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IntroductionAging is accompanied by physiological changes in cardiovascular regulation that can be evaluated using a variety of metrics. In this study, we employ machine learning on autonomic cardiovascular indices in order to estimate participants’ age.MethodsWe analyzed a database including resting state electrocardiogram and continuous blood pressure recordings of healthy volunteers. A total of 884 data sets met the inclusion criteria. Data of 72 other participants with an BMI indicating obesity (>30 kg/m²) were withheld as an evaluation sample. For all participants, 29 different cardiovascular indices were calculated including heart rate variability, blood pressure variability, baroreflex function, pulse wave dynamics, and QT interval characteristics. Based on cardiovascular indices, sex and device, four different approaches were applied in order to estimate the calendar age of healthy subjects, i.e., relevance vector regression (RVR), Gaussian process regression (GPR), support vector regression (SVR), and linear regression (LR). To estimate age in the obese group, we drew normal-weight controls from the large sample to build a training set and a validation set that had an age distribution similar to the obesity test sample.ResultsIn a five-fold cross validation scheme, we found the GPR model to be suited best to estimate calendar age, with a correlation of r=0.81 and a mean absolute error of MAE=5.6 years. In men, the error (MAE=5.4 years) seemed to be lower than that in women (MAE=6.0 years). In comparison to normal-weight subjects, GPR and SVR significantly overestimated the age of obese participants compared with controls. The highest age gap indicated advanced cardiovascular aging by 5.7 years in obese participants.DiscussionIn conclusion, machine learning can be used to estimate age on cardiovascular function in a healthy population when considering previous models of biological aging. The estimated age might serve as a comprehensive and readily interpretable marker of cardiovascular function. Whether it is a useful risk predictor should be investigated in future studies.

BackgroundPulse pressure (PP) may play a role in the development of cardiovascular disease, and the optimal PP for different ages and sexes is unknown. In a prospective cohort, we studied subjects with favorable cardiovascular health (CVH), proposed the mean PP as the optimal PP values, and demonstrated its relationship with healthy lifestyles.Methods and resultsBetween 1996 and 2016, a total of 162,636 participants (aged 20 years or above; mean age 34.9 years; 26.4% male subjects; meeting criteria for favorable health) were recruited for a medical examination program. PP in male subjects was 45.6 ± 9.4 mmHg and increased after the age of 50 years. PP in female subjects was 41.8 ± 9.5 mmHg and increased after the age of 40 years, exceeding that of male subjects after the age of 50 years. Except for female subjects with a PP of 40–70 mmHg, PP increase correlates with both systolic blood pressure (BP) increase and diastolic BP decrease. Individuals with mean PP values are more likely to meet health metrics, including body mass index (BMI)

Background and Objectives: Citrullus colocynthis belongs to the Cucurbitaceae family and is a wild medicinal plant used in folk literature to treat various diseases. The purpose of the current study was to explore the antihypertensive and antioxidant potentials of Citrullus colocynthis (CC) polyphenol-rich fractions using a spontaneous hypertensive rat (SHR) model. Materials and Methods: The concentrated aqueous ethanol extract of CC fruit was successively fractioned using solvents of increasing polarity, i.e., hexane, chloroform, ethyl acetate and n-butanol. The obtained extracts were analyzed for total phenolic content (TPC), total flavonoid content (TFC) and total flavonol content (TOF). Moreover, the CC extracts were further evaluated for radical scavenging capacity using 2,2-diphenyl-1-picrylhydrazyl (DPPH) and 2,2-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid (ABTS) assays and antioxidant activity using inhibition of linoleic acid peroxidation and determination of reducing potential protocols. The phytochemical components were characterized by HPLC–MWD–ESI–MS in positive ionization mode. Results: The results showed that ethyl acetate fraction (EAF) exhibited a higher content of phenolic compounds in term of TPC (289 mg/g), TFC (7.6 mg/g) and TOF (35.7 mg/g). EAF showed higher antioxidant and DPPH and ABTS scavenging activities with SC50 values of 6.2 and 79.5 µg/mL, respectively. LCMS analysis revealed that twenty polyphenol compounds were identified in the EAF, including phenolic acids and flavonoids, mainly myricetin and quercetin derivatives. The in vivo antihypertensive activity of EAF of CC on SHR revealed that it significantly decreased the mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressures (DBP) and pulse pressure (PP) as compared to normal and hypertensive control groups. Moreover, EAF of CC significantly reduced the oxidative stress in the animals in a dose-dependent manner by normalizing the levels of superoxide dismutase (SOD), malondialdehyde (MDA), reduced glutathione (GSH), nitric oxide (NOx) and total antioxidant capacity (TAC). Furthermore, the treatment groups, especially the 500 mg of EAF per kg body weight (EA-500) group, significantly (p ≤ 0.05) improved the electrocardiogram (ECG) pattern and pulse wave velocity (PWV). Conclusion: It was concluded that the EAF of CC is a rich source of polyphenols and showed the best antioxidant activity and antihypertensive potential in SHR.

To investigate if oxygen delivery index during cardiopulmonary bypass (DO 2 I) was more strongly associated with acute kidney injury (AKI), the higher the patient's preoperative pulse pressure (PP). Retrospective cohort of 1064 patients undergoing cardiac surgery. Single academic healthcare center. Adult patients undergoing coronary artery bypass grafting, valve, aortic, or combined surgery requiring cardiopulmonary bypass. Hemoglobin, arterial oxygen saturation, and pump flow recorded no fewer than every 30 min were extracted from the patients' perfusion records, and DO 2 I was calculated. The AKI was assessed from the pre- and postoperative creatinine and urine output values using the Acute Kidney Injury Network criteria. The sample was stratified in 5 categories of progressively higher PP. The patient characteristics and intraoperative variables were evaluated in univariate analysis for a relationship with AKI. The significant risk factors from the univariate analysis then were evaluated in a multivariate analysis and assessed for logistic fit with respect to AKI. The AKI assessed as a binary outcome. Age, body surface area, DO 2 I, history of heart failure, and baseline creatinine were associated significantly with AKI, as was an interaction term between the PP category and DO 2 I (p = 0.0067). The higher the PP category, the stronger the observed association between DO 2 I and AKI, and the higher the variability in the predicted risk of AKI dependent on DO 2 I. A lower DO 2 I during cardiopulmonary bypass appeared more strongly associated with a higher likelihood of developing AKI, the higher the patient's preoperative pulse pressure. [ABSTRACT FROM AUTHOR]

Increasing blood pressure variability (BPV) has been reported to be a strong predictor of cardiovascular events in patients with hypertension. However, the effects of BPV in the general population have not been intensively studied. The present study was designed to investigate a possible relationship between year‐to‐year BPV and hypertensive target organ damage (TOD) in a relatively low‐risk general population. A total of 5489 consecutive patients (mean age 58.6 ± 10.7 years) who visited our hospital for an annual physical checkup for five consecutive years during 2008–2013 were enrolled in this study. The average systolic and diastolic blood pressures and pulse pressure were calculated, as well as standard deviation, coefficient of variation, and average real variability in blood pressures. Cross‐sectional analysis was conducted and subjects without TOD at baseline (n = 3115) were followed up (median 1827 days) with the endpoint of TOD, defined as left ventricular hypertrophy on electrocardiogram or declining glomerular filtration rate. At baseline, BPV was closely associated with TOD. During follow‐up, left ventricular hypertrophy and declining glomerular filtration rate developed in 189 and 400 subjects, respectively. Although the standard deviation for systolic blood pressure and pulse pressure predicted future development of TOD in a univariate analysis, BPV was not a significant determinant of incident TOD in adjusted Cox hazard models. These results suggest that year‐to‐year BPV is a marker of the presence of TOD in the general population but does not independently predict future TOD. [ABSTRACT FROM AUTHOR]

