Central blood pressures: do we need them in the management of cardiovascular disease? Is it a feasible therapeutic target?

Protogerou, Athanase D.; Papaioannou, Theodore G.; Blacher, Jacques; Papamichael, Christos; Lekakis, John; Safar, Michel E.

doi:10.1097/hjh.0b013e3280114f23

Cited by 110 publications

(117 citation statements)

References 118 publications

(157 reference statements)

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“…29 Our study reconfirmed that the oscillometric method substantially underestimates brachial SBP and overestimates brachial DBP, while providing reasonably good estimates of the brachial MBP. 14,26,30 Although all current noninvasive methods for the estimation of aortic pressure are affected by the limited accuracy of the oscillometric blood pressure monitors, 31,32 the clinical values of the central blood pressure estimates remain evident. 5,7,8 Because brachial SBP2 represents a very significant weight in both the invasive and noninvasive prediction models, the accurate identification of SBP2 on a peripheral pulse without visible late systolic peak may deserve concerns.…”

Section: Discussionmentioning

confidence: 99%

Estimation of central systolic blood pressure using an oscillometric blood pressure monitor

et al. 2010

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Current noninvasive techniques for assessing central aortic pressure require the recording of an arterial pressure wave using a high-fidelity applanation tonometer. We therefore developed and validated a novel method to estimate the central aortic systolic pressure using an oscillometric blood pressure monitor alone. Invasive high-fidelity right brachial and central aortic pressure waves, and left-brachial pulse volume plethysmography from an oscillometric blood pressure monitor, were obtained at baseline and 3 min after administration of sublingual nitroglycerin in 100 patients during cardiac catheterization. In the initial 50 patients (Generation Group), Central systolic blood pressure was predicted by a multi-variate prediction model generated from the comprehensive analysis of the invasive brachial pressure wave, including brachial late-systolic shoulder pressure value and parameters related to wave reflection and arterial compliance. Another prediction model was similarly constructed from the noninvasively calibrated pulse volume plethysmography. Both models were validated in the subsequent 50 patients (Validation Group) with results: r¼0.98 (Po0.001) and mean difference¼0.5±4.5 (95% confidence interval À8.3 to 9.3) mm Hg for the invasive model, and r¼0.93 (Po0.001) and mean difference¼À0.1 ± 7.6 (95% confidence interval À15.0 to 14.8) mm Hg for the noninvasive model. Thus, our results indicate that central aortic systolic blood pressure could be estimated by analysis of the noninvasive brachial pressure wave alone from an oscillometric blood pressure monitor.

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Section: Discussionmentioning

confidence: 99%

Estimation of central systolic blood pressure using an oscillometric blood pressure monitor

et al. 2010

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“…Central blood pressure is determined by several factors including aortic diameter, arterial wave reflection, and left ventricular ejection characteristic 19 and is a better predictor of cardiovascular disease risks than brachial blood pressure. 20 Lower central blood pressure in swimmers was associated with greater arterial compliance. Taken together, these results are consistent with the notion that regular swimming exercise plays an important role in preventing arterial stiffening.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Central Artery Elasticity in Swimmers, Runners, and the Sedentary

Nualnim

Barnes

Tarumi

et al. 2011

The American Journal of Cardiology

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Although swimming is one of the most popular, most practiced, and most recommended forms of physical activity, little information is available regarding the influence of regular swimming on vascular disease risks. Using a cross-sectional study design, key measurements of vascular function were performed in middle-aged and older swimmers, runners, and sedentary controls. There were no group differences in age, height, dietary intake, and fasting plasma concentrations of glucose, total cholesterol, and low-density lipoprotein cholesterol. Runners and swimmers were not different in their weekly training volume. Brachial systolic blood pressure and pulse pressure were higher (p <0.05) in swimmers than in sedentary controls and runners. Runners and swimmers had lower (p <0.05) carotid systolic blood pressure and carotid pulse pressure than sedentary controls. Carotid arterial compliance was higher (p <0.05) and ␤-stiffness index was lower (p <0.05) in runners and swimmers than in sedentary controls. There were no significant group differences between runners and swimmers. Cardiovagal baroreflex sensitivity was greater (p <0.05) in runners than in sedentary controls and swimmers and baroreflex sensitivity tended to be higher in swimmers than in sedentary controls ( Swimming can be an ideal mode of exercise for those at increased risk of vascular disease including elderly patients, obese patients, and patients with arthritis. Although swimming is widely promoted and recommended as a mode of aerobic exercise by national and international organizations, 1-3 research focusing on influences of swimming on vascular disease risks is lacking. 4 The aims of the present investigation were to determine (1) whether swimmers would demonstrate higher levels of key vascular function measurements (i.e., central artery compliance, arterial baroreflex sensitivity, and endothelial-dependent vasodilation) than sedentary controls and (2) if levels of such vascular measurements are different from runners who are matched for age and exercise training status. MethodsWe studied 75 apparently healthy middle-aged and older adults (37 to 75 years of age). They were swimmers, runners, or sedentary controls. All subjects were nonobese, nonsmoking, normotensive (Ͻ140/90 mm Hg), normolipidemic, and free of overt cardiovascular and other chronic diseases as assessed by medical history questionnaire, blood chemistry, and hematologic evaluation. None of the subjects were taking cardiovascular-acting medications including hormone replacement therapy. Physical activity status was verified by a modified physical activity questionnaire 5 and maximal oxygen consumption. In average, runners and swimmers had been exercising 4.1 Ϯ 2.2 times/week for 9 Ϯ 2 years and 4.8 Ϯ 1.1 times/week for 9 Ϯ 2 years, respectively. Sedentary participants had been sedentary at least for the previous 12 months. All subjects gave their written informed consent to participate. The study was reviewed and approved by the institutional review board.Before they were tested, subjects ...

