The association between salt intake and arterial stiffness is influenced by a sex‐specific mediating effect through blood pressure in normotensive adults: The ELSA‐Brasil study

High salt intake is known to increase blood pressure (BP) and also to be associated with carotid‐femoral pulse wave velocity (cf‐PWV). However, recent data showed a sex‐specific pattern in the salt‐induced rise of BP. Thus, we aimed to investigate whether the association between salt intake and arterial stiffness also has a sex‐specific pattern. A total of 7755 normotensive participants with a validated 12‐h overnight urine collection in which daily salt intake was estimated were included. cf‐PWV, as well as clinical and anthropometric parameters, was measured. Salt intake positively correlated with cf‐PWV, in which the linear regression was steeper in women than in men (0.0199 ± 0.0045 vs 0.0326 ± 0.0052 m/s per gram of salt, P < .05). cf‐PWV increases over the salt quartiles in men and women. However, after adjustment for confounders, the association remained significant only for men. In the path analysis, the direct path (men: 0.048 P < .001, women: 0.029 P = .028) was higher in men while that mediated by SBP (men: 0.020 P < .001, women: 0.034 P < .001) was higher in women. We clearly demonstrated that high salt intake has a direct and independent effect increasing arterial stiffness regardless of sex. Also, the association between salt intake and arterial stiffness is more dependent on BP in normotensive women than it is in normotensive men. These results highlight the need for a sex‐specific approach in the evaluation of cardiovascular risk associated with dietary habits.     

Association of obstructive sleep apnea with arterial stiffness and nondipping blood pressure in patients with hypertension

Whether sex influences the association of obstructive sleep apnea (OSA) with markers of cardiovascular risk in patients with hypertension is unknown. In this study, 95 hypertensive participants underwent carotid‐femoral pulse wave velocity, 24‐hour ambulatory blood pressure monitoring, echocardiogram, and polysomnography after a 30‐day standardized treatment with hydrochlorothiazide plus enalapril or losartan. OSA was present in 52 patients. Compared with non‐OSA patients, pulse wave velocity values were higher in the OSA group (men: 11.1±2.2 vs 12.7±2.4 m/s, P=.04; women: 11.8±2.4 vs 13.2±2.2 m/s, P=.03). The proportion of diastolic dysfunction was significant in men and women with OSA. Compared with non‐OSA patients, nondipping systolic blood pressure in OSA was higher in men (14.3% vs 46.4%) and in women (41.4% vs 65.2%). OSA was independently associated with pulse wave velocity (β=1.050; P=.025) and nondipping systolic blood pressure (odds ratio, 3.03; 95% confidence interval, 1.08–8.55; P=.035) in the regression analysis. In conclusion, OSA is independently associated with arterial stiffness and nondipping blood pressure in patients with hypertension regardless of sex.     

Association of low diastolic blood pressure with all-cause death among US adults with normal systolic blood pressure

Although the effect of intensive systolic blood pressure lowering is widely recognized, treatment-related low diastolic blood pressure still worrisome. This was a prospective cohort study based on the National Health and Nutrition Examination Survey. Adults (≥20 years old) with guideline-recommended blood pressure were included and pregnant women were excluded. Survey-weighted logistic regression and cox models were used for analysis. A total of 25 858 participants were included in this study. After weighted, the overall mean age of the participants was 43.17 (16.03) years, including 53.7% women and 68.1% non-Hispanic white. Numerous factors were associated with low DBP (<60 mmHg), including advanced age, heart failure, myocardial infarction, and diabetes. The use of antihypertensive drugs was also associated with lower DBP (OR, 1.52; 95% CI, 1.26–1.83). DBP of less than 60 mmHg were associated with a higher risk of all-cause death (HR, 1.30; 95% CI, 1.12–1.51) and cardiovascular death (HR, 1.34; 95% CI, 1.00–1.79) compared to those with DBP between 70 and 80 mmHg. After regrouping, DBP <60 mmHg (no antihypertensive drugs) was associated with a higher risk of all-cause death (HR, 1.46; 95% CI, 1.21–1.75). DBP <60 mmHg after taking antihypertensive drugs was not associated with a higher risk of all-cause death (HR, 0.99; 95% CI, 0.73–1.36). Antihypertensive drug is an important factor contributing to DBP below 60 mmHg. But the pre-existing risk does not increase further with an additional reduction of DBP after antihypertensive drugs treatment.     

