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40 adolescents aged 15–17 years with functional cardiovascular pathology of vegetative origin underwent a 24-hour blood pressure monitoring (using the oscillometric method BPLabVasotens, Peter Telegin LLC, Nizhny Novgorod) with an assessment of central blood pressure parameters and rigidity of the main arteries.The scientists found significantly higher values of central systolic pressure during the day and night hours in the group of adolescents with arterial hypertension (n=13) compared to adolescents with normal blood pressure (n=27). They determined significantly higher values of the pulse wave velocity both during 24 hours and in the day and night hours in the group with arterial hypertension compared to the group of adolescents with normal blood pressure. No differences were found in the parameters of the propagation time of the reflected pulse wave and the augmentation index. The time of the reflected pulse wave propagation was significantly lower at nighttime compared to the daytime. In the group with arterial hypertension, the rate of pulse wave propagation in the aorta correlated only with the values of diastolic pressure over 24 hours and diastolic pressure in the daytime. In the adolescents with normal blood pressure, the pulse wave velocity correlated with systolic and pulse blood pressure. The augmentation index in the group of adolescents with arterial hypertension correlated with diastolic pressure, in contrast to the group of adolescents with normal blood pressure, where such a correlation was not detected.

Background. Changes in the vascular wall, in particular, an increase in its stiffness and an increase in pressure in the aorta, as well as hypertrophy of the left ventricular myocardium are factors that determine a poor prognosis in patients with arterial hypertension. At the same time, the peculiarities of changes in arterial stiffness indices and left ventricular myocardial remodeling in patients with different sensitivity to salt loading have not been adequately studied. Aim. To conduct a comparative analysis of the values of peripheral blood pressure and central aortic pressure, indicators of left ventricular myocardial remodeling in salt-sensitive and salt-resistant patients with arterial hypertension. Materials and methods. The study involved 180 patients with arterial hypertension: 96 men and 84 women. The median age was 59 years. Salt sensitivity test was performed according to V.I. Kharchenko. All patients underwent 24-hour blood pressure monitoring, echocardiography. Indicators of peripheral arterial pressure and central aortic pressure, remodeling of the left ventricular myocardium were determined. Results. According to the results of the test V.I. Kharchenko, 88 patients were classified as salt-sensitive, 92 as salt-resistant. After a salt sensitivity test in salt-sensitive patients, the main indicators of peripheral blood pressure and central aortic pressure exceeded those in salt-resistant patients in the daytime, at night, and throughout the day as a whole. In the group of salt-sensitive individuals, statistically more significant negative changes in echocardiographic parameters were recorded; a significant number of salt-sensitive patients were diagnosed with prognostically unfavorable variants of left ventricular myocardial remodeling. Conclusion. In salt-sensitive patients with arterial hypertension, compared with salt-resistant patients, there are higher values of both peripheral blood pressure and central aortic pressure, more significant negative changes in echocardiographic parameters with the formation of concentric hypertrophy and eccentric remodeling of the left ventricular myocardium. It can be assumed that the assessment of salt sensitivity makes it possible to verify patients with the most unfavorable changes in parameters of ambulatory blood pressure monitoring and significant remodeling of the left ventricular myocardium. This approach can be used to individualize pharmacotherapy in patients with arterial hypertension and increase its effectiveness.

Background. Anxiety-depressive disorders (ADD) afflict almost half of patients with arterial hypertension (AH). AH aggravation by psychoemotional disorders causes a more severe illness and rapid target organ injury, particularly, the increased arterial stiffness and central aortic pressure (CAP). However, the prospects of combined antihypertensive-antidepressant treatments in AH-ADD patients remain largely unexplored.Objectives. The effect assessment in combined antihypertensive-psychocorrective therapy on circadian blood pressure (BP), vascular stiffness and CAP, anxiety and depression in women with AH and ADD.Methods. The study enrolled 60 AH-ADD women randomised between two cohorts. Cohort 1 received a fixed combination of valsartan and hydrochlorothiazide, bisoprolol and sertraline antidepressant; cohort 2 only had same combined AH therapy. Past 24 weeks of trial, all patients had a general clinical examination and daily blood pressure monitoring (DBPM) with BpLab Vasotens (Petr Telegin Ltd., Russia) and control of daily BP, CAP and vascular stiffness. The psychometric HADS and CES-D scales were used along with psychiatric counselling.Results. Past four weeks of treatment, the target blood pressure (TBP) was revealed in 60 and 36.7% patients, and in 90 and 66.6% — past eight weeks in cohorts 1 and 2, respectively. Cohort 1 vs. 2 required a lower valsartan dose to attain TBP. Past six months, both cohorts showed improved main DBPM values reflecting vascular stiffness and CAP. However, a statistical decrease in nocturnal central and peripheral BP, as well as improved BP variability and vascular stiffness were registered at antidepressant use. A normalised daily BP profile was significantly more frequent in cohort 1. In addition, sertraline had a significant ADD-reductive impact.Conclusion. An antidepressant-combined conventional AH therapy in AH-ADD women facilitated a faster TBP achievement at lower AH agent doses and the significantly improved DBPM (nocturnal specifically), arterial stiffness and CAP values. A sertraline treatment improved the psychoemotional patient state.

Background. An elevated or inadequate sensitivity to salt intake is an important mechanism for maintaining high blood pressure in patients with arterial hypertension. Chronopharmacotherapy comprises an important approach to control arterial hypertension through personalised correction of blood pressure but requires a further proof of efficacy in salt-sensitive hypertensive patients.Objectives. An assessment of six-month dynamics of diurnal and nocturnal peripheral and central blood pressure in salt-sensitive patients with arterial hypertension under chronopharmacothe­rapy.Methods. A controlled randomised trial included 86 salt-sensitive patients with arterial hypertension. Salt sensitivity was estimated with a Kharchenko’s test. All patients had circadian monitoring of the peripheral and central blood pressure and glomerular filtration rate at baseline and in a six-month follow-up. The patients were randomised into 3 cohorts. Cohort A united patients received perindopril and amlodipine in morning, cohort B — perindopril in morning, amlodipine in evening, cohort C — perindopril in evening, amlodipine in morning. Statistica 12 (StatSoftInc, USA) was used for nonparametric statistical analyses.Results. In six months of chronopharmacotherapy a target arterial pressure was registered in 87.5% patients in cohort A, 96.4 and 96.2% patients in cohorts B and C, respectively. All cohorts exhibited a declining peripheral and central blood pressure over therapy. Cohort A had a greater decline in daytime, and cohorts B and C — both diurnally and nocturnally. Cohorts B and C had more patients with an adequate nocturnal blood pressure decline. Glomerular filtration rate also elevated with perindopril or amlodipine intake before bedtime.Conclusion. The perindopril or amlodipine intake before bedtime in a combined therapy for arterial hypertension provided for a target blood pressure in the overall majority of patients, effectively reduced peripheral and central blood pressure at all time intervals, contributed to optimising the circadian blood pressure profile and increased the glomerular filtration rate.

