Arterial stiffness in black adults from Angola and Brazil

Ethnicity is an important determinant of blood pressure levels, being black individuals affected more than any other ethnic group. Arterial stiffening, an independent risk factor for hypertension, is also influenced by ethnicity. However, whether black individuals from different continents would have different patterns of arterial stiffening is still unknown. Thus, the authors aimed to compare pulse wave velocity (PWV) in black subjects living in Angola and Brazil. A total of 677 black individuals from two independent cross‐sectional studies conducted in Brazil and Angola were included in this analysis. Carotid‐to‐femoral PWV was measured following the same protocols for both studies, as well as clinical and anthropometric variables. Adjusted PWV was higher in Brazilian blacks than in Angolans, regardless of sex (men from Brazil: 10.7 ± 1.8 vs men from Angola: 9.9 ± 1.8 m/s, P < .001; women from Brazil: 10.3 ± 1.5 vs women from Angola: 9.2 ± 1.3 m/s, P < .001). Although the cf‐PWV was higher in Brazilian blacks, the age‐related increase in cf‐PWV was higher in Angolan men compared to Brazilians, but not in women. SBP showed the strongest association with cf‐PWV, regardless of sex and country. However, age was associated with cf‐PWV in all groups, except in Brazilian men. Our results clearly show a difference in PWV between two black populations, and highlight for sex differences in the hemodynamic parameters that might affect blood pressure levels in these populations.     

Acute Effects of Submaximal Endurance Training on Arterial Stiffness in Healthy Middle‐ and Long‐Distance Runners

Measures of arterial stiffness are indicators for cardiovascular health and predictors of cardiovascular events. Arterial stiffness is responsive to acute physiologic stressors such as exercise. However, the acute effects of intensive exercise and recovery on arterial stiffness are controversial. Thirty‐seven healthy middle‐ and long‐distance runners (33 men, mean age 26.5±6.6 years) underwent evaluation of their cardiovascular stiffness at rest, after a 15‐minute warm‐up, immediately after vigorous running 3 km at the pace of their 10‐km personal best, and finally 30 minutes after terminating their workout. Peripheral and central systolic blood pressure, as well as augmentation index and pulse wave velocity (PWV), increased during exercise in comparison to baseline (P<.001, general linear model). Thirty minutes after terminating the workout, a drop in peripheral blood pressure (P<.001), central blood pressure (P<.001), and PWV (P=.001) below baseline was observed. Therefore, the authors found that exercise of either moderate or vigorous intensity causes a temporary increase in arterial stiffness in middle‐ and long‐distance runners.     

Salt Loading and Potassium Supplementation: Effects on Ambulatory Arterial Stiffness Index and Endothelin‐1 Levels in Normotensive and Mild Hypertensive Patients

The authors investigated effects of excessive salt intake and potassium supplementation on ambulatory arterial stiffness index (AASI) and endothelin‐1 (ET‐1) in salt‐sensitive and non–salt‐sensitive individuals. AASI and symmetric AASI (s‐AASI) were used as indicators of arterial stiffness. Plasma ET‐1 levels were used as an index of endothelial function. Chronic salt‐loading and potassium supplementation were studied in 155 normotensive to mild hypertensive patients from rural northern China. After 3 days of baseline investigation, participants were maintained sequentially for 7 days each on diets of low salt (51.3 mmol/d), high salt (307.7 mmol/d), and high salt+potassium (60 mmol/d). Ambulatory 24‐hour blood pressure (BP) and plasma ET‐1 were measured at baseline and on the last 2 days of each intervention. High‐salt intervention significantly increased BP, AASI, s‐AASI (all P<.001); potassium supplementation reversed increased plasma ET‐1 levels. High‐salt–induced changes in BP, s‐AASI, and plasma ET‐1 were greater in salt‐sensitive individuals. Potassium supplementation decreased systolic BP and ET‐1 to a significantly greater extent in salt‐sensitive vs non–salt‐sensitive individuals (P<.001). Significant correlations were identified between s‐AASI and ET‐1 change ratios in response to both high‐salt intervention and potassium supplementation (P<.001). Reducing dietary salt and increasing daily potassium improves arterial compliance and ameliorates endothelial dysfunction.     

