Central wave reflection is associated with peripheral arterial resistance in addition to arterial stiffness in subjects without antihypertensive medication

Wilenius, Matias; Tikkakoski, Antti; Tahvanainen, Anna; Haring, Antti; Koskela, Jenni; Huhtala, Heini; Kähönen, Mika; Kööbi, Tiit; Mustonen, Jukka; Pörsti, Ilkka

doi:10.1186/s12872-016-0303-6

Cited by 50 publications

(85 citation statements)

References 37 publications

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“…The supine and upright cardiac output values measured with CircMon R agree well with the values measured using thermodilution . The pulse wave velocity values recorded using CircMon R show very good correlations with values measured using ultrasound and the tonometric SphygmoCor method .…”

Section: Methodssupporting

confidence: 72%

“…We applied non‐invasive recordings to evaluate cardiac output, and this requires mathematical equations and simplification of physiology , but invasive haemodynamic measurements are not justified without a clinical indication. The present methods have been validated against invasive methods, three‐dimensional ultrasound, and tonometric measurements of pulse wave velocity . Nevertheless, systemic vascular resistance was indirectly determined from the tonometric BP recordings and cardiac output measurements using whole‐body impedance cardiography, and the results must be interpreted with caution.…”

Section: Discussionmentioning

confidence: 99%

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Salbutamol‐induced Decrease in Augmentation Index is Related to the Parallel Increase in Heart Rate

Tikkakoski

Kangas

Suojanen

et al. 2018

Basic Clin Pharma Tox

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The change in augmentation index following salbutamol inhalation has been applied to evaluate endothelial function. We examined the contribution of salbutamol-induced increase in heart rate to the observed decrease in augmentation index. Haemodynamics were recorded using whole-body impedance cardiography and continuous pulse wave analysis from tonometric radial blood pressure. All subjects (n = 335, mean age 46, body mass index 26, 48% men) were without medications with cardiovascular influences. The effects of salbutamol inhalation (0.4 mg) versus the endothelium-independent agent nitroglycerin resoriblet (0.25 mg) were examined during passive head-up tilt, as the haemodynamic influences of these compounds depend on body position. Salbutamol decreased augmentation index by ~3-4% units in supine and upright positions. Although salbutamol moderately increased cardiac index (+4.5%) and decreased systemic vascular resistance (-8.5%), the significant haemodynamic explanatory factors for decreased augmentation index in multivariate analysis were increased supine heart rate, and increased upright heart rate and decreased ejection duration (p < 0.001 for all, r = 0.36-0.37). Sublingual nitroglycerin decreased supine and upright augmentation index by ~15% units and ~23% units, respectively. The haemodynamic explanatory factors for these changes in multivariate analysis were increased heart rate, reduced ejection duration and reduced systemic vascular resistance (p ≤ 0.021 for all, r = 0.22-0.34). In conclusion, the lowering influence of salbutamol on augmentation index may be largely explained by increased heart rate, suggesting that this effect may not predominantly reflect endothelial function.

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Section: Methodssupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Salbutamol‐induced Decrease in Augmentation Index is Related to the Parallel Increase in Heart Rate

Tikkakoski

Kangas

Suojanen

et al. 2018

Basic Clin Pharma Tox

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“…AIx was clearly increased during bisoprolol in the upright position. The level of AIx is inversely related with heart rate [28] and directly with SVR [8]. Therefore, the observed changes in these hemodynamic determinants of wave reflection provide the likely explanation for the upright increase in AIx during bisoprolol treatment.…”

Section: Discussionmentioning

confidence: 90%

“…Augmentation index (AIx) is delineated as the proportion of the reflected pressure wave (augmentation pressure, AP) to pulse pressure (PP). It has been applied as a surrogate measure of arterial stiffness, but it is mainly a measure of wave reflections [7] that is also influenced by systemic vascular resistance (SVR) [8]. The position of AIx as an independent predictor of cardiovascular events is still controversial [9].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, AIx decreases in the upright position but remains constantly higher in hypertensive than normotensive subjects [14]. The wave reflections in the arterial tree are influenced by the time of the systolic ejection, heart rate, arterial stiffness, arterial branching, and SVR [8]. Beta-blocker therapy has profound effects on the regulation of heart rate and CO [11,15].…”

Section: Introductionmentioning

confidence: 99%

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Adverse influence of bisoprolol on central blood pressure in the upright position: a double-blind placebo-controlled cross-over study

