Temporal Relationship Between Elevated Blood Pressure and Arterial Stiffening Among Middle-Aged Black and White Adults
|
|
- Geraldine Powers
- 5 years ago
- Views:
Transcription
1 American Journal of Epidemiology The Author Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please Vol. 183, No. 7 DOI: /aje/kwv274 Advance Access publication: March 8, 2016 Original Contribution Temporal Relationship Between Elevated Blood Pressure and Arterial Stiffening Among Middle-Aged Black and White Adults The Bogalusa Heart Study Wei Chen*, Shengxu Li, Camilo Fernandez, Dianjianyi Sun, Chin-Chih Lai, Tao Zhang, Lydia Bazzano, Elaine M. Urbina, and Hong-Wen Deng * Correspondence to Dr. Wei Chen, Tulane University Health Sciences Center, 1440 Canal Street, Room 1504, New Orleans, LA ( wchen1@tulane.edu). Initially submitted March 2, 2015; accepted for publication July 23, This study assessed the temporal relationship between elevated blood pressure (BP) and arterial stiffness in a biracial (black-white) cohort of middle-aged adults aged years from the semirural community of Bogalusa, Louisiana. Measurements of aortic-femoral pulse wave velocity (afpwv; n = 446) and large- and small-arterial compliance (n = 381) were obtained at 2 time points between 2000 and 2010, with an average follow-up period of 7 years. A cross-lagged path analysis model was used to examine the temporal relationship of elevated BP to arterial stiffness and elasticity. The cross-lagged path coefficients did not differ significantly between blacks and whites. The path coefficient (ρ 2 ) from baseline BP to follow-up afpwv was significantly greater than the path coefficient (ρ 1 ) from baseline afpwv to follow-up BP (ρ 2 = 0.20 vs. ρ 1 = 0.07 (P = 0.048) for systolic BP; ρ 2 = 0.19 vs. ρ 1 = 0.05 (P = 0.034) for diastolic BP). The results for this 1-directional path from baseline BP to follow-up afpwv were confirmed, although marginally significant, by using large- and small-artery elasticity measurements. These findings provide strong evidence that elevated BP precedes large-artery stiffening in middle-aged adults. Unlike the case in older adults, the large-arterial wall is not stiff enough in youth to alter BP levels during young adulthood. arterial elasticity; arterial stiffness; blood pressure; longitudinal analysis; temporal relationships Abbreviations: afpwv, aortic-femoral pulse wave velocity; BMI, body mass index; BP, blood pressure; DBP, diastolic blood pressure; HDI, Hypertension Diagnostics, Inc.; MESA, Multi-Ethnic Study of Atherosclerosis; SBP, systolic blood pressure; SVR, systemic vascular resistance. Editor s note:an invited commentary on this article appears on page 609. Hypertension and vascular stiffness contribute to morbidity and mortality from coronary heart disease, stroke, heart failure, and renal disease (1, 2). Blood pressure (BP) levels and arterial elasticity measures are hypertension-related traits and are influenced by aging processes and cardiovascular risk factors (3 6). The strong association between arterial stiffening and elevated BP levels suggests that this functional relationship is probably bidirectional, based on vascular biology and hemodynamics. The concept that arterial stiffness increases systolic BP, leading to an increase in pulse pressure due to alterations of the buffering function of the conduit arteries in older individuals, has been well established. However, existing data are inconsistent regarding whether elevated BP accelerates arterial stiffening during childhood and early adulthood due to increased wear and tear on the artery walls, subsequently leading to an increase in arterial stiffness (2, 7, 8). In particular, it is inadequately understood whether the answer to this chicken-and-egg question differs by age period during the development of hypertension. The Bogalusa Heart Study, a biracial (black-white), community-based long-term investigation of the early natural history of cardiovascular disease beginning in childhood 599
2 600 Chen et al. (9), provides a longitudinal database with both BP and arterial vascular alteration measurements. Utilizing data from this longitudinal cohort study, we examined the temporal relationship between elevated BP levels and vascular stiffening during young adulthood. METHODS Study cohort In the community of Bogalusa, Louisiana, 584 adult subjects were evaluated twice for aortic-femoral pulse wave velocity (afpwv), arterial elasticity measures, and cardiovascular risk factors at both baseline and follow-up examinations conducted during and , respectively. After exclusion of 138 hypertensive persons who were receiving treatment at either baseline or follow-up, 446 subjects (342 whites and 104 blacks; 41.9% male; mean age = 43.3 years; age range years at follow-up) were included in this analysis, with a follow-up period of 6.8 years, on average (range, years). Among these 446 study subjects, there were still 78 hypertensive persons included in the analysis who were not receiving antihypertensive treatment. In addition, 381 subjects (277 whites and 104 blacks; 40.4% male; mean age = 44.5 years; age range years at follow-up) had baseline and follow-up measurements of large- and small-arterial compliance available, with a follow-up period of 7.0 years, on average (range, years). This sample (n = 381) was used to confirm the results for the BP-afPWV temporal relationship. In these 2 cohorts, a subset of 286 subjects had both afpwv and arterial compliance measurements available. All subjects in this study gave informed consent for each examination. Study protocols were approved by the Institutional Review Board of the Tulane University Health Sciences Center (New Orleans, Louisiana). BMI and BP measurements Replicate measurements of height and weight were obtained, and the mean values were used for analysis. Body mass index (BMI; weight in kilograms divided by the square of height in meters) was used as a measure of overall adiposity. BP levels were measured by 2 trained observers (3 replicates each) between 8:00 AM and 10:00 AM on subjects right arms while they rested in a relaxed, sitting position. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded using a mercury sphygmomanometer. The fifth Korotkoff phase was used for DBP. The mean values of the 6 readings were used for analysis. Hypertension was defined as SBP 140 mm Hg or DBP 90 mm Hg or use of antihypertensive medication at the time of examination. Aortic-femoral pulse wave velocity We measured afpwv using a Toshiba digital ultrasound instrument (Xario SSA-660A; Toshiba America Medical Systems, Tustin, California). A nondirectional transcutaneous Doppler flow probe (Toshiba PSK25AT, 2.5 MHz; Toshiba America Medical Systems) was positioned at the suprasternal notch, and another probe (Toshiba PCK703AT, 7.5 MHz; Toshiba America Medical Systems) was positioned at the left femoral artery with the subject lying in a supine position. A computer system displayed and recorded output from the electrocardiogram and the 2 Doppler probes. The arterial flow waves from the 2 arterial sites were recorded, and the output was captured and stored in the computer system for subsequent scoring. After collection of the waveform data, the distance between the aorta and femoral arteries was measured with a caliper instrument to reduce the influence of body contours on the distance measured. The software averages the selected waveforms and determines the time from the R wave of the electrocardiogram to the foot of each waveform. The difference in timing between the 2 waves represents the time component of the velocity equation. We then calculated afpwv by dividing the distance traveled by the time differential between the 2 waveforms (10). In 46 re-screenees, afpwv was remeasured for reproducibility analysis. The correlation between the 2 measurements was 0.91 on the same day and 0.68 on different days. The day-to-day variations were influenced by both measurement errors and physiological fluctuations. Pulsatile arterial function Radial arterial pulse pressure waveforms were recorded by an acoustic transducer using the HD/PulseWave CR-2000 Research Cardiovascular Profiling System (Hypertension Diagnostics, Inc. (HDI), Eagan, Minnesota). A wrist stabilizer was used to gently immobilize the right wrist and stabilize the radial artery during measurements. For each subject, pressure waveforms were recorded for 30 seconds in the supine position, digitized at 200 samples per second, and stored in a computer. A modified windkessel ( air chamber ) model of the circulation was used to match the diastolic pressure decay of the waveforms and to quantify changes in arterial waveform morphology in terms of large-artery (capacitive) compliance (C 1, representative of the aorta and major branches), smallartery (oscillatory) compliance (C 2, representative of the distal part of the circulation, including small arteries and arterioles), and systemic vascular resistance (SVR; mean arterial pressure divided by cardiac output) (11). Four measurements were taken for each subject, and the mean values were used in the analyses. The intraclass correlation of the 4 measurements was 0.71 for C 1,0.85forC 2, and 0.93 for SVR. Considering that mean arterial pressure is included as a function of BP in the calculation of C 1 and C 2 by the HDI device, C 1 SVR (C 1 R) and C 2 SVR (C 2 R) were used in the current analysis to separate the BP component from the waveform information. C 1 R and C 2 R are measures closely related to largeand small-artery elasticity, respectively. Unlike the afpwv, for which a higher value is worse, higher values of C 1 R and C 2 R represent better vascular function. Statistical methods Analyses of covariance were performed using generalized linear models to test differences in continuous variables between blacks and whites and to calculate covariate-adjusted least-squares mean yearly rates of change in BP, afpwv, C 1 R, and C 2 R during the follow-up period.