Relevance. Arterial hypertension (AH) and anxiety-depressive disorders (ADD) are comorbid pathologies that are common in clinical practice. At the same time, the possibility of including an antidepressant in antihypertensive therapy for optimal control of hypertension, as well as to ensure a vasoprotective effect, has not been studied enough. Aim. To compare the effect of traditional antihypertensive therapy and therapy, including an antidepressant, on indicators of the daily profile of blood pressure (BP), stiffness of the vascular wall and central aortic pressure (CAP), the severity of anxiety and depression, as well as on cognitive function (CF) in patients AH and ADD. Materials and methods. The study included 90 patients with AH and ADD, who were randomized into two groups: group 1 patients who received a fixed combination of an angiotensin II receptor blocker and a diuretic, a b-blocker and an antidepressant; group 2 persons who took only three-component antihypertensive therapy. Before and after 24 weeks, all patients underwent a general clinical examination, 24-hour BP monitoring ABPM (BpLab Vasotens, Petr Telegin, Russia) with an assessment of the daily profile of BP, CAP and vascular stiffness. In addition, testing was carried out on the HADS, CES-D scales; CF were rated according to the Montreal scale. Results. In the group of patients treated with an antidepressant, it was noted that the target BP level was achieved more quickly when lower doses of angiotensin II receptor blockers were prescribed. After 6 months of therapy in both groups, there was a comparable positive dynamics of the main indicators of ABPM. In group 1, a statistically more pronounced decrease in both peripheral and CAP at night was recorded. In both groups of patients, a decrease in the augmentation index was noted; however, a statistically significant improvement in the parameters of the speed of propagation of the pulse wave in the aorta and the time of propagation of the reflected wave was recorded only in persons receiving antidepressant. In group 1, there was a regression of ADD, as well as a significant improvement in CF. Conclusions. The use of sertraline as part of a combination antihypertensive therapy in patients with AH and ADD contributed to a more rapid achievement of target BP values, a significant improvement in ABPM (especially at night), vascular wall stiffness and CAP. It is also important that the appointment of sertraline was accompanied by a regression of anxiety-depressive symptoms, an improvement in CF.

Aim: to assess changes in parameters of vascular stiffness, central aortic pressure (CAP) as well as reflected pulse wave in women in different phases of the climacteric period.Materials and Methods. An open non-randomized single-center comparative study was conducted with 384 menopausal women subdivided into: Group 1 – 168 women at menopausal transition, Group 2 – 216 women at early postmenopause. A 24-hour blood pressure (BP) monitoring was performed with assessing daily dynamics of parameters of arterial stiffness, CAP and reflected pulse wave. The aortic pulse wave velocity and local aortic stiffness were estimated.Results. It was found that women in early postmenopausal period vs. menopausal transition showed significantly higher values of daily central BP combined with more prominent changes in vascular stiffness. Menopausal women were characterized by lowered difference between nocturnal central and peripheral BP level (less amplified nocturnal vs. diurnal peripheral BP magnitude), which is associated with a greater augmented CAP at this time point. Such pattern was more pronounced in women at postmenopausal period.Conclusion. Women in climacteric period were found to have increased vascular stiffness combined with elevated CAP, decreased amplification of pulse pressure and increased amplitude of the reflected pulse wave may be associated with increased risk of cardiovascular complications. Much more prominent changes were noted in women in early postmenopausal period.

The purpose of the study was to determine which out-of-office BP measurement modality has the best correlation with central aortic systolic BP, arterial stiffness (a determinant of central aortic pressure) and LV mass index (LVMI) which represents LV adaptation to elevated central aortic pressures. In this prospective study, we demonstrated that 24h ambulatory systolic BP has better correlation with central aortic systolic BP (arterial load) and LVMI as compared to home systolic BP. 24h ambulatory systolic BP also correlated with arterial stiffness (determinant of arterial load), although this correlation was comparable to that observed with home systolic BP. Collectively, these results suggest that ambulatory systolic BP provides the best approximation of arterial load, which is the underpinning hemodynamic stress leading to LV remodeling, end-organ dysfunction, and cardiovascular mortality in patients with COA. These findings provide a foundation for further studies to determine whether titrating antihypertensive therapy based on ambulatory BP indices will slow the progression of LV remodeling and end-organ dysfunction due to hypertension, and in turn, reduce cardiovascular death in this population.

In recent years, arterial stiffness has been shown to be increased in ankylosing spondylitis (AS). However, this issue has not been sufficiently studied today. Objective: to investigate central aortic pressure values and pulse wave velocity (PWV) in patients with AS and their relationship to the clinical manifestations of the disease. Subjects and methods . A total of 47 patients (mean age 37.0+10.1) with AS were examined. ASDAS-CRP averaged 3.2+0.9; the duration of AS was 6.0+4.6 years; and the radiographic stage of sacroiliitis was 2.3+1.4. A control group included 33 healthy individuals. The groups were matched for age, gender, and office blood pressure (BP). Central aortic pressure and PWV were determined by applanation tonometry on a SphygmoCor apparatus (AtCorMedical, Australia). The Mann-Whitney U test and the Spearman correlation coefficient test were used for statistical analysis. Results and discussion . In the patients with AS, central systolic and diastolic BP was significantly higher than that in the controls (115.4+14.04 and 101.1 + 10.2 mm Hg, p=0.00001 and 78.6+12.3 and 71.8+7.3 mm Hg respectively, p=0.001). The patients with AS showed a 15.01% increase in mean central aortic pressure values compared to the control group (106.5+13.7 and 92.6+9.4 mm Hg, respectively; p=0.0001). Carotid-femoral PWV averaged 6.6+1.7 m/sec in the patients with AS and 5.20+0.96 m/sec in the controls (p=0.0001). There was a direct correlation of PWV with the occiput-wall distance r= 0.36; p=0.01) and an inverse correlation with Schober's test (r=-0.54; p=0.0001). Conclusion. The patients with AS were found to have increased arterial stiffness parameters, such as PWV, central aortic pressure, central diastolic BP, and central hemodynamic pressure. PWV was demonstrated to be related to clinical data.

Aim. To evaluate gender-related differences of left atrial (LA) phasic function and structural remodeling in conjunction with the parameters of left ventricular (LV) diastolic dysfunction and central aortic pressure in patients with hypertension and recurrent atrial fibrillation (AF).Material and methods. The comparative study included 30 men and 37 women with non-valvular AF, hypertension and LV hypertrophy. Conventional echocardiographic measures were extended with LA measures, including its volume in three phases, LAemptying fraction (LAEF), passive and active ejection fraction. The parameters of central aortic pressure were estimated by applanation tonometry method.Results. No difference was observed between LA and LV structural parameters in men and women. However, in women LAEF (39 [28;50] vs 50 [42;55]%; p=0.02) and E/E’(9.7 [7.8;12] vs 7.1 [5.6;8.6]; p=0.001) were worse than in men. Active LA ejection fraction was higher in women (31 [21;42] vs 24 [19;31]%; p=0.04), whereas passive one – in men (12 [10;14] vs 33 [23;38]%; pConclusion. Patients of different genders with recurrent AF and hypertension have comparable LA structuralremodeling. However, women characterized by a more pronounced decrease in LAEF and impaired LV diastolic function than men. In women as distinct from men LV filling is predominantly due to LA systole. In a multivariate regression analysis in men LAEF was significantly associated with height, weight, E’, E/E’ and GFR, whereas in women – with E’ and AI 75.

