Inverse Relationship Between Ambulatory Arterial Stiffness Index and Glomerular Filtration Rate in Arterial Hypertension

Mulè, Giuseppe; Cottone, Santina; Cusimano, Paola; Incalcaterra, Francesca; Giandalia, Maria; Costanzo, M.; Nardi, Emilio; Palermo, Alessandro; Geraci, Calogero; Costa, Renato; Cerasola, Giovanni

doi:10.1038/ajh.2007.10

Cited by 41 publications

(35 citation statements)

References 27 publications

(44 reference statements)

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“…25 More recently, Mulè et al found that AASI was inversely related to GFR in a group of 143 untreated hypertensive subjects with serum creatinine <1.5 mg/dL. 26 Other authors have found similar correlations with creatinine clearance estimated from serum creatinine 24 or with GFR computed from the scintigraphic determination of the technetium-99m diethylenetriaminepentaacetic acid uptake within the kidneys, by the Gates method. 25 There is less experience with Sym-AASI but in a recent report Sym-AASI showed a significant relationship with creatinine clearance, serum creatinine, and eGFR estimated using Modification of Diet in Renal Disease-4 equation.…”

Section: Discussionmentioning

confidence: 88%

Symmetrical Ambulatory Arterial Stiffness Index: Relationship with Serum Cystatin C Levels

Robles

Mena²,

Prado³

et al. 2011

Renal Failure

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Objective: Increased central arterial stiffening is the consequence of many disease states such as diabetes, atherosclerosis, and chronic renal disease. Symmetrical Ambulatory Arterial Stiffness Index (Sym-AASI) may provide a simple clinical approach to evaluate arterial stiffness. This study has tried to evaluate the relationship of Sym-AASI with cystatin C levels. Design and methods: The sample subjects were 53 males and 34 females (mean age = 59.3 ± 13.5 years). Kidney function was evaluated by measuring serum cystatin C and estimated glomerular filtration rate (eGFR). The ambulatory BP was measured noninvasively for 24 h. Results: Patients in the highest quartile showed an older age ( p < 0.001) and worse eGFR (p < 0.001). Pulse pressure (PP) increased as cystatin C was higher. Mean Sym-AASI showed an increase from the first to the last cystatin C quartile. Correlation test showed a significant relationship of Sym-AASI with age (r = 0.573), serum creatinine (r = 0.237), eGFR (-0.323), cystatin C (r = 0.427), systolic blood pressure (r = 0.525), and PP (r = 0.647). Multivariate regression analysis showed that age, cystatin C, nocturnal systolic blood pressure reduction, and nocturnal diastolic blood pressure fall were independently related to Sym-AASI. There was not any independent association between eGFR and Sym-AASI or between cystatin C and PP. Conclusions: Increased Sym-AASI seems to be independently associated with serum cystatin C levels. Sym-AASI seems to be better than PP to detect changes in the arterial wall. This could be a simple and easy method to evaluate arterial stiffness in hypertensive patients without needing more complex devices.

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Section: Discussionmentioning

confidence: 88%

Symmetrical Ambulatory Arterial Stiffness Index: Relationship with Serum Cystatin C Levels

Robles

Mena²,

Prado³

et al. 2011

Renal Failure

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“…AASI and its related slope have been shown to predict outcome, 5,7,8,29 as well as target organ damage. 6,30 However, the importance of these parameters as measures of arterial properties has been questioned by downplaying the role of AASI as a genuine correlate of arterial stiffness 31,32 because of its strong dependence on age, gender, 31,32 pulse pressure 32 and nocturnal BP decline. 3,25, 32 We report here that the slope-related indices, AASI, AASI(bisect), Slope(bisect) and BPVR, all predict mortality to a certain extent, and that the indices derived from the proper symmetric regression 8 and the calculated BPVR, tend to predict even better.…”

Section: Discussionmentioning

confidence: 99%

The association of a simple blood pressure-independent parameter derived from ambulatory blood pressure variability with short-term mortality

et al. 2009

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We explored the predictive ability of the blood pressure variability ratio (BPVR), defined as the ratio of 24-h ambulatory systolic blood pressure variability to diastolic variability, and evaluated its predictable relation with blood pressure and the Ambulatory Arterial Stiffness Index (AASI). A total of 3433 consecutive patients were followed up to 16 years for all-cause mortality. Blood pressure variability was expressed by the standard deviation. BPVR, which is the systolic-on-diastolic slope estimated by a known type of symmetric regression ('reduced major axis'), was compared with other expressions of this slope and with AASI using other regression procedures. Time-dependent Cox proportional hazard models, adjusted for demographics, 24-h mean blood pressure, 24-h pulse pressure and dipping were used to assess the association of BPVR and slope-related parameters with all-cause mortality. We found that Pearson's correlation between BPVR and the symmetric slope was 0.957, and between 1-1/BPVR (an AASI-equivalent expression) and the symmetric version of AASI was 0.973. BPVR was entirely independent of mean arterial pressure (r¼0.013). Systolic and diastolic ambulatory blood pressure variability was not significantly associated with mortality. Over 16 years, BPVR predicted all-cause mortality [hazard ratio¼1.21 (95% CI 1.05-1.40) per 1 s.d. increase]. In time-dependent models, increased BPVR was strongly associated with an 18-month mortality, weakly related to 7 years mortality, showing no effect thereafter. Thus, the ratio between 24-h systolic and diastolic blood pressure variability, readily available from ambulatory monitoring reports, is an easy-to-calculate systolic-on-diastolic slope. It is a blood pressureindependent measure believed to express an arterial property, with prognostic power similar to that of AASI.