3 Blood Pressure and Arterial Stiffness 601 The longitudinal changes in BP, afpwv, C 1 R,andC 2 R measured at 2 time points can be modeled using a crosslagged panel design. Cross-lagged panel analysis is a form of path analysis that simultaneously examines reciprocal, longitudinal relationships among a set of intercorrelated variables (12 15). A simplified, conceptual version of the model used in the current analysis is presented in the figures and tables. The path with ρ 1 describes the effect of baseline arterial function measures (afpwv, C 1 R, and C 2 R) on subsequent BP, and the path with ρ 2 describes the effect of baseline BP on subsequent arterial function measures. Prior to cross-lagged path analysis, the baseline and follow-up values of BP, afpwv, C 1 R,andC 2 R were adjusted for age, sex, BMI, heart rate, smoking, and diabetes in regression residual analyses and then standardized with z-transformation (mean = 0; standard deviation, 1) by race/ethnicity. Pearson correlation coefficients for the z-transformed quantitative variables of BP, afpwv, C 1 R, and C 2 R at baseline and follow-up were calculated, adjusted for duration of follow-up (years). The crosslagged path coefficients (ρ 1 and ρ 2 ) in the path diagrams were estimated simultaneously based on the correlation matrix using the maximum likelihood method with the software program LISREL, version 8.52 (15, 16). The validity of model fitting was evaluated by means of a goodness-of-fit χ 2 test and the comparative fitness index. The temporal relationships of SBP and DBP with afpwv, C 1 R, and C 2 R were examined in separate models. The difference between ρ 1 and ρ 2 derived from the standardized variables (z scores) was tested using Fisher s z test as described in a previous article (17). Although the significance of an individual ρ 1 or ρ 2 Table 1. Characteristics of Study Participants at Baseline and Follow-up, by Race/Ethnicity, Bogalusa Heart Study, Mean (SD) % Mean (SD) % Mean (SD) % Characteristic a Whites (n = 342) Blacks (n = 104) P Value b Total (n = 446) Baseline Age, years 36.8 (4.2) 35.6 (4.4) (4.3) BMI c 27.7 (5.8) 28.7 (6.9) (6.1) HR, beats/minute 68.0 (8.4) 69.5 (9.6) (8.7) Smoking Diabetes SBP, mm Hg (10.2) (12.6) < (11.0) DBP, mm Hg 75.8 (7.7) 78.5 (9.1) < (8.2) afpwv, m/second 5.1 (0.8) 5.3 (1.0) (0.8) C 1, d ml/mm Hg 10 e 15.6 (4.2) 14.4 (4.3) (4.3) C 2, d ml/mm Hg 100 e 6.7 (2.6) 5.5 (2.5) < (2.6) SVR, dynessecondcm 5e 1,297 (235) 1,403 (284) < ,326 (253) Follow-up Age, years 43.6 (4.4) 42.4 (4.5) (4.4) BMI 28.9 (6.1) 30.1 (7.4) (6.4) HR, beats/minute 69.7 (8.9) 71.4 (9.6) (9.1) Smoking Diabetes SBP, mm Hg (11.7) (15.2) < (13.0) DBP, mm Hg 79.3 (7.9) 82.9 (11.0) < (8.9) afpwv, m/second 6.9 (2.1) 7.0 (1.9) (2.0) C 1, ml/mm Hg 10 e 15.2 (4.4) 13.2 (4.4) < (4.5) C 2, ml/mm Hg 100 e 6.2 (2.8) 4.8 (2.1) < (2.7) SVR, dynessecondcm 5e 1,358 (249) 1,530 (339) < ,405 (287) Abbreviations: afpwv, aortic-femoral pulse wave velocity; BMI, body mass index; DBP, diastolic blood pressure; HR, heart rate; SBP, systolic blood pressure; SVR, systemic vascular resistance. a Unless otherwise noted, the total number of subjects was 446 (342 whites and 104 blacks), with 148 males and 194 females among whites and 39 males and 65 females among blacks. b P values for racial/ethnic differences in continuous variables were adjusted for sex and age (except age itself). c Weight (kg)/height (m) 2. d C 1, large-artery (capacitive) compliance; C 2, small-artery (oscillatory) compliance. e The total number of subjects was 381 (277 whites and 104 blacks), with 116 males and 161 females among whites and 38 males and 66 females among blacks.
4 602 Chen et al. value suggests a directional relationship, a significant difference between ρ 1 and ρ 2 provides stronger evidence for a temporal relationship between BP and arterial function measures. RESULTS Table 1 shows mean levels of study variables at baseline and follow-up, by race/ethnicity. The mean levels of continuous variables were compared between racial/ethnic groups, adjusting for sex and age (except age itself). BMI, heart rate, and prevalence of smoking did not differ significantly between racial/ethnic groups; however, blacks had a significantly higher prevalence of type 2 diabetes than whites. Baseline and follow-up values of SBP, DBP (blacks > whites), C 1, C 2 (blacks < whites), and SVR (blacks > whites) showed significant racial differences; afpwv differed significantly by race/ethnicity (blacks > whites) at baseline only. Analyses of the temporal relationship of SBP and DBP with afpwv, C 1 R, and C 2 R were performed in separate models by race/ethnicity, with adjustment for age, sex, BMI, heart rate, smoking, diabetes, and duration of follow-up. Crosslaggedpathcoefficients from the 6 models did not differ significantly between blacks and whites, as presented in Appendix Table 1. Cross-lagged path coefficients for the total sample are given in Table 2. After adjustment for age, sex, race/ethnicity, BMI, heart rate, smoking, diabetes, and duration of follow-up, the path coefficients (ρ 2 ) from baseline to follow-up afpwv were significantly greater than the path coefficients Table 2. Cross-Lagged Path Coefficients for the Association of Blood Pressure With Aortic-Femoral Pulse Wave Velocity (n = 446) and Artery Elasticity (n = 381) in the Total Sample, With Adjustment for Covariates, a Bogalusa Heart Study, Model ρ 1 b Path Coefficient ρ 2 c Model Goodness of Fit P Value d P Value e CFI SBP-afPWV f < DBP-afPWV f < SBP-C 1 R g < DBP-C 1 R < SBP-C 2 R g < DBP-C 2 R Abbreviations: afpwv, aortic-femoral pulse wave velocity; CFI, comparative fitness index; DBP, diastolic blood pressure; SBP, systolic blood pressure. a Covariates included age, sex, body mass index, heart rate, smoking, diabetes, and duration of follow-up. b ρ 1 describes the path from baseline measures of arterial function (afpwv, C 1 R, and C 2 R) to follow-up BP. c ρ 2 describes the path from baseline BP to follow-up measures of arterial function (afpwv, C 1 R, and C 2 R). d P value for difference between ρ 1 and ρ 2. e P value for χ 2 test of model fitting. f For ρ 1 and ρ 2 being different from 0, P < g C 1 R, large-artery (capacitive) compliance systemic vascular resistance; C 2 R, small-artery (oscillatory) compliance systemic vascular resistance Survey Survey Baseline r 1 = 0.19 (SBP) r 1 = 0.21 (DBP) Baseline afpwv (ρ 1 ) from baseline afpwv to follow-up. In BP-C 1 R analysis models, the paths of SBP C 1 R (ρ 2 = 0.11, P = 0.056) and DBP C 1 R (ρ 2 = 0.10, P = 0.068) were marginally significant; the difference between ρ 1 and ρ 2 in the DBP-C 1 R model was significant (P = 0.019). In Survey Survey r 2 = 0.59 (SBP) Baseline Follow-up r 2 = 0.55 (DBP) r 1 = 0.05 (SBP) r 1 = 0.04 (DBP) Baseline C 1 R r 2 = 0.59 (SBP) r 2 = 0.50 (DBP) r 3 = 0.13 (SBP included) r 3 = 0.13 (DBP included) r 3 = 0.22 (SBP included) r 3 = 0.23 (DBP included) Follow-up 1 = 0.07 (SBP); 1 = 0.05 (DBP) 2 = 0.20 (SBP); 2 = 0.19 (DBP) Follow-up afpwv Figure 1. Cross-lagged path analysis models for the association of systolic blood pressure (SBP) and diastolic blood pressure (DBP) with aortic-femoral pulse wave velocity (afpwv) in the total sample (n = 446), Bogalusa Heart Study, Results were adjusted for race/ethnicity, age, sex, body mass index, heart rate, smoking, diabetes, and duration of follow-up. ρ 1, cross-lagged path coefficient from baseline afpwv to follow-up blood pressure (BP); ρ 2, cross-lagged path coefficient from baseline BP to follow-up afpwv. r 1 represents synchronous correlations; r 2 and r 3 represent tracking correlations. Variance of follow-up BP explained: R 2 =0.36(SBP)andR 2 =0.25 (DBP). Variance of follow-up afpwv explained: R 2 = 0.08 (SBP included) and R 2 = 0.08 (DBP included). For r 1, r 2, ρ 1, and ρ 2 being different from 0 for SBP and DBP, P < 0.01; for r 3 being different from 0 for SBP and DBP, P < 0.05; for difference in SBP between ρ 1 and ρ 2, P = 0.048; and for difference in DBP between ρ 1 and ρ 2, P = = 0.02 (SBP); 1 = 0.07 (DBP) 2 = 0.11 (SBP); 2 = 0.10 (DBP) Follow-up C 1 R Figure 2. Cross-lagged path analysis models for the association of systolic blood pressure (SBP) and diastolic blood pressure (DBP) with large-artery elasticity (C 1 R) in the total sample (n = 381), Bogalusa Heart Study, Results were adjusted for race/ethnicity, age, sex, body mass index, heart rate, smoking, diabetes, and duration of follow-up. ρ 1, cross-lagged path coefficient from baseline C 1 R to follow-up blood pressure (BP); ρ 2, cross-lagged path coefficient from baseline BP to follow-up C 1 R. r 1 represents synchronous correlations; r 2 and r 3 represent tracking correlations. Variance of follow-up BP explained: R 2 = 0.36 (SBP) and R 2 = 0.31 (DBP); variance of follow-up C 1 R explained: R 2 = 0.16 (SBP included) and R 2 =0.12 (DBP included). For r 2 and r 3 being different from 0 for SBP and DBP, P < 0.01; for difference in SBP between ρ 1 and ρ 2, P = 0.214; and for difference in DBP between ρ 1 and ρ 2, P =
