radial waveform, averaged 123.7 and 42.5 mm Hg, and pSBP and pPP 134.1 and 53.9 mm Hg. The primary composite cardiovascular endpoint occurred in 255 participants (4.5%). Across fourths of the cPP distribution, rates increased exponentially (4.1, 5.0, 7.3, and 22.0 per 1000 person-years) with comparable estimates for cSBP, pSBP and pPP. The multivariable-adjusted hazard ratios, expressing the risk per 1-SD increment in BP (HR), were 1.50 (95% confidence interval, 1.33–1.70) for cSBP, 1.36 (1.19–1.54) for cPP, 1.49 (1.33–1.67) for pSBP, and 1.34 (1.19–1.51) for pPP (P < 0.001). Further adjustment of cSBP and cPP, respectively for pSBP and pPP, and vice versa, removed the significance of all HRs. Adding cSBP, cPP, pSBP, pPP to a base model including covariables increased the model fit (P < 0.001) with generalized R2 increments ranging from 0.37 to 0.74%, but adding a second BP to a model including already one did not. Analyses of the secondary endpoints, including total mortality (204 deaths), coronary endpoints (109) and strokes (89), and various sensitivity analyses produced consistent results. In conclusion, associations of the primary and secondary endpoints with SBP and pulse pressure were not stronger if BP was measured centrally compared with peripherally.
Objective:Brachial blood pressure (BP) presents a circadian rhythm. Abnormal rhythms are associated with adverse outcomes. However, it is not clear about the circadian rhythm of central BP and its predictive value.Methods:The study participants were patients referred to the outpatient clinic of Ruijin Hospital for 24-hour ambulatory BP monitoring from the year 2017 to 2020. The 24-hour brachial and central ambulatory BP monitoring were performed with the use of the Mobil-O-Graph (Germany) monitors. Dipping, non-dipping, reverse dipping and extreme dipping were defined as a night-to-day systolic BP ratio of 0.8–0.9, 0.9–1.0, > 1.0, and < 0.8, respectively. In cross-classification analysis of brachial and central dipping status, extreme dipping and reverse dipping were grouped with dipping and non-dipping, respectively. The vital status of patients until Dec 2020 was ascertained according to the vital statistics of the Shanghai Center for Disease Prevention and Control.Results:In 26,023 enrolled patients (men 47.4%, average age 53.0 years) followed up for a median of 1.8 years, 120 deaths occurred. The prevalence of non-dipping (46.7% vs. 43.7%, respectively) and reverse dipping (16.0% vs. 13.1%) was significantly (P < 0.001) higher for central than for brachial BP. The hazard ratios (95% confidence intervals, [CI]) for all-cause mortality were statistically significant for reverse dipping (1.95 [1.18–3.23] and 2.37 [1.43–3.94], respectively), but not other dipping status, versus dipping in brachial and central BP, respectively. In the brachial and central cross-classification analysis, the prevalence of consistent dipping, consistent non-dipping, isolated central non-dipping, and isolated brachial non-dipping was 34.7%, 54.2%, 8.6%, and 2.5%, respectively. Taking the consistent dipping as reference, the hazard ratios (95% CI) for all-cause mortality were 1.83 (0.77–4.31), 1.34 (0.46–3.95), and 1.94 (1.20–3.15) for isolated central, isolated brachial and consistent non-dipping, respectively. Furthermore, cross-classification significantly improved the risk prediction of all-cause mortality with a net reclassification improvement index (95% CI) of 0.193 (0.069–0.304).Conclusions:Non-dipping and reverse dipping were more common for central than for brachial BP, and were associated with a higher mortality risk irrespective of brachial or central BP. Cross-classification of brachial and central dipping status further improved risk stratification.
