267 results on '"Angela J. Woodiwiss"'
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2. Proximal aortic stiffness modifies the relationship between heart rate and backward wave and hence central arterial pulse pressure
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Nonhlanhla Mthembu, Vernice R. Peterson, Gavin R. Norton, Eitzaz Sadiq, Andrea Kolkenbeck-Ruh, Ravi Naran, Suraj M. Yusuf, Grace Tade, Hamza Bello, Adamu Bamaiyi, Carlos D. Libhaber, Patrick Dessein, Ferande Peters, Taalib Monareng, Talib Abdool-Carrim, Ismail Cassimjee, Pinhas Sareli, Girish Modi, and Angela J. Woodiwiss
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heart rate ,aortic pressure ,flow ,forward waves ,backward waves ,age ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
AimsA lower heart rate (HR) increases central blood pressure through enhanced backward wave pressures (Pb). We aimed to determine whether these relationships are modified by increases in aortic stiffness.MethodsUsing non-invasive central pressure, aortic velocity and diameter measurements in the outflow tract (echocardiography), we assessed the impact of aortic stiffness on relationships between HR and arterial wave morphology in 603 community participants < 60 years of age, 221 ≥ 60 years, and in 287 participants with arterial events [stroke and critical limb ischemia (CLI)].ResultsAs compared to community participants < 60 years, those ≥ 60 years or with events had increased multivariate adjusted proximal aortic characteristic impedance (Zc) and carotid femoral pulse wave velocity (PWV) (p < 0.05 to < 0.0001). Community participants ≥ 60 years and those with events also had a greater slope of the inverse relationship between HR and Pb (p < 0.001 for comparison). While in community participants < 60 years, no interaction between indexes of aortic stiffness and HR occurred, in those ≥ 60 years (p < 0.02) and in those with arterial events (p = 0.001), beyond aortic root diameter, an interaction between Zc and HR, but not between PWV and HR independently associated with Pb. This translated into stepwise increases in the slope of HR-Pb relationships at incremental tertiles of Zc. Although HR was inversely associated with the systemic reflection coefficient in community participants ≥ 60 years (p < 0.0001), adjustments for the reflection coefficient failed to modify HR-Pb relations.ConclusionBeyond the impact on systemic wave reflection, increases in proximal aortic stiffness enhance the adverse effects of HR on Pb and hence central BP.
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- 2022
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3. Associations between circulating resistin concentrations and left ventricular mass are not accounted for by effects on aortic stiffness or renal dysfunction
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Glenda Norman, Gavin R. Norton, Vernice Peterson, Monica Gomes, Carlos D. Libhaber, Pinhas Sareli, and Angela J. Woodiwiss
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Obesity ,Inappropriate left ventricular mass ,Resistin ,Aortic stiffness ,Renal function ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Although, in-part through an impact on left ventricular mass (LVM), resistin (an adipokine) may contribute to heart failure, whether this is explained by the adverse effects of resistin on aortic stiffness and renal function is unknown. Methods Relationships between circulating resistin concentrations and LVM index (LVMI), and LVM beyond that predicted by stroke work (inappropriate LVM [LVMinappr]) (echocardiography) were determined in 647 randomly selected community participants, and in regression analysis, the extent to which these relations could be explained by aortic pulse wave velocity (PWV) or estimated glomerular filtration rate (eGFR) was evaluated. Results Independent of confounders, resistin concentrations were independently associated with LVMI, LVMinappr, LV hypertrophy (LVH), PWV and eGFR. Furthermore, independent of confounders, LVMI, LVMinappr and LVH were independently associated with PWV and eGFR. However, adjustments for either PWV or eGFR failed to modify the relationships between resistin concentrations and LVMI, LVMinappr or LVH. Moreover, in multivariate regression analysis neither PWV nor eGFR significantly modified the contribution of resistin to LVMinappr or LVMI. Conclusions Independent relationships between circulating concentrations of the adipocytokine resistin and LVM are not explained by the impact of resistin on ventricular-vascular coupling or renal dysfunction. Resistin’s effects on LVM are therefore likely to be through direct actions on the myocardium.
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- 2020
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4. Cardiovascular Risk Factor Profiles and Disease in Black Compared to Other Africans with Chronic Kidney Disease
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Hon-Chun Hsu, Chanel Robinson, Angela J. Woodiwiss, Gavin R. Norton, and Patrick H. Dessein
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Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Background and Objectives. The extent to which chronic kidney disease (CKD) impacts cardiovascular disease (CVD) in black Africans is uncertain. We compared cardiovascular risk factors and CVD between black and other African CKD patients. Methods. Cardiovascular risk factors, aortic and cardiac function, atherosclerosis extent, and cardiovascular event rates were assessed in 115 consecutive predialysis (n = 67) and dialysis patients (n = 48) including 46 black and 69 other (32 Asian, 28 white, and 9 mixed race) participants. Data were analysed in multivariable regression models. Results. Overall, black compared to other African CKD patients had less frequent carotid artery plaque (OR (95% CI) = 0.38 (0.16–0.91)) despite an increased cardiovascular risk factor burden. In receiver operator characteristic curve analysis, the Framingham score performed well in identifying non-black but not black CKD patients with carotid plaque (area under the curve (AUC) (95% CI) = 0.818 (0.714–0.921) and AUC (95% CI) = 0.556 (0.375–0.921), respectively). Black compared to other African predialysis patients experienced larger Framingham scores and more adverse nontraditional cardiovascular risk factors, impaired arterial and diastolic function but similar cardiovascular event rates (OR (95% CI) = 0.93 (0.22 to 3.87)). Among dialysis patients, black compared to other Africans had an overall similar traditional and nontraditional cardiovascular risk factor burden, similar arterial and diastolic function but increased systolic function (partial R = 0.356, p = 0.01 and partial R = 0.315, p = 0.03 for ejection fraction and stroke volume, respectively) and reduced cardiovascular event rates (OR (95% CI) = 0.22 (0.05 to 0.88)). Conclusion. Black compared to other African CKD patients have less frequent very high risk atherosclerosis and experience weaker cardiovascular risk factor-atherosclerotic CVD relationships. These disparities may be due to differences in epidemiological health transition stages. Among dialysis patients, black compared to other Africans have less cardiovascular events, which may represent a selection bias as previously documented in black Americans.