5 Blood Pressure and Arterial Stiffness Survey Survey r 2 = 0.59 (SBP) Baseline Follow-up r 2 = 0.55 (DBP) r 1 = 0.21 (SBP) r 1 = 0.20 (DBP) Baseline C 2 R BP-C 2 R analysis models, the paths of C 2 R SBP (ρ 1 = 0.08, P = 0.057) and DBP C 2 R (ρ 2 = 0.09, P = 0.053) were marginally significant; the paths of SBP C 2 R and C 2 R DBP were not significant. The difference between ρ 1 and ρ 2 was not significant in the BP-C 2 R models. Based on the model-fitting parameters, P values were less than in χ 2 goodness-of-fit tests for all models, indicating a difference between the hypothesized models and the observed data. However, this was probably due to the high sensitivity of the A) B) 0.5 Δ afpwv, m/second/year r 3 = 0.40 (SBP included) r 3 = 0.42 (DBP included) 1 = 0.08 (SBP); 1 = 0.05 (DBP) 2 = 0.06 (SBP); 2 = 0.09 (DBP) Follow-up C 2 R Figure 3. Cross-lagged path analysis models for the association of systolic blood pressure (SBP) and diastolic blood pressure (DBP) with small-artery elasticity (C 2 R)inthetotalsample(n = 381), Bogalusa Heart Study, Results were adjusted for race/ethnicity, age, sex, body mass index, heart rate, smoking, diabetes, and duration of follow-up. ρ 1, cross-lagged path coefficient from baseline C 2 R to follow-up blood pressure (BP); ρ 2, cross-lagged path coefficient from baseline BP to follow-up C 2 R. r 1 represents synchronous correlations; r 2 and r 3 represent tracking correlations. Variance of follow-up BP explained: R 2 = 0.36 (SBP) and R 2 = 0.33 (DBP); variance of follow-up C 2 R explained: R 2 = 0.17 (SBP included) and R 2 =0.19 (DBP included). For r 1, r 2,andr 3 being different from 0 for SBP and DBP, P < χ 2 test to a large sample size. Comparative fit index values ranged from 0.88 to 0.96, indicating a good fit to the observed data in 4 of the 6 models according to the standard criterion of a comparative fit index of Figure 1 provides detailed parameter information on crosslagged path analysis models of the association of SBP and DBP with afpwv in the total sample, with adjustment for age, sex, race/ethnicity, BMI, heart rate, smoking, diabetes, and duration of follow-up. The variance of follow-up BP explained by baseline predictors was greater than that of follow-up afpwv. Tracking correlation over time was much lower for afpwv than for BP. There was no change in device, protocol, or method of measuring BP, afpwv, or arterial elasticity between baseline and follow-up. The only possible explanation for the lower tracking correlation (r = 0.13) is that afpwv increased more over the years and had a relatively greater measurement error. Figure 2 provides detailed parameter information on crosslagged path analysis models of the association of SBP and DBP with C 1 R in the total sample, with adjustment for age, sex, race/ethnicity, BMI, heart rate, smoking, diabetes, and duration of follow-up. The variance of follow-up BP explained by baseline predictors was greater than that of follow-up C 1 R. Tracking correlation over time was stronger for BP than for C 1 R. Figure 3 provides detailed parameter information on crosslagged path analysis models of the association of SBP and DBP with C 2 R in the total sample, with adjustment for age, sex, race/ethnicity, BMI, heart rate, smoking, diabetes, and duration of follow-up. The variance of follow-up BP explained by baseline predictors was greater than that of follow-up C 2 R. Tracking correlation over time was stronger for BP than for C 2 R. Figure 4 illustrates yearly rates of change (adjusted for race/ethnicity, sex, age, BMI, heart rate, smoking, and diabetes) in afpwv and SBP according to quartiles of their Δ SBP, mm Hg/year Quartile of Baseline SBP 0.0 Quartile of Baseline afpwv Figure 4. Yearly rates of change (Δ) in aortic-femoral pulse wave velocity (afpwv) (A) and systolic blood pressure (SBP) (B) according to quartiles of their baseline values in the total sample (n = 446), Bogalusa Heart Study, Results were adjusted for race/ethnicity, sex, age, body mass index, heart rate, smoking, and diabetes. P-trend = for ΔafPWV; P-trend = for ΔSBP.
6 604 Chen et al. A) B) Δ C 1 R per Year Quartile of Baseline SBP baseline values in the total sample. The rate of change in afpwv during the follow-up period significantly increased across increasing quartiles of baseline SBP (P = 0.017) (Figure 4A). However, the covariate-adjusted rate of change in SBP did not show a significantly increasing trend across quartiles of baseline afpwv (Figure 4B). The rates of change in DBP and afpwv (data not shown) had trend patterns similar to those noted for SBP and afpwv. The results for rates of change shown in Figure 4 were consistent with the BP Δ SBP, mm Hg/year Quartile of Baseline C 1 R Figure 5. Yearly rates of change (Δ) in large-artery elasticity (C 1 R) (A) and systolic blood pressure (SBP) (B) according to quartiles of their baseline values in the total sample (n = 381), Bogalusa Heart Study, Results were adjusted for race/ethnicity, sex, age, body mass index, heart rate, smoking, and diabetes. P-trend = for ΔC 1 R; P-trend = for ΔSBP. A) B) 200 Δ C 2 R per Year afpwv 1-directional relationship in the cross-lagged path analyses shown in Table 2 and Figure 1. Figure 5 illustrates yearly rates of change (adjusted for race/ethnicity, sex, age, BMI, heart rate, smoking, and diabetes) in C 1 R and SBP according to quartiles of their baseline values. As can be seen in Figure 5A, the trend in the rate of decrease in C 1 R during the follow-up period was borderline significant (P = 0.052) across increasing quartiles of baseline SBP. On the other hand, the decreasing trend was not Δ SBP, mm Hg/year Quartile of Baseline SBP 0.0 Quartile of Baseline C 2 R Figure 6. Yearly rates of change (Δ) in small-artery elasticity (C 2 R) (A) and systolic blood pressure (SBP) (B) according to quartiles of their baseline values in the total sample (n = 381), Bogalusa Heart Study, Results were adjusted for race/ethnicity, sex, age, body mass index, heart rate, smoking, and diabetes. P-trend = for ΔC 2 R; P-trend = for ΔSBP.
7 Blood Pressure and Arterial Stiffness 605 significant for the rate of change in SBP by increasing quartile of baseline C 1 R (Figure 5B). The rates of change in DBP and C 1 R (data not shown) had similar trend patterns as those noted for SBP and C 1 R. The results for yearly rates of change in SBP and C 1 R by their baseline quartiles shown in Figure 5 were consistent with the parameters of the cross-lagged path analyses shown in Table 2 and Figure 2. Note that C 1 R is a measure related to large-artery elasticity; the annual ΔC 1 R was calculated as the follow-up value minus the baseline value, divided by the duration of follow-up. Therefore, the greater absolute value of the negative ΔC 1 R is worse with respect to vascular function. Figure 6 illustrates yearly rates of change (adjusted for race/ethnicity, sex, age, BMI, heart rate, smoking, and diabetes) in C 2 R and SBP according to quartiles of their baseline values. As can be seen in Figure 6A, the trend in the rate of decrease in C 2 R during the follow-up period was not significant (P = 0.875) across increasing quartiles of baseline SBP; the trend was also not significant for the rate of change in SBP by increasing quartile of baseline C 2 R (P =0.331) (Figure 6B). The rates of change in DBP and C 2 R (data not shown) had trend patterns similar to those noted for SBP and C 2 R. The results for yearly rates of change in SBP and C 2 R by their baseline quartiles shown in Figure 6 were consistent with the parameters of the cross-lagged path analyses shown in Table 2 and Figure 3. C 2 R is a measure related to small-artery elasticity; as for ΔC 1 R, the greater absolute value of the negative ΔC 2 R is worse with respect to vascular function. DISCUSSION Although the role of arterial stiffness in isolated systolic hypertension and pulse pressure amplitude has been well documented in elderly populations (1, 2, 18 21), the temporal relationship between arterial stiffening and BP elevation during childhood and early adulthood has been incompletely elucidated. In the present study, we examined the temporal relationship between BP and arterial function measures in a longitudinal cohort of black and white middle-aged adults using a cross-lagged path analysis model, a powerful statistical approach in dissecting a causal relationship between intercorrelated variables. The results indicated that elevated BP preceded increased large-artery stiffness during young adulthood, with blacks and whites showing similar patterns of this 1-directional relationship. These findings on the BP arterial stiffness pathway were partly confirmed using large- (C 1 R)and small- (C 2 R) artery elasticity, as measured by the HDI device, in this longitudinal study cohort. The observations from the current study suggest that the mechanisms underlying the development of hypertension might be different during younger and older age periods. BP levels and arterial vascular alterations are both influenced by aging processes and cardiovascular risk factors (3 6). In a systematic review of 77 cross-sectional studies in adults, age and BP were found to be consistently, independently associated with aortic pulse wave velocity in 91% and 90% of studies, respectively (3). The Bogalusa Heart Study has shown that BP is one of the important risk factors for arterial stiffness in children and young adults (5, 6). An important question raised by these cross-sectional studies is whether an increase in arterial stiffness precedes increases in BP or vice versa, or whether the relationship is bidirectional. The observations from cross-sectional studies limit inference regarding the temporal relationship between BP and arterial function changes. Although BP has been used as a predictor variable in previous cross-sectional studies (3, 4), it is largely unknown whether changes in mechanical properties of the arterial wall or increased BP occurs first or whether the causal relationship varies in different age periods. Several longitudinal studies have analyzed the temporal relationship between BP and arterial stiffness and elasticity; however, their results have not been consistent. In the Framingham Study, Kaess et al. (18) found that higher aortic stiffness, forward pressure-wave amplitude, and augmentation index were associated with higher risk of future incident hypertension. However, initial BP was not independently associated with risk of progressive aortic stiffening in a cohort of participants with a mean age of 60 years followed over a 7-year period (18). In another large epidemiologic study, the Atherosclerosis Risk in Communities (ARIC) Study, Liao et al. (19) reported that higher carotid artery stiffness was associated with future incident hypertension in the elderly. The Multi-Ethnic Study of Atherosclerosis (MESA) showed that lower large- and small-artery elasticity (C 1 and C 2 ) was associated with incident hypertension in a cohort aged years (mean age = 58.1 years) with a mean follow-up time of 4.3 years (20). Other investigators have also reported similar results regarding the relationship between arterial vascular alteration and BP (21 23). In contrast, some