Arterial stiffness index: A new evaluation for arterial stiffness in elderly patients with essential hypertension

Background: Arterial stiffness is one of the predictors of cardiovascular event. Arterial stiffness is commonly measured by pulse wave velocity between the carotid and femoral arteries. Recently the arterial stiffness index which is measured by computerized oscillometry at the upper arm was developed. As this procedure is a convenient means of measuring pulse wave velocity, we considered it suitable to evaluate arterial stiffness in elderly patients. We evaluated this arterial stiffness index and compared it with other methods of evaluating arterial stiffness in hypertensive patients, including the elderly. Methods: Forty‐two patients with essential hypertension, including 26 subjects over 60 years old were enrolled. We evaluated the arterial stiffness index by computerized oscillometry, and also evaluated arterial stiffness between the carotid‐femoral artery and the brachial‐tibial artery, the second derivative of photoplethysmogram, the forearm vasodilator response to reactive hyperemia by strain‐gauge plethysmography. Results: Arterial stiffness index was positively correlated with pulse wave velocity between the carotid‐femoral artery (P < 0.0001; r = 0.579), the heart‐carotid artery (r = 0.454) and right brachial‐tibial artery (r = 0.549). It was also correlated with b/a (r = 0.474) and d/a (r = 0.568) by a second derivative of photoplethysmogram, but not correlated with a reactive vasodilator response. In elderly patients, arterial stiffness index was also correlated with carotid‐femoral pulse wave velocity (P < 0.05; r = 0.456) but not correlated with a vasodilator response to reactive hyperemia. Conclusion: These data suggest that arterial stiffness index is correlated to common pulse wave velocity between the carotid and femoral arteries, so this index might be useful to evaluate arterial stiffness in hypertensive patients including the elderly.     

Development and validation of a nomogram for arterial stiffness

Even though as a gold standard for noninvasive measurement of arterial stiffness, carotid-femoral pulse wave velocity (cfPWV) is not widely used in primary healthcare institutions due to time-consuming and unavailable equipment. The aim of this study was to develop a convenient and low-cost nomogram model for arterial stiffness screening. A cross-sectional study was undertaken in the department of general practice, the First Affiliated Hospital of Fujian Medical University. Arterial stiffness was defined as cfPWV ≥ 10 m/s. A total of 2717 participants were recruited to construct the nomogram using the least absolute shrinkage and selection operator and logistic regressions. Receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis, clinical impact curve were used to evaluate the performance of the model. The model was validated internally and externally (399 participants) by bootstrap method. Arterial stiffness was identified in 913 participants (33.60%). Age, sex, waist to hip ratio, systolic blood pressure, duration of diabetes, heart rate were selected to construct the nomogram model. Good discrimination and accuracy were exhibited with area under curve of 0.820 (95% CI 0.803–0.837) in ROC curve and mean absolute error = 0.005 in calibration curve. A positive net benefit was shown in decision curve analysis and clinical impact curve. A satisfactory agreement was displayed in internal validation and external validation. The low cost and user-friendly nomogram is suitable for arterial stiffness screening in primary healthcare institutions.     

基于脉搏波传导速度的动脉硬化无创检测方法进展

动脉硬化的早期检查对于心血管疾病的防治有重要作用,无创的检测方法可以使动脉硬化的早期检查具有重要临床意义.脉搏波传导速度作为无创测量动脉硬化的指标,已获得医学界广泛认可.脉搏波传导速度的测量主要有张力测定法、示波法、超声成像法、光电容积描记法、生物阻抗容积描记法、磁共振成像法等方法.本文对这些技术和方法的优缺点及其研究...     

Evaluation of increased arterial stiffness in pediatric patients with cystic fibrosis by augmentation index and pulse wave velocity analysis

With the increase in life expectancy, cardiovascular complications of cystic fibrosis (CF) have come to the forefront. Increased arterial stiffness is a marker of increased cardiovascular risk. The aim of this study was to compare both pulse wave velocity (PWV) and augmentation index (Aix) measurements in children with CF and to compare them with healthy controls. We hypothesized that children with CF had increased arterial stiffness, although traditional risk factors for CVD were not observed. Forty‐four patients and age and sex‐matched 30 healthy controls were included in the study. Hemodynamic measurements were compared in both groups, together with traditional risk factors. Peripheral blood pressure parameters of CF and control groups were similar (P > .05). Bodyweight and BMI were significantly lower in the CF group (P < .001). Serum cholesterol, HDL, and LDL levels were significantly lower in the CF group, whereas fasting blood glucose and triglyceride levels were significantly higher than the control group (P < .05). Mean ± SD Aix was significantly higher in the CF group (33.22 ± 13.87%) compared with the control group (24.93 ± 10.58%), respectively (P < .05), while PWV was similar. No significant correlation between PWV and Aix and fasting blood glucose and lipid profile in both groups (P > .05). Children with CF have been shown to have increased arterial stiffness compared to healthy children. Although there are not many traditional risk factors, increased arterial stiffness have been demonstrated in children with CF. The effects of this process starting from childhood on the development of CVD in adulthood are not known. Therefore, further studies are needed.     