Arterial stiffness in elderly patients with normotension and hypertension in Brazil

Data on arterial stiffness in older populations, according to blood pressure (BP) levels, are scarce in Brazil. The objective of this study was to establish reference values for core measures of arterial stiffness, including carotid‐femoral pulse wave velocity (cf‐PWV) and aortic augmentation index (AIx), in a cohort of older individuals with normotension (NT) and hypertension. Cross‐sectional analysis was performed with applanation tonometry data from 1192 patients aged 60 years or older. The authors classified patients according to their BP levels as having NT, controlled hypertension (CH), and uncontrolled hypertension (UH). The cf‐PWV values were 9.11 ± 0.16 m/s (NT), 9.12 ± 0.18 m/s (CH), and 9.42 ± 2.2 m/s (UH) (P < 0.005; UH vs NT and CH). The AIx was 33.3% for the entire cohort and similar across all groups. The cf‐PWV increased with age but reached a ceiling at 75 years. Compared with men, women had a higher AIx but similar cf‐PWV levels. In conclusion, the markers of arterial stiffness were similar among individuals with NT/CH and higher among individuals with UH.     

Aortic blood pressure and arterial stiffness in patients with controlled resistant and non‐resistant hypertension

The purpose of the current study was to determine whether aortic blood pressure (BP) and arterial stiffness are greater in patients with controlled resistant hypertension (RHTN) than controlled non‐resistant hypertension (non‐RHTN) despite similar clinic BP level. Participants were recruited from University of Alabama at Birmingham (UAB) Hypertension Clinic. Controlled hypertension was defined as automated office BP measurement with BP < 135/85 mm Hg. A total of 141 participants were evaluated by pulse wave analysis (PWA) and carotid‐femoral pulse wave velocity (cf‐PWV). Among them, 75 patients had controlled RHTN with use of 4 or more antihypertensive medications and 56 patients had controlled non‐RHTN with use of 3 or less antihypertensive medications. Compared to patients with controlled non‐RHTN, those with controlled RHTN were more likely to be African American and had a higher prevalence of diabetes mellitus and congestive heart failure. The mean number of antihypertensive medications was greater in patients with controlled RHTN (4.4 ± 0.8 vs 2.3 ± 0.7, P < .001). Clinic brachial BP, aortic BP, augmentation pressure (AP), augmentation index normalized for heart rate of 75 beats per minute (AIx@75) and cf‐PWV were similar in both groups. In summary, there was no significant difference in central BP or arterial stiffness between patients with controlled RHTN and controlled non‐RHTN. These findings suggest that the higher residual cardiovascular risk observed in patients with RHTN after achieving BP control compared to patients with more easily controlled hypertension is not likely attributable to persistent differences in central BP and arterial stiffness.     

Monocyte Chemoattractant Protein‐1 and Large Artery Structure and Function in Young Individuals: The African‐PREDICT Study

To better understand hypertension development, the authors determined whether monocyte chemoattractant protein‐1 (MCP‐1) is associated with arterial stiffness (pulse wave velocity [PWV]) and carotid intima‐media wall thickness (cIMT) in a young apparently healthy black and white population (N=403, aged 20–30 years). Carotid‐femoral PWV, central systolic blood pressure, and cIMT were measured, and MCP‐1, reactive oxygen species, inflammatory markers (interleukin 6, tumor necrosis factor α), and endothelial activation (intercellular adhesion molecule, vascular cell adhesion molecule) were determined from blood samples. Although carotid‐femoral PWV and cIMT were similar between blacks and whites, black men and women showed higher central systolic blood pressure, MCP‐1, and reactive oxygen species than whites (all P<.05). In addition, black women had higher brachial blood pressure and interleukin 6 (all P<.001). A consistent positive association only in black women between cIMT and MCP‐1 in multiple regression analyses was found (R²=0.151, β=0.248; P=.021). In this model, cIMT was also independently associated with vascular cell adhesion molecule (β=0.251; P=.022). The authors found elevated central systolic blood pressure and MCP‐1 in young blacks, where cIMT was independently associated with MCP‐1 in black women.     

