Phenotypes of office systolic blood pressure according to both brachial and aortic measurements

Protogerou, Athanase D.; Aissopou, Evaggelia; Argyris, Antonis; Nasothimiou, Efthimia; Konstantonis, George; Karamanou, Marianna; Παπαϊωάννου, Θεόδωρος; Blacher, Jacques; Safar, Michel E.; Sfikakis, Petros P.

doi:10.1097/hjh.0000000000000955

Cited by 10 publications

(7 citation statements)

References 20 publications

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“…39 The stronger correlations of TSI indices with aortic rather than brachial BP are important because aortic BP has been more strongly associated with indices of preclinical organ damage than brachial BP. 44,45 In hypertension, the vascular phenotype is characterized by reduced compliance, elasticity/distensibility, and increased stiffness. 46 With increased stiffness in large vessels, the pulsatile pressure/flow of the left ventricular ejection (which is normally transformed in a continuous flow) moves downstream to the small vessels of the arterial tree.…”

Section: Muscle Oxidative Capacity and Microvascular Reactivitymentioning

confidence: 99%

Impaired Muscle Oxygenation and Elevated Exercise Blood Pressure in Hypertensive Patients

et al. 2017

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E ssential hypertension is characterized by sustained elevations of blood pressure (BP) that can lead to target organ damage and an increased risk for cardiovascular disease. 1Potential life-threatening outcomes of hypertension, such as stroke, renal insufficiency, and cardiac hypertrophy, had been initially perceived as a result of macrovascular alterations. These macrovascular events, however, do not occur independently of microvascular derangement. [2][3][4] Studies have shown that alterations in microvascular structure (rarefaction), vasomotor tonus (enhanced vasoconstriction or blunted vasodilation), and endothelial dysfunction are principal processes in the pathogenesis of hypertension and are evident in several organs/tissue types. [5][6][7][8] In the skeletal muscle, microvascularization is important for oxygen and nutrient supply and for effective metabolite clearance. Studies in hypertension have shown structural or functional impairments in the microvasculature within skeletal muscles, 8 implying a reduced capacity for oxygen delivery and exchange. Furthermore, animal studies using experimental models of hypertension suggested that mitochondrial dysfunction (ie, decreased expression of mitochondrial components and defects in respiratory complexes) and increased oxidative stress result in impaired oxidative capacity and reduced mitochondrial ATP production.9,10 Importantly, in these animals, the mitochondrial dysfunction and the reduced oxidative capacity were present before the development of hypertension, suggesting a possible role of these processes to the pathogenesis of hypertension.11 However, information on skeletal muscle microvascular alterations and oxidative Abstract-This study examined in vivo (1) skeletal muscle oxygenation and microvascular function, at rest and during handgrip exercise, and (2) their association with macrovascular function and exercise blood pressure (BP), in newly diagnosed, never-treated patients with hypertension and normotensive individuals. Ninety-one individuals (51 hypertensives and 40 normotensives) underwent office and 24-hour ambulatory BP, arterial stiffness, and central aortic BP assessment, followed by a 5-minute arterial occlusion and a 3-minute submaximal handgrip exercise. Changes in muscle oxygenated and deoxygenated hemoglobin and tissue oxygen saturation were continuously monitored by nearinfrared spectroscopy and beat-by-beat BP by Finapres. Hypertensives had higher (P<0.001) central aortic BP and pulse wave velocity versus normotensives and exhibited (1) a blunted tissue oxygen saturation response during occlusion, with slower (P=0.006) deoxygenation rate, suggesting reduced muscle oxidative capacity, and (2) a slower reoxygenation rate and blunted hyperemic response (P<0.05), showing reduced microvascular reactivity. Muscle oxygenation responses were correlated with aortic systolic and pulse pressure and augmentation index (P<0.05; age and body mass index (BMI) adjusted). When exercising at the same submaximal intensity, hypertensives required a sig...

