Adiposity, Obesity, and Arterial Aging

Brunner, Eric J.; Shipley, Martin J.; Ahmadi‐Abhari, Sara; Tabák, Ádám G.; McEniery, Carmel M.; Wilkinson, Ian B.; Marmot, Michael; Singh‐Manoux, Archana; Kivimäki, Mika

doi:10.1161/hypertensionaha.115.05494

Cited by 104 publications

(61 citation statements)

References 46 publications

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“…Older age and obesity are 2 of the strongest risk factors for HFpEF and are believed to play major roles in the pathogenesis (3). Importantly, the differences in arterial stiffness observed in this study during exercise persisted even after adjusting for age and BMI, which are known to directly affect arterial properties (29,30), and these differences were not related to differences in arterial blood pressure. This important observation demonstrates that arterial stiffening and reduced arterial reserve is specific to the HFpEF phenotype, and is thus a potentially important therapeutic target.…”

Section: Discussionmentioning

confidence: 54%

Arterial Stiffening With Exercise in Patients With Heart Failure and Preserved Ejection Fraction

Reddy

Andersen

Obokata

et al. 2017

Journal of the American College of Cardiology

216

179

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BACKGROUND Aortic stiffening and reduced nitric oxide (NO) availability may contribute to the pathophysiology of heart failure with preserved ejection fraction (HFpEF). OBJECTIVES We assessed indices of arterial stiffness at rest and during exercise in subjects with HFpEF and hypertensive controls, to examine their relationship to cardiac hemodynamics and determine whether exertional arterial stiffening can be mitigated by inorganic nitrite. METHODS Twenty-two hypertensive controls and 98 HFpEF subjects underwent hemodynamic exercise testing with simultaneous expired gas analysis. Invasively measured radial artery pressure waveforms were converted to central aortic waveforms by transfer function to assess integrated measures of pulsatile aortic load, including arterial compliance, resistance, elastance, and wave reflection. RESULTS Arterial load and wave reflections were similar in HFpEF and controls at rest. During submaximal exercise, HFpEF subjects displayed reduced total arterial compliance and higher effective arterial elastance despite similar mean arterial pressures to controls. This was directly correlated with higher ventricular filling pressures and depressed cardiac output reserve (both p <0.0001). With peak exercise, increased wave reflections impaired compliance, resistance and elastance were observed. A subset of HFpEF subjects (n = 52) received sodium nitrite or placebo in a 1:1 double blind, randomized fashion. Compared to placebo, nitrite decreased aortic wave reflections at rest and improved arterial compliance, elastance, and improved central hemodynamics during exercise. CONCLUSION Abnormal pulsatile aortic loading during exercise occurs in HFpEF independent of hypertension, and is correlated with classical hemodynamic derangements that develop with stress. Inorganic nitrite mitigates arterial stiffening with exercise and improves hemodynamics, indicating that arterial stiffening with exercise is at least partially reversible. Further study is required to test effects of agents that target the NO pathway in reducing arterial stiffness in HFpEF.

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Section: Discussionmentioning

confidence: 54%

Arterial Stiffening With Exercise in Patients With Heart Failure and Preserved Ejection Fraction

Reddy

Andersen

Obokata

et al. 2017

Journal of the American College of Cardiology

216

179

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“…Since the kidney is a high-flow organ, the renal vasculature may be easily affected by haemodynamic stress, which could result in microvascular ischaemia, endothelial dysfunction and ultimately kidney dysfunction [35]. However, baPWV may not be a direct indicator of eGFR in a multiple regression model.…”

Section: Discussionmentioning

confidence: 99%

Pulse Pressure, Instead of Brachium-Ankle Pulse Wave Velocity, is Associated with Reduced Kidney Function in a Chinese Han Population

Jia

Zhang

et al. 2017

Kidney Blood Press Res

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Background/Aims: In this study, we aim to investigate the association between renal function and arterial stiffness in a Chinese Han population, and further to discuss the effects of smoking on renal function. Methods: We collected the data of the brachium-ankle pulse wave velocity (baPWV), blood pressure, blood chemistry and smoking status. Then, the multiple linear regression was done to explore the relationship between estimated glomerular filtration (eGFR) and baPWV. Further, the parameters were compared among the four groups divided according to the quartiles of baPWV. Finally, the baPWV, eGFR and albuminuria values were compared between smokers and non-smokers. Results: baPWV is associated with eGFR in the correlation analysis and univariate linear regression model. After adjustment, the pulse pressure (PP) instead of baPWV showed a significant association with eGFR. Nevertheless, the eGFR values differed among the four baPWV groups; the baPWV values were significantly higher in the subjects at the CKD (eGFR<60 mL/min/1.73 m²) and the early CKD stage (eGFR60–80 mL/min/1.73 m²). The baPWV values and the ratio of proteinuria were significantly increased in smokers. Conclusion: PP but not baPWV is a predictor of declined renal function. Smokers have worse arterial stiffness and worse renal function.

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“…*P Ͻ 0.01, task effect versus baseline. 7,24,50). The controlled-HTN group had fairly low resting heart rate comparable to that of the no-HTN group, which contributes to changes in aortic stiffness over time (29).…”

Section: Hypertension Vascular Stiffness and Neurovascular Couplingmentioning

confidence: 97%

Neurovascular coupling during cognitive activity in adults with controlled hypertension

Lefferts

DeBlois

Barreira

et al. 2018

Journal of Applied Physiology

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Hypertension, even when controlled, may accelerate arterial stiffening and impair the ability of the cerebrovasculature to increase blood flow to support neural activity (neurovascular coupling [NVC]). Optimal NVC depends on continuous, non-pulsatile flow, which is partially determined by extra- and intra-cranial vessel function. We sought to compare extra- and intra-cranial hemodynamics during cognitive activity (Stroop task) in 30 middle-aged, well-controlled medicated hypertensive and 30 age-, sex-, and body mass index (BMI)-matched non-hypertensive adults (56±6 yrs, BMI 28.2±2.9 kg/m; 32 men). Aortic and carotid (single-point) pulse wave velocity (PWV) were assessed via tonometry and ultrasound respectively. Carotid and middle cerebral artery (MCA) blood velocity pulsatility were measured via ultrasound and Doppler. Prefrontal cortex (PFC) oxygenation (tissue saturation index; TSI) was measured using near-infrared spectroscopy. Accuracy and reaction times were computed to assess cognitive performance. Stroop performance was similar between groups (p>0.01). Aortic and carotid PWV increased, carotid flow pulsatility decreased (p<0.01), and MCA flow pulsatility and PFC TSI were maintained during Stroop (p>0.01). Our findings indicate that middle-age adults with medically-controlled hypertension and adults without hypertension demonstrate similar intra- and extra-cranial cerebrovascular reactivity during cognitive engagement. Despite increases in large artery stiffness, middle-aged adults with controlled-hypertension and without hypertension exhibit reductions in extracranial flow pulsatility during cognitive engagement that may be part of a concerted cerebrovascular response to support downstream cerebral oxygenation and overall NVC.

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Adiposity, Obesity, and Arterial Aging

Abstract: Supplemental Digital Content is available in the text.

Cited by 104 publications

References 46 publications

Arterial Stiffening With Exercise in Patients With Heart Failure and Preserved Ejection Fraction

Arterial Stiffening With Exercise in Patients With Heart Failure and Preserved Ejection Fraction

Pulse Pressure, Instead of Brachium-Ankle Pulse Wave Velocity, is Associated with Reduced Kidney Function in a Chinese Han Population

Neurovascular coupling during cognitive activity in adults with controlled hypertension

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