老年住院患者双上肢收缩压差异的危险因素

目的探讨影响老年住院患者双上肢收缩压差异(IASBPD)的相关因素。方法选取2016年1月至2017年6月咸阳市第一人民医院心血管内科住院老年患者1 542例,于病情平稳或相对平稳24 h后行无创血压检测,根据IASBPD值将患者分为0～5 mmHg组570例、6～15 mmHg组834例、≥16 mmHg组138例。收集并比较3组患者体质量指数(BMI)、其他合并疾病、C-反应蛋白(CRP)等。采用logistic回归分析探讨影响IASBPD的相关因素。结果患者总体IASBPD为(8.5±5.4)mmHg,高血压患者与无高血压患者的IASBPD分别为(10.6±5.2)mmHg和(4.3±2.6)mmHg,二者比较差异有统计学意义(P0.001)。单因素方差分析及单因素logistic回归显示,女性、BMI及CRP水平、高血压、高血压家族史、降压药使用、糖尿病、高脂血症及其他合并疾病是影响IASBPD的相关因素(P0.01)。多因素logistic回归分析显示,女性(OR=2.286,95%CI 1.784～2.929)、BMI (OR=1.101,95%CI 1.054～1.150)、高血压(OR=7.726,95%CI 5.575～10.706)、糖尿病(OR=1.701,95%CI 1.125～2.570)、高脂血症(OR=2.182,95%CI 1.660～2.869)及CRP(OR=1.260,95%CI 1.190～1.333)是影响IASBPD的独立危险因素。结论老年住院患者IASBPD较大,高血压、女性、BMI、糖尿病、高脂血症、CRP是影响IASBPD的独立危险因素。     

老年单纯收缩期高血压患者动脉僵硬度的临床研究

目的探讨老年单纯收缩期高血压患者动脉僵硬度的改变。方法应用脉搏波速度自动分析仪测定颈动脉-股动脉脉搏波速度(CFPWV)和颈动脉-桡动脉脉搏波速度(CRPWV)分别作为评估中央弹性大动脉和外周中等肌性动脉僵硬度的指标,对43例健康老年人:男24例,女19例,年龄60～79岁,平均(68.2±4.6)岁和87例(单纯收缩期高血压患者40例,非单纯收缩期高血压患者47例)老年高血压患者:男41例,女46例,年龄60～78岁,平均(68.1±5.2)岁,进行脉搏波速度检测。结果老年单纯收缩期高血压患者CFPWV显著高于非单纯收缩期高血压及正常血压者(均P<0.01),CRPWV在3组间无显著差异(P>0.05);CFPWV与脉压(r=0.229,P=0.009)及年龄(r=0.203,P=0.020)呈显著正相关,CRPWV与脉压及年龄无显著相关性(均P>0.05)。多元逐步回归分析显示,脉压是CFPWV最主要的影响因素。结论老年单纯收缩期高血压患者大动脉僵硬度明显升高。     

Central aortic systolic blood pressure can predict prolonged QTc duration better than brachial artery systolic blood pressure in rural community residents