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- 2021
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5. The relationship between the nitric oxide synthase gene and the risk of hypertension defined according to ambulatory blood pressures
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Geoffrey Candy, Danelle Badenhorst, Elena Libhaber, Pinhas Sareli, Gavin R. Norton, Richard Brooksbank, and Angela J. Woodiwiss
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nitric oxide ,hypertension ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Although nitric oxide (NO) plays an important role in blood pressure (BP) control, whether variation of genes involved in regulating the synthesis of NO influences BP is uncertain. As the heritability of BP is stronger for ambulatory than it is for conventional BP, we assessed the independent association of the well described functional exon 7 Glu298Asp variant of the eNOS gene with the presence of hypertension in 511 randomly selected normotensive control participants and 503 hypertensives with a diagnosis of hypertension confirmed with 24-hour ambulatory BP profiles whilst off therapy. We also assessed the relationship between eNOS genotype and 24 hour ambulatory BP. Comparisons of genotype and allele frequencies indicated a lack of association of the exon 7 Glu298Asp gene variant with hypertension (Odds ratio of genotype predicting the presence of hypertension=0.97, confidence interval=0.70-1.30, p=0.92). However, patients with the Glu/Glu genotype of the Glu298Asp variant (n=424) had increased 24-hour systolic and diastolic blood pressures (152±1/97±1 mm Hg) in comparison to patients heterozygous for the Glu298Asp variant or homozygous for the 298Asp allele (n=79) (145±1/94±1 mm Hg, p‹0.005 for systolic BP and p‹0.001 for diastolic BP after multiple adjustments including age, gender, body mass index and the presence of diabetes mellitus). Differences in systolic and diastolic BP between genotype groups were noted during the day as well as at night. The association of eNOS genotype with ambulatory BP translated into an increased risk of more severe grades of hypertension in patients with the Glu/Glu genotype (grade II and III vs. grade I, Odds ratio=2.20, confidence interval=1.34-3.59, p‹0.0002). In conclusion, a functional gene variant (Glu298Asp) at the eNOS locus contributes ~1.4-2.5% to the variation in ambulatory blood pressure within hypertensives, but is not associated with the presence of hypertension in patients in whom the diagnosis has been confirmed by 24-hour ambulatory BP values. The relationship between eNOS genotype and 24-hour ambulatory BP and the severity of hypertension warrants further study.
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- 2017
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6. Impact of dietary-induced obesity on adrenergic-induced cardiomyocyte damage in rats
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Leanda Vengethasamy, Olebogeng H.I. Majane, Eugene F. du Toit, Gavin R. Norton, and Angela J. Woodiwiss
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obesity ,heart failure ,cardiomyocyte apoptosis ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Although obesity is an independent risk factor for heart failure and even mild-to-moderate forms of obesity are associated with myocardial systolic dysfunction the mechanisms of the myocardial dysfunction have not been identified. We assessed whether dietary-induced obesity is associated with an increased sensitivity of the myocardium to ß-adrenergic-induced cardiomyocyte apoptosis or fibrosis. To induce obesity, rats were fed a diet that promotes an increased caloric intake. Adrenergic-induced cardiomyocyte apoptosis was determined by injecting rats for 5 days with isoproterenol (0.01 mg/kg/day for 3 days and 0.02 mg/kg/day for 2 days) and then studying the degree of cardiomyocyte damage using a TUNEL assay and assessing the pathological score. Five months of feeding rats a diet that promoted the development of an increased body weight (Control=481±4.3 g, Diet=550±7.8 g, p‹0.001) and visceral fat content (Control=19.6±0.8 g, Diet=33.0±1.2 g, p‹0.0001), did not alter baseline cardiomyocyte apoptosis. However, 5 days of ß-adrenergic activation resulted in an enhanced cardiomyocyte apoptosis in rats receiving the experimental diet as compared to rats receiving a normal diet (p‹0.01). No changes in the myocardial pathological score (fibrosis) were noted. The enhanced adrenergic-induced cardiomyocyte apoptosis in obese rats could not be explained by dietary-induced increases in baseline left ventricular internal diameters, decreases in systolic function (endocardial or midwall fractional shortening) or differences in the response of the heart to adrenergic-induced increases in inotropic or chronotropic function. In conclusion, the present study suggests that obesity may contribute to myocardial dysfunction by increasing the sensitivity of the myocardium to adrenergic-induced cardiomyocyte damage.
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- 2017
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7. Hypertension in Africa: Redressing the burden of cardiovascular disease using cost-effective nonpharmacological approaches
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Gavin R. Norton and Angela J. Woodiwiss
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hypertension ,cardiovascular disease ,africa ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Hypertension may affect approximately one fifth or more of all adult South Africans. Despite the considerable evidence derived from economically developed countries to indicate the extent to which hypertension contributes to cardiovascular disease (CVD), it is only more recently that data has emerged from the African continent to support a contention that hypertension is the principal risk factor for CVD in African populations and that CVD accounts for a major proportion of deaths in the elderly and in younger adults in rural Africa. Active engagement in the harsh realities of managing this complex clinical trait should therefore be foremost on the minds of the healthcare sector in Africa. In this regard there are unique challenges. In the present personal review we synthesise the evidence for or against the view that at a public health level, the answer to significantly reducing the burden of CVD produced by hypertension in African populations, may lie in something as simple as generating a healthier lifestyle. In this regard, we place recent evidence obtained from South African studies of the importance of modifiable cardiovascular risk factors related to hypertension, including salt intake and obesity, in the context of previously published evidence. We highlight the very recent and the first substantive evidence derived from an African community to show that salt intake indeed contributes to a significant portion of blood pressure (BP) variability in African populations, but this effect may be hidden because the impact is largely on central (aortic) rather than brachial BP. We also discuss the increasing evidence to show that in African populations, the adverse effects of the epidemic of obesity that faces emerging communities is likely to account for a substantial proportion of cardiovascular risk not through marked effects on brachial BP, but through indirect effects by promoting the adverse effects of BP on the heart. In the present review we therefore argue that despite limited absolute effects of salt intake and obesity on brachial BP, a marked benefit could be gained by the BP effects of salt restriction and body weight reduction in African communities.
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- 2017
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8. Limited contribution of insulin resistance and metabolic parameters to obesity-associated increases in ambulatory blood pressure in a black African community
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Adamu J. Bamaiyi, Gavin R. Norton, Glenda Norman, Olebogeng HI. Majane, Pinhas Sareli, and Angela J. Woodiwiss
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Obesity ,Ambulatory blood pressure ,Insulin resistance ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Although accounting for a striking proportion of obesity effects on blood pressure (BP) in other populations, the extent to which obesity-associated increases in BP are explained by insulin resistance and metabolic changes in populations of African ancestry is uncertain. We determined the contribution of insulin resistance and associated metabolic abnormalities to variations in office or ambulatory BP in a black African community with prevalent obesity and hypertension. In 1225 randomly selected participants of black South African ancestry (age>16years, 43.1% obese, 47.4% abdominal obesity), we assessed adiposity indexes, the homeostasis model of insulin resistance (HOMA-IR) and associated metabolic abnormalities and office or ambulatory (n = 798) BP. In separate models, waist circumference (p
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- 2019
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9. The Impact of Different Classification Criteria Sets on the Estimated Prevalence and Associated Risk Factors of Diastolic Dysfunction in Rheumatoid Arthritis
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Lebogang Mokotedi, Sulé Gunter, Chanel Robinson, Gavin R. Norton, Angela J. Woodiwiss, Linda Tsang, Patrick H. Dessein, and Aletta M. E. Millen
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Diseases of the musculoskeletal system ,RC925-935 - Abstract
This study compared the estimated prevalence and potential determinants of left ventricular (LV) diastolic dysfunction upon applying different classification criteria in rheumatoid arthritis (RA). LV diastolic function was assessed echocardiographically by pulsed Doppler (E/A), tissue Doppler (E/e′, lateral and septal e′), and left atrial volume index in 176 RA patients. Relationships of traditional cardiovascular risk factors and RA characteristics with LV diastolic function and dysfunction according to previous and current criteria were determined in multivariate regression models. Waist-hip ratio was associated with E/A (standardised β (SE) = -0.28±0.09, p=0.0002) and lateral e′ (standardised β (SE) = 0.26±0.09, p=0.01); low diastolic blood pressure was related to E/e′ (standardised β (SE) = -0.16±0.08, p=0.04). Diastolic dysfunction prevalence differed upon applying previous (59%) compared to current (22%) criteria (p
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- 2017
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10. Adiponectin and Atherosclerosis in Rheumatoid Arthritis
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Patrick H. Dessein, Linda Tsang, Ahmed Solomon, Angela J. Woodiwiss, Aletta M. E. Millen, and Gavin R. Norton
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Pathology ,RB1-214 - Abstract
In the present study, we examined the potential impact of adiponectin on carotid ultrasound determined atherosclerosis in 210 (119 black and 91 white) RA patients in mixed regression models. Total adiponectin concentrations were smaller in patients with compared to those without the metabolic syndrome (MetS) defined waist criterion (median (range) = 6.47 (1.23–34.54) versus 8.38 (0.82–85.30) ng/mL, P=0.02, resp.); both total and high molecular weight (HMW) adiponectin concentrations were larger in patients with compared to those without joint deformities (7.97 (0.82–85.30) and 3.51 (0.01–35.40) versus 5.36 (1.29–19.49) and 2.34 (0.01–19.49) ng/mL, P=0.003 and 0.02, resp.). Total and HMW adiponectin concentrations were associated with carotid artery plaque in patients with MetS waist (odds ratio (95% CI) = 0.87 (0.76–0.99) and 0.92 (0.85–0.99) per 1-standard deviation increment, P=0.02 for both) and those without joint deformities (odds ratio (95% CI) = 0.94 (0.88–0.99) and 0.94 (0.89–0.99), P=0.03 for both). Plaque prevalence was lower in patients without compared to those with joint deformities (23.4% versus 42.6, P=0.004 in multivariable analysis). In RA patients with abdominal obesity or no clinically evident joint damage, adiponectin concentrations are reduced but nevertheless associated with decreased carotid atherosclerosis.
