Arterial distensibility and circadian blood pressure variability.

Asar, R; Scuteri, Angelo; Topouchian, Jirar; Am, Brisac; Maldonado, J.; Cloarec, L; Safar, M

doi:10.1016/0895-7061(96)81643-8

Cited by 13 publications

(17 citation statements)

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“…When studied, the findings have been conflicting. The first study to address this issue, 23 which evaluated 106 untreated hypertensive individuals, found that aortic PWV was an independent predictor of the nocturnal SBP reduction. Similarly, three other studies [24][25][26] reported significant associations between the non-dipping pattern and arterial stiffness.…”

Section: Discussionmentioning

confidence: 99%

A blunted decrease in nocturnal blood pressure is independently associated with increased aortic stiffness in patients with resistant hypertension

et al. 2009

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Increased arterial stiffness may be causally related to resistant hypertension. Our objective was to investigate the variables, particularly those derived from ambulatory blood pressure (BP) monitoring (ABPM), associated with increased aortic stiffness in resistant hypertensives. In a cross-sectional study, 600 resistant hypertensive patients without peripheral arterial disease were evaluated. Arterial stiffness was assessed by aortic pulse wave velocity (PWV), and was considered increased if 412 m s À1 . Statistical analyses included multiple linear and logistic regressions to assess the independent correlates of increased aortic stiffness. One hundred and sixty-eight patients (28%) had aortic PWV 412 m s À1 . Patients with increased PWV were older and had a higher prevalence of cardiovascular risk factors than did those patients with low PWV. On ABPM, patients with elevated PWV had higher daytime and night time systolic BP (SBP) and pulse pressures (PP), less nocturnal decrease in SBP and a higher prevalence of non-dipping pattern. On multiple linear regression, the independently associated variables with aortic PWV were age (Po0.001), 24-h PP (Po0.001), high-density lipoprotein (HDL)-cholesterol (Po0.001), microalbuminuria (Po0.001), fasting glycemia (P¼0.001) and a decrease in nocturnal SBP (P¼0.002). Multivariate logistic regression confirmed these results, with the non-dipping patients having a 72% higher likelihood of presenting with increased aortic stiffness (95% confidence interval: 1.12-2.65, P¼0.013). This association was observed in both the reduced and reverted dipping patterns, but not in the extreme dipping pattern. In conclusion, a blunted nocturnal decrease in BP is independently associated with increased aortic stiffness in resistant hypertensive patients. Other independent correlates are older age, diabetes, microalbuminuria, low HDL-cholesterol and a widened 24-h PP.

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Section: Discussionmentioning

confidence: 99%

A blunted decrease in nocturnal blood pressure is independently associated with increased aortic stiffness in patients with resistant hypertension

et al. 2009

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“…Furthermore, an inappropriate dipping was found to be associated with an increased arterial stiffness (27,28). Yet, daytime AASI still identified the increases seen in 24-h assessments in both groups of hypertensive individuals, children and adults, independent of their dipping status.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory Arterial Stiffness Index Is Increased in Hypertensive Childhood Disease