Catheter‐Based Renal Sympathetic Denervation Improves Central Hemodynamics and Arterial Stiffness: A Pilot Study

J Clin Hypertens (Greenwich). 2012;14:861–870. ©2012 Wiley Periodicals, Inc. Renal sympathetic denervation (RDN) is a novel treatment strategy for patients with resistant arterial hypertension. Recently, the Symplicity trials demonstrated significant peripheral blood pressure (BP) reduction. The present study aimed at measuring central aortic pressures and arterial stiffness as better predictors for cardiovascular risk in patients undergoing RDN. RDN was performed in 21 patients (systolic peripheral BP ≥150 mm Hg) with an Ardian/Medtronic (Mountain View, CA) ablation system. Data were recorded with an Arteriograph. After 6 months, peripheral systolic BP was reduced by 6.1% (P<.05) while central systolic pressure was reduced by 7.0% (P<.05). Subgroup analysis showed that in responders, peripheral systolic BP was reduced by 16.1% (P<.01) while central systolic pressure was reduced by 18.3% (P<.01). Arterial stiffness improved significantly. Aortic augmentation index (AIx) improved by 9.5% (P<.05). In responders, AIx improved by 19.2% (P<.02). Pulse wave velocity (PWV) was high at baseline (10.8 m/s) and improved by 10.4% (P<.05). In responders, PWV improved by 13.7% (P<.05). Multivariate analysis showed that short‐term effects on PWV were BP‐related, whereas during follow‐up, improvement of PWV becomes BP‐unrelated. RDN improves peripheral and central blood pressure as well as arterial stiffness and, thus, may improve cardiovascular outcome.     

Relationship Between Inter‐Arm Difference in Systolic Blood Pressure and Arterial Stiffness in Community‐Dwelling Older Adults

A significant inter‐arm difference in systolic blood pressure (IADSBP) has recently been associated with worse cardiovascular outcomes. The authors hypothesized that part of this association is mediated by arterial stiffness, and examined the relationship between significant IADSBP and carotid‐femoral pulse wave velocity (CF‐PWV) in a sample from the Baltimore Longitudinal Study of Aging. Of 1045 participants, 50 (4.8%) had an IADSBP ≥10 mm Hg at baseline, and 629 had completed data from ≥2 visits (for a total of 1704 visits during 8 years). CF‐PWV was significantly higher in patients with an IADSBP ≥10 mm Hg (7.3±1.9 vs 8.2±2, P=.002). Compared with others, patients with IADSBP ≥10 mm Hg also had higher body mass index, waist circumference, and triglycerides; higher prevalence of diabetes; and lower high‐density lipoprotein (HDL) cholesterol (P<.001 for all). A significant association with IADSBP ≥10 mm Hg was observed for CF‐PWV in both cross‐sectional (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.06–1.87; P=.01) and longitudinal (OR, 1.15; 95% CI, 1.03–1.29; P=.01) multivariate analyses. Female sex, Caucasian race, high body mass index (plus diabetes and low HDL cholesterol only cross‐sectionally) were other independent correlates of IADSBP ≥10 mm Hg. Significant IADSBP is associated with increased arterial stiffness in community‐dwelling older adults.     

Plasma Homocysteine is a Predictive Factor for Arterial Stiffness: A Community‐Based 4.8‐Year Prospective Study

The authors investigated whether plasma total homocysteine (tHcy) is a predictive factor for arterial stiffness (carotid‐femoral pulse wave velocity [cf‐PWV] and carotid‐radial PWV) in 1447 patients from a 4.8‐year prospective study in Beijing, People's Republic of China. Baseline tHcy showed a significant relationship with follow‐up cf‐PWV (β=0.817, P=.015) in a multivariable linear regression analysis. A stepwise logistic regression model showed that baseline levels of tHcy were significantly associated with follow‐up cf‐PWV in the adjusted models. Furthermore, the baseline tHcy levels showed a significant association with increases in cf‐PWV. There was no association between the change in tHcy and increase in PWV. The present study clearly demonstrated an association between tHcy levels and arterial stiffness, indicating that tHcy is an independent predictive factor for arterial stiffness in a community‐based population.     