За результатами чисельних досліджень було встановлено і запропоновано референтні нормативні значення для центрального артеріального тиску та його ампліфікації в пацієнтів з різним серцево- судинним ризиком. Проте можливість їх практичного застосування в пацієнтів різних вікових груп повністю не вивчена. Було обстежено 132 пацієнти з неускладненою есенціальною артеріальною гіпертензією, що не отримували антигіпертензивну терапію (23 жінки та 109 чоловіків), яких було розподілено на 3 групи залежно від віку (ВООЗ, 2012): I група включала 47 пацієнтів молодого віку, II група - 50 пацієнтів середнього віку та III група – 35 пацієнтів літнього віку. Вимірювання центрального систолічного артеріального тиску (цСАТ), ампліфікаційного САТ, швидкість розповсюдження пульсової хвилі (ШРПХ) проводили за допомогою артеріографа Tensioclinic (Tensiomed, Hungary). Ураження органів-мішеней включало гіпертрофію лівого шлуночка (ГЛШ), яку визначали за ехокардіографічним індексом маси міокарда лівого шлуночка, скоригованим до поверхні тіла ( г/м2) або зросту (ГЛШ2,7) і ШРПХ в аорті >10 м/с. Встановлено, що використання персоналізованого підходу при обстеженні хворих на артеріальну гіпертензію дозволяє підвищити ефективність діагностики зумовлених гіпертензією субклінічних уражень органів. Таким чином, для виявлення ураження судинної стінки у хворих молодого віку з артеріальною гіпертензією і надмірною масою тіла та ожирінням слід використовувати референтні значення ШРПХ і цСАТ відповідно до вікової норми. Саме в цій групі пацієнтів виявлено найбільш несприятливий вплив судинної жорсткості та індексу маси тіла (ІМТ) на формування гіпертрофії лівого шлуночка. Разом з тим в осіб похилого віку необхідно використовувати референтні значення цСАТ залежно від ступеня артеріальної гіпертензії.Based on the cumulative data of scientific research reference values for the central blood pressure and its amplification were proposed in patients with different cardiovascular risk factors. Still, the possibility of its practical implementation in patients of different age groups has not been fully studied. There were examined 132 untreated patients (23 females and 109 males) with uncomplicated essential hypertension, which were divided into 3 groups depending on age (WHO, 2012): I group included 47 patients of the young age, II group - 50 middle-aged patients and III group – 35 elderly patients. Measurements of central systolic blood pressure (cSBP), SBP amplification (SBP Amp), pulse wave velocity (PWV) were carried out by Arteriograph Tensioclinic (Tensiomed, Hungary). Target-organ damage included LVH which was determined by echocardiographic left ventricular mass index (LVMI), adjusted for body surface (g/m2) or height (LVMI2,7), aortic PWV>10 m/s. It was established that the use of a personalized approach in the examination of patients with arterial hypertension makes it possible to increase the efficiency of diagnosis of hypertensive-mediated subclinical organ damage. So in order to identify impairment of the vascular wall in patients of a young age with hypertension, with overweight and obesity, the reference values of PWV and cSBP in accordance with the age norm should be taken into account. It was particularly in this cohort of patients that the greatest adverse effect of vascular stiffness and body mass index (BMI) on the formation of left ventricular hypertrophy was revealed, while in elderly people it is necessary to use the reference values of cSBP, depending on the degree of hypertension.

Aim.There is evidence that central aortic blood pressure (BP) is more associated with left ventricular myocardial hypertrophy than brachial BP. The purpose of this work is to compare the association of brachial and central aortic BP with electrocardiographic parameters of left ventricular hypertrophy in the general population of Novosibirsk.Material and methods. We examined 327 people: 155 men and 172 women aged 25-44 years from a representative sample from the general population of Novosibirsk. The study program included anthropometry, BP measurement, electrocardiography, biochemical blood analysis. Radial artery applanation tonometry and pulse wave analysis were performed using the SphygmoCor system. Left ventricular hypertrophy was determined by electrocardiographic parameters.Results.In the general population of Novosibirsk, central aortic BP is more associated with left ventricular myocardial hypertrophy than brachial BP. Central pulse pressure, in contrast to brachial BP, is significantly associated with the R+S index (p=0,0085), as well as RI (p=0,0038) and RaVL (p=0,0039) wave amplitude. Central systolic aortic BP, in contrast to brachial systolic BP, is significantly associated with RI (p=0,042) and RaVL (p=0,029) wave amplitudes. Amplification parameters of central aortic BP, regardless of brachial BP, are associated with indices of left ventricular hypertrophy. Pulse pressure amplification in groups with or without left ventricular hypertrophy, standardized for age, gender, height, waist circumference, heart rate, triglyceride levels, high density lipoprotein cholesterol, low density lipoprotein cholesterol, blood glucose, and brachial pulse pressure, was 13,3 mm Hg and 12,5 mm Hg, respectively (p=0,035).Conclusion.The results of this study substantiate the relevance of the practical use of central aortic BP parameters in addition to the office measurement of brachial BP.

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 (beta= 0.500, p = .010, adjusted R-2 = 0.37) after adjustment for confounding factors. The use of BBs significantly reduced PPA (beta = -0.059, p = .017, adjusted R-2 = 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.

Introduction Structural and functional changes of the vascular wall in women occur already at the very early stages of reproductive aging. An emergence of applanation tonometry made it possible to evaluate arterial stiffness and central hemodynamic parameters non-invasively, which considerably expanded the information that had been provided previously by invasive methods used for studying these parameters during cardiac catheterization. Whereas a few studies have assessed central aortic pressure (CAP) parameters and reflected pulse wave in women at different phases of their reproductive aging, none investigated the daily profile of CAP and reflected pulse wave parameters in women undergoing different stages of the menopause. Background: assessment of the daily variability in CAP and daily profile of amplification and augmentation of pulse blood pressure (PBP) in women at different menopause phases. Methods The study involved 384 climacteric women. The first group included 168 women undergoing perimenopause, the second group comprised of 216 women in their early postmenopausal stage. A 24-h blood pressure (BP) monitoring in the brachial artery and aorta (BPLab® Vasotens® system, Petr Telegin LLC, Russia) was performed via the measurements of the following indicators: systolic blood pressure (SBP), pulse blood pressure (PBP), central aortic systolic pressure (CASP), central aortic pulse pressure (CAPP), aortic augmentation index (AIxao), and pulse pressure amplification (PPA). Results When investigating PPA values in the brachial artery and aorta, we detected smaller amplification and higher aortic augmentation index at night than in daytime, which reflected a disproportionately higher CAP level during night hours. This pattern was more pronounced in postmenopausal women. We calculated the logistic regression equation (adjusted R2 = 0.49, log-likelihood = − 50.3, chi-square (19) = 97.6, p Conclusion Rising CAP, in combination with declining PPA and augmenting reflected pulse wave amplitude, may be associated with an increased risk of cardiovascular complications.