Late chronotype (LC) correlates with reduced metabolic insulin sensitivity and cardiovascular disease. It is unclear if insulin action on aortic waveforms and inflammation is altered in LC versus early chronotype (EC). Adults with metabolic syndrome (n = 39, MetS) were classified as either EC (Morning‐Eveningness Questionnaire [MEQ] = 63.5 ± 1.2) or LC (MEQ = 45.5 ± 1.3). A 120 min euglycemic clamp (40 mU/m2/min, 90 mg/dL) with indirect calorimetry was used to determine metabolic insulin sensitivity (glucose infusion rate [GIR]) and nonoxidative glucose disposal (NOGD). Aortic waveforms via applanation tonometry and inflammation by blood biochemistries were assessed at 0 and 120 min of the clamp. LC had higher fat‐free mass and lower VO2max, GIR, and NOGD (between groups, all p ≤ 0.05) than EC. Despite no difference in 0 min waveforms, both groups had insulin‐stimulated elevations in pulse pressure amplification with reduced AIx75 and augmentation pressure (AP; time effect, p ≤ 0.05). However, EC had decreased forward pressure (Pf; interaction effect, p = 0.007) with insulin versus rises in LC. Although LC had higher tumor necrosis factor‐α (TNF‐α; group effect, p ≤ 0.01) than EC, both LC and EC had insulin‐stimulated increases in TNF‐α and decreases in hs‐CRP (time effect, both p ≤ 0.01). Higher MEQ scores related to greater insulin‐stimulated reductions in AP (r = −0.42, p = 0.016) and Pf (r = −0.41, p = 0.02). VO2max correlated with insulin‐mediated reductions in AIx75 (r = −0.56, p < 0.01) and AP (r = −0.49, p < 0.01). NOGD related to decreased AP (r = −0.44, p = 0.03) and Pf (r = −0.43, p = 0.04) during insulin infusion. LC was depicted by blunted forward pressure waveform responses to insulin and higher TNF‐α in MetS. More work is needed to assess endothelial function across chronotypes. [ABSTRACT FROM AUTHOR]

Background and Aims: Pulse pressure (PP) is a prognostic predictor of cardiovascular mortality. This retrospective cohort study aimed to investigate the association between home PP measurements and cardiovascular disease in patients with type 2 diabetes.Methods and Results: Home blood pressure was measured for 14 consecutive days in 1082 patients with type 2 diabetes, and pulse pressure was calculated. A 10 mmHg increase in morning PP was associated with a 1.30-fold increase in the risk of cardiovascular disease. The risk of cardiovascular disease was 1.88 times higher in the morning in the higher PP group than in the lower PP group. In the receiver operating characteristic analysis, the areas under the curve (95% confidence interval) corresponding to the PP (morning, evening, and clinic) for new-onset cardiovascular disease were 0.63 (0.58-0.69), 0.62 (0.57-0.67), and 0.59 (0.54-0.64), respectively. The area under the curve for PP measured in the morning was significantly greater than that for PP measured in the clinic (P = 0.032).Conclusion: Home-measured PP is a better predictor of new-onset cardiovascular disease than clinic-measured PP, in patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Although antibiotic exposure in the general population has been well documented by a biomonitoring approach, epidemiologic data on the relationships between urinary antibiotic burden in the elderly with blood pressure (BP) are still lacking. The current study revealed thirty-four antibiotics in urine specimens from 990 elderly patients in Lu'an City, China, with detection frequencies ranging from 0.2 to 35.5%. Among the elderly, the prevalence of hypertension was 72.0%, and 12 antibiotics were detected in more than 10% of individuals with hypertension. The elderly with hypertension had the maximum daily exposure (5450.45 μg/kg/day) to fluoroquinolones (FQs). Multiple linear regression analyses revealed significant associations of BP and pulse pressure (PP) with exposure to specific antibiotics. The estimated β values (95% confidence interval) of associations with systolic blood pressure (SBP) in the right arm were 4.42 (1.15, 7.69) for FQs, 4.26 (0.52, 8.01) for the preferred as human antibiotics (PHAs), and 3.48 (0.20, 6.77) for the mixtures (FQs + tetracyclines [TCs] (tertile 3 vs. tertile 1)), respectively. Increased concentrations of TCs were associated with decreased diastolic BP (DBP; tertile 3: −1.75 [−3.39, −0.12]) for the right arm. Higher levels of FQs (tertile 3: 4.28 [1.02, 7.54]), PHAs (tertile 3: 4.25 [0.49, 8.01]), and FQs + TCs (tertile 3: 3.99 [0.71, 7.26]) were associated with increased SBP, and an increase in DBP for FQs (tertile 3: 1.82 [0.22, 3.42]) was shown in the left arm. Also, higher urinary concentrations of FQs (tertile 3: 3.18 [0.53, 5.82]), PHAs (tertile 3: 3.42 [0.40, 6.45]), and FQs + TCs (tertile 3: 3.06 [0.40, 5.72]) were related to increased PP, whereas a decline in PP for TCs (tertile 2: −2.93 [−5.60, −0.25]) in the right arm. And increased concentrations of penicillin V (tertile 3: 5.31 [1.53, 9.10]) and FQs + TCs (tertile 3: 2.84 [0.19, 5.49]) were related to higher PP in the left arm. By utilizing restricted cubic splines, our current study revealed a potential nonlinear dose-response association between FQ exposure and hypertension risk. In conclusion, this investigation is the first to present antibiotic exposure using a biomonitoring approach, and informs understanding of impacts of antibiotic residues, as emerging hazardous pollutants, on the hypertension risk in the elderly. [ABSTRACT FROM AUTHOR]

Background: A promising risk loci for sporadic Alzheimer's disease (AD), Bridging Integrator 1 (BIN1), is thought to operate through the tau pathology pathway.Objective: We examine BIN1 risk for a moderating role with vascular health (pulse pressure; PP) and sex in predictions of episodic memory trajectories in asymptomatic aging adults.Methods: The sample included 623 participants (Baseline Mean age = 70.1; 66.8% female) covering a 44-year longitudinal band (53-97 years). With an established memory latent variable arrayed as individualized trajectories, we applied Mplus 8.5 to determine the best fitting longitudinal growth model. Main analyses were conducted in three sequential phases to investigate: 1) memory trajectory prediction by PP, 2) moderation by BIN1 genetic risk, and 3) stratification by sex.Results: We first confirmed that good vascular health (lower PP) was associated with higher memory level and shallower decline and males were more severely affected by worsening PP in both memory performance and longitudinal decline. Second, the PP prediction of memory trajectories was significant for BIN1 C/C and C/T carriers but not for persons with the highest AD risk (T/T homozygotes). Third, when further stratified by sex, the BIN1 moderation of memory prediction by PP was selective for females.Conclusion: We observed a novel interaction whereby BIN1 (linked with tauopathy in AD) and sex sequentially moderated a benchmark PP prediction of differential memory decline in asymptomatic aging. This multi-modal biomarker interaction approach, disaggregated by sex, can be an effective method for enhancing precision of AD genetic risk assessment. [ABSTRACT FROM AUTHOR]

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Introduction. Increased arterial stiffness is one of the key links in the formation of cardiovascular pathology in older age groups. At the same time, the effect of vascular stiffness on myocardial function in cardiac patients with frailty remains insufficiently studied.Aim of study. Тo analyze the data of arterial stiffness and diastolic function of left ventricle (LV) in patients older than 65 years with arterial hypertension and frailty.Materials and methods. The study included 90 outpatient and inpatient patients older than 65 years with the presence of arterial hypertension. All patients were divided into two groups: with the presence and absence of frailty. To identify frailty, we used the questionnaire “Age is not a hindrance”, a short battery of physical activity tests. Methods of volumetric sphygmometry, echocardiography, including tissue Doppler were used. The obtained data were analyzed using a package of statistical programs.Results. The results of a comparative simultaneous non-randomized descriptive study of two groups of patients are presented. The study found that the systolic function, diastolic dysfunction of the left ventricle by the type of slowing down of LV relaxation in both groups did not significantly differ in their indicators. In the group of patients with frailty, LV diastolic dysfunction was significantly more often detected by the type of pseudonormalization – with an increase in filling pressure. When analyzing data of arterial stiffness, differences were obtained in both groups in the left cardio-ankle vascular index (LCAVI), systolic blood pressure (LB SAD), pulse pressure (LB PD) in the left shoulder area, and the delta of average blood pressure in the left ankle area (LA% IDA), which were significantly higher in patients with frailty.Conclusion. In the group of patients with hypertension older than 65 years with frailty, a violation of the LV diastolic function by the type of pseudonormalization with an increase in filling pressure prevails. An increase in filling pressure in the group of patients older than 65 years with hypertension and the presence of frailty is associated with an increase in the complex of indicators characterizing arterial stiffness – the cardio-ankle vascular index, systolic blood pressure, pulse pressure in the left shoulder area, the delta of average blood pressure in the left ankle area.