s e5with white-coat hypertension (WCH) it is virtually the same as in the normotensive individuals. However, no conclusive evidence exists as to whether WCH and MH are accompanied by a greater rate of development of a "sustained" hypertensive state, i.e. hypertension both in and outside the clinical environment. We investigated the risk of progression to sustained hypertension in initially untreated participants of cohort studies included in the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcome (IDACO) study.Within the IDACO, 5 populations comprising 1081 individuals had ambulatory (ABP) and conventional (CBP) blood pressure measured at baseline and at follow up. We excluded from the analysis subjects on BP-lowering treatment at baseline (n=252) and individuals with untreated sustained hypertension at baseline (n=80), leaving 749 subjects included in the current analysis. The cut-off value for elevated CBP was ≥140/90 mm Hg and for daytime ABP ≥135/85 mm Hg.At baseline, 110 individuals (14.7%) was defined as MH, 64 subjects as WCH (8.5%), and 575 (76.8%) as normotensives. MH patients were older (50 vs 45 years compared to normotensives, P<0.01) and more frequently male (50.9 vs 31.5% compared to normotensives, P<0.01). During median follow-up of 9.7 years, there were 264 incident cases of sustained hypertension. In the analyses adjusted for cohort, sex, age, body mass index, smoking and drinking, both MH (hazard ratio, 2.23; 95% confidence interval, 1.57-3.17) and WCH (hazard ratio, 1.84; 95% confidence interval, 1.37-2.47) significantly increased risk of progression to sustained hypertension.
In stage G3, the dipper type of ABPM did not change, and the non-dipper type improved slightly. In stage G5 it was improved the degree of descent at night, and a change in category. However, in the case of peritoneal dialysis, the mean blood pressure did not improve, and the effect of pattern improvement was not observed.Discussion / Conclusion: ARNI was found to exert a strong antihypertensive effect on CKD patients that has not been treated with dialysis. And ARNI did not affect the antihypertensive effect even if there is residual urine during the dialysis period. In addition, edema can be expected to have a reducing effect regardless of proteinuria, and if blood pressure can be lowered firmly, it can also be expected to have a reducing effect on proteinuria.
Objective:Current guidelines recommend a carotid-femoral pulse wave velocity (cf-PWV) > 10m/s of as a sign of large arterial stiffening, which was mainly based on cross-sectional analyses on the distribution of cf-PWV in healthy populations. Using data from the International Database of Central Arterial Properties for Risk Stratification (IDCARS), we aimed to determine an outcome-driven threshold for cf-PWV.Methods:Adults (> = 18 years) recruited from eight IDCARS centres and followed up for 6 months or longer were qualified for inclusion in the current meta-analysis. Cf PWV was measured using the Sphygmocor device. The primary endpoint consisted of fatal and nonfatal cardiovascular events. Secondary endpoints were total and cardiovascular mortality, and fatal and nonfatal coronary events. We calculated multivariable-adjusted hazard ratios (HRs) versus the average risk of the whole population for cf-PWV ranging from the 10th to the 90th percentile with an increment of 0.1 m/s. We plotted the HRs and their 95% confidence limits versus the increasing cutoff points of cf-PWV with the goal to determine at which level the lower confidence limit crossed unity.Results:Of 3494 participants (mean age: 52.2 years; women: 55.3%; mean cf-PWV: 7.8 m/s) followed up for a median of 5.0 years, 156 (4.5%) experienced the primary endpoint and 104 (3.0%) died. Multivariable adjusted outcome-driven thresholds of cf-PWV (m/s) were 8.6 for the primary cardiovascular endpoint, and 9.1, 8.7 and 8.6 for all-cause and cardiovascular mortality and coronary event, respectively. Subjects with a cf-PWV > = 9 m/s (n = 752, 21.5%), compared with the rest of the population, had an increased risk of the primary cardiovascular endpoint (HR: 1.75; 95% CI: 1.20–2.54, P = 0.004).Conclusions:The outcome-based threshold of > = 9 m/s for cf-PWV is close to the cut-off proposed by the current guidelines, according to which 20% of the IDCARS participants had arterial stiffness and were associated with increased cardiovascular risk.
The Rossmax wrist blood pressure monitor S150 has passed the requirements of the International Protocol revision 2010, and hence can be recommended for home use in adults.
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