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Section: Muscle Oxidative Capacity and Microvascular Reactivitymentioning

confidence: 99%

Impaired Muscle Oxygenation and Elevated Exercise Blood Pressure in Hypertensive Patients

et al. 2017

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“…Increased BP levels increase wall stress in vessels, promoting hypertrophy as an adaptive mechanism. Therefore, it is not surprising that many large adult studies, such as MESA (29), have demonstrated greater IMT at higher levels of BP whether measured in the clinic (30), at home (31), or by ambulatory BP monitoring (32). Longitudinal studies have demonstrated that baseline BP influences change in IMT (33,34), whereas improving morning BP peak leads to regression of IMT (35).…”

Section: Discussionmentioning

confidence: 99%

Direct and indirect effects of obesity on progression of carotid arterial injury in youth

Gao

Khoury

Dolan

et al. 2021

Obesity

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Objective Increased carotid intima‐media thickness (cIMT) is associated with cardiovascular (CV) events in adults and with elevated CV risk factors in youth. The aim of this study was to determine whether obesity has an direct or indirect association with cIMT. Methods Structural equation modeling was used to elucidate pathways for obesity to change cIMT. Complete data were collected twice on 294 participants (mean age 17.5 years, 16% with type 2 diabetes). Latent baseline and follow‐up cIMT, BMI, and CV risk factors were analyzed with SAS 9.4. Model fit was assessed. Results There were increases in BMI, mean arterial pressure (MAP), low‐density lipoprotein cholesterol, triglycerides, high‐density lipoprotein (HDL) cholesterol, C‐reactive protein, and glucose and a decrease in insulin and glycosylated hemoglobin over 5 years (all p < 0.05). Only bulb (0.031 mm) and internal (0.027 mm) cIMT increased (all p < 0.001). Significant direct effects on cIMT change were baseline MAP (β 0.23), BMI z score (β 0.16), change in glucose (β 0.37), and age (β 0.37; all p < 0.05). Change in MAP showed a trend (β 0.14, p = 0.10). BMI also had a significant indirect effect (β 0.17), whereas non‐HDL demonstrated no significant effect. Conclusions Baseline adiposity drives increasing blood pressure and glucose in high‐risk youth leading to accelerated accumulation of carotid arterial injury. Prevention of acquisition of obesity in youth is critical in slowing development of CV disease.

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“…Пациенты распределялись в зависимости от АД на плечевой артерии и аортального давления. Пациенты, фенотип которых характеризовался повышением центрального АД, с нормальными или повышенными уровнями АД на плечевой артерии, имели более высокую вероятность уменьшения площади сечения сонных артерий даже после коррекции влияния других факторов по сравнению с лицами, имеющими нормальное центральное АД [16].…”

Section: клинические семинары §unclassified

New Targets in Blood Pressure Control: Arguments Pro and Contra

Антропова

Осипова

2019

Kardiologiia

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The review contains results of analysis of clinical studies on the problem of defining the target level of the blood pressure (BP). The rationale for selection the target systolic BP level below120 mmHg was obtained in the SPRINT study comparing the target levels <120 mmHg and <140 mmHg. A considerably lower number of cardiovascular complications and deaths was seen in the group of a stricter BP control. Nevertheless, this study had some limitations related to certain patient populations, and methods of BP measurement. More ambitious target of BP lowering was associated with elevated risk of iatrogenic hypotension and fainting. Moreover, the ACCORD study, exploring the same target levels failed to demonstrate similar risk reduction. Taking into account various literature data, the authors find it reasonable to use personalized approach to determining BP targets, and utilize assessment of central aortic pressure and state of vessels for more accurate risk stratification and selection of treatment.

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Phenotypes of office systolic blood pressure according to both brachial and aortic measurements

Abstract: Type II (i.e. isolated high bSBP) and type III (i.e. isolated high aSBP) office SBP phenotypes were common and had intermediate level (between types I and IV) of arterial damage.

Cited by 10 publications

References 20 publications

Impaired Muscle Oxygenation and Elevated Exercise Blood Pressure in Hypertensive Patients

Impaired Muscle Oxygenation and Elevated Exercise Blood Pressure in Hypertensive Patients

Direct and indirect effects of obesity on progression of carotid arterial injury in youth

New Targets in Blood Pressure Control: Arguments Pro and Contra

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