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“…AASI is defined as 1 minus the DBP-on-SBP regression slope, the latter obtained using a standard asymmetric regression of DBP-on-SBP readings during a 24-h ambulatory BP monitoring session. 7 The clinical relevance of AASI is suggested by its cross-sectional correlation with preclinical target-organ damage [16][17][18] and its predictive value for future cardiovascular morbidity and mortality, [19][20][21][22] although the superiority of AASI over more widely accepted surrogate measures of arterial stiffness such as 24-h pulse pressure 23 has not been established. 24,25 Some methodological drawbacks of AASI need to be considered, however.…”

Section: How To Measure Sbp-on-dbp Regression Slope?mentioning

confidence: 99%

The relationship between systolic and diastolic blood pressure: a clinically meaningful slope?

Schillaci

Pucci

2011

Hypertens Res

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T he traditional paradigm of hypertension as a product of increased stroke volume and peripheral resistance 1 has been progressively replaced over the last few decades by a more complex interpretative model, in which the left ventricle and peripheral arteries are functionally coupled with large arteries. The growing scientific interest in the functional properties of the large arteries has been driven primarily by an improved understanding of waveforms and of their modifications in physiological and pathological conditions. 2 Additional factors include the availability of non-invasive devices that are able to accurately estimate large-artery and muscularartery stiffness, 3 and the publication of several clinical studies that have shown the role of arterial stiffness as a predictor of cardiovascular damage and complications. 4,5 Aortic pulse-wave velocity, an index of large-artery stiffness and an independent predictor of cardiovascular complications in different clinical settings, 4,5 has thus been added to the list of factors influencing prognosis in hypertensive subjects, 6 although the need for dedicated equipment and trained personnel has hindered its application in daily clinical practice. A technique to estimate arterial stiffness without the use of special equipment or qualified observers would thus be welcome.By measuring blood pressure (BP) several times in a given individual, possibly under different circumstances, systolic BP (SBP) values can be plotted against diastolic BP (DBP) values. The slope of the relationship between SBP and DBP has been proposed as a theoretically attractive means of investigating large-artery functional properties. 7 In principle, the link between SBP-on-DBP slope and arterial functional properties is rather straightforward. 8 A change in DBP in a given subject is generally accompanied by a change in SBP that goes in the same direction. However, for a given increase in DBP, SBP might be expected to increase more in a stiffer artery than in a more pliable one. Thus, the increase in SBP for a given increase in DBP (SBP-on-DBP slope) could be related to arterial stiffness. The opposite holds for the increase in DBP for a given increase in SBP (DBP-on-SBP slope), which could be considered as a measure of arterial compliance. A slope-derived parameter obtained from 24-h ambulatory BP monitoring, namely the ambulatory arterial stiffness index (AASI), 7 has received great attention from the scientific community, despite the need for caution inherent to the use of a surrogate for more direct measures of arterial rigidity. 9,10 In the present issue of Hypertension Research, Gavish et al. 11 report the findings of a post-hoc analysis of three small studies that examined the effects of season, salt intake and paced breathing on 24-h BP and the related SBP-on-DBP slope. In one study, 13 hypertensive subjects were examined before and after 8 weeks of 15-min daily sessions of slow breathing guided by a device used to lower the high BP. In another study, 17 elderly subjects living in a nur...

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Inverse Relationship Between Ambulatory Arterial Stiffness Index and Glomerular Filtration Rate in Arterial Hypertension

Abstract: AASI is inversely related to GFR in arterial hypertension. This may help to explain the increased CV risk associated with mild-to-moderate renal dysfunction.

Cited by 41 publications

References 27 publications

Symmetrical Ambulatory Arterial Stiffness Index: Relationship with Serum Cystatin C Levels

Symmetrical Ambulatory Arterial Stiffness Index: Relationship with Serum Cystatin C Levels

The association of a simple blood pressure-independent parameter derived from ambulatory blood pressure variability with short-term mortality

The relationship between systolic and diastolic blood pressure: a clinically meaningful slope?

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