The present study was conducted to assess the relationship between aspartate aminotransferase/ alanine aminotransferase (AST/ALT) ratio and pulse pressure in Korean adults with hypertension. Data from 1,515 adults from the sixth Korean National Health and Nutrition Examination Survey (KNHANES VI–3, 2015) were analyzed. There were several key findings in the present study. First, aspartate aminotransferase (odds ratio [OR], 1.018; 95% confidence interval [CI], 1.002 to 1.033), alanine aminotransferase (OR, 0.982; 95% CI, 0.969 to 0.996), and aspartate aminotransferase/ alanine aminotransferase ratio (OR, 1.367; 95% CI, 1.027 to 1.819) were the independent factors determining high pulse pressure. Second, after adjusting for related variables [age, gender, smoking, alcohol consumption, regular exercise, total cholesterol (TC), triglycerides (TGs), high-density lipoprotein-cholesterol (HDL-C), fasting plasma glucose (FPG), body mass index (BMI), and waist circumference (WC)], the ORs of high pulse pressure with the 1st quartile as a reference were significantly higher in the 4th quartile of aspartate aminotransferase/alanine aminotransferase ratio [1.632 (95% CI, 1.113∼2.393)]. The high pulse pressure was positively associated with aspartate aminotransferase and alanine aminotransferase/alanine aminotransferase ratio in Korean adults with hypertension, but was inversely associated with alanine aminotransferase.

Abstract Suboptimal blood pressure (BP) control in patients with type 2 diabetes is associated with adverse micro‐ and macrovascular complications. This study aimed to investigate the predictors of uncontrolled hypertension in an Iranian population with type 2 diabetes. This is a cross‐sectional study of 2612 patients with type 2 diabetes, including 944 patients with hypertension. Controlled and uncontrolled hypertension were assessed. Multivariate logistic regression modeling was used to determined independent predictors of uncontrolled hypertension. Of 2612 patients with type 2 diabetes, 944 (36.1%) patients had hypertension. Of all patients with hypertension, 580 (61.4%) were still on monotherapy. Uncontrolled hypertension was detected in 536 participants (56.8%). Patients with uncontrolled hypertension had significantly higher body mass index (BMI) (29.8±4.8 vs. 28.6±4.6), waist circumference (99.11±10.95 vs. 96.68±10.92), pulse pressure (67.3±17.3 vs. 48.4±10.7), total cholesterol (177.1±45.5 vs. 164.3±40.5), non‐HDL cholesterol (133.0±43.5 vs. 120.1±38.7), triglycerides (175.7±80.3 vs. 157.4±76.7), and Atherogenic Index of Plasma (AIP) (0.57±0.23 vs. 0.52±0.24) (p 200 mg/dl non‐HDL cholesterol had a significant correlation with uncontrolled hypertension (OR = 4.635, CI95%:1.781–12.064, p = .002). In conclusion, BMI, pulse pressure, total cholesterol, and non‐HDL cholesterol are significant predictors of uncontrolled hypertension in patients with type 2 diabetes. Also, ineffective monotherapy, medical inertia and patients’ non‐compliance were other contributors to the uncontrolled hypertension.

AimsPost-stroke hypertension is associated with poor short-term outcome, although the results have been conflicting. Our objective was to evaluate the association of blood pressure (BP) and in-hospital outcomes in patients with acute ischaemic stroke.Methods and resultsPatients in the Get With The Guidelines-Stroke registry with acute ischaemic stroke were included. Admission systolic and diastolic BP was used to compute mean arterial pressure (MAP) and pulse pressure (PP). The outcomes of interest were: in-hospital mortality, not discharged home, inability to ambulate independently at discharge and haemorrhagic complications due to thrombolytic therapy. A total of 309 611 patients with an ischaemic stroke were included. There was a J-shaped/U-shaped relationship between systolic BP and outcomes. Both lower and higher systolic BP values, compared with a central reference value, had higher risk of in-hospital death [e.g. adjusted odds ratio (95% confidence interval) (OR[CI]) = 1.16[1.13-1.20] for 120 vs. 150 mmHg and 1.24[1.19-1.30] for 200 vs. 150 mmHg], not discharged home (OR[CI] = 1.11[1.09-1.13] for 120 vs. 150 mmHg and 1.15[1.12-1.18] for 200 vs. 150 mmHg), inability to ambulate independently at discharge (OR[CI] = 1.16[1.13-1.18] for 120 vs. 150 mmHg and 1.09[1.06-1.11] for 200 vs. 150 mmHg). However, risk of haemorrhagic complications of thrombolytic therapy was lower with lower systolic BP (OR[CI] = 0.89[0.83-0.97] for 120 vs. 150 mmHg), while higher with higher systolic BP (OR[CI] = 1.21[1.11-1.32] for 200 vs. 150 mmHg). The results were largely similar for admission diastolic BP, MAP, and PP.ConclusionIn patients hospitalized with ischaemic stroke, J-shaped, or U-shaped relationships were observed between BP variables and short-term outcomes. However, haemorrhagic complications with thrombolytic therapy were lower with lower BP.

The hemodynamic and geometric factors leading to propagation of acute Type B dissections are poorly understood. The objective is to elucidate whether geometric and hemodynamic parameters increase the predilection for aortic dissection propagation. A pulse duplicator set-up was used on porcine aorta with a single entry tear. Mean pressures of 100 and 180 mmHg were used, with pulse pressures ranging from 40 to 200 mmHg. The propagation for varying geometric conditions (%circumference of the entry tear: 15-65%, axial length: 0.5-3.2 cm) were tested for two flap thicknesses (1/3rd and 2/3rd of the thickness of vessel wall, respectively). To assess the effect of pulse and mean pressure on flap dynamics, the %true lumen (TL) cross-sectional area of the entry tear were compared. The % circumference for propagation of thin flap (47 ± 1%) was not significantly different (p = 0.14) from thick flap (44 ± 2%). On the contrary, the axial length of propagation for thin flap (2.57 ± 0.15 cm) was significantly different (p

BackgroundHypertension (HBP) is a common disease among both men and women. Central blood pressure (CBP) is a method of evaluating aorta pressure that can assess the intrinsic BP of an individual patient that more closely correlates with cardiovascular disease (CVD) outcomes than peripheral BP parameters. We evaluated gender-specific differences in CBP and optimal target BP based on a composite outcome of CVD, heart failure (HF), and hypertensive complications in patients with HBP.MethodPatients were enrolled from June 2011 to December 2015 and were followed through December 2019. CBP was measured using radial tonometry. The primary endpoint was a composite outcome.ResultThe median follow-up period for enrolled patients was 6.5 years. Out of a total of 2,115 patients with an average age of 57.9 ± 13.6 years, 266 patients (12.6%) had events of primary end points during the follow-up period. There was no difference in the lowest BP level between men and women in the incidence of CVD. Among the women (49.6%), 78.1% were postmenopausal. In a multivariable Cox proportional hazards model, CBP and systolic BP showed an increase in risk of 10 and 11%, respectively, with every 10 mmHg increase, and there was a similar trend of 12 and 13%, respectively, in postmenopausal women. However, PP showed an increase in risk of about 2% every 10 mmHg increase, but a tendency to increase risk by 19% in postmenopausal women.ConclusionThis study demonstrated that postmenopausal women will continue to show increased risk for CVD at BP higher than the optimal level. Conversely, there was no increase in CV risk due to menopause at BP values below the optimal level. Therefore, well-controlled BP is more important in postmenopausal women.

BackgroundHigh pulse pressure (PP) is associated with increased risk of decline of kidney function. However, little is known about the association between PP and RHF in young adults. This study aimed to evaluate the association between PP and RHF in healthy young adults.MethodsData were retrieved from the Korea National Health and Nutrition Examination Survey from 2010 to 2019. A total of 10,365 participants aged 19–39 years with no hypertension and normal kidney function were analyzed. RHF was defined as logarithm transformed estimated glomerular filtration rate (eGFR) with residuals >90th percentile after adjustment for sex, logarithm transformed age, weight, and height. Participants were divided into tertile based on PP levels.ResultsThe prevalence of RHF was higher in higher PP tertile group (6.6, 10.5, and 12.7% in T1, T2, and T3; P for trend < 0.001). In multivariable logistic regression analyses, the risk for RHF was increased in higher PP tertiles compared to the lowest tertile [odds ratio (OR), 1.42; 95% confidence interval (CI), 1.19–1.69 in T2; OR, 1.44; 95% CI, 1.20–1.73 in T3]. When PP levels were treated as continuous variable, the risk of RHF was increased 2.36 per 1.0 increase of PP (P < 0.001). In subgroup analyses stratified sex, histories of diabetes or dyslipidemia, and isolated systolic hypertension or isolated diastolic hypertension, there were no significant interactions with PP for the risk for RHF, suggesting that high PP was associated with increased risk of RHF regardless of subgroups. However, the subgroup with BMI showed significant interaction with PP for the risk of RHF, indicating that participants with BMI ≥ 25 kg/m2 were at higher risk of RHF with increasing PP levels than those with BMI < 25 kg/m2 (OR, 1.89; 95% CI, 1.25–2.87 in BMI < 25 kg/m2; OR, 3.16; 95% CI, 1.74–5.73 in BMI ≥ 25 kg/m2; P for interaction = 0.01).ConclusionHigh PP is associated with an increased risk of RHF in healthy young adults and this association is prominent in obese young adults. The assessment of PP and associated RHF may give benefit to early detect the potential risk of CKD development in young adults.