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- 2014
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11. Rheumatoid Arthritis Impacts on the Independent Relationships between Circulating Adiponectin Concentrations and Cardiovascular Metabolic Risk
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Patrick H. Dessein, Gavin R. Norton, Margaret Badenhorst, Angela J. Woodiwiss, and Ahmed Solomon
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Pathology ,RB1-214 - Abstract
Adiponectin and leptin are likely involved in the pathophysiology of rheumatoid arthritis (RA) and therefore potential new therapeutic targets. Adiponectin inhibition could be expected to enhance cardiovascular metabolic risk. However, it is unknown whether RA changes the influence of adipokines on cardiovascular metabolic risk. We determined whether RA impacts on the independent relationships of circulating leptin and adiponectin concentrations with cardiovascular risk factors and carotid intima-media thickness (cIMT) in 277 black African subjects from a developing population; 119 had RA. RA impacted on the relationships of adiponectin concentrations with lipid concentrations and blood pressure, independent of confounders including adiposity (interaction P
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- 2013
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12. Marked Independent Relationship between Circulating Interleukin-6 Concentrations and Endothelial Activation in Rheumatoid Arthritis
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Patrick H. Dessein, Ahmed Solomon, Angela J. Woodiwiss, Gavin R. Norton, Linda Tsang, and Miguel A. Gonzalez-Gay
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Pathology ,RB1-214 - Abstract
We examined the potential impact of conventional compared with nonconventional cardiovascular risk factors including interleukin-6 levels on endothelial activation in RA. Circulating soluble E-selectin, vascular cell adhesion molecule-1, intercellular adhesion molecule-1, and monocyte chemoattractant protein-1 concentrations were measured in 217 African patients (112 black and 105 white) with RA. In comprehensive confounder adjusted mixed regression models, 5 conventional and 4 nonconventional cardiovascular risk factors were associated (P=0.05 to
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- 2013
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13. Contribution of Increases in Late Systolic Ejection Volume to the Impact of Heart Rate on Central Arterial Pulse Pressure in a Community Sample
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Nonhlanhla Mthembu, Gavin R Norton, Vernice R Peterson, Ravi Naran, Suraj M Yusuf, Grace Tade, Hamza Bello, Adamu Bamaiyi, Carlos D Libhaber, Patrick Dessein, Ferande Peters, Pinhas Sareli, and Angela J Woodiwiss
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Internal Medicine - Abstract
BACKGROUND A lower heart rate (HR) increases left ventricular (LV) ejection volume. Whether this contributes to the adverse effects of HR on central pulse pressure (PPc) through reservoir volume effects is uncertain. METHODS Using noninvasive central pressure, aortic velocity, and diameter measurements in the outflow tract (echocardiography), we assessed the role of LV ejection volume as a determinant of HR relations with PPc in 824 community participants. RESULTS A lower HR was independently associated with both stroke volume (SV) (P < 0.001) and a shift in ejection volume from early (until the first systolic shoulder) to late (from first systolic shoulder to peak PP) systole (P < 0.05 to P < 0.005). Adjustments for LV end diastolic volume markedly diminished HR relations with SV and indexes of the shift in ejection volume to late systole. A lower HR was also independently associated with increases in forward traveling pressure waves (Pf) and PPc (P < 0.0001). However, adjustments for neither SV, nor indexes of a shift in ejection volume to late systole modified HR-Pf or PPc relations. This was despite relationships between indexes of a shift in ejection volume to late systole and both Pf and PPc (P < 0.0001). In contrast, adjustments for the increases in re-reflected and backward traveling wave pressures with a lower HR, eliminated HR-Pf and PPc relations. CONCLUSIONS In contrast to current thought, a lower HR is not associated with increases in PPc through an impact of increases in late systolic ejection volume on aortic reservoir volume, but rather through increases in backward wave pressures.