et al. 2008

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Arterial hypertension in adults is often associated with an increased arterial stiffness, which correlates with the ambulatory arterial stiffness index (AASI) as derived from ambulatory blood pressure (BP) measurements. The purpose of this study was to demonstrate whether children with diagnosed hypertension have an increased AASI as in hypertensive adults. AASI was calculated from 185 ambulatory BP measurements of 114 hypertensive and 71 normotensive, healthy children. Hypertensive children had higher AASI values compared with their normotensive healthy counterparts (0.370 Ϯ 0.120 versus 0.204 Ϯ 0.199, p Ͻ 0.0001). Children with longer duration of hypertension or a history of primary or secondary aortic coarctation displayed even more elevated AASI values. A receiver operator curve derived cut-off of AASI set at 0.301 distinguished (p Ͻ 0.0001) hypertensive from normotensive children with an odds ratio of 8.2, a sensitivity of 81%, and a specificity of 65%. Moreover, AASI correlated with pulse and systolic BP. In conclusion, AASI is elevated in hypertensive children and correlates with the duration and the origin of hypertension in childhood. D iseases linked to arterial hypertension are associated with a significant increased cardiovascular risk, either due to the primary disease (i.e. chronic kidney disease, obesity), or due to the effects of arterial hypertension on the cardiovascular system by consecutively damaging target organs such as the heart, the kidneys, and the brain (1). Increased left ventricular cardiac mass is an established marker of cardiovascular target organ involvement, but is only present in approximately 40% of children with hypertensive diseases (2). Additional and more sensitive noninvasive markers of hypertensive target organ damage are required to determine outcomes and to guide clinical and pharmacological management of childhood hypertension (3). Arterial stiffness, which is a strong predictor of cardiovascular complications and target organ damage in both the general population and patients with hypertensive diseases, would qualify as such a marker (4 -7).Most methods to measure arterial stiffness require special and expensive equipment and trained observers, often not available in clinical practice in a pediatric unit. A novel method to address arterial stiffness based on 24-h ambulatory blood pressure monitoring (ABPM) has been proposed (8): the ambulatory arterial stiffness index (AASI), defined as one minus the regression slope of diastolic over systolic blood pressure (BP) measurements obtained during a 24-h period. This ABPM-derived index has been shown to correlate with classical measures of arterial stiffness, such as pulse wave velocity (9), and to provide prognostic information on cardiovascular mortality and target organ damage throughout a wide age range, including young individuals (10 -12).The purpose of this study was to demonstrate whether AASI is increased in children with various hypertensive diseases, as in hypertensive adults (9 -11). MATERIALS AND MET...

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“…A first hypothesis that is frequently put forward 8,14 involves the change in sympathetic tone that usually goes with an increase of HR. This hypothesis has been elegantly addressed by Mircoli et al 25 by comparing the stiffening effect of tachycardia in sympathectomized and control rats.…”

Section: Lantelme Et Al Arterial Stiffness and Heart Ratementioning

confidence: 99%

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et al. 2002

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Abstract-Arterial stiffness is a strong determinant of cardiovascular risk. Pulse wave velocity (PWV) is an index of arterial stiffness, and its prognostic value has been repeatedly emphasized. The purpose of the present study was to assess the effect of heart rate (HR) on PWV. Twenty-two subjects with a mean age of 77.8Ϯ8.4 (SD) years and permanent cardiac pacing were studied. In each subject, PWV was measured at 5 different pacing frequencies in the same session (60, 70, 80, 90, 100 bpm), the order of the various frequencies being randomly determined. Furthermore, to test the reproducibility, a repeat measurement of PWV was obtained in one randomly selected frequency. Blood pressure (BP) was measured by conventional means at each pacing frequency. PWV appeared fairly reproducible because no significant difference was disclosed between the 2 measurements obtained at the same HR level (Pϭ0.5) and both measurements were strongly correlated (rϭ0.87, PϽ0.001). No significant BP variation was observed during pacing. There was a highly significant effect of HR on PWV estimated by a one-way, within-subjects analysis of variance (Pϭ0.01). This study demonstrates that HR is an important factor in the intraindividual variation of PWV in elderly subjects. This raises methodological concern about the measurement of this parameter. Standardizing PWV for HR level seems mandatory if one wants to interpret PWV changes in clinical trials or in the follow-up of patients.

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Arterial distensibility and circadian blood pressure variability.

Cited by 13 publications

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A blunted decrease in nocturnal blood pressure is independently associated with increased aortic stiffness in patients with resistant hypertension

A blunted decrease in nocturnal blood pressure is independently associated with increased aortic stiffness in patients with resistant hypertension

Ambulatory Arterial Stiffness Index Is Increased in Hypertensive Childhood Disease

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