Objective: To assess the prevalence of high central aortic pressure (CAP) in Indian patients with uncontrolled essential hypertension while on anti-hypertensive monotherapy. Also, to determine correlation between brachial blood pressure (BBP) and CAP, and ascertain if it is impacted by anti-hypertensive drug class and patients’ age. Methods: In this real-world, observational, prospective study, patients (30–70 years) with uncontrolled BBP (systolic BP [SBP] ≥140 mmHg or diastolic BP [DBP] ≥90 mmHg) were enrolled. Treatment was adjusted at Visit 1 (baseline), based on BBP and at treating physicians’ discretion. Primary endpoint was proportion of patients with uncontrolled central aortic SBP (>125 mmHg) at baseline. Secondary endpoints were comparison of BBP and CAP across drugs classes and age groups at baseline and Visit 2 (End-of-study, ∼8 weeks post-baseline), and proportion of patients with uncontrolled central SBP at end-of-study. Results: Of 2030 patients screened, 1949 patients reported at baseline and 1740 patients completed end-of-study visit. Central SBP was >125 mmHg for 84.3% patients at baseline, and 48% patients at end-of-study. Interestingly, at end-of-study, 6.6% patients still had uncontrolled brachial SBP and controlled central SBP, while 13.6% patients had uncontrolled central SBP and controlled brachial SBP. At both visits, brachial SBP and central SBP showed positive correlation across most drug classes and age groups. At baseline, ACE inhibitors showed better efficacy than other drug classes. At end-of-study, BP control was better with fixed-dose combinations, though free–drug combinations were more frequently prescribed. Conclusion: Measurement of CAP along with BBP can be vital in management of hypertension. Ctri registration number: CTRI/2015/10/006302. Keywords: Brachial blood pressure, Central aortic pressure, Hypertension, India, Real-world study

Aim. To assess and compare the efficacy of combination antihypertension drugs influence with various dosage regimens during 24 hour, on the parameters of daily blood pressure (BP) profile, central aortic pressure (CAP) and vessel wall stiffness in arterial hypertension (AH) patients with ischemic stroke (IS).Material and methods. To the study, 177 AH patients included, with IS within last 4 weeks. All patients were randomized to 3 groups depending on the regimen of antihypertensive drugs combination intake during 24 hours. At baseline and in 12 months of therapy all patients underwent 24 hour BP monitoring (ABPM), CAP measurement and vessel wall stiffness evaluation. Results. In 8 weeks of antihypertension therapy, target pressure level achievement was significantly more common in b. i.d. valsartan (group 3) comparing to once daily in the morning (group 1) or evening (group 2) (pConclusion. Two times a day or only evening intake of valsartan with thiazidelike diuretic in the morning facilitated more significant improvement of the main parameters of ABPM, CAP and vascular wall rigidity comparing to just morning intake. B.i.d. valsartan regimen led to significantly (p

Aim. To assess the features of diurnal blood pressure profile, arterial stiffness and central aortic pressure in patients with arterial hypertension (AH) and prediabetes. Materials and methods. The study included 118 patients with AH, 38 without prediabetes, 80 with prediabetes, 48 of them patients with impaired fasting glucose and 32 patients with impaired glucose tolerance. Prediabetes was determined by the results of an oral glucose tolerance test. All patients underwent 24-hour blood pressure monitoring the main parameters of arterial stiffness and central aortic pressure were determined using the BPLab Vasotens complex of OOO «Petr Telegin» (Russia). Results. The obtained data showed that in patients with hypertension and prediabetes there were recorded increased levels of systolic and pulsatile blood pressure in the brachial artery and aorta, a more pronounced "pressure load" was detected compared to patients without prediabetes. At night, the level of diastolic blood pressure in the brachial artery and aorta, the diastolic pressure time index was higher than in patients with AH without prediabetes. Pathological type of the "non-dipper" curve was detected 2.5 times more often in patients with AH and prediabetes. Moreover, the pulse wave velocity, the augmentation index in the brachial artery and aorta characterizing the stiffness of the vessel wall were significantly higher in hypertensive patients with prediabetes. Conclusion. Thereby, in patients with AH in combination with prediabetes, unlike patients without prediabetes, there were more pronounced changes in the parameters of the diurnal blood pressure profile, arterial stiffness and central aortic pressure including the pulse wave velocity, the augmentation index and pulsatile pressure which are known to be sensitive indicators of target organ damage and are associated with an increased risk of developing cardiovascular and cerebrovascular complications.

Actuality: the contribution of changes in central aortic pressure (CAP) to target organ damage and the effect of a fixed combination of perindopril with arnolate with amlodipine besylate on these parameters in patients with arterial hypertension (AH) and type 2 diabetes (DM) has not been studied. Objective: to reveal the relationship between the main indicators of CAP and the damage of target organs (vessels, kidneys and heart) in patients with AH and type 2 diabetes; assess the organoprotective properties of a 12-week therapy with a fixed combination of perindopril arginate with amlodipine besylate in this category of patients. Materials and methods: 30 patients with AH stage III and DM at the age of 45 to 65 years were examined. The indicators of CAP were determined by Vasotens 24 software (“Petr Telegin” LLC, Russia). The structural and functional state of the myocardium was assessed echocardiographically with a Doppler sensor. The pulse wave velocity (PWV) was measured with Polyspectr 8/E apparatus (Neurosoft, Russia). To evaluate the kidney function, the glomerular filtration rate (GFR) was calculated, and albumin excretion in the urine was determined. A fixed combination of perindopril arginine / amlodipine besylate was administered for 12 weeks. Results: 12-week therapy was accompanied by the achievement of target values of blood pressure in 100% of patients, a decrease in office systolic and diastolic blood pressure. There was a significant improvement in indicators of CAP, which was accompanied by a statistically significant decrease in PWV in vessels of the elastic and muscular type, an improvement in the functional state of the kidneys: a decrease in the level of the albumin/creatinine ratio of urine, an increase in rGFR, by a significant decrease in the left ventricular myocardium index. Conclusion: admission of a fixed combination of perindopril and amlodipine in patients with AH in combination with type 2 diabetes for 12 weeks is accompanied by reliable cardio, nephroprotective and endotheliotropic effects, statistically significantly reduces systolic and diastolic CAP, augmentation index in daytime and night hours, leads to a significant reduction of rigidity of the main arteries.

Aim. To assess antihypertensive efficacy of various 24-hour regimens of antihypertensive drugs prescription and the influence on 24-hour profile of blood pressure (BP) and aortic pressure, in systemic hypertension patients post transient ischemic attack. Material and methods. Totally, 174 patients were included, with grade 1-2 hypertension and previous non-effective treatment; who during the previous 4 weeks had transient ischemic attack. All patients were randomized to 3 groups according to the treatment variant: group 1 (n=59) — valsartan 160 mg and thiazide-like diuretic in the morning, group 2 (n=58) — thiazide-like diuretic in the morning and valsartan 160 mg at bedtime, group 3 (n=57) — thiazide-like diuretic in the morning and valsartan 80 mg b.i.d. (morning and bedtime). At baseline and in 12 months of therapy all patients underwent BP monitoring (ABPM) with assessment of mean 24 hour, daytime, nocturnal systolic BP (SBP) and diastolic BP (DBP), mean pulse pressure, time index of hypertension, SBP and DBP variability at daytime and at night, prominence and velocity of morning SBP and DBP raise, heart rate, central aortic pressure (CAP): SBP and DBP in aorta, variability of SBP and DBP in aorta, pulse BP in aorta, augmentation index in aorta, pulse pressure amplification, ejection period duration, efficacy index of subendocardial blood flow. Valsacor (KRKA, Slovenia) was included in the study as valsartan. Results. In 12 weeks of fixed combination therapy, the target levels of BP were registered: in group 1 — 43 patients (72,9%), group 2 — 48 (82,7%), group 3 — 55 (96,4%). Reached target BP was more common in b.i.d. intake of valsartan (group 3) comparing to group 1 (p=0,001) and group 2 (p=0,03). Statistically significant positive shifts of ABPM and CAP values were registered in all three regimens. However, in group 2 there was significantly more prominent decrease of the main parameters of ABPM and CAP, than in group 1. Valsartan two times daily (group 3) led to more prominent (p

