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Purpose of Review: Vascular stiffening is a hallmark of the aging process. Improvements in the methods used to measure central stiffness, particularly applanation tonometry, and their use as therapeutic targets have generated great interest., Recent Findings: Vascular stiffness is associated with increases in pulse pressure (PP), aortic augmentation index, and pulse wave velocity (PWV). This last has emerged as the gold standard for evaluation of vascular stiffness, as it is an independent predictor of coronary heart disease, stroke, and mortality. Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium-channel blockers with or without diuretics are all commonly used to ameliorate vascular stiffness; however, selective β-1 blockers (β-blockers) may actually worsen aortic PP and aortic augmentation index., Summary: Serial measurements of vascular stiffness, including PWV, augmentation index, and PP, may be especially beneficial in older patients to supplement brachial blood pressure. At present, given the lack of universally accepted normal values for vascular stiffness as measured by applanation tonometry, serial measurements over time may be more helpful than a single isolated value. In patients with suspected vascular stiffening, therapy should include inhibition of the renin-angiotensin-aldosterone system with ACE inhibitors or ARBs, calcium-channel blockers, and diuretics as needed to normalize blood pressure. β-Blockers should be reserved for patients with a history of myocardial infarction or congestive heart disease. It remains to be established whether β-blockers with vasodilator properties could improve the assessment of vascular compliance.

Introduction: Excess sodium intake is common across all age, sex, racial, and ethnic groups in the US and remains an important modifiable risk factor for elevated blood pressure (BP), a leading contributor to cardiovascular disease. While multiple 24 -hour urinary measures of sodium excretion are the preferred objective measure of sodium intake, multiple standardized, interviewer-administered 24 hour dietary recalls offer a useful surrogate measure for longitudinal group comparisons, especially unique among US Hispanics/Latinos of diverse backgrounds. Objectives: To assess whether dietary sodium intake was associated with change in systolic blood pressure (SBP) over six years, overall and by use of BP lowering medication. Methods: The Hispanic Community Health Study/Study of Latinos is an ongoing prospective population-based study of 16,415 diverse Hispanics/Latinos aged 18-74 yr from four US communities. Visit 1 (baseline) was conducted in 2008-2011, and visit 2 is currently ongoing (2014-2017). Dietary sodium intake was averaged from two interviewer-administered 24-hour diet recalls collected at visit 1. Likewise, SBP was the average from three seated measurements in visit 1 and about six years later in visit 2. Change in SBP from visit 1 to visit 2 was calculated. Using linear regression models adjusted for age, sex, study site, follow-up years, Hispanic/Latino background, education, income, nativity, diabetes, chronic kidney disease, dyslipidemia, family history of CVD, BMI, smoking, alcohol use, physical activity, and energy intake, we estimated the association of a 500 mg/day increment of sodium intake on change in SBP. Models were further stratified by self-reported use of BP lowering medication at visit 2. Results: The sample includes 7,904 adults who attended visit 2 by September 2016; average follow-up time was 5.8 years (SE: 0.02). At visit 1 mean age was 44.5 years (SE: 0.05); 57% were female (SE: 0.86). Overall, mean sodium intake was 3171 mg/day (SE: 33); a 500 mg/day higher sodium intake was associated with a 0.33 mmHg increase in SBP (95% CI: 0.07, 0.60). Among individuals not reporting taking BP lowering medication, mean sodium was 3,181 (SE: 34) and a 500 mg higher sodium intake was associated with a non-significant 0.29 mmHg increase in SBP (95% CI: -0.00, 0.58). Among individuals on BP lowering medication, mean sodium intake was 2,966 (SE: 50) and a 500 mg higher sodium intake was significantly associated with a 0.61 mmHg increase in SBP (95% CI: 0.11, 1.11). Conclusions: Among a large sample of diverse US Hispanics/Latinos, higher sodium intake was associated with small SBP increases in approximately six years. The effect of sodium on elevated SBP was stronger among individuals on BP lowering medications. [ABSTRACT FROM AUTHOR]