Suojanen¹,

Haring²,

Tikkakoski³

et al. 2019

J Hum Hypertens

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Treatment with beta-blockers is characterized by inferior reduction of central versus peripheral blood pressure. We examined changes in blood pressure, cardiac function, and vascular resistance after 3 weeks of bisoprolol treatment (5 mg/day) during passive head-up tilt in 16 never-treated Caucasian males with grade I-II primary hypertension. A double-blind, randomized, placebo-controlled cross-over design was applied, and hemodynamics were recorded using continuous tonometric pulse wave analysis and whole-body impedance cardiography. Bisoprolol decreased blood pressure in the aorta (~8/10 mmHg, p ≤ 0.032) and radial artery (~10/9 mmHg, p ≤ 0.037), but upright aortic systolic blood pressure was not significantly reduced (p = 0.085). Bisoprolol reduced heart rate and left cardiac work, and increased subendocardial viability index in supine and upright positions (p ≤ 0.044 for all). Bisoprolol increased stroke volume in the supine (~11 ml, p = 0.02) but not in the upright position, while only upright (~1 l/min, p = 0.007) but not supine cardiac output was reduced. Upright elevation in systemic vascular resistance was increased 2.7-fold (p = 0.002), while upright pulse pressure amplification was decreased bỹ 20% (p = 0.002) after bisoprolol. Aortic augmentation index, augmentation pressure, and pulse pressure were not changed in the supine position but were increased in the upright position (from 9% to 17%, 3-6 mmHg, and 30-34 mmHg, respectively, p ≤ 0.016 for all). In conclusion, although bisoprolol treatment reduced peripheral blood pressure, central systolic blood pressure in the upright position was not decreased. Importantly, the harmful influences of bisoprolol on central pulse pressure and pressure wave reflection were manifested in the upright position.

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Evaluation of Vascular Reactivity of Maternal Vascular Adaptations of Pregnancy With Quantitative MRI: Pilot Study

Langham

Caporale

Wehrli

et al. 2020

Magnetic Resonance Imaging

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BackgroundAbnormal maternal vascular function during pregnancy stemming from systemic endothelial dysfunction (EDF) has a central role in the pathophysiology of preeclampsia (PE).PurposeTo utilize quantitative MRI to investigate changes in physiological measures of vascular reactivity during normal pregnancy, and to explore EDF associated with preeclampsia.Study TypeProspective.PopulationHealthy pregnant (HP) (n = 14, mean GA = 26 ± 7 weeks) and nonpregnant women (NP; n = 14); newly postpartum (PP <48 hours) women with severe PE (PP‐PE; n = 4) and normotensive pregnancy (PP‐HP; n = 5).Field Strength/Sequence1.5T/3T. RF spoiled multiecho gradient‐recalled echo, 1D phase‐contrast MRI, time‐of‐flight.AssessmentThe micro‐ and macrovascular function (vasodilatory capacity of arterioles and conduit arteries, respectively) of the femoral vascular bed was evaluated with MRI‐based venous oximetry, arterial velocimetry, and luminal flow‐mediated dilation quantification, during cuff‐induced reactive hyperemia. Aortic arch pulse‐wave velocity (aPWV) was quantified to assess arterial stiffness using an ungated 1D technique.Statistical TestsTwo‐tailed unpaired t‐tests were performed to address our two, primary a priori comparisons, HP vs. NP, and PP‐PE vs. PP‐HP. Given the pilot nature of this study, adjustments for multiple comparisons were not performed.ResultsIn HP, microvascular function was attenuated compared to NP by a significant increase in the washout time (10 ± 2 vs. 8 ± 2 sec; P < 0.05) and reduced upslope (2.1 ± 0.5 vs. 3.2 ± 0.8%HbO2/s; P < 0.05), time of forward flow (28 ± 5 vs. 33 ± 6 sec, P < 0.05), and hyperemic index (11 ± 3 vs. 16 ± 4 cm/s2; P < 0.05), but luminal flow‐mediated dilatation (FMDL)was comparable between HP and NP. PP‐PE exhibited significant vascular dysfunction compared to PP‐HP, as evidenced by differences in upslope (2.2 ± 0.6 vs. 1.3 ± 0.2%HbO2/s, P < 0.05), overshoot (16 ± 5 vs. 7 ± 3%HbO2, P < 0.05), time of forward flow (28 ± 6 vs. 15 ± 7 s, P < 0.05), and aPWV (7 ± 1 vs. 8 ± 1 m/s, P < 0.05).Data ConclusionAttenuated vascular reactivity during pregnancy suggests that the systemic vasodilatory state partially depletes nitric oxide bioavailability. Preliminary data support the potential for MRI to identify vascular dysfunction in vivo that underlies PE.Level of Evidence 2Technical Efficacy Stage 1J. MAGN. RESON. IMAGING 2021;53:447–455.

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Central wave reflection is associated with peripheral arterial resistance in addition to arterial stiffness in subjects without antihypertensive medication

Cited by 50 publications

References 37 publications

Salbutamol‐induced Decrease in Augmentation Index is Related to the Parallel Increase in Heart Rate

Salbutamol‐induced Decrease in Augmentation Index is Related to the Parallel Increase in Heart Rate

Adverse influence of bisoprolol on central blood pressure in the upright position: a double-blind placebo-controlled cross-over study

Evaluation of Vascular Reactivity of Maternal Vascular Adaptations of Pregnancy With Quantitative MRI: Pilot Study

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