BackgroundPulse pressure (PP) and mean arterial pressure (MAP) are well-established markers of cardiovascular risk. In this study, we aimed to assess the temporal trend and associated factors of PP and MAP in Chinese children and adolescents.MethodsFrom the China Health and Nutrition Survey 1991–2015, a total of 11,123 children and adolescents aged 7–17 years were included. Stratified analyses and generalized estimating equation (GEE) were conducted to compare the trends of PP and MAP by age and sex over two decades, along with the calculation of average relative increase (ARI). Moreover, multivariable linear regression was used to estimate the associated factors of PP and MAP.ResultsDuring 1991–2015, upward trends were observed in both PP and MAP levels, with ARI of 0.30 and 0.34%, respectively. PP was higher in boys [PP1991 33.9 mmHg (95%CI, 33.40–34.33) to PP2015 35.4 mmHg (34.74–36.15)] than in girls [PP1991 33.3 mmHg (32.83–33.72) to PP2015 34.3 mmHg (33.59–34.99)]. PP was also higher in participants aged 13–17 years [PP1991 36.1 mmHg (35.63–36.62) to PP2015 38.3 mmHg (37.35–39.21)] than in those aged 7–12 years [PP1991 31.5 mmHg (31.09–31.88) to PP2015 33.7 mmHg (33.16–34.30)]. Similar results were found in MAP. Participants with high economic status, general obesity and central obesity, were more likely to have wider PP (βhigheconomicstatus = 0.60, 95% CI, 0.19–1.02; βgeneralobesity = 1.38, 0.87–1.89; βcentralobesity = 1.34, 0.70–1.97; all P-values < 0.001) and higher MAP (βhigheconomicstatus = 0.82, 0.38–1.26; βgeneralobesity = 2.88, 2.33–3.42; βcentralobesity = 3.14, 2.47–3.80; all P-values < 0.001). Body mass index (BMI) and waist circumference (WC) were positively correlated with PP (βBMI = 0.18, 0.13–0.24; βWC = 0.10, 0.08–0.12; both P-values < 0.001) and MAP (βBMI = 0.43, 0.37–0.49; βWC = 0.20, 0.18–0.22; both P-values < 0.001). In addition, rural setting and glucose level were positively associated with PP (both P < 0.05), while north region residency, uric acid, and total cholesterol were found to be positively associated with MAP (all P < 0.05).ConclusionPP and MAP levels have been increasing dramatically in Chinese children and adolescents over the last two decades. Age, sex, economic status, geographic factors, anthropometric and cardiometabolic factor were positively associated with PP and MAP in pediatric population.

Purpose There has been limited evidence for the association between socioeconomic status (SES) and arterial stiffness. This study was performed to investigate the association between household income and brachial pulse pressure (PP) in the general Korean population. Materials and methods This study was based on data acquired in the 2018 Korea National Health and Nutrition Examination Survey (2018 KNHANES). A total of 13004 subjects at the age of 20 years or older analysed. The information on monthly household income was obtained through the questionnaire, and was stratified into 5 groups for each quintile. Brachial blood pressure (BP) was measured 3 times, and the average of the second and third measured BPs were used. PP was calculated as the difference between systolic and diastolic BPs. Results A lower household income was associated with a higher prevalence of cardiovascular risk factors. As household income increased, PP decreased proportionally (p

Background: Maintaining a constant driving pressure during a prolonged sigh breath lung recruitment manoeuvre (LRM) from 20 to 45 cmH20 peak inspiratory pressure in mechanically ventilated patients has been shown to be a functional test to predict fluid responsiveness (FR) when using a linear regression model of hemodynamic parameters, such as central venous pressure (CVP) and pulse pressure (PP). However, two important limitations have been raised, the use of high ventilation pressures and a regression slope calculation that is difficult to apply at bedside. This ancillary study aimed to reanalyse absolute variations of CVP (ΔCVP) and PP (ΔPP) values at lower stages of the LRM, (40, 35, and 30 cm H20 of peak inspiratory pressure) for their ability to predict fluid responsiveness. Methods: Retrospective analysis of a prospective study data set in 18 mechanically ventilated patients, in an intensive care unit. CVP, systemic arterial pressure parameters and stroke volume (SV) were recorded during prolonged LRM followed by a 500 mL crystalloid volume expansion. Patients were considered as fluid responders if SV increased more than 10%. Receiver-operating curves (ROC) analysis with the corresponding grey zone approach were performed. Results: Areas under the ROC to predict fluid responsiveness for ΔCVP and ΔPP were not different between the successive stepwise increase of inspiratory pressures [0.88 and 0.89 for ΔCVP at 45 and 30 cm H20 (P = 0.89), respectively, and 0.92 and 0.95 for ΔPP at 45 and 30 cm H20, respectively (P = 0.51)]. Using a maximum of 30 cmH2O inspiratory pressure during the LRM, ΔCVP and ΔPP had a threshold value to predict fluid responsiveness of 2 mmHg and 4 mmHg, with sensitivities of 89% and 89% and specificities of 67% and 89%, respectively. Combining ΔPP and ΔCVP decreased the proportion of the patients in the grey zone from 28 to 11% and showed a sensitivity of 88% and a specificity of 83%. Conclusions: A stepwise PEEP elevation recruitment manoeuvre of up to 30 cm H20 may predict fluid responsiveness as well as 45 cm H20. The combination of ΔPP and ΔCVP optimizes the categorization of responder and non-responder patients. [ABSTRACT FROM AUTHOR]

Background: The prospective correlation between subclinical atherosclerosis and diabetic retinopathy (DR) incidence in Chinese patients with type 2 diabetes mellitus (T2DM) remains elusive. Methods: Prospective data were obtained from 2781 patients with diabetes, among whom 1,964 and 2,180 T2DM patients without any and referable DR at baseline, respectively, were included in the analysis. Multivariate analyses were performed using the Cox proportional hazards model. Results: Over a median follow-up of 22.2 months (interquartile range 12.7–27.7), 282 (14.36%) and 125 (5.73%) patients developed any and referable DR, respectively. After adjustment for confounders, each standard deviation (SD) increase in brachial-ankle pulse wave velocity (ba-PWV) was associated with 31% (95% confidence interval 1.15–1.50) and 38% (1.14–1.66) higher risks of incident any and referable DR, respectively. Compared with the lowest ba-PWV quartile, the highest ba-PWV quartile had 135% (1.48–3.72) and 293% (1.83–8.44) higher risks of developing any and referable DR, respectively. Per SD increase of pulse pressure (PP) was associated with 22% (1.09–1.38) and 22% (1.02–1.46) higher risks of incident any and referable DR, respectively. The restricted cubic spline models further indicated a significant linear association of baseline subclinical atherosclerosis with referable DR, and a nonlinear association with any DR. In addition, adding the ba-PWV to the prognostic model for DR incidence improved the C-statistic value, the integrated discrimination improvement value, and the net reclassification improvement value (all P < 0.05). Conclusions: Baseline subclinical atherosclerosis was significantly associated with an increased risk of DR incidence, and elevated ba-PWV independently predicted incident DR in T2DM patients. [ABSTRACT FROM AUTHOR]