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- 2022
14. Aortic Stiffness and Pulsatile Pressures as Potential Mediators of Chronic Kidney Disease Induced Impaired Diastolic Function
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Hon-Chun Hsu, Grace Tade, Gavin R Norton, Ferande Peters, Chanel Robinson, Noluntu Dlongolo, Gloria Teckie, Angela J Woodiwiss, and Patrick H Dessein
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Nephrology ,International Journal of Nephrology and Renovascular Disease - Abstract
Hon-Chun Hsu,1,2,* Grace Tade,1,* Gavin R Norton,1 Ferande Peters,1 Chanel Robinson,1 Noluntu Dlongolo,3 Gloria Teckie,4 Angela J Woodiwiss,1 Patrick H Dessein1,5 1Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Nephrology Unit, Milpark Hospital, Johannesburg, South Africa; 3Rheumatology Unit, Rosebank Hospital, Johannesburg, South Africa; 4Division of Nephrology, Department of Medicine, Chris Hani Baragwanath Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; 5Internal Medicine Department, University of the Witwatersrand, Johannesburg, South Africa*These authors contributed equally to this workCorrespondence: Patrick H Dessein, Tel +27 662491468, Email patrick.dessein22@gmail.comPurpose: We assessed whether aortic stiffness and pulsatile pressures can mediate chronic kidney disease (CKD)-associated impaired diastolic function.Participants and Methods: In 276 black Africans including 46 CKD (19 non-dialysis; 27 dialysis) and 230 control subjects, pulse wave velocity (PWV) estimated aortic stiffness and pulsatile pressures (forward and backward wave pressure, central systolic blood pressure (CSBP) and pulse pressure (CPP)) were determined by applanation tonometry; eâ as an index of left ventricular active relaxation and E/eâ as a measure of left ventricular filling pressure or passive relaxation were evaluated by echocardiography.Results: In age, sex, traditional cardiovascular risk factor and mean arterial pressure (MAP) adjusted regression models, CKD was inversely associated with eâ (p = 0.03) and directly with E/eâ (p < 0.01). The CKD-eâ relationship was attenuated and no longer significant (p = 0.31) upon additional adjustment for aortic PWV but not pulsatile pressures (p = 0.03â 0.05). In product of coefficient mediation analysis, PWV accounted for 47.6% of the CKD-eâ association. CSBP (22.9%) and CPP (18.6%) but not PWV (11.3%) accounted for a significant and relevant proportion of the CKD-E/eâ relationship. However, CKD remained strongly associated with E/eâ independent of aortic function measures (p < 0.01). Treatable covariates that were or tended to be consistently associated with diastolic function included MAP (p < 0.01) and diabetes (p = 0.02â 0.07) for the CKD-eâ and CKD-E/eâ relations, respectively.Conclusion: Aortic stiffness rather than pulsatile pressures mediates CKD-related impaired left ventricular active relaxation. By contrast, aortic pulsatile pressures (and not stiffness) contribute to CKD-related left ventricular filling pressures but do not fully account for the respective association.Keywords: chronic kidney disease, diastolic function, arteriosclerosis, aortic stiffness, pulsatile pressures
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- 2022
15. Uric Acid, Ferritin, Albumin, Parathyroid Hormone and Gamma-Glutamyl Transferase Concentrations are Associated with Uremic Cardiomyopathy Characteristics in Non-Dialysis and Dialysis Chronic Kidney Disease Patients
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Grace Tade, Hon-Chun Hsu, Angela J Woodiwiss, Ferande Peters, Chanel Robinson, Noluntu Dlongolo, Gloria Teckie, Ahmed Solomon, Gavin R Norton, and Patrick H Dessein
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Nephrology ,International Journal of Nephrology and Renovascular Disease - Abstract
Grace Tade,1,* Hon-Chun Hsu,1,2,* Angela J Woodiwiss,1 Ferande Peters,1 Chanel Robinson,1 Noluntu Dlongolo,3 Gloria Teckie,4 Ahmed Solomon,5 Gavin R Norton,1 Patrick H Dessein1,5,6 1Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Nephrology Unit, Milpark Hospital, Johannesburg, South Africa; 3Rheumatology Unit, Rosebank Hospital, Johannesburg, South Africa; 4Division of Nephrology, Department of Medicine, Chris Hani Baragwanath Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; 5Rheumatology Department, University of the Witwatersrand, Johannesburg, South Africa; 6Internal Medicine Department, University of the Witwatersrand, Johannesburg, South Africa*These authors contributed equally to this workCorrespondence: Patrick H Dessein, Departments of Medicine, Rheumatology and Physiology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand Medical School, 7 York Road, Parktown, Johannnesburg, 2193, South Africa, Tel +27 662491468, Email patrick.dessein22@gmail.comIntroduction: Circulating uric acid, ferritin, albumin, intact parathyroid hormone and gamma-glutamyl transferase each participate in biochemical reactions that reduce or/and enhance oxidative stress, which is considered the final common pathway through which pathophysiological mechanisms cause uremic cardiomyopathy. We hypothesized that the respective biomarkers may be involved in the development of uremic cardiomyopathy characteristics and can be useful in their identification among chronic kidney disease patients.Methods: We assessed traditional and non-traditional cardiovascular risk factors including biomarker concentrations and determined central systolic blood pressure using SphygmoCor software and cardiac structure and function by echocardiography in 109 (64 non-dialysis and 45 dialysis) patients. Associations were evaluated in multivariate regression models and receiver operator characteristic (ROC) curve analysis.Results: Each biomarker concentration was associated with left ventricular mass beyond stroke work and/or inappropriate left ventricular mass in all, non-dialysis and/or dialysis patients. Ferritin, albumin and gamma-glutamyl transferase levels were additionally associated with E/eâ in all, non-dialysis and/or dialysis patients. Dialysis status influenced the relationship of uric acid concentrations with inappropriate left ventricular mass and those of gamma-glutamyl transferase levels with left ventricular mass and inappropriate left ventricular mass. In stratified analysis, low uric acid levels were related to inappropriate left ventricular mass in dialysis but not non-dialysis patients (interaction p=0.001) whereas gamma-glutamyl transferase concentrations were associated with left ventricular mass and inappropriate left ventricular mass in non-dialysis but not dialysis patients (interaction p=0.020 to 0.036). In ROC curve analysis, uric acid (area under the curve (AUC)=0.877), ferritin (AUC=0.703) and albumin (AUC=0.728) concentrations effectively discriminated between dialysis patients with and without inappropriate left ventricular hypertrophy, left ventricular hypertrophy, and increased E/e,â respectively.Conclusion: Uric acid, ferritin, albumin, parathyroid hormone and gamma-glutamyl transferase were associated with uremic cardiomyopathy characteristics and could be useful in their identification. Our findings merit validation in future longitudinal studies.Keywords: uremic cardiomyopathy, uric acid, ferritin, albumin, parathyroid hormone and gamma-glutamyl transferase
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- 2022
16. Attenuated Relationships Between Indexes of Volume Overload and Atrial Natriuretic Peptide in Uncontrolled, Sustained Volume-Dependent Primary Hypertension
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Suraj M. Yusuf, Gavin R. Norton, Vernice R. Peterson, Nico Malan, Monica Gomes, Nonhlanhla Mthembu, Carlos D. Libhaber, Grace Tade, Hamza Bello, Adamu J. Bamaiyi, Keneilwe N. Mmopi, Ferande Peters, Pinhas Sareli, Patrick H. Dessein, and Angela J. Woodiwiss
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Internal Medicine - Abstract
Background: Whether systolic blood pressure (SBP) control in sustained volume-dependent primary hypertension is associated with blunted ANP (atrial natriuretic peptide) relationships with indexes of volume load is unknown. Methods: Systemic hemodynamics (central pressure, echocardiographic aortic velocity and diameter measurements in the outflow tract), circulating ANP concentrations (ELISA assays) and glomerular and tubular function (24-hour urine collections [n=519]) were determined in a community of African ancestry (n=772). Results: As compared with those with a controlled SBP, those with an uncontrolled SBP (n=198) showed lower ANP concentrations ( P P + excretion (FeNa + ; P P P P P P >0.25), cardiac output ( P >0.29), FeNa + ( P >0.77), or glomerular filtration rate ( P >0.47) and ANP concentrations were noted. Furthermore, in those with an uncontrolled SBP, no relationships between ANP concentrations and SVR or Zc were observed ( P >0.34). Conclusions: In a population where primary hypertension is strongly volume-dependent, those with an uncontrolled SBP have an attenuated relationship between ANP and both renal and hemodynamic indexes of volume overload and the vascular effects of ANP.