Relationship between physical fitness and arterial stiffness in Korean older adults

Pulse-wave velocity (PWV) is a widely used clinical marker of arterial stiffness. Associations between several physical fitness measures and arterial stiffness have been examined. However, these results were inconsistent. Therefore, we conducted a cross-sectional study to assess the relationship between various physical fitness parameters and arterial stiffness in older adults. From January 2014 to December 2015, 1500 participants (men, n = 587; mean age, 71.78 ± 5.10 years) in South Korea were enrolled in the study. Koreans aged >65 years who agreed to participate in the study were enrolled. Individuals who were unable to exercise because of underlying conditions were excluded. VO₂ max (mL/kg/min), handgrip strength (kg), handgrip strength (kg)/body weight (kg) ratio, one-leg standing time (s), and 10-meter walking speed (m/s) were measured. The brachial-ankle pulse wave velocity (baPWV) was measured using a VP-1000 instrument. VO₂ max (mL/kg/min), handgrip (kg)/body weight (kg) ratio, one-leg standing time (s), and 10-meter walking speed (m/s) were significantly inversely associated with baPWV. This association was consistent even after adjusting for confounding factors. Our study revealed a significant association between various aspects of physical fitness and arterial stiffness. This study suggests that physical fitness is a useful predictor of arterial stiffness in older adults.     

大动脉僵硬度与高血压人群新发糖尿病的关系

目的研究大动脉僵硬度与高血压人群新发糖尿病的关系。方法本研究对象均来自开滦研究人群,用肱踝动脉脉搏波传导速度(baPWV)评价动脉僵硬度。以参加2010-2011、2012-2013、2014-2015年度开滦集团体检的高血压非糖尿病员工为观察对象,以baPWV检测时间为观察起点,以新发糖尿病为终点事件,以2016-2017年度体检时间为观察终点,最终有8 061例纳入研究队列。按baPWV四分位分组,采用Cox比例风险模型分析baPWV对终点事件的影响,按体质量指数(BMI)分层做敏感性分析。结果观察对象平均随访(4.22±2.10)年,随访期间新发糖尿病874例(10.8%),平均发病密度25.71/千人年。按baPWV四分位分组,第1~4四分位组新发糖尿病的发病密度分别为14.60/千人年、23.77/千人年、27.15/千人年、37.70/千人年(P<0.001)。以是否新发糖尿病为因变量进行多因素Cox比例风险模型分析,以baPWV第1四分位组作对照,校正年龄、性别、平均动脉压、基线空腹血糖、高敏C反应蛋白等混杂因素后,第2、3、4四分位组发生糖尿病的HR及95%CI分别为1.57(1.24~1.98)、1.74(1.37~2.20)、2.38(1.87~3.03)。baPWV每增加1个标准差,发生糖尿病的HR及95%CI为1.32(1.24~1.42)。结论大动脉僵硬度与高血压人群新发糖尿病的发病风险增高相关。     

Osteoporosis is inversely associated with arterial stiffness in the elderly: An investigation using the Osteoporosis Self‐assessment Tool for Asians index in an elderly Chinese cohort

Although the association of arterial stiffness and osteoporosis has been reported, the relation of arterial stiffness with risk of osteoporosis and bone fracture is not established. The authors investigated the correlation between arterial stiffness (brachial‐ankle pulse wave velocity [baPWV]), including a cutoff value, and risk of osteoporosis as assessed by the Osteoporosis Self‐assessment Tool for Asia (OSTA) index in 129 elderly Chinese community‐dwelling individuals (age 83.2 ± 12.8 years, 63 females). OSTA was negatively correlated with baPWV (r = −0.326, P = 0.023) after adjusting for confounding factors such as gender, body mass index, low‐density lipoprotein, triglycerides, estimated glomerular filtration rate, absence or presence of diabetes, absence or presence of hypertension, and uric acid. baPWV was an independent factor for changes in OSTA (β = −0.001, P = 0.002). ROC curve analysis confirmed association between baPWV and OSTA index (AUC = 0.742 [CI: 0.660, 0.824]; P < 0.001) with a baPWV cutoff value of 1676 cm/s (sensitivity, 80.7%; specificity, 60%) for prediction of high OSTA index. The study showed a significant correlation between OSTA index and baPWV, suggesting a potential predictive value of baPWV in elderly patient at high risk of osteoporosis.     