From short‐term blood pressure variability to atherosclerosis: Relative roles of vascular stiffness and endothelial dysfunction

Both arterial blood pressure (BP) average levels and short‐term BP variability (BPV) relate to hypertension‐mediated organ damage, in particular increased carotid artery intima‐media thickness (IMT) and carotid‐femoral pulse wave velocity (PWV). Endothelial dysfunction possibly mediates such damage. The authors aimed at further investigating such role in hypertensive patients. In 189 recently diagnosed, untreated hypertensive patients the authors evaluated, in a cross‐sectional design, the relationships of BP average levels and short‐term systolic (S) BPV (standard deviation of awake SBP or of 24‐hour‐weighted SBP) with IMT and PWV, and how much these relationships are explained by endothelial function parameters—brachial artery flow‐mediated dilation (FMD) and digital reactive hyperemia index (RHI). Multivariable models assessed the strength of these relationships to derive a plausible pathogenetic sequence. Both average SBP values and our measures of SBPV were significantly related to IMT (24‐hour mean SBP: r = .156, P = .034; 24‐hour‐weighted SBPV: r = .157, P = .033) and to PWV (24‐hour mean SBP: r = .179, P = .015; 24‐hour‐weighted SBPV: r = .175; P = .018), but only poorly related to FMD or RHI (P > .05 for all). At univariable regression analysis, FMD and RHI were both related to IMT, (P < .001), but not to PWV. When FMD and RHI were added to average SBP and SBPV parameters in a multivariable model, both significantly (P < .005) contributed to predict IMT, but not PWV. Thus, endothelial dysfunction relates to IMT independently of BP parameters, but appears to play a minor role in the association between BP variability‐related variables and arterial stiffening.     

Sex‐specific patterns in the association between salt intake and blood pressure: The ELSA‐Brasil study

Blood pressure (BP) is a strong cardiovascular risk factor, predicting cardiovascular mortality in the general population. High salt consumption is a major contributor of increased BP and hypertension. However, there is a controversy on whether BP response to salt intake would be sex‐specific. Thus, we aimed to verify the changes in BP according to different salt intake in men and women in a large sample of adults. The present analysis refers to 12 813 participants (from 35 to 64 years) with a validated 12‐hour overnight urine collection in which salt intake was estimated. A set of questionnaires, clinical examination, and laboratory tests were carried out during a single visit to one of the six investigation centers involved. Salt intake was 12.9 ± 5.9 g/d in men and 9.3 ± 4.3 g/d in women. BP increases as salt intake increases, regardless of using BP‐lowering medication. The slope of increase in BP elicited by salt intake was significantly higher in women than in men. Thus, the increase in BP by salt intake was stepper in women even after controlling for confounders, regardless of using BP‐lowering medication or being hypertensive. In conclusion, salt intake is elevated in this large sample of Brazilian adults in which only a few participants are compliant with the recommendation. Also, women have a higher responsiveness of BP according to salt intake than men, and it is not associated with age, BP level, or the use of BP‐lowering medication.     

Accumulated brisk walking reduces arterial stiffness in overweight adults: Evidence from a randomized control trial

Arterial stiffness is a major contributor to the development of atherosclerosis and consequently cardiovascular disease. This study aimed to examine whether 6 months of accumulated (3 × 10 minutes, 5 days/week) brisk walking was sufficient to reduce arterial stiffness in sedentary, overweight individuals. Seventy-seven individuals (19 men, 58 women; age, 30-55 years) were randomly allocated to one of three groups; two groups completed 30 minutes of accumulated walking with either monthly or weekly telephone support; the third group (control) performed stretching exercises. The walking groups were combined and telephone support included as a covariate. Anthropometry, blood pressure (BP), blood lipids, pulse wave velocity (PWV), and NO_x (surrogate marker for nitric oxide) were measured at baseline, post-intervention and 4 months post-intervention. No changes were observed for anthropometry, BP, or lipids. However, at the end of the intervention, there was a decrease in PWV (P < .001) accompanied by an increase in NO_x (P < .001), with changes maintained 4 months post-intervention. A strong negative correlation between PWV and NO_x was also observed (P < .001; r = −0.65). A lifestyle approach to meeting current physical activity guidelines results in favorable alterations in arterial function in overweight individuals.     