Objectives: Previous studies have suggested that prolonged electrocardiogram QTc duration was independent risk factor for both increased cardiovascular and all-cause mortality, but there was no dating about the relationship between central aortic systolic blood pressure (CASP) and QTc duration. The aim of this study was to analyze the relationship between CASP and QTc duration, and assess whether CASP can predict prolonged QTc duration more than BSBP. Methods: A total of 500 patients were enrolled in this study, central and brachial aortic blood pressure and electrocardiogram QTc duration were measured. Pearson correlation was assessed for determining the associations of QTc duration with clinical conditions. Multivariate logistic regression analyses were performed to determine the independent predictor of prolonged QTc duration. Receiver operating characteristic (ROC) curve was used to evaluate the utility of blood pressure for prolonged QTc duration. Results: We found QTc durations were significantly positive with CASP (r = 0.308, p < 0.001), BSBP (r = 0.227, p < 0.001), and age (r = 0.154, p = 0.010), but negatively related to heart rate (r = ?440, p < 0.001). A multiple logistic regression analysis demonstrated that the CASP was an independent determinant of prolonged QTc (OR = 1.648; 95%CI: 1.032, 2.101; p < 0.001). CASP had a better predictive value for prolonged QTc duration than (AUC: 0.771 vs. 0.646, p < 0.001) BSBP. Conclusion: Our results suggested that the non-invasive CASP is independently correlated with QTc duration, and CASP can predict prolonged QTc duration more than BSBP.     

Association of thyroid hormones with blood pressure and arterial stiffness in the general population: The Dali study

Thyroid dysfunction plays a role in blood pressure (BP) regulation. However, the associations between thyroid function and BP and arterial stiffness in the general Chinese population without thyroid disease are unknown. This population‐based cross‐sectional study aimed to investigate the association between thyroid function and peripheral and central BP and arterial stiffness in Chinese individuals. After excluding those who had thyroid diseases or incomplete clinical measurements, this study included 691 participants. Of the participants, 444 (64.2%) were women and 215 (31.1%) had hypertension. After adjustment for covariates, serum FT3 was significantly associated with a higher pulse rate in both sexes. In men, each 2.72‐fold increase in serum FT4 levels was associated with higher peripheral systolic BP (+10.82 mmHg, p = .005) and pulse pressure (+5.71 mmHg, p = .03). Each 2.72‐fold increase in serum FT4 levels was associated with higher central systolic BP (+8.03 mmHg, p = .03) and pulse pressure (+3.89 mmHg, p = .05). In women, serum FT4 was only associated with a higher central pulse pressure (+2.96 mmHg, p = .04). After adjustment for covariates, serum FT4 was significantly associated with a faster cfPWV exclusively in men. Our study showed that serum FT4 is associated with higher peripheral and central BP and faster cfPWV in men, whereas serum FT3 is positively associated with a higher pulse rate in both sexes, indicating that the effects of thyroid function on BP and arterial stiffness are more significant in men than in women.     

Time point of nocturnal trough systolic blood pressure as an independent predictor of cardiovascular events

Nocturnal trough systolic blood pressure (NTSBP) and Time Point of Nocturnal Trough Systolic Blood Pressure (T‐NTSBP) were important parameters of nocturnal blood pressure, the predictive values of which are unclear for stroke outcome. This study aimed to examine the relationship between NTSBP/T‐NTSBP and stroke outcome. The authors used data from a nationwide ambulatory blood pressure monitoring cohort study conducted in China, which recruited 2348 ischemic stroke and transient ischemic attack (TIA) patients. NTSBP was defined as the lowest SBP during nighttime (22:00–6:00), and T‐NTSBP was defined as the corresponding time point of NTSBP. The associations between NTSBP/T‐NTSBP and stroke outcome (stroke recurrence and combined vascular event [CVE]) at 90 days or 1 year were analyzed using cox regression models. According to NTSBP classified by quartile, hazard ratio (HR) with 95% confidence interval (CI) for NTSBP quartile 4 (>129 mm Hg) was 2.727 (1.148–6.478) for CVE at 90‐day, compared with quartile 1 (≤102 mm Hg). However, an attenuated association between NTSBP and CVE was observed at 1 year. In addition, we observed the group of T‐NTSBP at 4:00–6:00 had a lowest CVE incidence at 90 days among four groups (22:00–23:59, 00:00–1:59 2:00–3:59, 4:00–6:00). After multivariable adjustment, T‐NTSBP was significantly associated with CVE incidence at 90 days (T‐NTSBP at the 4:00–6:00 versus the 22:00–23:59 group: HR, 0.433; 95%CI, 0.190–0.986), independent of NTSBP and average nocturnal SBP. Both of NTSBP and T‐NTSBP were important predictors for short‐term cardiovascular risk in ischemic stroke and TIA patients.     