非糖尿病人群空腹血糖水平对动脉僵硬度进展的影响

目的 探讨非糖尿病人群基线空腹血糖水平与动脉僵硬度进展的关联.方法 本研究选取了在2010-2018年完成了两次臂踝动脉脉搏波传导速度(baPWV)测量且第一次baPWV测量时为非糖尿病的开滦研究队列人群作为观察对象.采用多元线性回归方法,分析基线空腹血糖对随访baPWV和随访期间baPWV进展的影响.结果 符合纳入标...     

Higher arterial stiffness is associated with lower cognitive performance in patients with hypertension

Cognitive impairment and elevated arterial stiffness have been described in patients with arterial hypertension, but their association has not been well studied. We evaluated the correlation of arterial stiffness and different cognitive domains in patients with hypertension compared with those with normotension. We evaluated 211 patients (69 with normotension and 142 with hypertension). Patients were age matched and distributed according to their blood pressure: normotension, hypertension stage 1, and hypertension stage 2. Cognitive function was assessed using the Mini‐Mental State Examination, Montreal Cognitive Assessment, and a battery of neuropsychological evaluations that assessed six main cognitive domains. Pulse wave velocity was measured using a Complior device, and carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. The hypertension stage 2 group had higher arterial stiffness and worse performance either by Mini‐Mental State Examination (26.8±2.1 vs 27.3±2.1 vs 28.0±2.0, P=.003) or the Montreal Cognitive Assessment test (23.4±3.5 vs 24.9±2.9 vs 25.6±3.0, P<.001). On multivariable regression analysis, augmentation index, intima‐media thickness, and pulse wave velocity were the variables mainly associated with lower cognitive performance at different cognitive domains. Cognitive impairment in different domains was associated with higher arterial stiffness.     

缬沙坦对高血压患者动态的动脉硬化指数及脉搏波传导速度的影响

目的 研究缬沙坦对高血压患者动态的动脉硬化指数(AASI)及肱踝脉搏波传导速度(baPWV)的影响.方法 选择18例原发性高血压患者(1、2级),入选患者早晨7～9点一次服用缬沙坦80 mg/d进行降压,治疗2周后,不论血压高低,只要患者能耐受均将缬沙坦增至160 mg/d继续治疗8周.所有入选患者,治疗前后均进行门诊血压及24 h动态血压测量,进行空腹血糖和血脂检查及baPWV测定.并根据24 h动态血压计算AASI.结果 与治疗前比较,缬沙坦可降低高血压患者的收缩压[(133±9)mm Hg比(146±10) mm Hg,P＜0.01]、舒张压[(84±8)mm Hg比(93±8)mm Hg,P＜0.01)]及脉压,并降低高血压患者baPWV水平[(1385±132)cm/s比(1450±142) cm/s,P=0.014],AASI较治疗前也有所降低(0.31±0.14比0.34±0.14,P=0.330).结论 缬沙坦160mg/d在降低血压同时,可减慢baPWV,轻度改善动脉弹性功能.     

动态动脉硬化指数联合颈动脉超声与冠心病关系的研究

目的 分析动态动脉硬化指数（AASI）联合颈动脉超声与冠状动脉粥样硬化性心脏病（冠心病）的关系。方法 将2019年1月至2020年1月于北京潞河医院经冠状动脉（冠脉）造影确诊的216例冠心病患者作为研究对象,冠脉造影检查血管为单支病变者纳入对照组,多支病变纳入观察组,两组各108例。对比两组患者的血压、AASI、颈动脉狭窄、颈动脉内中膜厚度（IMT）、斑块积分及冠脉评分。结果 两组患者的收缩压及舒张压对比无明显差异（P>0.05）,均在正常血压范围内;AASI存在明显差异（P<0.05）,观察组显著高于对照组;两组患者颈动脉狭窄中度狭窄对比无明显差异（P>0.05）,观察组轻度狭窄明显低于对照组,但重度狭窄及闭塞明显高于对照组（P<0.05）;两组患者的IMT、斑块积分及冠脉评分对比存在明显差异（P<0.05）,且观察组明显高于对照组。结论 AASI联合颈动脉超声检查可为冠心病的动脉硬化及斑块病变程度的评估提供临床参考,多支病变AASI高于单支病变,数值更接近1,多支病变的IMT、斑块积分及冠脉评分均高于单支病变,且多支病变的颈动脉狭窄程度更重。     