Spironolactone and Hydrochlorothiazide Decrease Vascular Stiffness and Blood Pressure in Geriatric Hypertension

OBJECTIVES: To determine the efficacy of spironolactone (SPIRO) and hydrochlorothiazide (HCTZ) as monotherapy in older patients with hypertension in blood pressure (BP) control and measures of vascular stiffness. DESIGN: Randomized double‐blind trial. SETTING: University teaching hospital. PARTICIPANTS: Forty‐five subjects with hypertension (24 men, 21 women, mean age 69). INTERVENTION: Six months of HCTZ (n=21) or SPIRO (n=24) therapy titrated to a target systolic BP (SBP) less than 140 mmHg. MEASUREMENTS: Baseline (after 4 weeks of antihypertensive drug washout) and 6‐month 24‐hour ambulatory BP data were obtained. Pulse pressure (PP) was calculated as the difference between 24‐hour average SBP and DBP. Pulse wave velocity (PWV) was determined according to noninvasive recordings of carotid and femoral artery pulse waves. RESULTS: Six months of HCTZ and SPIRO treatment was associated with significant decreases in 24‐hour and nocturnal SBP and diastolic BP (DBP) (analysis of variance (ANOVA) P<.001). At 6 months, average 24‐hour and nocturnal SBP were lower in the SPIRO than the HCTZ group (P<.001). PP and PWV also decreased significantly with HCTZ and SPIRO treatments (ANOVA P<.001). CONCLUSIONS: Six months of therapy with HCTZ or SPIRO resulted in comparable reductions in 24‐hour average and nocturnal SBP and DBP, PP, and PWV in older subjects with hypertension.     

Association of pulse wave velocity and intima‐media thickness with cardiovascular risk factors in young adults

Pulse wave velocity (PWV), a measure of arterial stiffness, and intima‐media thickening (IMT), a measure of early atherosclerosis, are intermediate markers of cardiovascular disease which are predictive of cardiovascular events. Traditionally, both were thought to result from accumulative exposure to traditional cardiovascular risk factors. However, their association with risk factors in young adults in low‐income settings is unknown. We sought to investigate the association between PWV and IMT with traditional cardiovascular risk factors in the Andhra Pradesh Children and Parents Study cohort from Southern India. Male and female adults (N = 1440) aged between 20 and 24 years underwent measures of PWV and IMT. Exposure variables included smoking, body mass index (BMI), mean arterial pressure (MAP), glucose, homeostatic model assessment of insulin resistance (HOMA‐IR), total cholesterol, high‐density lipoprotein cholesterol (HDL‐cholesterol), and triglycerides. Association between outcome and exposure variables was assessed using linear regression analysis. Average values for PWV and IMT were 5.9 ± 0.6 m/s and 0.5 ± 0.1 mm. In univariable analysis, PWV associated with MAP, BMI, smoking, total cholesterol, glucose, and HOMA‐IR and IMT associated with MAP, BMI, tobacco use, and HDL‐cholesterol. In multivariable analysis, PWV remained strongly positively associated with MAP increasing by 0.5 m/s (P < .001) for a 10 mm Hg increase in MAP (R² = .37). In contrast, IMT negatively associated with HDL‐cholesterol (β = ?.10; P = .012, R² = .02). There was weak evidence that PWV and IMT positively associated with BMI. In young adults from Southern India, PWV positively associated with blood pressure and IMT negatively associated with HDL‐cholesterol. This suggests separate etiologies for atherosclerosis and arterial stiffening in young adults.     