studies have shown a relationship between BP and arterial stiffness in an opposite direction; that is, elevated BP resulted in increased arterial stiffening (24 27). Annual rates of progression in pulse wave velocity over a 6-year follow-up period among persons with treated hypertension were significantly higher than in normotensive persons (27). By comparing the ages of participants in the 2 groups of studies mentioned above, one can see that the cohorts for which an arterial vascular alteration BP relationship was reported were relatively older (18 20, 23) than those in studies reporting a BP pulse wave velocity relationship (24 27). Interestingly, a few studies, including ours, found that childhood BP levels predicted adult arterial stiffness (28 30). In our previous longitudinal analysis, childhood systolic BP showed the highest correlation (r = 0.111, P < 0.01) with adult brachial-ankle pulse wave velocity among cardiovascular risk factors (28). The controversy surrounding the temporal relationship between BP and arterial stiffness is mainly explained by the different age groups under study (27, 31). Further, in longitudinal studies, exclusion of hypertension patients receiving pharmacological treatment at baseline favors arterial vascular alteration-to-bp directionality but limits BP-to-arterial vascular alteration directionality, which makes it difficult to detect the temporal relationship consistently. BP levels and the structure-function properties of the largearterial wall are highly interrelated during the development of hypertension. The strong association suggests that their temporal relationship is bidirectional, like a 2-way street, based on vascular wall biology and hemodynamics; that is, they are mutually influenced during the aging process (7, 8). It is
8 606 Chen et al. generally thought that elevated BP from childhood to young adulthood accelerates arterial stiffness due to increased wear and tear on the artery walls, subsequently leading to muscle cell hypertrophy, collagen synthesis in the vascular wall, and fatigue fracture of the elastic elements within the media. In turn, arterial stiffness increases systolic BP, leading to widening of pulse pressure due to alterations in the buffering function of the conduit artery walls among older individuals (1, 2, 7, 8). A 1-way direction from elevated BP to increased arterial stiffness was found in the current study cohort of adults aged years. Furthermore, a subset of 381 adults had large- and small-arterial compliance measurements available at baseline and follow-up in this study cohort. The decreased arterial elasticity (C 1 and C 2 ) measured by the HDI device has been demonstrated to be associated with incident hypertension, cardiovascular disease, stroke, heart failure events, and kidney function decline in MESA (20, 32, 33). In the current study, the 1-way direction of BP to afpwv was partly confirmed using C 1 R and C 2 R, measures related to large- and small-artery elasticity, respectively. The observation in this and our previous study (28) supports the notion that elevated BP levels result in an accelerated arterial stiffening process that begins in early life. However, the data do not preclude arterial stiffening resulting in isolated systolic hypertension in older adults. Blacks outpace other racial/ethnic groups in the United States in terms of prevalence, early onset, and severity of hypertension (34). The black-white difference in BP is seen even in childhood, with blacks showing higher levels and a faster rate of change than whites (35, 36). Furthermore, a greater BP-dependent increase in aortic stiffness in blacks than in whites was observed in a cohort of young adults aged years, pointing towards differences in mechanical properties of large arteries between these racial/ethnic groups (37). In the present study cohort of middle-aged adults, blacks showed higher levels of BP, afpwv, and systemic vascular resistance but lower levels of C 1 and C 2 than whites (Table 1). The black-white difference in C 1 and C 2 in this study cohort was consistent with the racial/ethnic difference in C 1 and C 2 observed in the MESA cohort (38). With respect to the temporal parameters, however, the cross-lagged path coefficients (ρ 1 and ρ 2 ), as shown in Appendix Table 1, did not differ significantly between blacks and whites, except for ρ 2 in the DBP-C 1 R model. Further studies are needed to understand the temporal relationships between BP and arterial stiffness and elasticity in black and white populations. This community-based longitudinal cohort study provided a unique opportunity to examine temporal relationships; however, it also had certain limitations. First, exclusion of hypertensive persons receiving pharmacological treatment might have resulted in a loss of information, because these individuals represent a subgroup who, without treatment, would be expected to have the highest BP levels; thus, this may have led to underestimation of the BP arterial stiffness relationship. Second, the relatively small sample size, especially for blacks, meant that we had limited statistical power to detect the weak-to-moderate associations. Third, data on physical activity, serum lipid concentrations, and diet were either not available or only partly available in the present study cohort, which might have led to bias in the association analyses. In summary, in a longitudinal assessment of the temporal relationship between BP and vascular stiffness using a crosslagged path analysis model, we demonstrated that elevated SBP and DBP levels precede increased large-arterial stiffness in middle-aged adults. This 1-directional relationship was supported in part by analyses of the associations between BP and large- and small-artery elasticity. The results suggest that the hemodynamic and vascular functional changes underlying hypertension differ between younger and older age periods in that the arterial wall may not be stiff enough in youth to alter BP levels during young adulthood. These findings underscore the influence of BP elevation on the arterial stiffening process during young adulthood, which improves our understanding of the mechanisms involved and has implications for treating and preventing hypertension by targeting causal factors to delay subsequent arterial stiffening, especially early in life. ACKNOWLEDGMENTS Author affiliations: Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana (Wei Chen, Shengxu Li, Camilo Fernandez, Dianjianyi Sun, Chin-Chih Lai, Tao Zhang, Lydia Bazzano); Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China (Dianjianyi Sun); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (Chin-Chih Lai); Department of Biostatistics, School of Public Health, Shandong University, Jinan, China (Tao Zhang); Preventive Cardiology Program, Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio (Elaine M. Urbina); and Department of Biostatistics and Bioinformatics, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana (Hong-Wen Deng). This study was supported by grant 5R01ES from the National Institute of Environmental Health Sciences, grant 2R01AG from the National Institute on Aging, and grant 13SDG from the American Heart Association. S.L. is a scholar of the Building Interdisciplinary Research in Women s Health program, supported by grant K12HD from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. L.B. was supported by grant R01AG from the National Institute on Aging. Conflict of interest: none declared. REFERENCES 1. Arnett DK, Evans GW, Riley WA. Arterial stiffness: a new cardiovascular risk factor? Am J Epidemiol. 1994;140(8): O Rourke MF, Mancia G. Arterial stiffness. J Hypertens. 1999; 17(1): Cecelja M, Chowienczyk P. Dissociation of aortic pulse wave velocity with risk factors for cardiovascular disease other than
9 Blood Pressure and Arterial Stiffness 607 hypertension: a systematic review. Hypertension. 2009;54(6): Mitchell GF, Guo CY, Benjamin EJ, et al. Cross-sectional correlates of increased aortic stiffness in the community: the Framingham Heart Study. Circulation. 2007;115(20): Urbina EM, Srinivasan SR, Kieltyka RL, et al. Correlates of carotid artery stiffness in young adults: the Bogalusa Heart Study. Atherosclerosis. 2004;176(1): Li S, Chen W, Srinivasan SR, et al. Influence of metabolic syndrome on arterial stiffness and its age-related change in young adults: the Bogalusa Heart Study. Atherosclerosis. 2005; 180(2): Mitchell GF. Arterial stiffness and hypertension: chicken or egg? Hypertension. 2014;64(2): Franklin SS. Arterial stiffness and hypertension: a two-way street? Hypertension. 2005;45(3): Berenson GS, McMahan CA, Voors AW, et al. Cardiovascular Risk Factors in Children: The Early Natural History of Atherosclerosis and Essential Hypertension. New York, NY: Oxford University Press; 1980: Jo CO, Lande MB, Meagher CC, et al. A simple method of measuring thoracic aortic pulse wave velocity in children: methods and normal values. J Am Soc Echocardiogr. 2010; 23(7): Hypertension Diagnostics, Inc. HD/PulseWave CR-2000 Research CardioVascular Profiling System Operator s Manual. Eagan, MN: Hypertension Diagnostics, Inc.; Kenny DA. Cross-lagged panel correlation: a test for spuriousness. Psychol Bull. 1975;82(6): Kivimäki M, Feldt T, Vahtera J, et al. Sense of coherence and health: evidence from two cross-lagged longitudinal samples. Soc Sci Med. 2000;50(4): Li CC. Path Analysis A Primer. Pacific Grove, CA: Boxwood Press; Joreskog K, Sorbom D. LISREL 8.52: Structural Equation Modeling with the SIMPLIS Command Language. Chicago, IL: Scientific Software International; Joreskog K, Sorbom D. LISREL 8.52: User s Reference Guide. Chicago, IL: Scientific Software International; Chen W, Srinivasan SR, Berenson GS. Path analysis of metabolic syndrome components in black versus white children, adolescents, and adults: the Bogalusa Heart Study. Ann Epidemiol. 2008;18(2): Kaess BM, Rong J, Larson MG, et al. Aortic stiffness, blood pressure progression, and incident hypertension. JAMA. 2012; 308(9): Liao D, Arnett DK, Tyroler HA, et al. Arterial stiffness and the development of hypertension. The ARIC Study. Hypertension. 