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- 2022
17. Independent relationships between renal mechanisms and systemic flow, but not resistance to flow in primary hypertension in Africa
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Patrick H Dessein, Gavin R. Norton, Keneilwe N. Mmopi, Vernice R. Peterson, Ferande Peters, Nico Malan, Elena Libhaber, Carlos D. Libhaber, Pinhas Sareli, Angela J. Woodiwiss, Daniel Da Silva Fernandes, Grace Tade, Hamza Bello, Suraj M. Yusuf, Nonhlanhla Mthembu, and Mohlabani Masiu
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Adult ,medicine.medical_specialty ,Cardiac output ,Physiology ,Renal function ,Nephron ,Excretion ,Internal medicine ,Internal Medicine ,Humans ,Medicine ,Arterial Pressure ,business.industry ,Sodium ,Confounding ,Stroke Volume ,Stroke volume ,Compliance (physiology) ,medicine.anatomical_structure ,Hypertension ,Vascular resistance ,Cardiology ,Vascular Resistance ,Cardiology and Cardiovascular Medicine ,business ,Glomerular Filtration Rate - Abstract
AIMS Whether renal mechanisms of hypertension primarily translate into increases in systemic vascular resistance (SVR) in all populations is uncertain. We determined whether renal mechanisms associate with either increases in SVR (and impedance to flow) or systemic flow in a community of African ancestry. METHOD In a South African community sampled across the full adult age range (n = 546), we assessed stroke volume (SV), peak aortic flow (Q), SVR, characteristic impedance (Zc) and total arterial compliance (TAC) from velocity and diameter measurements in the outflow tract (echocardiography) and central arterial pressures. Renal changes were determined from creatinine clearance (glomerular filtration rate, GFR) and fractional Na+ excretion (FeNa+) (derived from 24-h urine collections). RESULTS Independent of confounders (including MAP and pressures generated by the product of Q and Zc), SV (and hence cardiac output) (P
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- 2021
18. Association of Post Transplantation Anaemia and Persistent Secondary Hyperparathyroidism with Diastolic Function in Stable Kidney Transplant Recipients
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Chanel Robinson, Ahmed Solomon, Gloria Teckie, Noluntu Dlongolo, Angela J. Woodiwiss, Gavin R. Norton, Ferande Peters, Patrick H Dessein, and Hon-Chun Hsu
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obesity ,medicine.medical_specialty ,business.industry ,International Journal of Nephrology and Renovascular Disease ,diastolic function ,kidney transplantation ,Parathyroid hormone ,Renal function ,medicine.disease ,haemoglobin ,Preload ,Afterload ,Nephrology ,Internal medicine ,medicine ,Cardiology ,parathyroid hormone ,Secondary hyperparathyroidism ,Heart failure with preserved ejection fraction ,business ,Body mass index ,Kidney transplantation ,Original Research - Abstract
Hon-Chun Hsu,1,2 Gavin R Norton,1 Ferande Peters,1 Chanel Robinson,1 Noluntu Dlongolo,3 Ahmed Solomon,4 Gloria Teckie,5 Angela J Woodiwiss,1 Patrick H Dessein1,6,7 1Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Nephrology Unit, Milpark Hospital, Johannesburg, South Africa; 3Rheumatology Unit, Rosebank Hospital, Johannesburg, South Africa; 4Division of Rheumatology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; 5Division of Nephrology, Department of Medicine, Chris Hani Baragwanath Hospital and Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa; 6Internal Medicine Department, University of the Witwatersrand, Johannesburg, South Africa; 7Internal Medicine Department, Free University and University Hospital, Brussels, BelgiumCorrespondence: Patrick H DesseinCardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 80 Scholtz Road, Norwood, 2117, Johannesburg, South AfricaTel +27662491468Email patrick.dessein22@gmail.comIntroduction: We hypothesized that post transplantation anaemia and persistent secondary hyperparathyroidism are potential determinants of diastolic function in stable kidney transplant recipients.Methods: We assessed traditional and non-traditional cardiovascular risk factors and determined carotid artery intima-media thickness and plaque by ultrasound, arterial function by applanation tonometry using SphygmoCor software and diastolic function by echocardiography in 43 kidney transplant recipients with a transplant duration of ⥠6 months, no acute rejection and a glomerular filtration rate of ⥠15 mL/min/1.73m2.Results: Mean (SD; range) transplant duration was 12.3 (8.0; 0.5â 33.8) years. Post transplantation anaemia and persistent secondary hyperparathyroidism were identified in 27.9% and 30.8% of the patients, respectively; 67.5% of the participants were overweight or obese. In established confounder adjusted analysis, haemoglobin (partial R=â 0.394, p=0.01) and parathyroid hormone concentrations (partial R=0.382, p=0.02) were associated with E/eâ. In multivariable analysis, haemoglobin (partial R=â 0.278, p=0.01) and parathyroid levels (partial R=0.324, p=0.04) were independently associated with E/eâ. Waistâheight ratio (partial R=â 0.526, p=0.001 and partial R=â 0.355, p=0.03), waist circumference (partial R=â 0.433, p=0.008 and partial R=â 0.393, p=0.02) and body mass index (partial R=â 0.332, p=0.04 and partial R=â 0.489, p=0.002) were associated with both eâ and E/A, respectively, in established confounder adjusted analysis. The haemoglobin-E/eâ (partial R=â 0.422, p=0.02), parathyroid hormone-E/eâ (partial R=0.434, p=0.03), waistâheight ratio-eâ (partial R=â 0.497, p=0.007) and body mass index-E/A (partial R=â 0.386, p=0.04) relationships remained consistent after additional adjustment for left ventricular mass index and cardiac preload and afterload measures.Conclusion: Haemoglobin and parathyroid hormone concentrations as well as adiposity measures are independently associated with diastolic function in kidney transplant recipients. Whether adequate management of post transplantation anaemia, persistent secondary hyperparathyroidism and excess adiposity can prevent the development of heart failure with preserved ejection fraction in kidney transplant recipients merits further investigation.Keywords: haemoglobin, parathyroid hormone, obesity, diastolic function, kidney transplantation
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- 2021
19. May Measurement Month 2019: an analysis of blood pressure screening results from South Africa
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Edith Phalane, Gavin R. Norton, Caitlynd Myburgh, Ané Orchard, Vernice R. Peterson, Thomas Beaney, Lizeth Kruger, Angela J. Woodiwiss, Benedicta N. Nkeh-Chungag, Lisa Uys, Neil R Poulter, Xin Xia, Andrea Kolkenbeck-Ruh, Blessing O. Ahiante, and Lebo F. Gafane-Matemane
- Subjects
medicine.medical_specialty ,Blood pressure ,business.industry ,Emergency medicine ,medicine ,Pharmacy ,Cardiology and Cardiovascular Medicine ,business - Abstract
Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension (ISH) aimed at raising awareness of high BP and acting as a temporary solution to the lack of screening programmes worldwide. As part of MMM, screening in South Africa in 2017 and 2018 revealed that approximately one-third of adults had hypertension, that only half of hypertensives were receiving anti-hypertensive therapy and that only a third of those with hypertension had controlled BP. These data highlight the need for continued screening and awareness campaigns. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2019. Blood pressure measurements, the definition of hypertension and statistical analyses followed the MMM protocol. The sites screened were general populations, pharmacies, and university campuses in preference to hospitals and clinics, aiming to raise awareness, and allow access to screening to those less likely to be aware of their BP. Of the 4727 individuals (age 40.9 ± 18.1 years) screened, 31.9% had hypertension. Of those with hypertension, only 42.5% were aware and 36.1% were receiving treatment for hypertension. A large proportion (48.5%) of individuals receiving antihypertensive medication had uncontrolled BP. In conclusion, the high proportions of individuals unaware of their hypertension and with uncontrolled BP highlight the need for hypertension awareness campaigns and more rigorous management of hypertension.