Objectives: The primary objective of the study was to assess the association between central aortic blood pressure indices and coronary artery disease (CAD) in patients undergoing elective angiography and the secondary objective was to study whether any association exists between central aortic pressure indices and the incidence of major adverse cardiovascular events (MACE) in the same patients during a 6-month follow-up period. Methods: We conducted a prospective observational study in consecutive patients undergoing coronary angiography. Central and peripheral pressures were invasively recorded and CAD was classified into obstructive and nonobstructive group. CAD severity was graded using the Gensini score and patients were divided into tertiles. Patients were followed up, and the role of central aortic pressure indices in the prediction of cardiovascular events was analyzed. Results: A total of 623 patients were enrolled. Central pulsatility was found to be most closely associated with severity of CAD by univariate analysis, with age, sex, and smoking status being important predictors of pulsatility. A positive correlation was found between the central and peripheral mean and pulse pressures. No significant association was noted between the central aortic pressures and MACE on short-term follow-up. Conclusions: Of the various central aortic pressure indices studied, central pulsatility was found to be most closely associated with the severity of CAD.

To evaluate the efficiency of triple antihypertensive therapy in patients with uncontrolled hypertension and depressive disorders (DD).153 patients with uncontrolled hypertension were examined, of whom 82 patients were diagnosed with mild and moderate DD. A combination of perindopril 10 mg/day, indapamide SR 1.5 mg/day, and amlodipine at an initial dose of 5 mg/day was given to patients with hypertension and DD. After 4 weeks of treatment, if target blood pressure (BP) levels could not be achieved, the dose of amlodipine was increased up to 10 mg/day. General clinical examination and 24-hour BP monitoring (BPM) were performed in all the patients at baseline and in the patients with DD also after 24 weeks of therapy. The traditional measures of the diurnal BP profile, as well as the parameters characterizing arterial stiffness and central aortic pressure (CAP) were estimated.After 8 weeks of therapy, target BP levels were recorded in 63 (76.8%) patients. After 24 weeks of treatment, the hypertensive patients with DD showed significant positive changes in all the investigated 24-hour BPM parameters and normalization of the diurnal BP profile in 65.1% of cases. During the treatment, there were significant decreases in pulse wave velocity, brachial arterial and aortic augmentation indices, aortic systolic and diastolic pressures, and mean aortic BP and an increase in the velocity of the reflected wave.Triple therapy, including perindopril, indapamide SR, and amlodipine, contributed to the achievement of target BP levels in the majority of hypertensive patients with DD, with significant positive changes in all 24-hour BPM parameters, optimization of the diurnal BP profile in most patients, clinically significant improvement of the parameters that characterize arterial stiffness and CAP.Цель исследования. Оценка эффективности трехкомпонентной антигипертензивной терапии у пациентов с неконтролируемой артериальной гипертонией (АГ) и депрессивными расстройствами (ДР). Материалы и методы. Обследованы 153 пациента с неконтролируемой АГ, из них у 82 больных диагностированы ДР легкой или средней тяжести. Пациентам с АГ и ДР назначена комбинация периндоприла 10 мг/сут, индапамида SR 1,5 мг/сут и амлодипина в начальной дозе 5 мг/сут. Через 4 нед терапии в отсутствие достижения целевого уровня (ЦУ) артериального давления (АД) дозу амлодипина увеличивали до 10 мг/сут. Всем пациентам исходно, а больным с ДР и через 24 нед терапии проводили общеклиническое исследование, суточное мониторирование АД (СМАД). Оценивали традиционные показатели суточного профиля АД, а также параметры, характеризующие ригидность артерии, и центральное аортальное давление (ЦАД). Результаты. Через 8 нед терапии ЦУ АД регистрировался у 63 (76,8%) больных. Через 24 нед лечения у пациентов с АГ и ДР фиксировались достоверные позитивные изменения всех исследуемых показателей СМАД и нормализация суточного профиля АД в 65,1% случаев. На фоне лечения достоверно уменьшились скорость распространения пульсовой волны, индексы аугментации в плечевой артерии и аорте, систолического и диастолического давления в аорте, среднего АД в аорте, а также увеличилась скорость отраженной волны. Заключение. Применение трехкомпонентной терапии, включавшей периндоприл, индапамид SR и амлодипин, способствовало достижению ЦУ АД у большинства больных с АГ и ДР, достоверным позитивным изменениям всех показателей СМАД, оптимизации суточного профиля АД у большинства пациентов, клинически значимому улучшению параметров, характеризующих ригидность артерий и ЦАД.

Kontext: Souvislost mezi tuhosti tepen (arterial stiffness, AS) a ischemickou chorobou srdecni (ICHS) již byla prokazana. V popisovane studii jsme se pokusili zjistit vztah mezi různými parametry AS a rozsahem a zavažnosti ICHS.Metody: Populaci ve studii tvořilo 411 pacientů s koronarograficky potvrzenou ICHS. Měřili jsme různe parametry AS vcetně augmentacniho indexu (augmentation index, AIx), augmentacniho tlaku (augmentation pressure, AP), rychlosti pulsni vlny (pulse wave velocity, PWV), centralniho systolickeho tlaku (central systolic pressure, cSys), centralniho diastolickeho tlaku (central diastolic pressure, cDia) a centralniho pulsniho tlaku (central pulse pressure, cPP); zaroveň jsme provedli analýzu pulsni vlny. K výpoctu Gensiniho skore a Syntax skore jsme použili angiogramy. Parametry AS byly porovnany s Gensiniho skore a se Syntax skore.Výsledky: Syntax skore koreluje s věkem i s hodnotami cSys, cPP, PWV, AP, brachialnim pulsnim tlakem (brachial pulse pressure, bPP), hemoglobinem, mocovinou, přitomnosti diabetes mellitus, postiženim kmene leve věncite tepny (vždy p < 0,10). Gensiniho skore vsak koreluje pouze s věkem, přitomnosti diabetes mellitus, postiženim kmene leve věncite tepny a bPP (vždy p < 0,10). Mnohorozměrova analýza prokazala, že věk, přitomnost diabetes mellitus, postiženi kmene leve věncite tepny a bPP významně predikuji hodnotu Syntax skore, zatimco v připadě Gensiniho skore byly za prediktory oznaceny věk, přitomnost diabetes mellitus, pohlavi, postiženi kmene leve věncite tepny a bPP.Zavěr: Parametry AS nijak nesouviseji s hodnotami Gensiniho skore ani Syntax skore. Kromě tradicnich rizikových faktorů se jediným významným prediktorem v připadě Gensiniho skore nebo Syntax skore zda být bPP.

Today there is enough data on gender differences in regard to epidemiology, pathogenesis and prognostic value of atrial fibrillation (AF). Left atrial structural and functional changes associated with development and persistence of AF can be more significant for women than for men. Explanation for it can be provided by a higher prevalence of left ventricular diastolic dysfunction in women, which is strongly related with central aortic pressures. Many studies have shown gender differences of central pulse wave contour; however further investigations of their prognostic power and relationship with left atrial remodeling are needed. According to current guidelines for AF management rhythm control is not a superior treatment strategy compared with heart rate control. The subanalysis of RACE study showed that rhythm control in female patients with AF increased significantly the risk of composite endpoints including cardiovascular mortality, heart failure, thromboembolic events, bleedings, severe side effects of antiarrhythmic drugs and the need for a pacemaker implantation. It seems that in some cases rate control approach may be preferable in female patients with recurrent AF. The current management of AF is still suboptimal and one of the ways to increase effectiveness should take into consideration the gender differences of left atrial, left ventricular and arterial interaction. More relevant randomized studies will be required to confirm this hypothesis.