1999;34(2): Peralta CA, Adeney KL, Shlipak MG, et al. Structural and functional vascular alterations and incident hypertension in normotensive adults: the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol. 2010;171(1): Takase H, Dohi Y, Toriyama T, et al. Brachial-ankle pulse wave velocity predicts increase in blood pressure and onset of hypertension. Am J Hypertens. 2011;24(6): Dernellis J, Panaretou M. Aortic stiffness is an independent predictor of progression to hypertension in nonhypertensive subjects. Hypertension. 2005;45(3): Najjar SS, Scuteri A, Shetty V, et al. Pulse wave velocity is an independent predictor of the longitudinal increase in systolic blood pressure and of incident hypertension in the Baltimore Longitudinal Study of Aging. J Am Coll Cardiol. 2008;51(14): Nürnberger J, Dammer S, Opazo Saez A, et al. Diastolic blood pressure is an important determinant of augmentation index and pulse wave velocity in young, healthy males. J Hum Hypertens. 2003;17(3): Tomiyama H, Yoshida M, Yamada J, et al. Arterial-cardiac destiffening following long-term antihypertensive treatment. Am J Hypertens. 2011;24(10): Tomiyama H, Hashimoto H, Hirayama Y, et al. Synergistic acceleration of arterial stiffening in the presence of raised blood pressure and raised plasma glucose. Hypertension. 2006;47(2): Benetos A, Adamopoulos C, Bureau JM, et al. Determinants of accelerated progression of arterial stiffness in normotensive subjects and in treated hypertensive subjects over a 6-year period. Circulation. 2002;105(10): Li S, Chen W, Srinivasan SR, et al. Childhood blood pressure as a predictor of arterial stiffness in young adults: the Bogalusa Heart Study. Hypertension. 2004;43(3): Aatola H, Hutri-Kähönen N, Juonala M, et al. Lifetime risk factors and arterial pulse wave velocity in adulthood: the Cardiovascular Risk in Young Finns Study. Hypertension. 2010;55(3): Koivistoinen T, Hutri-Kähönen N, Juonala M, et al. Metabolic syndrome in childhood and increased arterial stiffness in adulthood: the Cardiovascular Risk in Young Finns Study. Ann Med. 2011;43(4): Mitchell GF, Wang N, Palmisano JN, et al. Hemodynamic correlates of blood pressure across the adult age spectrum: noninvasive evaluation in the Framingham Heart Study. Circulation. 2010;122(14): Duprez DA, Jacobs DR Jr, Lutsey PL, et al. Association of small artery elasticity with incident cardiovascular disease in older adults: the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol. 2011;174(5): Peralta CA, Jacobs DR Jr, Katz R, et al. Association of pulse pressure, arterial elasticity, and endothelial function with kidney function decline among adults with estimated GFR >60 ml/min/1.73 m 2 : the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Kidney Dis. 2012;59(1): Pickering TG. Hypertension in blacks. Curr Opin Nephrol Hypertens. 1994;3(2): Voors AW, Berenson GS, Dalferes ER, et al. Racial differences in blood pressure control. Science. 1979;204(4397): Manatunga AK, Jones JJ, Pratt JH. Longitudinal assessment of blood pressures in black and white children. Hypertension. 1993;22(1): Ferreira AV, Viana MC, Mill JG, et al. Racial differences in aortic stiffness in normotensive and hypertensive adults. J Hypertens. 1999;17(5): Duprez DA, Jacobs DR Jr, Lutsey PL, et al. Race/ethnic and sex differences in large and small artery elasticity results of the Multi-Ethnic Study of Atherosclerosis (MESA). Ethn Dis. 2009;19(3): (Appendix follows)
10 608 Chen et al. Appendix Table 1. Cross-Lagged Path Coefficients for the Association of Blood Pressure With Aortic-Femoral Pulse Wave Velocity (n = 446) and Arterial Elasticity (n = 381), by Race/Ethnicity, With Adjustment for Covariates, a Bogalusa Heart Study, Model ρ 1 b Whites (n = 277) Blacks (n = 104) ρ 2 c P Value d ρ 1 b ρ 2 c Racial/Ethnic Difference P Value d P for ρ 1 P for ρ 2 SBP-afPWV 0.12 e 0.22 e NS f NS DBP-afPWV 0.10 g 0.19 e NS NS SBP-C 1 R h NS NS DBP-C 1 R g NS NS SBP-C 2 R h g NS NS DBP-C 2 R NS NS Abbreviations: afpwv, aortic-femoral pulse wave velocity; DBP, diastolic blood pressure; NS, not significant; SBP, systolic blood pressure. a Covariates included age, sex, body mass index, heart rate, smoking, diabetes, and duration of follow-up. b ρ 1 represents the path from afpwv, C 1 R,orC 2 R to BP. c ρ 2 represents the path from BP to afpwv, C 1 R,orC 2 R. d P value for difference between ρ 1 and ρ 2 within racial/ethnic groups. e For ρ 1 and ρ 2 being different from 0, P < f P > g For ρ 1 and ρ 2 being different from 0, P < h C 1 R, large-artery (capacitive) compliance systemic vascular resistance; C 2 R, small-artery (oscillatory) compliance systemic vascular resistance.
Clinical application of Arterial stiffness. pulse wave analysis pulse wave velocity
Clinical application of Arterial stiffness pulse wave analysis pulse wave velocity Arterial system 1. Large arteries: elastic arteries Aorta, carotid, iliac, Buffering reserve: store blood during systole
More informationNomogram of the Relation of Brachial-Ankle Pulse Wave Velocity with Blood Pressure
801 Original Article Nomogram of the Relation of Brachial-Ankle Pulse Wave Velocity with Blood Pressure Akira YAMASHINA, Hirofumi TOMIYAMA, Tomio ARAI, Yutaka KOJI, Minoru YAMBE, Hiroaki MOTOBE, Zydem
More informationVascular Compliance is Reduced in Geriatric People with Angiographic Coronary Atherosclerosis
The Journal of International Medical Research 2009; 37: 1443 1449 Vascular Compliance is Reduced in Geriatric People with Angiographic Coronary Atherosclerosis B-A YOU 1, H-Q GAO 1, G-S LI 2, X-Y HUO 1
More informationJournal of the American College of Cardiology Vol. 51, No. 14, by the American College of Cardiology Foundation ISSN /08/$34.
Journal of the American College of Cardiology Vol. 51, No. 14, 2008 2008 by the American College of Cardiology Foundation ISSN 0735-1097/08/$34.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2007.10.065
More informationDepartments of Cardiology and Vascular Surgery Michaelidion Cardiac Center University of Ioannina, Greece
Departments of Cardiology and Vascular Surgery Michaelidion Cardiac Center University of Ioannina, Greece ARGYRIS Vassilis, PEROULIS Michalis, MATSAGKAS Miltiadis, BECHLIOULIS Aris, MICHALIS Lampros, NAKA
More informationWhich method is better to measure arterial stiffness; augmentation index, pulse wave velocity, carotid distensibility? 전북의대내과 김원호
Which method is better to measure arterial stiffness; augmentation index, pulse wave velocity, carotid distensibility? 전북의대내과 김원호 Arterial stiffness Arterial stiffness is inversely related to arterial
More informationTODAY S TOPIC Blood Pressure & Pulse Wave Measurement Combined in One Procedure Re-classification of Risk Patients
CARDIOVASCULAR TECHNOLOGY AND INDICATION SERVICE TODAY S TOPIC Blood Pressure & Pulse Wave Measurement Combined in One Procedure Re-classification of Risk Patients SERIES Hypertension Management in the
More informationDirector of the Israeli Institute for Quality in Medicine Israeli Medical Association July 1st, 2016
The differential effect of Atherosclerosis on end organ damage in adult and elderly patients with CVRF: New Algorithm for Hypertension Diagnosis and Treatment R. Zimlichman, FAHA, FASH, FESC, FESH Chief
More informationArterial Pressure in CKD5 - ESRD Population Gérard M. London
Arterial Pressure in CKD5 - ESRD Population Gérard M. London INSERM U970 Paris 150 SBP & DBP by Age, Ethnicity &Gender (US Population Age 18 Years, NHANES III) 150 SBP (mm Hg) 130 110 80 Non-Hispanic Black
More informationBlood Pressure Response Under Chronic Antihypertensive Drug Therapy
Journal of the American College of Cardiology Vol. 53, No. 5, 29 29 by the American College of Cardiology Foundation ISSN 735-197/9/$36. Published by Elsevier Inc. doi:1.116/j.jacc.28.9.46 Hypertension
More informationThe Seventh Report of the Joint National Committee on
Aortic Stiffness Is an Independent Predictor of Progression to Hypertension in Nonhypertensive Subjects John Dernellis, Maria Panaretou Abstract Aortic stiffness may predict progression to hypertension
More informationCoronary artery disease (CAD) risk factors
Background Coronary artery disease (CAD) risk factors CAD Risk factors Hypertension Insulin resistance /diabetes Dyslipidemia Smoking /Obesity Male gender/ Old age Atherosclerosis Arterial stiffness precedes
More informationArterial stiffness and central BP as goals for antihypertensive therapy in pre- and elderly. Piotr Jankowski
Arterial stiffness and central BP as goals for antihypertensive therapy in pre- and elderly Piotr Jankowski I Department of Cardiology and Hypertension CM UJ, Kraków, Poland piotrjankowski@interia.pl Vienna,
More informationRelationship between Arterial Stiffness and the Risk of Coronary Artery Disease in Subjects with and without Metabolic Syndrome
243 Original Article Hypertens Res Vol.30 (2007) No.3 p.243-247 Relationship between Arterial Stiffness and the Risk of Coronary Artery Disease in Subjects with and without Metabolic Syndrome Yutaka KOJI
More informationAdult Hypertension Is Associated With Blood Pressure Variability in Childhood in Blacks and Whites: The Bogalusa Heart Study
nature publishing group original contributions Adult Hypertension Is Associated With Blood Pressure Variability in Childhood in Blacks and Whites: The Bogalusa Heart Study Wei Chen 1,2, Sathanur R. Srinivasan
More informationPulse wave velocity, augmentation index and arterial age in students
Pulse wave velocity, augmentation index and arterial age in students IOANA MOZOS 1, SERBAN GLIGOR 2 1 Department of Functional Sciences Victor Babes University of Medicine and Pharmacy Timisoara ROMANIA
More informationEffects of Renin-Angiotensin System blockade on arterial stiffness and function. Gérard M. LONDON Manhès Hospital Paris, France
Effects of Renin-Angiotensin System blockade on arterial stiffness and function Gérard M. LONDON Manhès Hospital Paris, France Determinants of vascular overload (afterload) on the heart Peripheral Resistance
More informationWhen should you treat blood pressure in the young?
