Relationship between ambulatory arterial stiffness index and subclinical target organ damage in hypertensive patients

García-García, Ángel; Gómez‐Marcos, Manuel A.; Recio-Rodríguez, José I; González-Elena, Luis J.; Parra-Sanchez, J.; Muñoz-Moreno, María Fe; Patino-Alonso, María C.; Gudé, Francisco; García‐Ortiz, Luis

doi:10.1038/hr.2010.195

Cited by 38 publications

(29 citation statements)

References 35 publications

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“…Previous studies have shown that AASI is a predictor of cardiovascular outcome in the general population and in patients with hypertension (8)(9)(10)(11). However, the correlation with the Pulse Wave Velocity, which is considered the gold standard for arterial stiffness measurement, has been subsequently reported to be weak, since the regression slope of diastolic on systolic BP in significantly influenced by several factors other than arterial stiffness, such as systolic and diastolic BP data scattering and nocturnal dipping (17).…”

Section: Discussionmentioning

confidence: 95%

“…In the present study, we employed the Ambulatory Arterial Stiffness Index (AASI), taken as the surrogate marker of arterial stiffness (7), which is associated either with preclinical target organ damage in hypertension or with an increased risk of cardiovascular mortality in hypertensive patients and stroke in the general population (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

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Association of Hemoglobin with Ambulatory Arterial Stiffness Index in Untreated Essential Hypertensive Patients Without Anemia

2011

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Objective Increased hemoglobin (Hb) levels are known to be associated with increased cardiovascular events and mortality in hypertensive patients, but the underlying mechanism remains unclear. However, an increased Ambulatory Arterial Stiffness Index (AASI), the surrogate maker of arterial stiffness, has been proven to be an independent predictor of cardiovascular disease. This pilot study evaluated the association between Hb and AASI in untreated essential hypertensive patients without anemia. Methods A total of 566 untreated essential hypertensive patients without anemia were divided into NormalHb and High-Hb groups according to their Hb levels. The AASI and its symmetric calculation (Sym_AASI) were derived from 24h-Ambulatory Blood Pressure Monitoring (24h-ABPM). A multivariable linear regression analysis was performed to determine the relationship between Hb and AASI, Sym_AASI. Results High-Hb group (n=127) showed higher AASI and Sym_AASI (0.51±0.11 vs 0.43±0.12, p<0.001; 0.33±0.10 vs 0.27±0.08, p<0.001) compared to Normal-Hb group (n=439). Univariate correlation analysis showed that Hb levels were positively related to AASI and Sym_AASI values (r=0.459, p<0.001; r=0.353, p<0.001). After adjustment for age, sex, BMI, current smoker, eGFR, uric acid, total cholesterol, high-density lipoprotein, 24h-SBP, 24h-PP and dipper status, Hb persisted as a independent determinant of AASI and Sym_AASI (β=0.402, p<0.001 and β=0.298, p<0.001, respectively). Conclusion High hemoglobin seems be to associated with increased AASI in untreated essential hypertensive patients without anemia.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Association of Hemoglobin with Ambulatory Arterial Stiffness Index in Untreated Essential Hypertensive Patients Without Anemia

2011

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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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“…As consequence, for non-dipper subjects the correlation coefficient of the regression of diastolic vs. systolic BP over 24 h tends to decrease and that of its complement, the AASI, tends to increase. 8 Á ngel García-García et al 9 found that an increased AASI was associated with the presence of vascular, cardiac and renal SOD in primary hypertensive patients, regardless of whether they were taking blood-pressurelowering drugs. In our opinion, these results are relevant because the AASI was calculated in a population of dippers independent of the use of blood-pressure-lowering drug treatment.…”

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confidence: 99%

Ambulatory arterial stiffness index: a marker of subclinical organ damage in treated and untreated dipper hypertensive patients

et al. 2010

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C ardiovascular risk assessment is a fundamental step in the management of hypertensive patients. It is not difficult to determine the degree of hypertension and the presence of co-existing risk factors, but detecting subclinical organ damage (SOD) is more complicated, and its success depends on the diagnostic test chosen.Large-artery stiffness is recognized as an indicator of SOD in hypertensive patients and as an important predictor of cardiovascular morbidity and mortality in subjects with essential hypertension. 1 Although systemic arterial stiffness can only be estimated from models of circulation, regional and local arterial stiffness can be measured directly at various sites along the arterial tree. One major problem with arterial stiffness determination is that accurate measurement of a given artery's stiffness necessarily requires simultaneous, accurate measurements of the local arterial cross-sectional area (or diameter) and pressure, which are difficult to obtain in vivo. Thus, in a compromise between simplicity and accuracy, indexes of arterial stiffness are used as surrogates of the 'true' stiffness. A number of surrogate measures of large-artery stiffness have been proposed, but each has important limitations. 2,3 The dynamic relationship between systolic and diastolic blood pressure (BP) provides a means of investigating arterial stiffness. For a given increase in diastolic BP, systolic BP is expected to increase to a limited extent in a compliant artery, whereas the increase will be greater in a stiff artery. The opposite holds for an increase in diastolic BP for a given increase in systolic BP; this relationship can be considered a measure of arterial compliance.These principles are the basis of the ambulatory arterial stiffness index (AASI). 4 Individual values of systolic and diastolic BP measurements obtained through 24-h non-invasive ambulatory BP monitoring are plotted, and the linear regression slope of diastolic BP vs. systolic BP is assumed to be a global measure of arterial compliance. The complement of the slope (1 minus the slope)-the AASI-has been accepted as a measure of arterial stiffness. 4 The AASI is associated with preclinical target organ damage in subjects with hypertension 5,6 and with an increased risk of cardiovascular mortality in hypertensive patients. 7 Its use does not require specialized equipment or dedicated personnel, and it is expected to be widely applied in the scientific and medical communities.The AASI is not appropriate for use in non-dipper hypertensive patients. Dipper subjects have nocturnal systolic and diastolic BP values that are much lower than the corresponding daytime values, resulting in an increase in the regression coefficient of diastolic BP vs. systolic BP. Non-dipper subjects, on the other hand, tend to have a narrower range of diastolic BP values over a 24-h period. As consequence, for non-dipper subjects the correlation coefficient of the regression of diastolic vs. systolic BP over 24 h tends to decrease and that of its complement, the AASI,...

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Relationship between ambulatory arterial stiffness index and subclinical target organ damage in hypertensive patients

Cited by 38 publications

References 35 publications

Association of Hemoglobin with Ambulatory Arterial Stiffness Index in Untreated Essential Hypertensive Patients Without Anemia

Association of Hemoglobin with Ambulatory Arterial Stiffness Index in Untreated Essential Hypertensive Patients Without Anemia

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

Ambulatory arterial stiffness index: a marker of subclinical organ damage in treated and untreated dipper hypertensive patients

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