Physician‐Pharmacist Co‐Management and 24‐Hour Blood Pressure Control

The objectives of this study were to compare indices of 24‐hour blood pressure (BP) following a physician‐pharmacist collaborative intervention and to describe the associated changes in antihypertensive medications. This was a secondary analysis of a prospective, cluster‐randomized clinical trial conducted in 6 family medicine clinics randomized to co‐managed (n=3 clinics, 176 patients) or control (n=3 clinics, 198 patients) groups. Mean ambulatory systolic BP (SBP) was significantly lower in the co‐managed vs the control group: daytime BP 122.8 mm Hg vs 134.4 mm Hg (P<.001); nighttime SBP 114.8 mm Hg vs 123.7 mm Hg (P<.001); and 24‐hour SBP 120.4 mm Hg vs 131.8 mm Hg (P<.001), respectively. Significantly more drug changes were made in the co‐managed than in the control group (2.7 vs 1.1 changes per patient, P<.001), and there was greater diuretic use in co‐managed patients (79.6% vs 62.6%, P<.001). Ambulatory BPs were significantly lower for the patients who had a diuretic added during the first month compared with those who never had a diuretic added (P<.01). Physician‐pharmacist co‐management significantly improved ambulatory BP compared with the control group. Antihypertensive drug therapy was intensified much more for patients in the co‐managed group.     

A Slightly Low Hemoglobin Level Is Beneficially Associated with Arterial Stiffness in Japanese Community-Dwelling Women

Pulse wave velocity (PWV) is a simple and noninvasive method of measuring arterial stiffness for the assessment of cardiovascular disease in high-risk populations. This association may be further confounded by hemoglobin status, which is involved in the development of atherosclerosis. We randomly recruited 120 men and 223 women aged 69 ± 9 and 68 ± 7 years, respectively, during their annual health examination in a single community. Arterial stiffness was evaluated by brachial–ankle PWV (baPWV). The value of baPWV was different from men and women. In men, baPWV was not related to hemoglobin levels (r = 0.013, P = .886), but in women baPWV increased significantly and progressively with increased hemoglobin levels (r = 0.276, P < .001). Stepwise multiple regression analysis using the baPWV as objective variables, adjusted for confounding factors as explanatory variables, showed that only in women, hemoglobin levels (β = 0.165, P = .001) as well as age (β = 0.268, P < .001), body mass index (BMI; β = ?0.165, P < .001), systolic blood pressure (SBP; β = 0.429, P < .001), prevalence of antihypertensive (β = 0.154, P = .002), heart rate (HR; β = 0.108, P = .017), and antilipidemic medication (β = 0.094, P = .036), and estimated glomerular filtration rate (eGFR; β = ?0.147, P = .003) were significantly and independently associated with baPWV. Multivariate-adjusted baPWV was significantly higher in hemoglobin groups of ≥12.7 g/dL (Group-2, Group-4) than in the lowest hemoglobin group (10.0–12.6 g/dL; P = .032). A slightly low hemoglobin level was beneficially associated with arterial stiffness in community-dwelling women but not men.     

Arterial stiffness and blood pressure self-measurement with loaned equipment

BackgroundA cross-sectional study was carried out in 415 hypertensive and normotensive subjects to determine the correlation between loaned self-measurement blood pressure (LSEM), arterial stiffness, and the different factors that contribute to it.MethodsThe LSEM model consists of lending a number of sphygmomanometers, property of the clinic, to patients for 3-day periods. Arterial stiffness was evaluated using the carotid-to-femoral pulse wave velocity (PWV), using an automatic apparatus. To determine the importance of each of these factors, a multiple linear regression analysis was carried out.ResultsOf the total number of patients, 78% were women, the average age was 57 ± 12 years, 55.8% were hypertensive, and 38.8% were diabetic. The PWV average for the whole group was 12.1 ± 4.2 m/sec. The correlation coefficients between the PVW and the self-measurements were 0.49 (P < .001) for the pulse pressure, and 0.46 (P < .001) for the systolic blood pressure (BP), respectively. Both represented 13.0 % of the total variation. The diastolic BP obtained by self-measurement and the serum creatinine values also had an effect on the stiffness, with 2.3 % (P = .05) each one.ConclusionsThe pulse pressure readings with self-measurement correlate better with the arterial stiffness, compared with the readings taken in the office.     