ESC Stockholm - Dilemmas in Cardiovascular Disease Prevention in the Young: 30 th August 2010 When should you treat blood pressure in the young? Bryan Williams MD FRCP FAHA FESC Professor of Medicine Department
More informationDifferences in Effects of Age and Blood Pressure on Augmentation Index
Original Article Differences in Effects of Age and Blood Pressure on Augmentation Index Hirofumi Tomiyama, 1 Mari Odaira, 1 Kazutaka Kimura, 1 Chisa Matsumoto, 1 Kazuki Shiina, 1 Kazuo Eguchi, 2 Hiroshi
More informationChapter 01. General introduction and outline
Chapter 01 General introduction and outline General introduction and outline Introduction Cardiovascular disease is the main cause of death in patients with hypertension and in patients with type-1 diabetes
More informationAdolescent Hypertension Roles of obesity and hyperuricemia. Daniel Landau, MD Pediatrics, Soroka University Medical Center
Adolescent Hypertension Roles of obesity and hyperuricemia Daniel Landau, MD Pediatrics, Soroka University Medical Center Blood Pressure Tables BP standards based on sex, age, and height provide a precise
More informationΗ σημασία της αρτηριακής σκληρίας στην εκτίμηση της διαστολικής δυσλειτουργίας στην υπέρταση. Θεραπευτικές παρεμβάσεις
Η σημασία της αρτηριακής σκληρίας στην εκτίμηση της διαστολικής δυσλειτουργίας στην υπέρταση. Θεραπευτικές παρεμβάσεις Ελένη Τριανταφυλλίδη Επιμελήτρια Α Β Πανεπιστημιακή Καρδιολογική Κλινική Αττικό Νοσοκομείο
More informationChanges in Blood Pressure and Vascular Physiology: Markers for Cardiovascular Disease
...SYMPOSIUM PROCEEDINGS... Changes in Blood Pressure and Vascular Physiology: Markers for Cardiovascular Disease Based on a presentation by Joseph L. Izzo, Jr., MD Presentation Summary Changes in systolic
More informationORIGINAL INVESTIGATION. C-Reactive Protein Concentration and Incident Hypertension in Young Adults
ORIGINAL INVESTIGATION C-Reactive Protein Concentration and Incident Hypertension in Young Adults The CARDIA Study Susan G. Lakoski, MD, MS; David M. Herrington, MD, MHS; David M. Siscovick, MD, MPH; Stephen
More information3 Aging, Arterial Stiffness,
Chapter 3 / Mechanisms of Hypertension 23 3 Aging, Arterial Stiffness, and Systolic Hypertension Joseph L. Izzo, Jr., MD CONTENTS INTRODUCTION POPULATION STUDIES PATHOPHYSIOLOGY NONINVASIVE MEASUREMENT
More informationArterial Age and Shift Work
340 Arterial Age and Shift Work Ioana Mozos 1*, Liliana Filimon 2 1 Department of Functional Sciences, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania 2 Department of Occupational
More informationEVALUATION OF NONINVASIVE PULSE TRANSIT TIME METHODOLOGIES FOR DIAGNOSIS OF HYPERTENSION DANIEL JOHN BADGER. A thesis submitted to the
EVALUATION OF NONINVASIVE PULSE TRANSIT TIME METHODOLOGIES FOR DIAGNOSIS OF HYPERTENSION by DANIEL JOHN BADGER A thesis submitted to the Graduate School-New Brunswick Rutgers, The State University of New
More informationThe augmentation index (AI) is the ratio of the ejection
Augmentation Index Is Elevated in Aortic Aneurysm and Dissection Yasushige Shingu, MD, Norihiko Shiiya, MD, PhD, Tomonori Ooka, MD, PhD, Tsuyoshi Tachibana, MD, PhD, Suguru Kubota, MD, PhD, Satoshi Morita,
More informationCardiovascular Diseases Detecting via Pulse Analysis
Engineering, 2013, 5, 176-180 http://dx.doi.org/10.4236/eng.2013.510b038 Published Online October 2013 (http://www.scirp.org/journal/eng) Cardiovascular Diseases Detecting via Pulse Analysis Jingjing Xia,
More informationIS PVR THE RIGHT METRIC FOR RV AFTERLOAD?
Echo Doppler Assessment of PVR The Children s Hospital Denver, CO Robin Shandas Professor of Pediatrics, Cardiology Professor of Mechanical Engineering Director, Center for Bioengineering University of
More informationMeasurement of Arterial Stiffness: Why should I measure both PWA and PWV?
Measurement of Arterial Stiffness: Why should I measure both PWA and PWV? Central blood pressure and measures of arterial stiffness have been shown to be powerful predictors of major cardiovascular events,
More informationHTA ET DIALYSE DR ALAIN GUERIN
HTA ET DIALYSE DR ALAIN GUERIN Cardiovascular Disease Mortality General Population vs ESRD Dialysis Patients 100 Annual CVD Mortality (%) 10 1 0.1 0.01 0.001 25-34 35-44 45-54 55-64 66-74 75-84 >85 Age
More information...SELECTED ABSTRACTS...
The following abstracts, from peer-reviewed journals containing literature on vascular compliance and hypertension, were selected for their relevance to this conference and to a managed care perspective.
More informationARIC Manuscript Proposal # PC Reviewed: 2/10/09 Status: A Priority: 2 SC Reviewed: Status: Priority:
ARIC Manuscript Proposal # 1475 PC Reviewed: 2/10/09 Status: A Priority: 2 SC Reviewed: Status: Priority: 1.a. Full Title: Hypertension, left ventricular hypertrophy, and risk of incident hospitalized
More informationEndothelial function is impaired in women who had pre-eclampsia
Endothelial function is impaired in women who had pre-eclampsia Christian Delles, Catriona E Brown, Joanne Flynn, David M Carty Institute of Cardiovascular and Medical Sciences University of Glasgow United
More informationComparison of Abnormal Cholesterol in Children, Adolescent & Adults in the United States, : Review
European Journal of Environment and Public Health, 2017, 1(1), 04 ISSN: 2468-1997 Comparison of Abnormal Cholesterol in Children, Adolescent & Adults in the United States, 2011-2014: Review Rasaki Aranmolate
More informationThe Conduit Artery Functional Endpoint (CAFE) study in ASCOT
(2001) 15, Suppl 1, S69 S73 2001 Nature Publishing Group All rights reserved 0950-9240/01 $15.00 www.nature.com/jhh A Sub-study of the ASCOT Trial The Conduit Artery Functional Endpoint (CAFE) study in
More informationCentral pressures and prediction of cardiovascular events in erectile dysfunction patients
Central pressures and prediction of cardiovascular events in erectile dysfunction patients N. Ioakeimidis, K. Rokkas, A. Angelis, Z. Kratiras, M. Abdelrasoul, C. Georgakopoulos, D. Terentes-Printzios,
More informationDiverse Techniques to Detect Arterial Stiffness
Diverse Techniques to Detect Arterial Stiffness 백상홍가톨릭대학교강남성모병원순환기내과 혈관연구회창립심포지움 2005, 3, 3 Small Arteries Arterial Remodelling Thickness Internal diameter Wall / Lumen Large Arteries Cross sectional
More informationVital Signs. Vital Signs. Pulse. Temperature. Respiration. Blood Pressure
Vital Signs Jarvis, Chapter 9 Vital Signs Classic Vital Signs TPR/BP Temperature Pulse Respirations Blood Pressure Additional Vital Signs Height Weight BMI (Kg/m2) or (702Xlbs/in2) Supine, orthostatic
More informationASSOCIATION OF SYSTEMIC INFLAMMATION WITH ARTERIAL STIFFNESS IN HYPERTENSION
ASSOCIATION OF SYSTEMIC INFLAMMATION WITH ARTERIAL STIFFNESS IN HYPERTENSION Jung-Sun Kim a and Sungha Park a,b, a Division of Cardiology, b Cardiovascular Genome Center, Yonsei Cardiovascular Center,
More informationAssociation between arterial stiffness and cardiovascular risk factors in a pediatric population
+ Association between arterial stiffness and cardiovascular risk factors in a pediatric population Maria Perticone Department of Experimental and Clinical Medicine University Magna Graecia of Catanzaro
More informationDeterminants of Accelerated Progression of Arterial Stiffness in Normotensive Subjects and in Treated Hypertensive Subjects Over a 6-Year Period
Determinants of Accelerated Progression of Arterial Stiffness in Normotensive and in Treated Hypertensive Over a 6-Year Period Athanase Benetos, MD, PhD; Chris Adamopoulos, MD; Jeanne-Marie Bureau, MD;
More informationAPPLICATION OF PHYSICAL METHODS FOR DETERMINATION OF FUNCTIONAL PARAMETERS OF ARTERIES IN RHEUMATIC PATIENTS
APPLICATION OF PHYSICAL METHODS FOR DETERMINATION OF FUNCTIONAL PARAMETERS OF ARTERIES IN RHEUMATIC PATIENTS Jolanta DADONIENE*, Alma CYPIENE**, Diana KARPEC***, Rita RUGIENE*, Sigita STROPUVIENE*, Aleksandras
More informationCARDIOVASCULAR RISK FACTORS & TARGET ORGAN DAMAGE IN GREEK HYPERTENSIVES
CARDIOVASCULAR RISK FACTORS & TARGET ORGAN DAMAGE IN GREEK HYPERTENSIVES C. Liakos, 1 G. Vyssoulis, 1 E. Karpanou, 2 S-M. Kyvelou, 1 V. Tzamou, 1 A. Michaelides, 1 A. Triantafyllou, 1 P. Spanos, 1 C. Stefanadis
More informationClinical Investigations
Clinical Investigations Type 2 Diabetes Is Associated With Increased Pulse Wave Velocity Measured at Different Sites of the Arterial System but Not Augmentation Index in a Chinese Population Address for