高血压患者动态动脉僵硬指数与血压变异性的关系

目的探讨高血压患者动态动脉僵硬指数(AASI)与血压变异性(BPV)的关系。方法入选2009-03-2011-10中国医科大学附属第一医院就诊的高血压患者119例,所有患者均行24h动态血压监测。AASI定义为1减去24h舒张压和收缩压的回归系数。依据AASI水平,分为4组:AASI<0.30、0.30～<0.41、0.41～<0.52、≥0.52。结果相关性分析显示,AASI分别与年龄(r=0.301,P<0.01)、24h收缩压(r=0.276,P=0.001)、白昼收缩压(r=0.225,P=0.008)、夜间收缩压(r=0.366,P<0.01)、24h脉压(r=0.510,P<0.01)、24h收缩压标准差(r=0.297,P=0.001)呈正相关,而与24h舒张压标准差(r=-0.256,P=0.002)、24h平均心率标准差(r=-0.205,P=0.017)及24h平均动脉压标准差(r=-0.202,P=0.017)呈负相关。多元线性逐步回归分析显示,AASI与24h脉压和24h收缩压标准差呈正相关(β=0.321,β=0.725,均P<0.01),与24h舒张压标准差和24h平均动脉压标准差呈负相关(β=-0.428,β=-0.346,均P<0.01)。结论 AASI与BPV密切相关。     

Long sleep duration and cardiovascular disease: Associations with arterial stiffness and blood pressure variability

Although short and long sleep duration are both risk factors of cardiovascular disease (CVD), the recent meta‐analyses have been shown that long sleep duration was closely associated with CVD mortality. While the specific mechanism underlying the association between long sleep duration and CVD remains unclear, long sleep duration was shown to be associated with arterial stiffness and blood pressure variability (BPV) in many Asian populations. This review article will focus on the pathophysiology of long sleep duration, arterial stiffness, BPV and their effects on CVD. To set the stage for this review, we first summarize the current insights for the relationship between long sleep duration and CVD in relation to arterial stiffness and BPV.     

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.     

Atrial fibrillation is associated with increased central blood pressure and arterial stiffness

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and beta blockers (BBs) are the drugs of choice for rate or rhythm control in these patients. The purpose of this study was to describe differences in arterial stiffness (AS), central blood pressure (cBP), and the role of BBs on cBP in patients with AF compared to healthy individuals. The authors included 76 patients with paroxysmal/persistent AF. Carotid‐femoral pulse wave velocity (PWV) and cBP were measured and compared with data from 75 healthy individuals. Patients with AF had higher PWV (8.0 m/s vs. 7.2 m/s, p < .001), central systolic blood pressure (cSBP) (118 mm Hg vs. 114 mm Hg, p = .033), central pulse pressure (cPP) (39 mm Hg vs. 37 mm Hg, p = .035) and lower pulse pressure amplification (PPA) (1.24 vs. 1.30, p = .015), without differences in peripheral blood pressure (pBP) and heart rate (HR). AF patients had significantly increased PWV (β= 0.500, p = .010, adjusted R² = 0.37) after adjustment for confounding factors. The use of BBs significantly reduced PPA (β = ‐0.059, p = .017, adjusted R² = 0.30). AF patients have higher PWV, cSBP, cPP, and lower PPA, compared to healthy patients. These findings support the role of AS in the development of AF. Use of BBs is related to a potential adverse effect on cBP.     