Evaluation of different metrics as an index for the assessment of arterial stiffness

Elevated intravascular pressure is a contributing factor to increased arterial stiffness, and is a risk factor for cardiovascular morbidity and mortality. Assessment of arterial stiffness is of importance in evaluating cardiovascular risk. Pulse wave velocity (PWV) has been broadly used in the assessment of arterial stiffness. We compared three different metrics of arterial stiffness to PWV. Hemodynamic recordings were carried out in anesthetized hypertensive and normotensive rats (n = 25; 13–14 weeks old). Four parameters were calculated (PWV, elastic modulus (E_inc), stiffness index (β), and pressure-strain modulus (E_p)) as metrics of arterial stiffness. Hypertensive in comparison to normotensive rats had significantly higher systolic and diastolic blood pressures. Metric for arterial stiffness were significantly (p < 0.002) higher in hypertensive animals: PWV (8.46 ± 2.01 vs. 6.39 ± 1.28 m/s), E_p (0.246 ± 0.019 vs. 0.137 ± 0.010 dyn/cm² × 10^–6), E_inc (17.5 ± 1.8 vs. 10.1 ± 0.9 dyn/cm² × 10^–6), and β (2.43 ± 0.11 vs. 1.98 ± 0.08) (mean±SE). Bland-Altman analysis revealed β as the only metric aligned with PWV in hypertensive state. We find in state of reduced arterial compliance associated with high systemic pressure, β but not E_inc or E_p is an index of arterial stiffness showing agreement with PWV.     

Association between reduced arterial stiffness and preserved diastolic function of the left ventricle in middle‐aged and elderly patients

The aim of this study was to investigate whether arterial stiffness plays a role in retaining normal diastolic function in a middle‐aged and elderly Korean population. A total of 267 patients without documented cardiovascular disease, 50 years and older (mean age, 57.3±6.3 years; 69.8% men) were retrospectively analyzed. All patients underwent both transthoracic echocardiography and brachial‐ankle pulse wave velocity measurement on the same day. Patients with septal annular peak velocity (e’) ≥8 cm/s and left atrial volume index <34 mL/m² were considered as having normal diastolic function. Ninety‐eight patients (36.7%) had normal diastolic function. Low brachial‐ankle pulse wave velocity (<1314 cm/s) was an independent factor for determining normal diastolic function even after controlling for potential confounders in multiple logistic regression analysis (odds ratio, 2.58; 95% confidence interval, 1.46–4.57; P=.001). Our results suggest that compliant arteries may play an important role in maintaining normal left ventricular diastolic function in middle‐aged and elderly patients without documented cardiovascular disease.     

Lipoprotein ratios are better than conventional lipid parameters in predicting arterial stiffness in young men

Although dyslipidemia is associated with cardiovascular disease, there are conflicting data about the role of serum lipids and their ratios in promoting arterial stiffness. The authors aimed to compare serum lipid profiles to predict arterial stiffness, which was assessed by brachial‐ankle pulse wave velocity in young Chinese men. A total of 1015 participants aged 18 to 44 years without serious comorbidities were recruited for conventional detection. Anthropometrics, brachial‐ankle pulse wave velocity, serum lipids, and other laboratory data were measured. Univariate analysis and multivariate logistic regression were performed to examine the relationship between serum lipid profiles and brachial‐ankle pulse wave velocity. Participants with high brachial‐ankle pulse wave velocity exhibited higher levels of total cholesterol, triglyceride (TG), low‐density lipoprotein cholesterol, non–high‐density lipoprotein cholesterol (HDL‐C), total cholesterol/HDL‐C, TG/HDL‐C, low‐density lipoprotein cholesterol/HDL‐C, and non–HDL‐C/HDL‐C. The subsequent multivariable logistic regression showed that TG/HDL‐C, total cholesterol/HDL‐C, non–HDL‐C/HDL‐C, and TG significantly increased the risk for arterial stiffness after adjustment for confounding factors. Results indicate that lipid ratios are superior to conventional lipid parameters for predicting arterial stiffness in young men and that the TG/HDL‐C ratio has the strongest association with arterial stiffness.     