More informationHOW CONSISTENT ARE THE BLOOD PRESSURE AND PULSE RATE MEASUREMENTS OF THE ELECTRONIC BP APPARATUS AND THE MANUAL SPHYGMOMANOMETER
HOW CONSISTENT ARE THE BLOOD PRESSURE AND PULSE RATE MEASUREMENTS OF THE ELECTRONIC BP APPARATUS AND THE MANUAL SPHYGMOMANOMETER Naser KA. Teaching Hospital Peradeniya, Peradeniya, Sri Lanka Zawahir S
More informationComparison of the Assessment of Orthostatic Hypotension Using Peripheral and Central Blood Pressure Measurements
Original Article J Clin Med Res. 2018;10(4):309-313 Comparison of the Assessment of Orthostatic Hypotension Using Peripheral and Central Blood Pressure Measurements Kannayiram Alagiakrishnan a, d, Ruojin
More informationTest-Retest Reproducibility of the Wideband External Pulse Device
Test-Retest Reproducibility of the Wideband External Pulse Device Cara A. Wasywich, FRACP Warwick Bagg, MD Gillian Whalley, MSc James Aoina, BSc Helen Walsh, BSc Greg Gamble, MSc Andrew Lowe, PhD Nigel
More informationA Comparative Study of Methods of Measurement of Peripheral Pulse Waveform
2009. Vol.30. No.3. 98-105 The Journal of Korean Oriental Medicine Original Article A Comparative Study of Methods of Measurement of Peripheral Pulse Waveform Hee-Jung Kang 1, Yong-Heum Lee 2, Kyung-Chul
More informationEffects of coexisting hypertension and type II diabetes mellitus on arterial stiffness
(2004) 18, 469 473 & 2004 Nature Publishing Group All rights reserved 0950-9240/04 $30.00 www.nature.com/jhh ORIGINAL ARTICLE Effects of coexisting hypertension and type II diabetes mellitus on arterial
More informationHemodynamic Correlates of Blood Pressure in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study
ORIGINAL PAPER Hemodynamic Correlates of Blood Pressure in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study Hirofumi Tanaka, PhD; 1 Gerardo Heiss, MD; 2 Elizabeth L. McCabe, PhD; 3 Michelle
More informationEffects of Kidney Disease on Cardiovascular Morbidity and Mortality
Effects of Kidney Disease on Cardiovascular Morbidity and Mortality Joachim H. Ix, MD, MAS Assistant Professor in Residence Division of Nephrology University of California San Diego, and Veterans Affairs
More informationDetermination of age-related increases in large artery stiffness by digital pulse contour analysis
Clinical Science (2002) 103, 371 377 (Printed in Great Britain) 371 Determination of age-related increases in large artery stiffness by digital pulse contour analysis S. C. MILLASSEAU, R. P. KELLY, J.
More informationPulse pressure as a haemodynamic variable in systolic heart failure Petrie, Colin James
University of Groningen Pulse pressure as a haemodynamic variable in systolic heart failure Petrie, Colin James IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you
More informationSlide notes: References:
1 2 3 Cut-off values for the definition of hypertension are systolic blood pressure (SBP) 135 and/or diastolic blood pressure (DBP) 85 mmhg for home blood pressure monitoring (HBPM) and daytime ambulatory
More informationUniversity of Padova, Padua, Italy, and HARVEST Study Group, Italy
University of Padova, Padua, Italy, and HARVEST Study Group, Italy ISOLATED SYSTOLIC HYPERTENSION IN THE YOUNG DOES NOT IMPLY AN INCREASED RISK OF FUTURE HYPERTENSION NEEDING TREATMENT Mos L, Saladini
More informationBrachial artery hyperaemic blood flow velocity and left ventricular geometry
(2011), 1 5 & 2011 Macmillan Publishers Limited All rights reserved 0950-9240/11 www.nature.com/jhh ORIGINAL ARTICLE Brachial artery hyperaemic blood flow velocity and left ventricular geometry SJ Järhult,
More informationDiastolic hypertension, defined as a diastolic blood pressure
Hypertension Predictors of New-Onset Diastolic and Systolic Hypertension The Framingham Heart Study Stanley S. Franklin, MD; Jose R. Pio, BS; Nathan D. Wong, PhD; Martin G. Larson, ScD; Eric P. Leip, MS;
More informationLow fractional diastolic pressure in the ascending aorta increased the risk of coronary heart disease
(2002) 16, 837 841 & 2002 Nature Publishing Group All rights reserved 0950-9240/02 $25.00 www.nature.com/jhh ORIGINAL ARTICLE Low fractional diastolic pressure in the ascending aorta increased the risk
More informationSmoking is a major risk factor in the development and
Rapid Communication Effect of Smoking on Arterial Stiffness and Pulse Pressure Amplification Azra Mahmud, John Feely Abstract The brachial artery pressure waveform is abnormal in smokers, but the effect
More informationExternal Oscillatory Blood Pressure - EOBPTM
External Oscillatory Blood Pressure - EOBPTM Development of Novel Principle To Measure Blood Pressure Mindaugas Pranevicius, M.D., Osvaldas Pranevicius, M.D., Ph.D. Pranevicius Biotech Inc., Forest Hills,
More informationMeasurement and Analysis of Radial Artery Blood Velocity in Young Normotensive Subjects
Informatica Medica Slovenica 2003; 8(1) 15 Research Paper Measurement and Analysis of Radial Artery Blood in Young Normotensive Subjects Damjan Oseli, Iztok Lebar Bajec, Matjaž Klemenc, Nikolaj Zimic Abstract.
More informationSpecial Lecture 10/28/2012
Special Lecture 10/28/2012 HYPERTENSION Dr. HN Mayrovitz Special Lecture 10/28/2012 Arterial Blood Pressure (ABP) - Definitions ABP Review Indirect Oscillographic Method Resistance (R), Compliance (C)
More informationCentral Pressures and Prehypertension
Central Pressures and Prehypertension Charalambos Vlachopoulos Associate Professor of Cardiology 1 st Cardiology Dept Athens Medical School Central Pressures and Prehypertension Charalambos Vlachopoulos
More informationVarious Indices of Arterial Stiffness: Are They Closely Related or Distinctly Different?
Received: October 19, 2016 Accepted after revision: February 8, 2017 Published online: April 7, 2017 Mini-Review Various Indices of Arterial Stiffness: Are They Closely Related or Distinctly Hirofumi Tanaka
More informationEstimated Pulse Wave Velocity Calculated from Age and Mean Arterial Blood Pressure
Received: August 19, 2016 Accepted after revision: November 4, 2016 Published online: December 1, 2016 2235 8676/16/0044 0175$39.50/0 Mini-Review Estimated Pulse Wave Velocity Calculated from Age and Mean
More informationPreventing Early Vascular Ageing (EVA) and its hemodynamic changes
Translational Research 31 st October 2013, Moscow Preventing Early Vascular Ageing (EVA) and its hemodynamic changes Peter M Nilsson, MD, PhD Department of Clinical Sciences Lund University University
More informationA comparison of diabetic and nondiabetic subjects
Pathophysiology/Complications O R I G I N A L A R T I C L E The Aging of Elastic and Muscular Arteries A comparison of diabetic and nondiabetic subjects JAMES D. CAMERON, MD, MENGSC 1 CHRISTOPHER J. BULPITT,
More informationImpedance Cardiography (ICG) Application of ICG for Hypertension Management
Application of ICG for Hypertension Management 1mA @ 100 khz Impedance Cardiography (ICG) Non-invasive Beat-to-beat Hemodynamic Monitoring Diastole Systole Aortic valve is closed No blood flow in the aorta
More informationCardiovascular Diseases in CKD
1 Cardiovascular Diseases in CKD Hung-Chun Chen, MD, PhD. Kaohsiung Medical University Taiwan Society of Nephrology 1 2 High Prevalence of CVD in CKD & ESRD Foley RN et al, AJKD 1998; 32(suppl 3):S112-9
More informationThe arterial system has a dual function:
Hellenic J Cardiol 2010; 51: 385-390 Editorial Aortic Stiffness: Prime Time for Integration into Clinical Practice? Charalambos Vlachopoulos, Nikolaos Alexopoulos, Christodoulos Stefanadis Peripheral Vessels
More informationLong-term Blood Pressure Variability throughout Young Adulthood and Cognitive Function in Midlife; CARDIA study
The EPI/NPAM Spring 2014 Scientific Sessions, Hilton San Francisco Union Square, San Francisco, CA Northwestern Mar. 18-21, 2014 University Feinberg School of Medicine Long-term Blood Pressure Variability
More informationPreventing heart disease by controlling hypertension: Impact of hypertensive subtype, stage, age, and sex
Prevention and Rehabilitation Preventing heart disease by controlling hypertension: Impact of hypertensive subtype, stage, age, and sex Nathan D. Wong, PhD, a Gaurav Thakral, BS, a Stanley S. Franklin,
More information4/4/17 HYPERTENSION TARGETS: WHAT DO WE DO NOW? SET THE STAGE BP IN CLINICAL TRIALS?