Excessive salt intake is currently the foremost universal risk factor for controllable chronic disease. This study evaluated the short-term effects of a modest salt intake reduction combined with the Chinese Modified Dietary Approaches to Stop Hypertension (CM-DASH) diet on sodium and potassium intake, mean arterial pressure (MAP), and pulse pressure (PP) in hypertensive patients with type II diabetes. Sixty-one participants were randomized to the intervention group (52% low-sodium salt and DASH) and control group (normal salt and DASH). An 8-week dietary intervention was applied. Daily salt intake, blood pressure (BP), and drug use were recorded every week. Twenty-four-hour urine, casual urine, and blood samples were measured at baseline, the 4th week, and the end of the intervention. Fifty-nine patients (25 men) completed the entire study. Sodium intake decreased by 1259.66 (792.76, 1726.56)/705.80 (149.21, 1262.39) mg/day after 4 weeks (intervention: P <.001; control: P =.015). Potassium intake increased by 641.14 (73.31, 1208.96)/43.43 (−259.66, 346.53) mg/day (intervention: P =.028); MAP decreased by 9.06 (6.69, 11.43)/7.16 (4.03, 10.28) mmHg (both: P <.001); PP decreased by 7.97 (3.05, 12.88)/5.74 (2.55,8.94) mmHg (intervention: P =.002; control: P =.001) after 8 weeks. However, the difference between the two groups was not statistically significant. Modest salt reduction and the CM-DASH diet for hypertensive patients with type II diabetes can achieve short-term salt reduction effects. The effect on changing salt-eating habits needs to be investigated with an extended follow-up. [ABSTRACT FROM AUTHOR]

The associations of blood pressure components with cardiovascular risks and death remain unclear, and the definition of wide pulse pressure (PP) is still controversial. Using data from 1257 participants without a history of cardiovascular disease, who were followed for 4.84 years, we performed multivariable Cox regression analyses to assess how systolic blood pressure (SBP), diastolic blood pressure (DBP), and PP contribute to risks of cardiovascular events and all‐cause death. Among all participants, SBP and PP were significantly associated with the risks of cardiovascular events and all‐cause death (all p <.05). DBP was not significantly associated with the risk of all‐cause death; rather, it was only associated with a marginally significant 1% increased risk for cardiovascular events (p = 0.051). In participants aged < 65 years, DBP was significantly associated with a 3% increased risk for cardiovascular events (hazard ratio [HR]: 1.03, 95% confidence interval [95% CI]: 1.01–1.06). The association between PP and cardiovascular events appeared to be J‐shaped in comparison to participants with the lowest‐risk PP (50–60 mmHg), with adjusted HRs of 1.71 (95% CI: 1.03–2.85), 1.63 (95% CI: 1.00–2.68), and 2.13 (95% CI: 1.32–3.43) in the <50, 60.0–72.5, and ≥72.5 mmHg subgroups, respectively. The optimal cutoff points of a wide PP for predicting the risks of cardiovascular events and all‐cause death were 70.25 and 76.25 mmHg, respectively. SBP and PP had a greater effect on cardiovascular risk, whereas DBP independently influenced cardiovascular events in middle‐aged participants. Considerable PP alterations should be avoided in antihypertensive treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND This study aimed to investigate the association of pulse pressure (PP) with the cardio-cerebrovascular disease (CCVD) risk and all-cause mortality according to blood pressure level using Korean national cohort data. METHODS This study was retrospectively designed and based on the Korean National Health Insurance Service-National Health Screening Cohort. Participants aged 40–69 years at baseline were categorized into normal, elevated, stage 1, and stage 2 groups according to blood pressure. Each group was further classified into 5 groups separated by 10-mm Hg increments in PP. The primary composite outcome was defined as CCVDs and all-cause mortality. Cox proportional hazards regression models were adopted after stepwise adjustment for confounders to investigate the composite outcome. RESULTS During the follow-up period (median follow-up period, 12.0 years), the primary composite outcome occurred in 18,444 (15.0%) of 122,783 men and 10,096 (11.4%) of 88,550 women. After complete adjustment for confounders, in the stage 1 hypertensive men, the hazard ratio (95% confidence intervals [CIs]) of the 31–40, 41–50, 51–60, and >60 mm Hg PP groups was 1.112 (1.013–1.221), 1.035 (0.942–1.137), 1.009 (0.907–1.123), and 1.324 (1.130–1.551) in comparison with the ≤30 mm Hg PP group. In the stage 2 hypertensive men, the HRs (95% CIs) were 1.069 (0.949–1.204), 1.059 (0.940–1.192), 1.123 (0.999–1.263), and 1.202 (1.061–1.358) compared to the ≤30 mm Hg PP group. However, these associations were not significant in women. CONCLUSIONS Hypertensive men with an increased PP have an increased risk of CCVDs and all-cause mortality. [ABSTRACT FROM AUTHOR]

Background: The association between post-operative diastolic blood pressure (DBP) and pulse pressure (PP) with outcomes following transcatheter aortic valve replacement (TAVR) remains unclear. We sought to assess the prevalence, predictors, and impact of post-operative DBP and PP on presence of post-procedural aortic insufficiency (AI) and mortality in adults undergoing TAVR.Methods: The study population included 194 patients who underwent TAVR from 2016 to 2017 at an academic tertiary medical center, of which 176 had invasive arterial pressures available postoperatively. Low DBP and widened PP were defined as ≤40 mmHg and ≥80 mmHg respectively on invasive arterial line on post-operative day 1. Clinical outcomes of interest included post-procedural AI and 1-year all-cause mortality.Results: Post-operative low DBP and widened PP were noted in 32.4% and 58.5% of the study population. No significant association between post-operative AI and low DBP (p = 0.82) or widened PP (p = 0.32) was noted. There was a trend toward higher rates of mortality in patients with low DBP (19.3% vs 9.2%, p = 0.06) but no difference in mortality in patients with widened PP (10.7% vs 15.1%, p = 0.39) or those with ≥1+ post-procedural AI (16.7% vs 10.7%, p = 0.32). In multivariable analysis, low DBP was associated with a trend toward higher rates of 1-year mortality [odds ratio (OR) 2.43, 95% confidence interval (CI) 0.97-6.11, p = 0.06]. When excluding patients with a post-operative invasive systolic blood pressure < 80 mmHg, low DBP was associated with significantly higher risk-adjusted mortality at 1 year [OR 2.75, 95% CI (1.07-7.07), p = 0.04].Conclusions: In this contemporary study of adults undergoing TAVR, low DBP and widened PP were widely prevalent post TAVR. Low DBP was associated with a trend toward higher rates of 1-year mortality but not with post-procedural AI. [ABSTRACT FROM AUTHOR]

Patients with schizophrenia are at higher risk of cardiovascular (CVS) related mortality. Close attention is being paid to the clinical utility of readily available CVS markers. A pilot one-year longitudinal study in inpatients with first-episode psychosis (FEP) was carried out to determine markers of inflammation and endothelial dysfunction (monocyte- and neutrophil-to-lymphocyte ratios) and basal blood pressure, pulse, and derived hemodynamic parameters (PP: pulse pressure; RPP: rate pressure product; and MAP: mean arterial pressure). After one year, PP and RPP increased, as did systolic blood pressure and heart rate. Systolic blood pressure, PP, total white blood cells, and neutrophils correlated with weight gain. After one year, correlations between monocyte-to-lymphocyte ratio and RPP and MAP were observed. Our study indicates worsening CVS health over the first year of treatment and emphasises the importance of early monitoring of CVS status using easily accessible parameters to prevent CVS-related mortality. Patients with schizophrenia are at higher risk of cardiovascular mortality. The CVS risk could be evaluated using affordable, routinely available CVS markers such as monocyte- and neutrophil-to-lymphocyte ratios, blood pressure, and pulse together with the derived parameters. Our pilot study in first-episode psychosis patients indicates worsening of CVS health based on these parameters during the first year of treatment, the early monitoring of CVS status is highly relevant in clinical practice. [ABSTRACT FROM AUTHOR]

An increase in the renal resistive index (RRI) in patients with essential hypertension (EH) predicts deterioration in renal function. In patients with EH, changes in hemodynamic parameters significantly affect the RRI. This study aimed to define changes in Ambulatory Blood Pressure Monitoring (ABPM) parameters that are significantly associated with a change in RRI in patients with EH. We evaluated ABPM and the RRI in 96 patients with EH without organ extrarenal changes at baseline and after two years of follow-up. The relationships between changes in ABPM parameters and the RRI over the period were evaluated. After two years of follow-up, the increase in RRI was consequential. Simultaneously, 24-h systolic blood pressure increased significantly and 24-h diastolic blood pressure decreased. In the whole group and in the group with calculated cystatin C clearance (eGFRcyst) ≥90 ml/min/1.73 m², the change in RRI significantly negatively correlated with the change in the ratio of 24-h diastolic to systolic blood pressure (D/S ratio), but also with the change in 24-h pulse blood pressure. However, in patients with eGFRcyst<90 ml/min/1.73 m², only the change in the 24-h D/S ratio significantly correlated with the change in RRI. Based on the backward stepwise regression analysis, the change in RRI was significantly dependent only on the change in 24-h D/S ratio and not on the change in 24-h pulse pressure. A change in the ratio of diastolic to systolic pressure better reflects a change in RRI than a change in pulse pressure. [ABSTRACT FROM AUTHOR]