Maximum home systolic blood pressure is a useful indicator of arterial stiffness in patients with type 2 diabetes mellitus: Post hoc analysis of a cross-sectional multicenter study

Aims

Maximum (max) home systolic blood pressure (HSBP) as well as mean HSBP or HSBP variability was reported to increase the predictive value of target organ damage. Yet, the association between max HSBP and target organ damage in patients with type 2 diabetes has never been reported. The aim of this study was to investigate the association between max HSBP and pulse wave velocity (PWV), a marker of arterial stiffness which in turn is a marker of target organ damage, in patients with type 2 diabetes.

Methods

We assessed the relationship of mean HSBP or max HSBP to PWV, and compared area under the receiver-operating characteristic curve (AUC) of mean HSBP or max HSBP for arterial stiffness in 758 patients with type 2 diabetes.

Results

In the univariate analyses, age, duration of diabetes mellitus, body mass index, mean clinic systolic blood pressure (SBP), mean HSBP and max HSBP were associated with PWV. Multivariate linear regression analyses indicated that mean morning SBP (β = 0.156, P = 0.001) or max morning SBP (β = 0.146, P = 0.001) were significantly associated with PWV. AUC (95% CI) for arterial stiffness, defined as PWV equal to or more than 1800 cm per second, in mean morning SBP and max morning SBP were 0.622 (0.582–0.662; P < 0.001) and 0.631 (0.591–0.670; P < 0.001), respectively.

Conclusions

Our findings implicate that max HSBP as well as mean HSBP was significantly associated with arterial stiffness in patients with type 2 diabetes.     

Non‐interventional weight changes affect systolic blood pressure in normotensive individuals

The association between obesity and hypertension is well established. Weight loss has been shown to reduce blood pressure (BP) among hypertensive patients. Nevertheless, the effect of weight changes on BP in normotensive individuals is less clear. The author explored the association between non‐interventional weight alterations and BP changes in a large cohort of normotensive adults. This is a retrospective analysis of normotensive individuals, between 2010 and 2018. All weight changes were non‐interventional. Body mass index (BMI) and BP were measured annually. Patients were divided according to the change in BMI between visits: reduction of more than 5% ("large reduction"), between 2.5% and 5% ("moderate reduction"), reduction of <2.5% or elevation of <2.5% ("unchanged"), elevation between 2.5% and 5% ("moderate increase"), and elevation of more than 5% ("large increase"). The primary outcome was the change in systolic BP (SBP) between the visits. The final analysis included 8723 individuals. 20% of the patients reduced their BMI by at least 2.5% and 24.5% increased their BMI by more than 2.5%. "High reduction" inferred an absolute decrease of 3.6 mmHg in SBP, while "large increase" resulted in an absolute increase of 1.9 mmHg in SBP. The proportion of individuals with at least 10 mmHg decrease in SBP progressively declined according to the relative decrease in BMI, and the proportion of patients with at least 10 mmHg increase in SBP progressively increased. This effect was more pronounced in individuals with higher baseline SBP. Among normotensive adults, modest non‐interventional weight changes may have significant effects on SBP.     

Prediction of cardiovascular events from systolic or diastolic blood pressure

Over time, a focus on blood pressure has transferred from diastolic pressure to systolic pressure. Formal analyses of differences in predictive value are scarce. Our goal of the study was whether office SBP adds prognostic information to office DBP and whether both 24‐h ambulatory SBP and 24‐h ambulatory DBP is specifically important. The authors examined 2097 participants from a population cohort recruited in Copenhagen, Denmark. Cause‐specific Cox regression was performed to predict 10‐year person‐specific absolute risks of fatal and non‐fatal cardiovascular (CV) events. Also, the time‐dependent area under the receiver operator curve (AUC) was utilized to evaluate discriminative ability. The calibration plots of the models (Hosmer‐May test) were calculated as well as the Brier score which combines (discrimination and calibration). Adding both 24‐h ambulatory SBP and 24‐h ambulatory diastolic blood pressure did not significantly increase AUC for CV mortality and CV events. Moreover, adding both office SBP and office DBP did not significantly improve AUC for both CV mortality and CV events. The difference in AUC (95% confidence interval; p‐value) was .26% (‐.2% to .73%; .27) for 10‐year CV mortality and .69% (‐.09% to 1.46%; .082) for 10‐year risk of CV events. The difference in AUC was .12% (‐.2% to .44%; .46) for 10‐year CV mortality and .04% (‐.35 to .42%; .85) for 10‐year risk of CV events. Moreover, for both CV mortality and CV events, office SBP did not improve prognostic information to office DBP. In addition, the Brier scores of office BP in both CV mortality and CV events were .078 and .077, respectively. Furthermore, the Brier scores were .077 and .078 in CV mortality and CV events of 24‐h ambulatory. For the average population as those participating in a population survey, the 10‐year discriminative ability for long‐term predictions of CV death and CV events is not improved by adding systolic to diastolic blood pressure. This finding is found for ambulatory as well as office blood pressure.     