HYPERTENSION TARGETS: WHAT DO WE DO NOW? MICHAEL LEFEVRE, MD, MSPH PROFESSOR AND VICE CHAIR DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE UNIVERSITY OF MISSOURI 4/4/17 DISCLOSURE: MEMBER OF THE JNC 8 PANEL
More informationAnalyzing diastolic and systolic blood pressure individually or jointly?
Analyzing diastolic and systolic blood pressure individually or jointly? Chenglin Ye a, Gary Foster a, Lisa Dolovich b, Lehana Thabane a,c a. Department of Clinical Epidemiology and Biostatistics, McMaster
More informationImpedance Cardiography (ICG) Method, Technology and Validity
Method, Technology and Validity Hemodynamic Basics Cardiovascular System Cardiac Output (CO) Mean arterial pressure (MAP) Variable resistance (SVR) Aortic valve Left ventricle Elastic arteries / Aorta
More informationTheoretical and practical questions in the evaluation of arterial function Miklós Illyés MD. Ph.D.
Theoretical and practical questions in the evaluation of arterial function Miklós Illyés MD. Ph.D. TensioMed Arterial Stiffness Centre, Budapest Heart Institute, Faculty of Medicine, University of Pécs
More informationName of Policy: Computerized Pulse Waveform Analysis
Name of Policy: Computerized Pulse Waveform Analysis Policy #: 020 Latest Review Date: September 2012 Category: Medical Policy Grade: Active Policy but no longer scheduled for regular literature reviews
More informationClinical usefulness of the second peak of radial systolic blood pressure for estimation of aortic systolic blood pressure
(2009) 23, 538 545 & 2009 Macmillan Publishers Limited All rights reserved 0950-9240/09 $32.00 www.nature.com/jhh ORIGINAL ARTICLE Clinical usefulness of the second peak of radial systolic blood pressure
More informationThe Effect of Isosorbide Dinitrate Intravenous Injection on the Hemodynamics and Arterial Stiffness of Patients with Isolated Systolic Hypertension
Original ORIGINAL Article ARTICLE Korean Circulation J 2007;37:359-364 ISSN 1738-5520 c 2007, The Korean Society of Circulation The Effect of Isosorbide Dinitrate Intravenous Injection on the Hemodynamics
More informationArterial stiffness index: A new evaluation for arterial stiffness in elderly patients with essential hypertension
Blackwell Science, LtdOxford, UK GGIGeriatrics and Gerontology International1444-15862002 Blackwell Science Asia Pty Ltd 24December 2002 045 ASI in elderly hypertensive patients M Kaibe et al. 10.1046/j.1444-1586.2002.00045.x
More informationMean Arterial Pressure Classification: A Better Tool for Statistical Interpretation of Blood Pressure Related Risk Covariates
Cardiology and Angiology: An International Journal 6(1): XX-XX, 2017; Article no.ca.30255 ISSN: 2347-520X, NLM ID: 101658392 SCIENCEDOMAIN international www.sciencedomain.org Mean Arterial Pressure Classification:
More informationCigarette smoking is one of the most important avoidable
Arterial Stiffness Impact of Smoking and Smoking Cessation on Arterial Stiffness and Aortic Wave Reflection in Hypertension Noor A. Jatoi, Paula Jerrard-Dunne, John Feely, Azra Mahmud Abstract Cigarette
More informationPULSE WAVE VELOCITY AS A NEW ASSESSMENT TOOL FOR ATHEROSCLEROSIS
PULSE WAVE VELOCITY AS A NEW ASSESSMENT TOOL FOR ATHEROSCLEROSIS Introduction Hirohide Yokokawa, M.D., Ph.D. 1 , Aya Goto, M.D., MPH, Ph.D. 2 , and Seiji Yasumura, M.D., Ph.D.
More informationTodd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM
Todd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM Faculty Disclosure I have no financial interest to disclose No off-label use of medications will be discussed FIFTH ANNUAL SYMPOSIUM Recognize changes between
More informationCHAPTER 4 ESTIMATION OF BLOOD PRESSURE USING PULSE TRANSIT TIME
64 CHAPTER 4 ESTIMATION OF BLOOD PRESSURE USING PULSE TRANSIT TIME 4.1 GENERAL This chapter presents the methodologies that are usually adopted for the measurement of blood pressure, heart rate and pulse
More informationDespite the acknowledged importance of hypertension as
Does the Relation of Blood Pressure to Coronary Heart Disease Risk Change With Aging? The Framingham Heart Study Stanley S. Franklin, MD; Martin G. Larson, ScD; Shehzad A. Khan, BS; Nathan D. Wong, PhD;
More information(received 23 September 2004; accepted 18 October 2004)
ARCHIVES OF ACOUSTICS 29, 4, 597 606 (2004) NON-INVASIVE ULTRASONIC EXAMINATION OF THE LOCAL PULSE WAVE VELOCITY IN THE COMMON CAROTID ARTERY T. POWAŁOWSKI, Z. TRAWIŃSKI Institute of Fundamental Technological
More informationBlood pressure (BP) is an established major risk factor for
Pulse Pressure Compared With Other Blood Pressure Indexes in the Prediction of 25-Year Cardiovascular and All-Cause Mortality Rates The Chicago Heart Association Detection Project in Industry Study Katsuyuki
More informationOsama Sanad (MD) Prof. of Cardiology Benha University 2016
Osama Sanad (MD) Prof. of Cardiology Benha University 2016 Back in time. 1912 Back in time. 1912 No body knows that hypertension is a lethal disease Hypertension in 1940s Among anti-hypertensives mentioned
More informationAssociations between cardiovascular risk factors and
Predictors of Carotid Intima-Media Thickness Progression in Young Adults The Bogalusa Heart Study Heather M. Johnson, MD; Pamela S. Douglas, MD; Sathanur R. Srinivasan, PhD; M. Gene Bond, PhD; Rong Tang,
More informationThe New England Journal of Medicine ASSOCIATION BETWEEN MULTIPLE CARDIOVASCULAR RISK FACTORS AND ATHEROSCLEROSIS IN CHILDREN AND YOUNG ADULTS
ASSOCIATION BETWEEN MULTIPLE CARDIOVASCULAR RISK FACTORS AND ATHEROSCLEROSIS IN CHILDREN AND YOUNG ADULTS GERALD S. BERENSON, M.D., SATHANUR R. SRINIVASAN, PH.D., WEIHANG BAO, PH.D., WILLIAM P. NEWMAN
More informationCan Arterial Stiffness Be Reversed? And If So, What Are the Benefits?
...SYMPOSIUM PROCEEDINGS... Can Arterial Stiffness Be Reversed? And If So, What Are the Benefits? Based on a presentation by Michel E. Safar, MD Presentation Summary Systolic and diastolic blood pressure
More informationPrevalence of diabetes and impaired fasting glucose in Uygur children of Xinjiang, China
Prevalence of diabetes and impaired fasting glucose in Uygur children of Xinjiang, China J. Zhang 1, Y.T. Ma 1, X. Xie 1, Y.N. Yang 1, F. Liu 2, X.M. Li 1, Z.Y. Fu 1, X. Ma 1, B.D. Chen 2, Y.Y. Zheng 1,
More informationJournal of the American College of Cardiology Vol. 41, No. 6, by the American College of Cardiology Foundation ISSN /03/$30.
Journal of the American College of Cardiology Vol. 41, No. 6, 2003 2003 by the American College of Cardiology Foundation ISSN 0735-1097/03/$30.00 Published by Elsevier Science Inc. doi:10.1016/s0735-1097(03)00052-4
More informationMechanisms of heart failure with normal EF Arterial stiffness and ventricular-arterial coupling. What is the pathophysiology at presentation?
Mechanisms of heart failure with normal EF Arterial stiffness and ventricular-arterial coupling What is the pathophysiology at presentation? Ventricular-arterial coupling elastance Central arterial pressure
More informationPediatric Blood Pressure and Adult Preclinical Markers of Cardiovascular Disease
Pediatric Blood Pressure and Adult Preclinical Markers of Cardiovascular Disease Costan G. Magnussen 1,2 and Kylie J. Smith 1 1 Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
More informationHeart Failure with Preserved Ejection Fraction: Mechanisms and Management
Heart Failure with Preserved Ejection Fraction: Mechanisms and Management Jay N. Cohn, M.D. Professor of Medicine Director, Rasmussen Center for Cardiovascular Disease Prevention University of Minnesota
More information