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- 2021
20. The International Database of Central Arterial Properties for Risk Stratification: Research Objectives and Baseline Characteristics of Participants
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Jessica Barochiner, José Boggia, Antti Jula, Jan Filipovský, Yan Li, Zhenyu Zhang, Kalina Kawecka-Jaszcz, Augustine N. Odili, Jesus D. Melgarejo, Dong-Mei Wei, Natasza Gilis-Malinowska, Chang-Sheng Sheng, Gavin R. Norton, Edoardo Casiglia, Aletta E. Schutte, Qi-Fang Huang, Lucas S Aparicio, Angela J. Woodiwiss, Teemu J. Niiranen, Krzysztof Narkiewicz, Wen-Yi Yang, Lutgar de Thijs, Valérie Tikhonoff, Jan A. Staessen, Ji-Guang Wang, Katarzyna Stolarz-Skrzypek, Daniel Ackermann, Fang-Fei Wei, Murielle Bochud, International Database of Central Arterial Properties for Risk Stratification (IDCARS) Investigators, Aparicio, L.S., Barochiner, J., Wei, D.M., Melgarejo, J.D., Thijs, L., Staessen, J.A., Wei, F.F., Yang, W.Y., Zhang, Z.Y., An, D.W., Cheng, Y.B., Guo, Q.H., Huang, J.F., Huang, Q.F., Li, Y., Sheng, C.S., Wang, J.G., Filipovský, J., Seidlerová, J., Juhanoja, E.P., Jula, A.M., Lindroos, A.S., Niiranen, T.J., Sivén, S.S., Casiglia, E., Pizzioli, A., Tikhonoff, V., Chori, B.S., Danladi, B., Odili, A.N., Oshaju, H., Kucharska, W., Kunicka, K., Gilis-Malinowska, N., Narkiewicz, K., Sakiewicz, W., Swierblewska, E., Kawecka-Jaszcz, K., Stolarz-Skrzypek, K., Rajzer, M., Mels, C., Kruger, R., Mokwatsi, G., Schutte, A.E., Norton, G.R., Woodiwiss, A.J., Ackermann, D., Bochud, M., Ehret, G., Álvarez-Vaz, R., Américo, C., Baccino, C., Borgarello, L., Florio, L., Moliterno, P., Noboa, A., Noboa, O., Olascoaga, A., Parnizari, P., and Pécora, M.
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Male ,Ajhype/Ajh-08 ,medicine.medical_specialty ,Percentile ,cardiovascular outcome ,hypertension ,Epidemiology ,Original Contributions ,pulse wave velocity ,central blood pressure ,Hemodynamics ,Disease ,030204 cardiovascular system & hematology ,hemodynamics ,Cardiovascular outcome ,pulse wave analysis ,blood pressure ,03 medical and health sciences ,0302 clinical medicine ,International database ,Diabetes mellitus ,Internal Medicine ,Medicine ,Humans ,AcademicSubjects/MED00200 ,030212 general & internal medicine ,610 Medicine & health ,Pulse wave velocity ,business.industry ,Middle Aged ,medicine.disease ,3. Good health ,Blood pressure ,Cross-Sectional Studies ,Cardiovascular Diseases ,Emergency medicine ,AcademicSubjects/SCI00960 ,Female ,business ,Cohort study - Abstract
OBJECTIVE To address to what extent central hemodynamic measurements, improve risk stratification, and determine outcome-based diagnostic thresholds, we constructed the International Database of Central Arterial Properties for Risk Stratification (IDCARS), allowing a participant-level meta-analysis. The purpose of this article was to describe the characteristics of IDCARS participants and to highlight research perspectives. METHODS Longitudinal or cross-sectional cohort studies with central blood pressure measured with the SphygmoCor devices and software were included. RESULTS The database included 10,930 subjects (54.8% women; median age 46.0 years) from 13 studies in Europe, Africa, Asia, and South America. The prevalence of office hypertension was 4,446 (40.1%), of which 2,713 (61.0%) were treated, and of diabetes mellitus was 629 (5.8%). The peripheral and central systolic/diastolic blood pressure averaged 129.5/78.7 mm Hg and 118.2/79.7 mm Hg, respectively. Mean aortic pulse wave velocity was 7.3 m per seconds. Among 6,871 participants enrolled in 9 longitudinal studies, the median follow-up was 4.2 years (5th–95th percentile interval, 1.3–12.2 years). During 38,957 person-years of follow-up, 339 participants experienced a composite cardiovascular event and 212 died, 67 of cardiovascular disease. CONCLUSIONS IDCARS will provide a unique opportunity to investigate hypotheses on central hemodynamic measurements that could not reliably be studied in individual studies. The results of these analyses might inform guidelines and be of help to clinicians involved in the management of patients with suspected or established hypertension., Graphical Abstract Graphical Abstract
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- 2022
21. May Measurement Month 2018: an analysis of blood pressure screening results in South Africa
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Ruan Kruger, Muhammed Vally, Erika Jones, Blessing O. Ahiante, Edith Phalane, Angela J. Woodiwiss, Thomas Beaney, Gavin R. Norton, Lebo F. Gafane-Matemane, Aletta E. Schutte, Benedicta N. Nkeh-Chungag, Justin Marsh, Neil R Poulter, Anca Chis Ster, Xin Xia, Caitlynd Myburgh, Vernice R. Peterson, and Constance R Sewani-Rusike
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medicine.medical_specialty ,business.industry ,Articles ,030204 cardiovascular system & hematology ,Treatment ,03 medical and health sciences ,0302 clinical medicine ,Blood pressure ,Cardiovascular System & Hematology ,Hypertension ,Control ,Emergency medicine ,Screening ,medicine ,AcademicSubjects/MED00200 ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,1102 Cardiorespiratory Medicine and Haematology - Abstract
Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension (ISH) aimed at raising awareness of high BP and acting as a temporary solution to the lack of screening programmes worldwide. As part of MMM, screening in South Africa in 2017 revealed that 24.5% of adults (mean age = 31 years) have hypertension and only half of those with hypertension had controlled BP. These data highlight the need for continued screening and awareness campaigns. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2018. Blood pressure measurements, the definition of hypertension and statistical analyses followed the MMM protocol. The sites screened were general populations and university campuses in preference to hospitals and clinics, aiming to raise awareness and allow access to screening to those less likely to be aware of their BP. In total, 2965 individuals (age 40.5 ± 18.2 years) were screened. After multiple imputation for missing BP readings, 34.6% had hypertension, only 56.7% of those with hypertension were aware, 21.2% of those not receiving treatment for hypertension were hypertensive, and a large proportion (42.5%) of individuals receiving antihypertensive medication had uncontrolled BP. These results suggest that opportunistic screening campaigns can identify significant numbers with undiagnosed and uncontrolled hypertension. The high proportions of individuals with undiagnosed and treated uncontrolled hypertension highlight the need for hypertension awareness campaigns and more rigorous management of hypertension.