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“…9 It was available in 296 subjects. Aortic hemodynamics were also estimated by the use of generalized transfer function from radial pressure wave (Sphygmocor AtCor).…”

Section: Assessment Of Bp Arterial Stiffness and Pressure Wave Reflmentioning

confidence: 99%

“…Because the validity of the generalized transfer function in such an elderly population is not known, the data that are presented on central AI in this study are derived from direct carotid artery tonometry, which is a very good surrogate of invasively acquired aortic AI. 9 Aortic pulse wave velocity (PWV) was determined using the foot-to-foot method as described previously 12 (Complior, Colson); it was available in 283 subjects. The superficial distance covered by the pulse wave was measured directly from the carotid to the femoral artery.…”

Section: Assessment Of Bp Arterial Stiffness and Pressure Wave Reflmentioning

confidence: 99%

Diastolic Blood Pressure and Mortality in the Elderly With Cardiovascular Disease

et al. 2007

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Abstract-Isolated systolic hypertension is predominantly observed in the elderly because of increased arterial stiffness.Aggressive treatment leads to excessive lowering of diastolic blood pressure and favors the presence of a J-shaped curve association with mortality. We investigated whether, in the elderly, this pattern of association is a simple epiphenomenon of increased arterial stiffness and impaired cardiac function. In a cohort of 331 hospitalized subjects Ͼ70 years old (mean ageϮSD: 85Ϯ7 years), aortic pulse wave velocity and pressure wave reflections, by pulse wave analysis, and cardiac function, by ultrasound, were assessed. During a 2-year follow-up period, 110 subjects died. No association of prognosis with systolic pressure, pulse pressure, or pulse wave velocity was observed. A J-shaped association between diastolic pressure and overall and cardiovascular mortality was observed. Unadjusted Cox regression analysis showed that patients in the first tertile of diastolic pressure (Յ60 mm Hg) had higher mortality.In Cox regression analysis, diastolic pressure Յ60 mm Hg was a predictor of mortality independently from cardiac-vascular properties, cardiovascular risk factors, and drug treatment. Multivariate regression analysis showed that increased age and low total peripheral resistance, but not left ventricular function, were the cardinal determinants of low diastolic pressure. An "optimal" diastolic pressure of 70 mm Hg in subjects with isolated systolic hypertension was found. We showed that, in the frail elderly, a value of diastolic blood pressure Յ60 mm Hg is associated with reduced survival, independent from large artery stiffness and left ventricular function, suggesting that more rational antihypertensive therapy, not only based on systolic pressure level, is needed. Key Words: diastolic blood pressure Ⅲ mortality Ⅲ elderly Ⅲ arterial stiffness Ⅲ pressure wave reflections Ⅲ total peripheral resistance T he goal of antihypertensive treatment is to prevent cardiovascular (CV) complications through the reduction of systolic (SBP) and diastolic blood pressure (DBP). However, since the primary work of Cruickshank et al, 1 several reports, but not all, have shown that, in hypertensive subjects treated with drugs, low DBP is frequently associated with increased mortality (reviewed in Reference 2 ). This finding was constantly difficult to evaluate. First, it is difficult in epidemiological studies to assess a J-or U-shaped association with mortality, and it is often easier, using a semilogarithmic scale, to show a linear relation between DBP and mortality. Second, in humans, the decrease of DBP is the consequence of both the aging process 3 and the result of drug treatment, making the net drug effect quite difficult to define. Finally it should be noted that isolated systolic hypertension is difficult to treat and, therefore, aggressive treatment may lead to excessive lowering of diastolic blood pressure and that, in the oldest old, treating high SBP is not always related to reduced overall mortality....

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Central blood pressures: do we need them in the management of cardiovascular disease? Is it a feasible therapeutic target?

Cited by 110 publications

References 118 publications

Estimation of central systolic blood pressure using an oscillometric blood pressure monitor

Estimation of central systolic blood pressure using an oscillometric blood pressure monitor

Comparison of Central Artery Elasticity in Swimmers, Runners, and the Sedentary

Diastolic Blood Pressure and Mortality in the Elderly With Cardiovascular Disease

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