Goal: We introduce a novel approach to estimate cardiac output (CO) and central systolic blood pressure (cSBP) from noninvasive measurements of peripheral cuff-pressure and carotid-to-femoral pulse wave velocity (cf-PWV). Methods: The adjustment of a previously validated one-dimensional arterial tree model is achieved via an optimization process. In the optimization loop, compliance and resistance of the generic arterial tree model as well as aortic flow are adjusted so that simulated brachial systolic and diastolic pressures and cf-PWV converge towards the measured brachial systolic and diastolic pressures and cf-PWV. The process is repeated until full convergence in terms of both brachial pressures and cf-PWV is reached. To assess the accuracy of the proposed framework, we implemented the algorithm on in vivo anonymized data from 20 subjects and compared the method-derived estimates of CO and cSBP to patient-specific measurements obtained with Mobil-O-Graph apparatus (central pressure) and two-dimensional transthoracic echocardiography (aortic blood flow). Results: Both CO and cSBP estimates were found to be in good agreement with the reference values achieving an RMSE of 0.36 L/min and 2.46 mmHg, respectively. Low biases were reported, namely −0.04 ± 0.36 L/min for CO predictions and −0.27 ± 2.51 mmHg for cSBP predictions . Significance: Our one-dimensional model can be successfully “tuned” to partially patient-specific standards by using noninvasive, easily obtained peripheral measurement data. The in vivo evaluation demonstrated that this method can potentially be used to obtain central aortic hemodynamic parameters in a noninvasive and accurate way.

The VASOTENS Registry is an international telehealth-based repository of 24-hour ambulatory blood pressure monitorings (ABPM) obtained through an oscillometric upper-arm BP monitor allowing combined estimation of some vascular biomarkers. The present paper reports the results obtained in 1200 participants according to different categories of CV risk. Individual readings were averaged for each recording and 24-hour mean of brachial and aortic systolic (SBP) and diastolic blood pressure (DBP), pulse wave velocity (PWV), and augmentation index (AIx) obtained. Peripheral and central BP, PWVand AIx values were increased in older participants (SBP only) and in case of hypertension (SBP and DBP). BP was lower and PWVand AIx higher in females. PWV was increased and BP unchanged in case of metabolic syndrome. Our results suggest that ambulatory pulse wave analysis in a daily life setting may help evaluate vascular health of individuals at risk for CV disease.

Aim. To evaluate an antihypertensive efficacy and influence on the arterial stiffness of 24-week treatment with metoprolol tartrate in patients with hypertension (HT) degree 1-2. Material and Methods. Patients with HT degree 1-2 (n=38) received therapy with metoprolol tartrate 50-200 mg QD for 24 weeks. Bifunctional daily blood pressure (BP) and electrocardiogramm monitoring with evaluation of central aortic pressure indicators as well as volume sphygmography were performed at baseline and after 24 weeks of therapy. Results. The 24-week therapy with metoprolol tartrate was effective in 47.2% of patients. Significant improvement in central aortic pressure [systolic BP decreased from 129.8±7.3 to 118.8±7.2 mm Hg; p0.05). Significant reduction in arterial stiffness indexes was revealed with volume sphygmography: CAVI1 from 8.6 (8.1;9.6) to 8.0 (7.3;8.3); p

BACKGROUND The heart ejects in the central elastic arteries. No previous study in workers described the diurnal profile of central blood pressure (BP) or addressed the question whether electrocardiogram (ECG) indexes are more closely associated with central than peripheral BP. METHODS In 177 men (mean age, 29.1 years), we compared the associations of ECG indexes with brachial and central ambulatory BP, measured over 24 hours by the validated oscillometric Mobil-O-Graph 24h PWA monitor. RESULTS From wakefulness to sleep, as documented by diaries, systolic/diastolic BP decreased by 11.7/13.1 mm Hg peripherally and 9.3/13.6 mm Hg centrally, whereas central pulse pressure (PP) increased by 4.3 mm Hg (P < 0.0001). Over 24 hours and the awake and asleep periods, the peripheral-minus-central differences in systolic/diastolic BPs averaged 11.8/-1.6, 12.7/-1.8, and 10.3/-1.2 mm Hg, respectively (P < 0.0001). Cornell voltage and index averaged 1.18 mV and 114.8 mV.ms. Per 1-SD increment in systolic/diastolic BP, the Cornell voltages were 0.104/0.086 mV and 0.082/0.105 mV higher in relation to brachial 24-hour and asleep BP and 0.088/0.90 mV and 0.087/0.107 mV higher in relation to central BP. The corresponding estimates for the Cornell indexes were 9.6/8.6 and 8.2/10.5 mV.ms peripherally and 8.6/8.9 and 8.8/10.7 mV.ms centrally. The regression slopes (P = 0.067) and correlation coefficients (P = 0.088) were similar for brachial and central BP. Associations of ECG measurements with awake BP and PP were not significant. CONCLUSIONS Peripheral and central BPs run in parallel throughout the day and are similarly associated with the Cornell voltage and index. The authors acknowledge the expert clerical assistance of Vera De Leebeeck, Yvette Piccart, and Renilde Wolfs. ILZRO supports SPHERL by an unrestricted research grant. The European Union (HEALTH-F7-305507 HOMAGE) and the European Research Council (Advanced Researcher Grant 2011-294713-EPLORE and Proof-of-Concept Grant 713601-uPROPHET) and the Fonds voor Wetenschappelijk Onderzoek Vlaanderen, Ministry of the Flemish Community, Brussels, Belgium (G.0881.13) currently support the Studies Coordinating Centre in Leuven.

Aim. To study the main risk factors on representative group of first-year students of StSMU during their screening, and on pilot group of students to study possible ways of influencing on these factors on CBP and its augmentation index. Material and methods. Totally 1351 first-year students screened for risk factors as inheritance of early onset of CVD, overweight, PH (prehypertension)/AH, smoking, chronic infectiousand immunity-related inflammations, wrong diet, hypodynamia, low stress resistibility, and for some of them — dyslipidemia and hyperglycemia (capillar test). In 80 patients, taken their risk factors, we assessed CBP and its augmentation index with diagnostical complex BPLab Vasotens Office (LLC “Piotr Telegin”, Nizhniy Novgorod). Results. Among first-year students with PH/AH overweight were each tenth, inheritance or focal infections — almost in each fifth. Wrong diet, hypodynamia and low stress resistibility are found in each fourth-fifth of enrolled in university. Absence of risk factors was found only in one fifth of first-graders. Most of them have two and more risk factors. Having these factors students usually had an increase of systolic, mean and pulse pressure in aorta, and augmentation index of central pulse pressure. Significantly more common in them is to find systemic and isolated central PH/AH. Conclusion. Regardless of young age and short anamnesis of adverse factors, students have preclinical, however quite clear damage of target organs such as vessel remodeling, including large vessels. It is necessary to implement broader into the centers of student healthcare and outpatient institutions the methods of CBP assessment as an office procedure with the aim of earlier vessel remodeling relevance during screening events with the aim for risk groups formation and control of efficacy of prevention procedures in such risk groups.