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- 2020
22. Distinct Contribution of Systemic Blood Flow to Hypertension in an African Population Across the Adult Lifespan
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Daniel Da Silva Fernandes, Angela J. Woodiwiss, Hamza Bello, Pinhas Sareli, Grace Tade, Nonhlanhla Mthembu, Carlos D. Libhaber, Ferande Peters, Gavin R. Norton, Vernice R. Peterson, Mohlabani Masiu, and Keneilwe N. Mmopi
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Adult ,Male ,medicine.medical_specialty ,Ventricular End-Diastolic Volume ,Mean arterial pressure ,Adolescent ,Longevity ,Hemodynamics ,Blood Pressure ,030204 cardiovascular system & hematology ,Young Adult ,03 medical and health sciences ,Vascular Stiffness ,0302 clinical medicine ,Internal medicine ,Internal Medicine ,Humans ,Medicine ,030212 general & internal medicine ,Aorta ,Aged ,Aged, 80 and over ,business.industry ,Stroke Volume ,Arteries ,Stroke volume ,Middle Aged ,Pulse pressure ,Black or African American ,Compliance (physiology) ,medicine.anatomical_structure ,Blood pressure ,Hypertension ,Vascular resistance ,Cardiology ,Female ,Vascular Resistance ,business - Abstract
Although hypertension in groups of African ancestry is volume-dependent, the relative impact of systemic flow (stroke volume, peak aortic flow [Q]) versus vascular mechanisms (systemic vascular resistance, aortic characteristic impedance [Zc], total arterial compliance) components of arterial load has not been evaluated across the adult age range. In participants of African ancestry (n=824, age=16–99 years, 68.3% female), using central arterial pressure and aortic velocity and diameter measurements in the outflow tract, we determined the hemodynamic correlates of age-related increases in blood pressure. Strong independent positive relations between age and stroke volume or peak aortic Q were noted ( P P P P P P
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- 2020
23. Hemodynamic Determinants of Age Versus Left Ventricular Diastolic Function Relations Across the Full Adult Age Range
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Nonhlanhla Mthembu, Vernice R. Peterson, Hamza Bello, Adamu J. Bamaiyi, Ferande Peters, Angela J. Woodiwiss, Carlos D. Libhaber, Mohlabani Masiu, Keneilwe N. Mmopi, Pinhas Sareli, Gavin R. Norton, and Daniel Da Silva Fernandes
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Adult ,Male ,Aging ,medicine.medical_specialty ,Longevity ,Diastole ,Hemodynamics ,Pulse Wave Analysis ,030204 cardiovascular system & hematology ,Adult age ,Ventricular Function, Left ,Ventricular Dysfunction, Left ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Mass index ,030212 general & internal medicine ,Young adult ,Aorta ,Aged ,Heart Failure, Diastolic ,business.industry ,Age Factors ,Stroke Volume ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Blood pressure ,Echocardiography ,Heart failure ,Hypertension ,Vascular resistance ,Cardiology ,Female ,Vascular Resistance ,business - Abstract
The relative contribution of loading conditions at different ages across the full adult lifespan to decreases in left ventricular (LV) diastolic function is unclear. Using central arterial pressure and aortic velocity and diameter measurements in the outflow tract, we determined the contribution of systemic vascular resistance, compression wave pressures (characteristic impedance [Zc]×aortic flow [Q], [P Q×Zc ]) and backward wave pressures (Pb) to LV diastolic function (echocardiography) in a community sample across the full adult lifespan (n=605). Starting from early adulthood, stepwise age-related increases in LV filling pressures (E/e’) and decreases in myocardial relaxation (e’) were noted ( P Q×Zc positively correlates with age, Pb, but not systemic vascular resistance was independently associated with LV mass index ( P P P Q×Zc positively correlates with age, again Pb, but neither P QxZc nor systemic vascular resistance was independently associated with LV mass index ( P P P
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- 2020
24. Impact of metabolic and inflammatory changes on glomerular function beyond conventional risk factors in an urban South Africa community with prevalent obesity
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Glenda Norman, Vernice R. Peterson, Pinhas Sareli, Angela J. Woodiwiss, Gavin R. Norton, and Monica Gomes
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Adult ,Blood Glucose ,Male ,Ambulatory blood pressure ,Kidney Glomerulus ,Physiology ,Renal function ,Blood Pressure ,Risk Assessment ,South Africa ,Insulin resistance ,Risk Factors ,Diabetes mellitus ,Prevalence ,medicine ,Humans ,Insulin ,Resistin ,Obesity ,Renal Insufficiency, Chronic ,Adiposity ,Inflammation ,business.industry ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Cross-Sectional Studies ,Blood pressure ,Female ,Inflammation Mediators ,Insulin Resistance ,Metabolic syndrome ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,Glomerular Filtration Rate ,Kidney disease - Abstract
OBJECTIVES To determine the extent to which metabolic and inflammatory changes are associated with renal damage beyond conventional risk factors in a community sample with a high prevalence of obesity in urban South Africa. METHODS This was a cross-sectional, community-based study in 1 010 (n = 872 without diabetes mellitus, DM) randomly selected participants over 16 years of age in an urban, developing community (Soweto, Johannesburg) with a high prevalence of obesity (41.8%). We assessed estimated glomerular filtration rate (eGFR), conventional risk factors including adiposity indices, and metabolic changes and plasma resistin concentrations (ELISA) and the homeostasis model of insulin resistance (HOMA-IR). Relationships independent of haemodynamic loads were confirmed using ambulatory blood pressure and central arterial haemodynamics. RESULTS In multivariate regression models conducted in those without DM, HOMA-IR (standardised β-coefficient = -0.13 ± 0.03, p < 0.0001) and plasma resistin concentrations (β-coefficient = -0.10 ± 0.02, p < 0.0001) were second only to age, and at least as strong as systolic blood pressure (β -coefficient = -0.04 ± 0.03, p = 0.19) in the impact on eGFR, while alternative conventional risk factors including adiposity indices and the metabolic syndrome features contributed little to eGFR. Similar results were obtained in relationships with chronic kidney disease (CKD) and in the whole group including those with DM. Adjustments for ambulatory blood pressure or central arterial loads did not influence these relationships. CONCLUSIONS The impact on glomerular function of insulin resistance and inflammatory changes is well beyond modifiable conventional risk factors, including the metabolic syndrome. Targeting conventional risk factors alone is likely to result in a marked residual risk of renal damage produced by insulin resistance and inflammation.