Abnormal Pulsatile Hemodynamics in Hypertensive Patients With Normalized 24‐Hour Ambulatory Blood Pressure by Combination Therapy of Three or More Antihypertensive Agents

It remains uncertain whether intensive antihypertensive therapy can normalize pulsatile hemodynamics resulting in minimized residual cardiovascular risks. In this study, office and 24‐hour ambulatory systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure, carotid‐femoral pulse wave velocity (PWV), and forward (Pf) and reflected (Pb) pressure wave from a decomposed carotid pressure wave were measured in hypertensive participants. Among them, 57 patients whose 24‐hour SBP and DBP were normalized by three or more classes of antihypertensive medications were included. Another 57 age‐ and sex‐matched normotensive participants were randomly selected from a community survey. The well‐treated hypertensive patients had similar 24‐hour SBP, lower DBP, and higher PP values. The treated patients had higher PWV (11.7±0.3 vs 8.3±0.2 m/s, P<.001), Pf, Pb, Pb/Pf, and left ventricular mass index values. After adjustment for age, sex, body mass index, and office SBP, the differences for PWV, Pb, and Pb/Pf remained significant. Hypertensive patients whose 24‐hour SBP and DBP are normalized may still have markedly increased arterial stiffness and wave reflection.     

Carotid to Femoral Pulse Wave Velocity Reflects the Extent of Coronary Artery Disease

Arterial stiffness is a well ‐ established risk factor for cardiovascular disease and mortality. Carotid to femoral pulse wave velocity (cfPWV) as a measure of arterial stiffness was obtained in 155 (47 women; 67.2±9.1 years, range 44–87 years) patients with detected coronary artery disease (CAD) scheduled for coronary artery bypass surgery. The authors set out to analyze how cfPWV in CAD patients correlates with reference values for healthy, normotensive volunteers and whether cfPWV values reflect the extent of CAD. cfPWV was measured with an oscillometric device. Mean cfPWV value of CAD patients was 9.3±1.9 m/s vs 7.7±1.1 m/s in healthy volunteers (P<.0001). In a multiple regression model, age (P<.0001), sex (P=.006), systolic arterial pressure (P=.04), mean arterial pressure (P=.04), and severity of CAD (P<.001) emerged as independent predictive markers for cfPWV in CAD patients. This study established reference values for cfPWV in CAD patients measured with an oscillometric device and confirmed the strong association between arterial stiffness and severity of CAD.     

Elevated Diastolic,But Not Systolic,Blood Pressure Measured in the Emergency Department Predicts Future Development of Hypertension in Normotensive Individuals

Elevated blood pressure (BP) is reported in many individuals without hypertension presenting to the emergency department (ED). Whether this condition represents a transient state or is predictive for the development of future hypertension is unknown. This observational prospective study investigated patients admitted to an ED without a diagnosis of hypertension in whom BP values were ≥140/90 mm Hg. The primary outcome was development of hypertension during follow‐up. Overall, 195 patients were recruited and at the end of follow‐up (average 30.14±15.96 months), 142 patients were diagnosed with hypertension (73%). The mean age (50±12.25 vs 48.31±13.9, P=.419) and sex distribution (78 men/64 women vs 24 men/20 women, respectively; P=.148) were similar in both groups. There were significant differences in systolic and diastolic BP between those who developed hypertension on follow‐up and those who did not (177.6 mm Hg±22.6/106.1 mm Hg±16.9 vs 168.6 mm Hg±18/95.2 mm Hg±12.2; P=.011 for systolic BP, P<.001 for diastolic BP). In multivariate analysis the only significant predictive factor for the development of hypertension was diastolic hypertension recorded in the ED (P=.03). Elevated diastolic, but not systolic, BP among patients presenting to the ED is associated with future development of hypertension in previously normotensive individuals.