Abstract Aims Aortic pulsatility index (API), calculated as (systolic–diastolic blood pressure)/pulmonary capillary wedge pressure (PCWP), is a novel haemodynamic measurement representing both cardiac filling pressures and contractility. We hypothesized that API would better predict clinical outcomes than traditional haemodynamic metrics of cardiac function. Methods and results The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial individual‐level data were used. Routine haemodynamic measurements, including Fick cardiac index (CI), and the advanced haemodynamic metrics of API, cardiac power output (CPO), and pulmonary artery pulsatility index (PAPI) were calculated after final haemodynamic‐monitored optimization. The primary outcome was a composite endpoint of death or need for orthotopic heart transplant (OHT) or left ventricular assist device (LVAD) at 6 months. A total of 433 participants were enrolled in the ESCAPE trial of which 145 had final haemodynamic data. Final API measurements predicted the primary outcome, OR 0.47 (95% CI 0.32–0.70, P

Abstract Objectives To determine the correlation between anthropometric indices and the selected hemodynamic parameters among secondary adolescents aged 12–17 years. Results Our findings showed weak positive correlation between generally body surface area, neck circumference and conicity index with the hemodynamic parameters (systolic blood pressure, diastolic blood pressure, resting pulse rate, mean arterial pressure, rate pressure product and pulse pressure). However, the ponderosity index, body mass index and waist hip ratio showed negative weak correlations with the hemodynamic parameters. There was a significant difference in pulse pressure among the BMI categories. All parameters showed significant (p

BackgroundPulse pressure (PP) is a surrogate of aortic stiffness, and reflects cardiac performance and stroke volume. Previous studies have indicated that PP was a robust predictor of cardiovascular outcomes and mortality. However, results have been mixed, and very few studies have focused on the association of PP with mortality in acute coronary syndrome (ACS). Thus, we aimed to investigate the relationship between admission PP and the prognosis of patients with ACS.MethodsThis cohort study included 10,824 patients diagnosed with ACS from the Cardiovascular Center Beijing Friendship Hospital Database Bank (CBDBANK) from January 2013 to October 2018. Patients with cardiogenic shock, malignancy, severe trauma and, no PP at admission were excluded. Restricted cubic spline and Cox proportional hazards regression were used to evaluate the association between PP and 1-year all-cause and cardiac mortality.ResultsIn the whole cohort, a total of 237 (2.19%) all-cause deaths were reported at 1-year follow-up. Restricted cubic spline analysis suggested a J-shaped relationship between PP and mortality. Among patients with ACS, both lower and higher PP levels were related to an increased risk of mortality (Pnon–linear < 0.001); with a PP level of 30 or 80 mmHg, as compared with 50 mmHg, the adjusted hazard ratios for 1-year all-cause mortality were 2.02 (95% CI, 1.27–3.22) and 1.62 (95% CI, 1.13–2.33), respectively, after adjustments for potential confounders. Similar results were observed for cardiac deaths. The J-shaped relationship between PP and mortality remained in a series of subgroup analyses.ConclusionOur results suggested that both low and high PP were associated with an increased risk of mortality in patients with ACS.

BackgroundHIV is associated with elevated markers of vascular remodeling that may contribute to arterial fibrosis and stiffening and changes in pulse pressure (PP). These changes may, in turn, deleteriously affect autoregulation of cerebral blood flow and neurocognitive function.MethodsTo evaluate these mechanisms, we studied markers of vascular remodeling, PP, and neurocognitive function among older (≥50 years of age) HIV-infected (HIV+, n = 72) and HIV-seronegative (HIV-, n = 36) adults. Participants completed standardized neurobehavioral and neuromedical assessments. Neurocognitive functioning was evaluated using a well-validated comprehensive battery. Three plasma biomarkers of vascular remodeling (ie, angiopoietin 2, Tie-2, and vascular endothelial growth factor, VEGF) were collected.ResultsHIV+ and HIV- participants had similar levels of plasma angiopoietin 2 (P = 0.48), Tie-2 (P = 0.27), VEGF (P = 0.18), and PP (P = 0.98). In a multivariable regression model, HIV interacted with Tie-2 (β = 0.41, P < 0.01) and VEGF (β = -0.43, P = 0.01) on neurocognitive function, such that lower Tie-2 and higher VEGF values were associated with worse neurocognitive function for HIV+ participants. Greater Tie-2 values were associated with increased PP (r = 0.31, P < 0.01). In turn, PP demonstrated a quadratic association with neurocognitive function (β = -0.33, P = 0.01), such that lower and higher, relative to mean sample, PP values were associated with worse neurocognitive function.ConclusionsThese findings indicate that vascular remodeling and altered cerebral blood flow autoregulation contribute to neurocognitive function. Furthermore, HIV moderates the association between vascular remodeling and neurocognitive function but not the association between PP and neurocognitive function.

We investigated whether midlife pulse pressure is associated with brain atrophy and cognitive decline, and whether the association was modified by apolipoprotein-E ε4 (APOE-ε4) and hypertension. Participants (549 stroke-free and dementia-free Framingham Offspring Cohort Study participants, age range=55.0 to 64.9 y) underwent baseline neuropsychological and magnetic resonance imaging (subset, n=454) evaluations with 5- to 7-year follow-up. Regression analyses investigated associations between baseline pulse pressure (systolic-diastolic pressure) and cognition, total cerebral volume and temporal horn ventricular volume (as an index of smaller hippocampal volume) at follow-up, and longitudinal change in these measures. Interactions with APOE-ε4 and hypertension were assessed. Covariates included age, sex, education, assessment interval, and interim stroke. In the total sample, baseline pulse pressure was associated with worse executive ability, lower total cerebral volume, and greater temporal horn ventricular volume 5 to 7 years later, and longitudinal decline in executive ability and increase in temporal horn ventricular volume. Among APOE-ε4 carriers only, baseline pulse pressure was associated with longitudinal decline in visuospatial organization. Findings indicate arterial stiffening, indexed by pulse pressure, may play a role in early cognitive decline and brain atrophy in mid to late life, particularly among APOE-ε4 carriers.

Low levels of the Klotho protein are associated with accelerated tissue aging, including arterial stiffness, in patients with cardiovascular and renal diseases. However, this association has not been examined in a diverse cohort. We aimed to investigate the association between serum Klotho protein levels and pulse pressure, as an indicator of arterial stiffness, in a cohort representative of the US population. We used the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016. Association between pulse pressure and Klotho levels as a continuous variable and in quartiles were examined using survey weight-adjusted linear regression models. Multivariable models were adjusted for age, gender, race, BMI, hypertension, diabetes, smoking, alcohol use, total cholesterol, and estimated GFR. Of the 13,362 participants, 3954(29.6%) were > 65 years, 5792(43%) were Caucasian, and 6773(50.7%) had hypertension. Mean(SD) Klotho was 0.85(0.31) ng/mL and pulse pressure was 55.8(18.5) mmHg. In unadjusted and adjusted models, each ng/mL increase in Klotho was associated with a 3.88 mmHg (95%CI = −5.19,−2.57; P < 0.001) and 1.63 mmHg (95%CI = −3.01,−0.24; P = 0.02) decrease in pulse pressure, respectively. Similarly, participants in the highest quartile of Klotho had lower pulse pressure than those in the lowest quartile (−3.05 mmHg; 95%CI = −4.05,−2.05; P < 0.001), and this difference remained significant in adjusted models (−1.10 mmHg; 95%CI = −2.20,−0.01; P = 0.05). In this large diverse cohort, we found an inverse and independent association between serum Klotho levels and pulse pressure suggesting that Klotho is associated with arterial stiffness. The mechanisms underlying this association need further study. • Low levels of serum Klotho protein are associated with accelerated aging of several tissues. • We examined the association between the serum soluble Klotho protein levels and pulse pressure. • An inverse relationship between soluble serum Klotho levels and pulse pressure was observed independent of confounders. [ABSTRACT FROM AUTHOR]

Aims: This study evaluated the relationship between pulse pressure (PP) and periodontal disease in Korean adults with or without hypertension (classified as HTN and non-HTN, respectively). Methods: Data on 3496 adults (≥20 years) were obtained from the Korean National Health and Nutrition Examination Survey (2015). We classified those with HTN as SBP ≥ 140 mmHg, DBP ≥ 90 mmHg, or current use of anti-hypertensive medications. Results: There were a few key findings: when logistic regression analysis was applied for periodontal disease (community periodontal index score ≥ 3), the odds ratios (OR) were significantly higher in the high PP (PP > 60 mmHg) than in the normal PP (PP ≤ 60 mmHg) in the HTN group (OR, 2.131; 95% confidence interval (CI), 1.579–2.876). However, periodontal disease was not associated with high PP in the non-HTN group and was not significant (OR, 0.866; 95% CI, 0.494–1.518). Conclusions: In Korean adults, periodontal disease was positively associated with PP in the HTN group but not in the non-HTN group. [ABSTRACT FROM AUTHOR]

Aortic dissection and rupture are the major causes of premature death in persons with Marfan syndrome (MFS), a rare genetic disorder featuring cardiovascular, skeletal, and ocular impairments. We and others have found that obstructive sleep apnea (OSA) confers significant vascular stress in this population and may accelerate aortic disease progression. We hypothesized that D-dimer, a diagnostic biomarker for several types of vascular injury that is also elevated in persons with MFS with aortic enlargement, may be sensitive to cardiovascular stresses caused by OSA. To test this concept, we recruited 16 persons with MFS without aortic dissection and randomized them to two nights of polysomnography, without (baseline) and with OSA treatment: continuous positive airway pressure (CPAP). In addition to scoring OSA by the apnea-hypopnea index (AHI), beat-by-beat systolic BP (SBP) and pulse-pressure (PP) fluctuations were quantified. Morning blood samples were also assayed for D-dimer levels. In this cohort (male:female, 10:6; age, 36 ± 13 yr; aortic diameter, 4 ± 1 cm), CPAP eliminated OSA (AHI: 20± 17 vs. 3 ± 2 events/h, P = 0.001) and decreased fluctuations in SBP (13 ± 4 vs. 9 ± 3 mmHg, P = 0.011) and PP (7±2 vs. 5±2 mmHg, P = 0.013). CPAP also reduced D-dimer levels from 1,108 ± 656 to 882 ± 532 ng/mL (P = 0.023). Linear regression revealed a positive association between the maximum PP during OSA and D-dimer in both the unadjusted (r = 0.523, P = 0.038) and a model adjusted for contemporaneous aortic root diameter (r = 0.733, P = 0.028). Our study revealed that overnight CPAP reduces D-dimer levels commensurate with the elimination of OSA and concomitant hemodynamic fluctuations. Morning D-dimer measurements together with OSA screening might serve as predictors of vascular injury in MFS. [ABSTRACT FROM AUTHOR]

Small vessel disease is associated with age, mean blood pressure (MAP) and blood pressure pulsatility (PP). We used data from the UK Biobank cohort study to determine the relative importance of MAP versus PP driving white matter injury within individual white matter tracts, particularly in the anterior and posterior vascular territory. The associations between blood pressure and diffusion indices in 27 major tracts were analysed using unadjusted and fully-adjusted general linear models and mixed-effect linear models. Blood pressure and neuroimaging data were available for 37,041 participants (mean age 64+/−7.5 years, 53% female). In unadjusted analyses, MAP and PP were similarly associated with diffusion indices in the anterior circulation. In the posterior circulation, the associations were weaker, particularly for MAP. In fully-adjusted analyses, MAP remained associated with all diffusion indices in the anterior circulation, independently of age. In the posterior circulation, the effect of MAP became protective. PP remained associated with greater mean diffusivity and extracellular free water diffusion in the anterior circulation and all diffusion indices in the posterior circulation. There was a significant interaction between PP and age. This implies discordant mechanisms for chronic white matter injury in different brain regions and potentially in the associated stroke risks. [ABSTRACT FROM AUTHOR]

The purpose of this study is to investigate the potential causal relationships between blood pressure and inflammatory bowel disease (IBD) by using the bidirectional Mendelian randomization (MR) approach. Summary‐level data for blood pressure was extracted from the hitherto largest genome‐wide study (GWAS) with 759 601 participants of European‐descent. We used 56 single nucleotide polymorphisms (SNPs) as instrumental variables (IVs) for blood pressure. Summary statistics for IBD were derived from a GWAS with an overall 59 957 participants of European ancestry, of which 109 IVs were selected. Several robust analytical methods, including inverse‐variance weighted (IVW) method, weighted‐median method, MR‐Egger regression, MR‐PRESSO test, maximum likelihood method, "leave‐one‐out" and multivariable MR analysis were used to evaluate the causal associations between blood pressure and IBD. Genetically predicted higher systolic blood pressure (SBP) was associated with an increased risk of IBD (odds ratio (OR) = 1.05, 95% confidence interval (CI):1.02–1.08, P =.001 by IVW). Subgroup analysis showed that higher SBP was positively associated with Crohn's disease (CD) (OR = 1.06, 95% CI:1.03–1.09, P = 9.18 × 10−5) and ulcerative colitis (UC) (OR = 1.05, 95% CI:1.01–1.09, P =.017) risk, respectively. In reverse‐direction MR analysis, the authors observed no evidence for the causal effect of IBD on blood pressure. Our findings suggested that high SBP was associated with an increased risk of IBD (for both UC and CD). Further studies are required to clarify the underlying mechanism of this causal association. [ABSTRACT FROM AUTHOR]

Background. Pulse pressure (PP) is a pulsatile component of blood pressure (BP), strongly correlated with arterial stiffness (AS) and impacting prognosis. Disproportionally increased PP values in individuals with autosomal dominant polycystic kidney disease (ADPKD) should be expected, given the multifactorial cardiovascular involvement in the natural course of this disease. Objectives. To investigate ambulatory PP in a group of ADPKD patients, and to examine the impact of age, sex, kidney function, hypertension, circadian rhythm, and antihypertensive drugs (AH) on studied parameters. Materials and methods. A total of 130 ADPKD patients (median age 41 years, 35% men) who underwent 24-hour BP measurement with portable oscillometer Spacelabs 90217, were included in the study and their recordings were retrospectively analyzed. Demographic data and the medical history including antihypertensive treatment were collected, ADPKD was diagnosed based on the criteria by Pei et al., and estimated glomerular filtration rate (eGFR) was calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Results. Pulse pressure in the whole group was 46 (IQR: 42--53) mm Hg and it was significantly higher in men than in women and during the day compared to nighttime. There was a negative correlation of PP with eGFR and a positive correlation with age. Pulse pressure was not different in ADPKD patients with or without a diagnosis of hypertension. Conclusions. Ambulatory PP is not substantially increased in ADPKD patients across different stages of CKD. It follows a regular pattern of being increased with age, male sex, daytime, and decreasing eGFR, but not with the diagnosis of hypertension. [ABSTRACT FROM AUTHOR]

Background. Both intraoperative hypotension and hypertension have been reported to increase the occurrence of acute kidney injury (AKI). However, the impact of the intraoperative pulse pressure (PP) on the latter complications remains relatively unknown. Objectives. To explore whether high intraoperative PP values are associated with postoperative AKI. Materials and methods. The data for this study come from a prospective cohort study in which patients who underwent abdominal surgery between October 1, 2018 and July 15, 2019 in university hospital in Katowice, Poland were included in the analysis. Pre- and intraoperative data, including blood pressure measurements, were acquired from medical charts. Several PP thresholds were applied: >50, >55, >60, >65, >70, >75, >80, >85, and >90 mm Hg. Additionally, by analyzing the maximal PP during the procedures, the cutoff point for the occurrence of outcomes was estimated. Postoperative AKI was considered as the outcome of the study. Univariable and multivariable analyses were performed to assess PP relationship with AKI. Results. Four hundred and ninety-four patients were included in the analysis. The AKI was present in 32 (6.5%) cases. The receiver operating characteristic (ROC) curve analysis estimated a cutoff point of >84 mm Hg of maximal PP to be associated with the outcome. The PP values above 80 mm Hg and onward were successfully included in the multivariable statistical models. A model in which PP > 90 mm Hg (odds ratio (OR) = 4.03; 95% confidence interval (95% CI): [1.53; 10.62]) was included, had the best predicting value in predicting hypoperfusion injury (area under the receiver operating characteristics (AUROC) = 0.88). Apart from PP, intraoperative hypotension, presence of chronic arterial hypertension, chronic kidney disease, and procedure duration were independently associated with AKI. Conclusions. High intraoperative PP may be associated with the occurrence of postoperative AKI. However, the effect of high PP should be confirmed in other noncardiac populations to prove the generalizability of our results. [ABSTRACT FROM AUTHOR]