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- 2020
25. Increased Aortic Characteristic Impedance Explains Relations Between Urinary Na + /K + and Pulse or Systolic Blood Pressure
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Angela J. Woodiwiss, Vernice R. Peterson, Hamza Bello, Mohlabani Masiu, Carlos D. Libhaber, Keneilwe N. Mmopi, Daniel Da Silva Fernandes, Pinhas Sareli, and Gavin R. Norton
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medicine.medical_specialty ,Aorta ,Mean arterial pressure ,Chemistry ,Pulsatile flow ,Blood volume ,030204 cardiovascular system & hematology ,Pulse pressure ,03 medical and health sciences ,0302 clinical medicine ,Blood pressure ,Internal medicine ,medicine.artery ,Internal Medicine ,medicine ,Aortic pressure ,Cardiology ,030212 general & internal medicine ,Pulse wave velocity - Abstract
Alterations in sodium (Na + ) relative to potassium (K + ) intake increase systolic blood pressure, effects in-part attributed to enhanced pulsatile loads (pulse pressure) beyond steady-state pressures (mean arterial pressure). Whether this effect is through reversible changes (increases in blood volume and hence aortic flow [Q] or wave reflection [Pb]), or potentially irreversible structural changes in the proximal aorta, is unknown. In 581 black South Africans, we determined 24-hour urinary Na + and K + excretion and aortic function from central aortic pressure (radial pulse wave analysis [SphygmoCor software]), velocity, and diameter measurements. Proximal aortic function was assessed from characteristic impedance (Zc). Beyond mean arterial pressure and additional confounders, urinary Na + /K + was independently associated with Zc ( P P =0.30) or alternative aspects of Q or ejection volume. Although age was strongly associated with proximal aortic diameter, no independent relations between urinary Na + /K + and aortic diameter were noted ( P =0.17). Relations between urinary Na + /K + and Zc translated into independent relations with early systolic compression wave pressures (QxZc [P QxZc ]) and aortic forward wave pressures but not Pb. Moreover, neither reflected wave magnitude ( P =0.92) nor aortic pulse wave velocity were independently associated with urinary Na + /K + . In product of coefficient mediation analysis, the independent relations between urinary Na + /K + and peak aortic or brachial pulse pressure or systolic blood pressure were accounted for by Zc and P QxZc . In conclusion, abnormalities in Na + /K + intake determine pulse pressure or systolic blood pressure beyond mean arterial pressure mainly through potentially irreversible impacts on proximal aortic impedance rather than readily modifiable increases in aortic flow (blood volume) or wave reflection.
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- 2020
26. Associations between circulating resistin concentrations and left ventricular mass are not accounted for by effects on aortic stiffness or renal dysfunction
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Carlos D. Libhaber, Pinhas Sareli, Vernice R. Peterson, Glenda Norman, Angela J. Woodiwiss, Gavin R. Norton, and Monica Gomes
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Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,endocrine system diseases ,030204 cardiovascular system & hematology ,Kidney ,Ventricular Function, Left ,0302 clinical medicine ,Risk Factors ,Resistin ,Pulse wave velocity ,0303 health sciences ,Ventricular Remodeling ,Confounding ,Aortic stiffness ,Middle Aged ,Inappropriate left ventricular mass ,Echocardiography ,Cardiology ,cardiovascular system ,Female ,Hypertrophy, Left Ventricular ,Kidney Diseases ,Cardiology and Cardiovascular Medicine ,hormones, hormone substitutes, and hormone antagonists ,Glomerular Filtration Rate ,Research Article ,Adult ,medicine.medical_specialty ,Adipokine ,Renal function ,Pulse Wave Analysis ,Risk Assessment ,03 medical and health sciences ,Vascular Stiffness ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Obesity ,030304 developmental biology ,Angiology ,business.industry ,nutritional and metabolic diseases ,medicine.disease ,Cross-Sectional Studies ,lcsh:RC666-701 ,Heart failure ,business ,Biomarkers - Abstract
Background Although, in-part through an impact on left ventricular mass (LVM), resistin (an adipokine) may contribute to heart failure, whether this is explained by the adverse effects of resistin on aortic stiffness and renal function is unknown. Methods Relationships between circulating resistin concentrations and LVM index (LVMI), and LVM beyond that predicted by stroke work (inappropriate LVM [LVMinappr]) (echocardiography) were determined in 647 randomly selected community participants, and in regression analysis, the extent to which these relations could be explained by aortic pulse wave velocity (PWV) or estimated glomerular filtration rate (eGFR) was evaluated. Results Independent of confounders, resistin concentrations were independently associated with LVMI, LVMinappr, LV hypertrophy (LVH), PWV and eGFR. Furthermore, independent of confounders, LVMI, LVMinappr and LVH were independently associated with PWV and eGFR. However, adjustments for either PWV or eGFR failed to modify the relationships between resistin concentrations and LVMI, LVMinappr or LVH. Moreover, in multivariate regression analysis neither PWV nor eGFR significantly modified the contribution of resistin to LVMinappr or LVMI. Conclusions Independent relationships between circulating concentrations of the adipocytokine resistin and LVM are not explained by the impact of resistin on ventricular-vascular coupling or renal dysfunction. Resistin’s effects on LVM are therefore likely to be through direct actions on the myocardium.
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- 2020
27. Marked intrafamilial aggregation and heritability of aortic flow in a community with prevalent volume-dependent hypertension in Africa
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Suraj M, Yusuf, Gavin R, Norton, Vernice, Peterson, Carlos D, Libhaber, Keneilwe N, Mmopi, Hamza, Bello, Mohlabani, Masiu, Daniel, Da Silva Fernandes, Grace, Tade, Nonhlanhla, Mthembu, Ferande, Peters, Patrick, Dessein, Pinhas, Sareli, and Angela J, Woodiwiss
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Physiology ,Hypertension ,Hemodynamics ,Internal Medicine ,Humans ,Arterial Pressure ,Blood Pressure ,Cardiology and Cardiovascular Medicine ,Aorta - Abstract
Although peak aortic flow (Q) is now recognized as a major determinant of hypertension in Africa, current therapy has no proven ability to target this change. The mechanisms of this effect, therefore, require elucidation. We compared the intrafamilial aggregation and heritability of Q to that of the vascular determinants of pulse pressure (PP) and SBP in Africa.The intrafamilial aggregation and heritability of Q and aortic characteristic impedance (Zc) or total arterial compliance (TAC) was determined in 669 participants of 194 families (69 father-mother, 385 parent-child, 157 sibling-sibling pairs) in a community in Africa with prevalent flow-dependent primary hypertension. Haemodynamics were determined from velocity and diameter measurements in the outflow tract (echocardiography) and central arterial pressures.No mother-father correlations were noted for either Q or Zc. However, with adjustments for confounders, parent-child (P 0.0001) and sibling-sibling (P 0.0001) correlations were noted for Q. Parent-child and/or sibling-sibling correlations were also noted for Zc or TAC but were weaker for Zc and mother-father correlations were noted for TAC. Moreover, Q showed markedly stronger multivariate adjusted heritability estimates (h2 = 0.82 ± 0.07, P 0.0001) than Zc (h2 = 0.44 ± 0.10, P 0.0001)(P 0.005 for comparisons) and TAC (h2 = 0.47 ± 0.08, P 0.0001)(P 0.005 for comparisons). Importantly, the heritability of Q was also greater than that for PP (h2 = 0.12 ± 0.09, P = 0.11) (P 0.0001 for comparisons), or SBP (h2 = 0.13 ± 0.10, P = 0.08) (P 0.0001 for comparisons).Of the haemodynamic determinants of SBP, peak aortic flow is the most strongly inherited in Africa. Peak aortic flow, therefore, represents an important target for identifying novel therapeutic approaches to controlling SBP in Africa.
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- 2021
28. Increased Backward Wave Pressures Rather than Flow Explain Age-Dependent Heart Rate Effects on Central, But not Peripheral Arterial Pressure
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Hamza Bello, