Isolated Systolic Hypertension

Domanski, Michael J.; Davis, Barry R.; Pfeffer, Marc A.; Kastantin, Mark; Mitchell, Gary F.

doi:10.1161/01.hyp.34.3.375

Cited by 340 publications

(132 citation statements)

References 57 publications

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“…The association between arterial stiffness measured by carotid‐femoral PWV index and stroke, which was also adjusted for MAP, has, however, been described previously 31. Also the associations of PP with stroke are inconsistent with earlier work in older people with isolated systolic hypertension, where they found an 11% increased risk per 10 mm Hg higher PP, but also showed that MAP increased risk of stroke 38. However, a later study in uncontrolled hypertensive subjects found, similar to this study, that the relationship between PP and stroke was dependent on MAP,39 indicating that MAP may be a confounder in the association between PP and stroke.…”

Section: Discussionmentioning

confidence: 69%

Relationship of Arterial Stiffness Index and Pulse Pressure With Cardiovascular Disease and Mortality

Said

Eppinga

Lipšic

et al. 2018

JAHA

165

131

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BackgroundVascular aging results in stiffer arteries and may have a role in the development of cardiovascular disease (CVD). Arterial stiffness index (ASI), measured by finger photoplethysmography, and pulse pressure (PP) are 2 independent vascular aging indices. We investigated whether ASI or PP predict new‐onset CVD and mortality in a large community‐based population.Methods and ResultsWe studied 169 613 UK Biobank participants (mean age 56.8 years; 45.8% males) who underwent ASI measurement and blood pressure measurement for PP calculation. Mean±SD ASI was 9.30±3.1 m/s and mean±SD PP was 50.98±13.2 mm Hg. During a median disease follow‐up of 2.8 years (interquartile range 1.4–4.0), 18 190 participants developed CVD, of which 1587 myocardial infarction (MI), 4326 coronary heart disease, 1192 heart failure, and 1319 stroke. During a median mortality follow‐up of 6.1 years (interquartile range 5.8–6.3), 3678 participants died, of which 1180 of CVD. Higher ASI was associated with increased risk of overall CVD (unadjusted hazard ratio 1.27; 95% confidence interval [CI], 1.25–1.28), myocardial infarction (1.38; 95% CI, 1.32–1.44), coronary heart disease (1.31; 95% CI, 1.27–1.34), and heart failure (1.31; 95% CI 1.24–1.37). ASI also predicted mortality (all‐cause, CVD, other). Higher PP was associated with overall CVD (1.57; 95% CI, 1.55–1.59), myocardial infarction (1.48; 95% CI, 1.42–1.54), coronary heart disease (1.47; 95% CI, 1.43–1.50), heart failure (1.47; 95% CI, 1.40–1.55), and CVD mortality (1.47; 95% CI, 1.40–1.55). PP improved risk reclassification of CVD in a non–laboratory‐based Framingham Risk Score by 5.4%, ASI by 2.3%.Conclusions ASI and PP are independent predictors of CVD and mortality outcomes. Although both improved risk prediction for new‐onset disease, PP appears to have a larger clinical value than ASI.

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Section: Discussionmentioning

confidence: 69%

Relationship of Arterial Stiffness Index and Pulse Pressure With Cardiovascular Disease and Mortality

Said

Eppinga

Lipšic

et al. 2018

JAHA

165

131

View full text Add to dashboard Cite

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“…H emodynamics research has shifted away from a steadyflow approach toward a pulsatile flow approach, because the former was less predictive in relation to cardiovascular morbidity and mortality. [1][2][3][4][5] The growing importance of pulsatile pressure indices (systolic blood pressure [SBP] and pulse pressure) paralleled the notion that not only increases in systemic vascular resistance (SVR) but also increases in arterial stiffness are important in the pathophysiology of hypertension. 6,7 This interest in the arterial cushioning function of pulsatile flow has given us a myriad of arterial stiffness indices generated by a wide array of methodologically varied noninvasive measurement techniques.…”

mentioning

confidence: 99%

A Comparison Between Systolic and Diastolic Pulse Contour Analysis in the Evaluation of Arterial Stiffness