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BACKGROUND Heart failure (HF) is frequent in patients with diabetes mellitus (DM), and early detection improves prognosis. We investigated whether analysis of brachial blood pressure (BP) in daily practice can identify patients with DM and high risk for subsequent HF, as defined by brain natriuretic peptide (BNP) >50 pg/ml. METHODS 3,367 outpatients with DM without a history of cardiovascular disease were enrolled in a prospective study. RESULTS Age (mean ± SD) was 56 ± 14 years, 57% were male, 78% had type 2 DM, and HbA1C was 7.4 ± 1.4%. A history of hypertension was recorded in 43% of patients and uncontrolled BP was observed in 13%. BNP concentration (mean ± SD) was 21 ± 21 ng/l and 9% of patients had high risk of incident HF. Brachial pulse pressure (PP) was the best BP parameter associated with high risk of incident HF compared with diastolic, systolic, or mean BP (area under the receiver operating characteristic curve: 0.70, 0.65, 0.57, and 0.57, respectively). A multivariate analysis demonstrated that elevated PP was independently associated with high risk of incident HF (odds ratio [95% confidence interval, CI]: 2.1 [1.5–2.8] for PP ≥65 mm Hg). Study of central aortic BP and pulse wave velocity on 117 patients demonstrated that high risk of incident HF was associated with increased arterial stiffness and subendocardial ischemia. After a mean follow-up of 811 days, elevated PP was associated with increased all-cause mortality (hazard ratio [95% CI]: 1.7 [1.1–2.8]). CONCLUSIONS Brachial PP is powerful and independent "easy to record" BP parameter associated with high risk of incident HF in diabetic patients. [ABSTRACT FROM AUTHOR]

Background: Growing evidence suggests that vascular risk factors, especially hypertension, relate not only to cardiovascular disease but also to cognitive impairment. However, the impact of pulse pressure on cognitive function remains controversial. In this study, we evaluated the associations between pulse pressure and cognitive function in a Japanese health examination cohort using propensity matching analysis.Methods: We examined 2,546 individuals with a mean age of 60.8 ± 10.3 years who voluntarily participated in health examination. Clinical variables included pulse pressure, and brain magnetic resonance imaging (MRI). We divided the participants into the high and low pulse pressure groups with a pre-defined cut-off value of 65 mmHg and evaluated their physical examination data, cognitive functions including Okabe's test, Kohs' test, and silent brain lesions using propensity matching. To clarify whether pulse pressure and blood pressure have different implications for cognitive function, a mediating analysis was also conducted.Results: From the 2,546 subjects, 439 (17.2%) were in the high PP group. The propensity matching algorithm produced 433 pairs of patients with similar propensities. Higher pulse pressure corresponded to lower Okabe and Kohs' scores (44.3 ± 7.1 vs 42.7 ± 7.5; p = 0.002, 97.9 ± 18.0 vs 95.0 ± 18.1 p = 0.019, respectively). The relationship between pulse pressure and cognitive impairment was not significantly mediated by systolic blood pressure. We observed no significant associations between silent brain lesions and pulse pressure.Conclusion: High pulse pressure was associated with lower cognitive performance without systolic blood pressure mediation in Japanese subjects without dementia. [ABSTRACT FROM AUTHOR]

Background: Prevalence of hypertension and scanty of evidences related to the clinical efficacy and safety of antihypertensive regimens among post menopausal women were almost negligible in India. So, the aim of the present study was aimed to evaluate the efficacy of antihypertensive as monotherapy in hypertensive postmenopausal women. Materials and Methods: A prospective observational study was conducted in Department of General Medicine at Karuna Medical College Hospital, Palakkad, Kerala for a period of November 2019 to October 2020. The patients were divided in to four groups according to the class (Angitensin Receptor Blockers (ARBs) or Calcium Channel Blockers (CCBs) or Diuretics or Beta Blockers) as monotherapy and their BP values were noted. Results: A total of 250 post menopausal hypertensive women were enrolled in this study. The patients achieved the goal on ARBs with 78% and CCBs with 69.5% was higher compared than BB (54.3%) and Diuretics (45.7%). ARBs and CCBs treated patients showed statistically significant differences in reduction of systolic blood pressure, Diastolic blood pressure, Pulse Pressure and Mean Arterial Pressure in hypertensive women. Conclusion: The twothirds of hypertensive post menopausal women are not being achieved the BP goal; those have more risk for cardiovascular disease and stroke. [ABSTRACT FROM AUTHOR]

Background: The VentriFlo® True Pulse Pump (VentriFlo, Inc, Pelham, NH, USA) is a new pulsatile blood pump intended for use during short‐term circulatory support. The purpose of this study was to evaluate the feasibility of the VentriFlo and compare it to a conventional centrifugal pump (ROTAFLOW, Getinge, Gothenberg, Sweden) in acute pig experiments. Methods: Pigs (40–45 kg) were supported by cardiopulmonary bypass (CPB) with the VentriFlo (n = 9) or ROTAFLOW (n = 5) for 6 h. Both VentriFlo and ROTAFLOW circuits utilized standard CPB components. We evaluated hemodynamics, blood chemistry, gas analysis, plasma hemoglobin, and microcirculation at the groin skin with computer‐assisted video microscopy (Optilia, Sollentuna, Sweden). Results: Pigs were successfully supported by CPB for 6 h without any pump‐related complications in either group. The VentriFlo delivered an average stroke volume of 29.2 ± 4.8 ml. VentriFlo delivered significantly higher pulse pressure (29.1 ± 7.2 mm Hg vs. 4.4 ± 7.0 mm Hg, p < 0.01) as measured in the carotid artery, with mean aortic pressure and pump flow comparable with those in ROTAFLOW. In blood gas analysis, arterial pH was significantly lower after five hours support in the VentriFlo group (7.30 ± 0.07 vs. 7.43 ± 0.03, p = 0.001). There was no significant difference in plasma hemoglobin level in both groups after six hours of CPB support. In microcirculatory assessment, VentriFlo tended to keep normal capillary flow, but it was not statistically significant. Conclusions: VentriFlo‐supported pigs showed comparable hemodynamic parameters with significantly higher pulse pressure compared to ROTAFLOW without hemolysis. [ABSTRACT FROM AUTHOR]

The impact of obstructive sleep apnea (OSA) on arterial stiffness is less studied. We aimed to investigate the prevalence and covariates of increased pulse pressure (PP), a surrogate marker of arterial stiffness, in the entire study population as well as in separate analyses in normotensive and hypertensive patients. Further, we also explored the impact of smoking on brachial BP in hypertensive patients. Between 2012 and 2019, a total of 6408 participants with suspected OSA underwent a standard out‐of‐center respiratory polygraphy. OSA was defined by an apnea‐hypopnea index (AHI) ≥15/h regardless of symptoms. PP ≥60 mmHg was used as a surrogate marker of increased arterial stiffness. Mean age was 49.3±13.7 years, 69.4% were male, and 34.5% had OSA. The prevalence of hypertension was 70.8% in OSA and 46.7% in No‐OSA (AHI < 15/h) controls (P <.0001). Hypertension was controlled (clinic BP < 140/90 mmHg) in 45.5% and uncontrolled in 54.5% (P <.001). Mean PP was 50±12 mmHg in smokers and 52±12 mmHg in non‐smokers (P =.001). Increased PP was found in 24.2% of the entire study population and was higher in patients with OSA compared to No‐OSA group (27.5% vs 22.4%, P <.0001). In an unadjusted logistic regression model, OSA was associated with a 1.3‐fold higher risk of having increased PP (95% CI 1.16‐1.48, P <.001). In a multivariable‐adjusted model, higher age, male sex, and history of hypertension, but not OSA (OR 0.89; 95% CI 0.77‐1.02, P =.104) were associated with increased PP. In this large study of nearly 6500 participants who were referred with suspected OSA, one‐third were diagnosed with OSA and a quarter had increased arterial stiffness by elevated brachial PP. Hypertension but not OSA per se was associated with increased arterial stiffness. Hypertension was highly prevalent and poorly controlled. [ABSTRACT FROM AUTHOR]