Hypertension is increasingly being found in children and adolescence. The purpose of this study was to find out differences in the central arterial (aortic) blood pressure parameters in young adults with hypertensive and normotensive parents. 109 healthy volunteers between the ages of 17 and 25 years were enrolled for the study after taking consent. Brachial artery pressures and aortic parameters were recorded using PeriScope™ which determines aortic parameters and functional vascular age non-invasively based on oscillometric method. The results of this study showed no statistically significant difference between offspring of hypertensive parents and offspring of normotensive parents for both peripheral and central blood pressure parameters.

Research objective was investigating arterial wall stiffness in patients with hypertension at young age and assessing the relationship between subclinical target organs damage and ambulatory blood pressure monitoring (ABPM) parameters. 30 male patients aged 18-35 years with essential hypertension stage I and II, hypertension 1 and 2nd grade were surveyed. The examination included general clinical methods, echocardiography, ABPM and suprasystolic sfigmography. It was found that the pulse wave velocity (PWVao) (r = 0,557 p

Aim. To study the correlation of arterial pressure variability on brachial artery and central arterial pressure variability with condition of target organs among menopausal women. Material and methods. This research included 93 women of menopause age — 37 premenopausal women and 56 women at early postmenopause. The age was 49,1 (48,0; 51,0) and 53,9 (50,0; 56,0), resp. Of those 69 (74,2%) had arterial hypertension. No one received continuous antihypertension therapy. 24-hour blood pressure mon itoring with variability estimating of systolic and diastolic pressure and evaluation of arterial stiffnes was taken by oscillometric method. Daily index of arterial stiffness, ambulatory index of arterial stiffness, augmentation index and indicators of central aortal pressure were estimated. Echocardiogram was used for left ventricular remodeling estimation. Pulse wave velocity was measured by ultrasonic method. Vascular regulation of endoltelium of brachial artery was estimated by the test of reactive hyperemia. As a sign of large elastic arteries remodeling the intima-media thickness was used. All women with arterial hypertension divided into 2 groups depending on variability of arterial pressure — 16 women with high levels of systolic and dyastolic arterial pressure were in first group and 53 women with normal indicators of variability were in second group. Control group consisted of 24 women that had no arterial hypertension with normal indicators of arterial pressure variability. Results. Disordered arterial pressure was prevalent among women in early postmeno­pause. Raise of variability of arterial pressure was correlated with morphofunctional changes of the heart, structure-functional vascular changes, increase of arterial stiffeness, disturbances of endoltelial vascular regulation and subclinical kidneys damage. Conclusion. Central arterial pressure variability has no additional advantages in comparison with estimated variability of brachial artery pressure. Increased variability of arterial pressure among menopausal women can be considered as additional factor of target organ damage in early stages of climacteric.

The clustering of cardio-metabolic risk factors, either when called metabolic syndrome (MetS) or not, substantially increases the risk of cardiovascular disease (CVD) and causes mortality. One of the possible mechanisms for this clustering's adverse effect is an increase in arterial stiffness (AS), and in high central aortic blood pressure (CABP), which are significant and independent CVD risk factors. Arterial hypertension was connected to AS long ago; however, other MetS components (obesity, dyslipidaemia, dysglycaemia) or MetS associated abnormalities not included in MetS diagnostic criteria (renal dysfunction, hyperuricaemia, hypercoaglutability, menopause, non alcoholic fatty liver disease, and obstructive sleep apnea) have been implicated too. We discuss the evidence connecting these cardio-metabolic risk factors, which negatively affect AS and finally increase CVD risk. Furthermore, we discuss the impact of possible lifestyle and pharmacological interventions on all these cardio-metabolic risk factors, in an effort to reduce CVD risk and identify features that should be taken into consideration when treating MetS patients with or without arterial hypertension.

Aim. To evaluate the parameters of central aortic pressure in patients with chronic heart failure (CHF) of ischemic aetiology. Material and methods . The study included 89 patients with ischemic CHF, aged from 41 to 73 years (mean age 56,1±0,8 years), and 15 controls, aged 39–56 years (mean age 49,4±1,5 years) without overt cardiovascular disease. All participants underwent the measurement of central aortic pressure (applanation tonometry, SphygmoCor) and the echocardiographic assessment of systolic and diastolic left ventricular function (ACUSON). Results. An accurate interpretation of central aortic pressure parameters in patients with ischemic CHF requires taking into account the baseline levels of blood pressure (BP). In these patients, the complex assessment of all measured parameters is preferable (by contrast, in patients with arterial hypertension, the main parameter of interest is typically augmentation index). Conclusion. The investigation of central aortic pressure parameters in patients with ischemic CHF provides an opportunity for non-invasive assessment of both peripheral and central pulse waves, for the measurement of central BP levels, for the identification of the BP-modifying factors (augmentation and amplification), and for the selection of a pathogenesis-based therapy.

Objectives: The Vicorder is a new brachial cuff-based device that estimates central blood pressure (cBP) using a brachial-to-aortic transfer function. The aim of this study was to evaluate cBP estimated by the Vicorder. Methods: During cardiac angiography, cBP estimated by the Vicorder and the SphygmoCor was evaluated against simultaneous invasive cBP in 50 patients. The two devices were also compared noninvasively in a separate group of 90 healthy individuals. Results: Central SBP (cSBP) obtained with each device satisfied the American Association for the Advancement of Medical Instrumentation accuracy criteria when peripheral waveforms were calibrated to invasive mean arterial

Arterial stiffness can nowadays be measured easily and noninvasively around the globe. Although well established as an independent predictor of cardiovascular events, less is known about the role of arterial stiffness in the progressive loss of kidney function once chronic kidney disease (CKD) is established. In addition to measures of arterial stiffness, a number of devices now noninvasively record the pulse profile from sites such as the radial artery and, using internal algorithms, are able to estimate central pressure profiles. Although these devices have generated much data on the prediction of cardiovascular events, e.g. measures of arterial stiffness, there is much less known about the predictive utility of these measures in CKD progression. In this review, we cover approaches to arterial stiffness as measured by pulse wave velocity and discuss measures of the systolic and diastolic contour of the pulse waveform vis-à-vis their relationship to declines in kidney function over time. We restrict our coverage to studies that have longitudinal data, but we also include a table of studies, which, to our knowledge, have only published cross-sectional data at this time.

Background and aims: Endothelial dysfunction is considered the first stage in the development of atherosclerosis and cardiovascular disease, and brachial flow-mediated dilation (FMD) is a measure of endothelial function. It is uncertain which of central systolic aortic pressure (CAP) or brachial systolic blood pressure (SBP) is more strongly associated with FMD. Therefore, we examined the correlations of CAP and SBP with FMD in Japanese men., Methods: The study subjects comprised 507 male volunteers aged 30-79 years that were residents in two communities under the Circulatory Risk in Communities Study (CIRCS) between 2013 and 2015. The low percent change of FMD (%FMD) ≤5.0%, after 5min of reactive hyperemia evaluated by the brachial artery diameter, was used to assess endothelial dysfunction. Values of CAP and SBP were divided into tertiles, with the lowest tertile used as a reference., Results: After adjustment for cardiovascular risk factors, the multivariable odds ratio (95% CI) of low FMD for the highest versus lowest tertile of CAP was 1.5 (0.9-2.6) for total subjects and 1.4 (0.5-3.8) for those with, and 2.4 (1.2-4.8) for those without antihypertensive medication use. The corresponding odd ratios for the highest versus lowest tertile of SBP were 0.9 (0.5-1.5), 0.8 (0.3-2.2), and 1.3 (0.7-2.5), respectively., Conclusions: Higher CAP levels were associated with low FMD for men without antihypertensive medication, but such an association was not found for SBP levels.

Background Early return of reflected blood pressure (BP) waves from the lower body augments central systolic BP and increases systolic pressure-time index (SPTI) and wasted left ventricular (LV) pressure energy, which increase afterload and myocardial oxygen (MVO 2 ) demand. Accordingly, we sought to determine wave reflection characteristics and diastolic timing in a group of patients with chronic stable angina resistant to anti-anginal therapy. Methods Radial artery BP waveforms were recorded non-invasively by applanation tonometry in 36 patients with refractory angina (RA) and a reference control (CON) group of 36 successfully treated hypertensive patients without angina matched for age, gender, height, BMI, and mean BP. Pulse wave analysis (PWA) of the ascending aortic BP waveform was used to determine central hemodynamics, diastolic timing, wave reflection characteristics and wasted LV pressure energy (LVEw). Results Compared to the CON group, RA patients had higher central aortic augmented BP, augmentation index (Alx) and reflected pressure wave systolic duration (SDR). These modifications in wave reflection characteristics were associated with an increase in SPTI and LVEw and a decrease in pulse BP amplification and the diastolic pressure time fraction. Conclusions RA patients have changes in systolic wave reflections and diastolic timing that increase LV afterload, MVO 2 demand and wasted LV energy and reduce coronary artery perfusion. These alterations in cardiovascular function contribute to an undesirable mismatch in the MVO 2 supply/demand ratio that favors ischemia and angina pectoris and may precipitate future adverse cardiovascular events.

The development of non-invasive technology to perform pulse wave analysis and accurately determine central blood pressure has facilitated the study of central blood pressure as a physiologic and biomarker parameter. Central systolic blood pressure (cSBP) has been shown to be significantly associated with adverse outcome such as mortality and associated with adverse outcome. One of the most commonly evaluated features of the arterial pressure waveforms is augmentation index (AIx). Nowadays, there are multiple devices that have been developed for calculate AIx at peripheral arteries. The aim of our study was to assess the repeatability measurements of second systolic shoulder of the radial waveform (pSBP2) and peripheral augmentation index (pAIx) using the OMRON HEM-9000AI. 36 young subjects were studied. The paired t student test showed no significant difference. The mean difference between the two consecutive measures of pSBP2 was 0.3 ± 4; P = 0.58, pAIx (0.3 ± 7; P = 0.80) and pAIx75 (0.5 ± 6.6; P = 0.62). This study demonstrates good repeatability and reliability of this method in our study population, compared to other populations the variability between measurements.

Background Preventive cardiology has expanded beyond coronary heart disease towards prevention of a broader spectrum of cardiovascular diseases. Ethnic minorities are at proportionately greater risk for developing extracoronary vascular disease including heart failure and cerebrovascular disease. Methods We performed a cross sectional study of Latino and White hypertension patients in a safety-net healthcare system. Framingham risk factors, markers of inflammation (hsCRP, LPpLA2), arterial stiffness (Pulse wave velocity, augmentation index, and central aortic pressure), and endothelial function (brachial artery flow-mediated dilatation) were measured. Univariate and multivariable associations between these parameters and an index of extracoronary atherosclerosis (carotid intima media thickness) was performed. Results Among 177 subjects, mean age was 62 years, 67% were female, and 67% were Latino. In univariate analysis, markers associated with carotid intima media thickness (IMT) at p < 0.25 included pulse wave velocity (PWV), augmentation index (AIx), central aortic pressure (cAP), and LpPLA2 activity rank. However, AIx, cAP, and LpPLA2 activity were not significantly associated with carotid IMT after adjusting for Framingham risk factors (all p > .10). Only PWV retained a significant association with carotid IMT independent of the Framingham general risk profile parameters (p = .016). No statistically significant interactions between Framingham and other independent variables with ethnicity (all p > .05) were observed. Conclusion In this safety net cohort, PWV is a potentially useful adjunctive atherosclerotic risk marker independent of traditional risk factors and irrespective of ethnicity.

BACKGROUND: The renin-angiotensin system (RAS) plays a major role in promoting left ventricular (LV) remodeling in essential hypertension. We designed a controlled, randomized pilot study aimed to test the hypothesis that the dual RAS blockade with angiotensin-converting enzyme (ACE) inhibitor (ACEi) + angiotensin II receptor blocker (ARB) can be more effective in decreasing LV hypertrophy and improving diastolic function than a largely employed association such as ACEi + calcium-antagonist (Ca-A). METHODS: Twenty-four never-treated hypertensive patients with LV concentric hypertrophy were randomized to ramipril + candesartan or ramipril + lercanidipine. Before and after the 6-month treatment they underwent a 24-h blood pressure (BP) monitoring and echocardiographic examination. RESULTS: At baseline, age, body mass index (BMI), 24-h BP, and LV morpho-functional parameters were similar between the two groups. The 6-month treatment induced in both groups a significant decrease of 24-h BP, septal and posterior wall thickness, and LV mass index (LVMi) (ACEi + ARB 155 +/- 19 to 122 +/- 17 g/m(2), P < 0.0001; ACEi + Ca-A 146 +/- 18 to 127 +/- 20 g/m(2), P < 0.0001). Systolic function remained unchanged; LV diastolic parameters increased significantly in both groups. The extent of 24-h BP decrease was similar between the two groups (-13.3/16.3% vs. -12.3/15.8%, P = 0.63/P = 0.71), whereas the decrease of LV mass (-22% vs. -12.8%, P < 0.005) and the improvement of diastolic function were greater in ACEi + ARB group. CONCLUSIONS: In comparison with ACEi + Ca-A, ACEi + ARB treatment showed a greater antiremodeling effect, that can be reasonably ascribed to a BP-independent effect of the dual RAS blockade.

Clinical trials have reported reduced cardiovascular events with certain antihypertensive agents at a rate that could not be predicted by changes in brachial arterial pressure alone. These findings may be explained, in part, by pleiotropic effects of these agents and modulation of central blood pressures. This review focuses on the mechanisms by which calcium channel blockers exert pleiotropic effects, both alone and in combination with statins and inhibitors of the renin-angiotensin system. The essential role of nitric oxide (NO) in maintaining endothelial function and the relationship between NO and reactive oxygen species are discussed in the context of the etiology of hypertension. The importance of managing global cardiovascular risk is emphasized, as hypertension commonly clusters with dyslipidemia and loss of glucose control. From a mechanistic viewpoint, these risk factors contribute to endothelial dysfunction, oxidative stress, and inflammation in a synergistic fashion. A greater understanding of the mechanisms of actions of these cardiovascular agents may lead to more effective drug combinations, to the benefit of individual patients. Furthermore, by elucidating the biological mechanisms by which cardiovascular risk factors lead to vascular injury, we may highlight common pathways and identify novel therapeutic targets.