High blood pressure worsens age-related increases in arterial stiffness evaluated by pulse wave velocity in subjects with lifestyle-related diseases

Objective:   Arterial stiffness is a risk factor for cardiovascular diseases, and is altered by age and blood pressure. Lifestyle-related diseases are also major risk factors for cardiovascular events and influence arterial stiffness. The goal of this study was to clarify the clinical influence of aging on pulse wave velocity in patients with hypertension, diabetes and/or dyslipidemia.
Methods:   Eight hundred and forty-seven outpatients (480 males, 367 females, mean age 61.5 years) at the Division of Geriatric Medicine and Hypertension in Osaka University Hospital who had lifestyle-related diseases such as hypertension ( n  = 720), diabetes ( n  = 228) and dyslipidemia ( n  = 613) were enrolled. We evaluated arterial stiffness as measured by carotid-femoral pulse wave velocity.
Results:   After age and systolic blood pressure adjustment, pulse wave velocity was higher in hypertensive patients ( P  = 0.0048), but not in patients with diabetes or dyslipidemia. By single linear regression analysis, pulse wave velocity and age were positively correlated in patients with ( r  = 0.359, P  < 0.0001) and without ( r  = 0.377, P  < 0.0001) hypertension, and the regression coefficients of these two groups were similar. Moreover, these variables were positively correlated with pulse wave velocity in hypertensive patients receiving medication ( r  = 0.324, P  < 0.0001) and without medication ( r  = 0.425, P  < 0.0001), and the regression coefficient with medication (0.033) was lower than that without medication (0.045).
Conclusion   These data suggest that the presence of hypertension worsened the age-related increase in arterial stiffness in patients with lifestyle-related diseases.     

Arterial stiffness as a cause of cognitive decline and dementia: a systematic review and meta-analysis

Background: Although arterial stiffness has recently been confirmed as a predictor of cardiovascular disease, the association between arterial stiffness and cognitive decline is less clear. Aim: We performed a systematic review and meta‐analysis to examine the evidence for large artery stiffness as a cause of cognitive decline and dementia. Method: Electronic databases were systematically searched until September 2011 for studies reporting on the longitudinal relationship between any validated measure of large artery stiffness and cognitive decline or dementia. Meta‐analysis was performed on four studies investigating the association between aortic pulse wave velocity and a decline in Mini‐Mental State Examination scores. Results: Six relevant longitudinal studies were located, conducted over an average of 5 years follow up. Arterial stiffness was predictive of cognitive decline in five/six studies. In meta‐analysis, higher aortic stiffness predicted lower Mini‐Mental State Examination scores within the sample (β=?0.03, 95% confidence interval (CI): ?0.06 to 0.01, n= 3947), although studies were not all homogeneous, and statistical heterogeneity was present (I²= 71.9%, P= 0.01). Removal of one study with a relatively younger cohort and lower median aortic stiffness found higher aortic stiffness to significantly predict cognitive decline (β=?0.04, 95% CI: ?0.07 to ?0.01, n= 3687) without evidence of heterogeneity (I²= 9.5%, P= 0.33). There was little research investigating the effects of aortic stiffness on the development of dementia. Conclusion: Aortic stiffness was found to predict cognitive decline in both qualitative review and quantitative analysis.     

Association of impaired endothelial glycocalyx with arterial stiffness,coronary microcirculatory dysfunction,and abnormal myocardial deformation in untreated hypertensives

We investigated the association of endothelial glycocalyx damage with arterial stiffness, impairment of coronary microcirculatory function, and LV myocardial deformation in 320 untreated hypertensives and 160 controls. We measured perfused boundary region (PBR) of the sublingual microvessels, a marker inversely related with glycocalyx thickness, coronary flow reserve (CFR), and Global Longitudinal strain (GLS) by echocardiography, pulse wave velocity (PWV), and central systolic blood pressure (cSBP). Hypertensives had higher PBR, PWV cSBP, and lower CFR and GLS than controls (P < .05). In hypertensives, increased PBR was associated with increased cSBP, PWV, and decreased CFR and GLS after adjustment for age, sex, BMI, smoking LV mass, heart rate, hyperlipidemia, and office SBP (P < .05). PBR had an additive value to PWV, CFR, and office SBP for the prediction of abnormal GLS (x² = 2.4‐3.8, P for change = .03). Endothelial glycocalyx is impaired in untreated hypertensives and is related to arterial stiffness, coronary, and myocardial dysfunction.