Relationship between systolic time intervals and arterial blood pressure

It has been suggested that systolic time intervals (STI) can be used to monitor the cardiac effects of antihypertensive treatments and also to evaluate hypertensive patients. STI changes observed in hypertensives have been ascribed to myocardial disease, although they could be due to the existence of a relationship between STI and blood pressure. A group of 37 subjects (18 normotensives and 19 hypertensives) with no signs of heart failure and left ventricular dysfunction were studied to examine the relationship of STI to blood pressure. Pacing with an external battery pulse generator was performed at the rate of 95 beats/min in order to eliminate differences in heart rate. STI were measured from good quality high speed (100 mm/s) recordings and the average value of 10 consecutive cardiac cycles was used for statistical analysis. Normal subjects showed significantly lower values of pre-ejection period (PEP), electromechanical systole (QS2), and pre-ejection period/left ventricular ejection time ratio (PEP/LVET). Moreover, a significant inverse relationship between diastolic pressure and LVET and significant direct relationships between diastolic pressure and PEP, systolic pressure and PEP, diastolic pressure and PEP/LVET, and between systolic pressure and PEP/LVET were demonstrated. We suggest to consider the relation of STI to blood pressure to provide regression equations to best appreciate and use STI.     

一氧化氮对老年单纯收缩期高血压大动脉僵硬度及血压的调节作用

老年单纯收缩期高血压大动脉僵硬度增加,一氧化氮参与大动脉僵硬度调节,外源性一氧化氮供体硝酸酯类药物可选择性地降低收缩压,减小脉压。硝酸酯类药物联合传统降压药有助于老年单纯收缩期高血压患者血压控制。     

厄贝沙坦联合维生素D对老年高血压患者晨峰血压及动脉僵硬度的影响

目的 探讨厄贝沙坦联合维生素D对老年高血压患者晨峰血压及动脉僵硬度的影响.方法 选择我院2020年1月至6月期间收治的老年高血压病患者80例,随机分为对照组(40例)和观察组(40例).对照组口服厄贝沙坦片治疗,观察组在此基础上肌注维生素D3治疗.比较两组治疗前后24h平均收缩压(24h SBP)、平均舒张压(24h ...     

房颤伴高血压患者随诊间收缩压波动对预后的影响

目的 探讨收缩压波动对房颤伴高血压患者预后的预测意义 方法 选取2012-2014年于新疆维吾尔自治区人民医院确诊为心房颤动伴高血压的患者，随访其收缩压的变化及平均收缩压，并监测其心源性死亡、急性冠脉综合征、慢性心力衰竭、脑栓塞及外周血管栓塞的发生率。结果在随访的过程中，随着收缩压波动幅度的增加，其终点事件发生率也在不断的增加，收缩压波动最大的四分位组主要终点事件及次要终点事件的发生率是要明显高于收缩压波动最小的四分位组，且患者随诊次数越多，收缩压波动对房颤患者预后的预测意义就越大，这种预测意义在平均收缩压较高的患者中更为明显。结论 收缩压波动可影响房颤伴高血压患者的预后，且收缩压波动越大，房颤患者的预后越不佳。