et al. 2001

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Abstract-Several methodologically independent measures of arterial stiffness derived from either the systolic or diastolic segments of the arterial pulse have been proposed. The exact nature of the large and small artery elasticity indices (C1 and C2, respectively) derived from diastolic pulse contour analysis remains largely unexplored, although C2 has controversially been termed to be "oscillatory" and "reflective." We investigated the relation between C2 and, respectively, a prototype of arterial reflectivity (ie, the augmentation index, AIx) and a covariate of arterial reflectivity (body height). A validated transfer function is used to transform a tonometrically obtained radial pressure wave into an ascending aortic pressure wave, from which AIx is derived using systolic pulse contour analysis. Diastolic pulse contour analysis using a modified Windkessel model is used to derive C1 and C2. H emodynamics research has shifted away from a steadyflow approach toward a pulsatile flow approach, because the former was less predictive in relation to cardiovascular morbidity and mortality. [1][2][3][4][5] The growing importance of pulsatile pressure indices (systolic blood pressure [SBP] and pulse pressure) paralleled the notion that not only increases in systemic vascular resistance (SVR) but also increases in arterial stiffness are important in the pathophysiology of hypertension. 6,7 This interest in the arterial cushioning function of pulsatile flow has given us a myriad of arterial stiffness indices generated by a wide array of methodologically varied noninvasive measurement techniques. 8 -10 Several working definitions of arterial stiffness have been introduced: parameters of compliance or distensibility, which essentially express changes in mono-dimensional, bidimensional, or tridimensional space for a given pressure difference; parameters quantifying speed of wave propagation along an arterial segment (pulse-wave velocity); and parameters of global vascular elastic behavior derived from the arterial pressure pulse waveform.Given the complexity of the latter approach, simplified mathematical models have been developed. 9 The arterial pressure pulse waveform can be regarded as the result of incident (anterograde) and reflected (retrograde) pressure waves. [11][12][13] Wave reflection occurs at sites of discontinuity in calibre (bifurcations, branching points, and arterioles) or discontinuity in elastic properties (atherosclerosis) along the arterial tree. 14 Changes in amplitude and timing of wave reflections play a key role in aortic hemodynamics and, on a broader level, give us information on how the arterial vasculature affects the heart. [15][16][17][18][19] The SphygmoCor BPAS-1/A device (model SPT-301, PWV Medical Pty Ltd) calculates a number of parameters of ventriculo-arterial coupling and wave reflectance, of which the augmentation index (AIx) is preeminent. 11,20,21 Another approach in analyzing the arterial pulse is to regard the waveform as a basic pattern of exponential decay on which damped oscil...

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“…[23][24][25][26] The randomized multicenter clinical trial Systolic Hypertension in the Elderly Program found that in patients with ISH a decrease of the DBP and concomitant increase in PP increased the risk for stroke, coronary heart disease, and cardiovascular disease. 26 This study also showed that the occurrence of both Probabilities were determined from generalized estimation equation analysis for male gender with age 55 years.…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure Parameters and Carotid Intraplaque Hemorrhage as Measured by Magnetic Resonance Imaging

Selwaness¹,

Bouwhuijsen²,

Verwoert³

et al. 2013

Hypertension

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A therosclerotic plaques in the carotid arteries represent an important cause of cerebral ischemia. The composition of an atherosclerotic plaque is an important predictor for plaque rupture and subsequent thromboembolic events. Intraplaque hemorrhage (IPH) is considered as a high-risk component of the vulnerable plaque through contribution of cholesterol to the necrotic core of the plaque and by increasing macrophage infiltration, making the plaque more unstable. 1-3 Several studies have indicated a strong association of IPH with cerebrovascular events. [3][4][5] Furthermore, even in atherosclerotic lesions of asymptomatic subjects, IPH was shown to contribute to plaque progression and destabilization. 6,7 Magnetic resonance imaging (MRI) has emerged as a reliable and accurate tool for discriminating plaque components in vivo and for detecting IPH. 7,8 However, only few studies have investigated determinants of plaque composition in the carotid artery 9,10 and, specifically, studies relating risk factors to IPH are scarce. We recently reported that sex, age, smoking, and hypertension are associated with IPH in the general population. 11 Hypertension is a highly prevalent condition and a major contributor to atherosclerotic cardiovascular disease. However, the pathophysiology of the contribution of high blood pressure to atherosclerotic plaques is still not fully elucidated.For a long time, hemodynamic forces have been linked to atherosclerosis formation and plaque destabilization. 12 Plaque instability is, in part, determined by local factors, but it has been suggested that systemic factors are also important. 13 Atherosclerotic plaques form at positions of disturbed blood flow and concomitant low and oscillating wall shear stress, 14 whereas all structures of the arterial wall are influenced by blood pressure fluctuations.As a continuation of our previous study, 11 the current study was designed to determine the association of various blood pressure parameters with the presence of carotid IPH in a large population-based study.Abstract-Intraplaque hemorrhage (IPH) is a characteristic of the vulnerable atherosclerotic plaque that has been associated with ischemic stroke. Not much is known about determinants of IPH. We studied whether blood pressure parameters are associated with presence of IPH. Within the framework of a prospective population-based cohort study, The Rotterdam Study, the carotid arteries of 1006 healthy participants ≥45 years and with intima-media thickening (≥2.5 mm) on ultrasound were imaged with a 1.5-T magnetic resonance imaging scanner. IPH was defined as a hyperintense signal on a 3D-T1w-GRE magnetic resonance sequence. Generalized estimation equation analysis, adjusted for age, sex, carotid wall thickness, and cardiovascular risk factors, was used to assess the association between blood pressure parameters and IPH. Magnetic resonance imaging of the carotid arteries revealed presence of IPH in 444 of 1860 plaques (24%). Systolic blood pressure and pulse pressure (PP) were significantly asso...

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Isolated Systolic Hypertension

Cited by 340 publications

References 57 publications

Relationship of Arterial Stiffness Index and Pulse Pressure With Cardiovascular Disease and Mortality

Relationship of Arterial Stiffness Index and Pulse Pressure With Cardiovascular Disease and Mortality

A Comparison Between Systolic and Diastolic Pulse Contour Analysis in the Evaluation of Arterial Stiffness

Blood Pressure Parameters and Carotid Intraplaque Hemorrhage as Measured by Magnetic Resonance Imaging

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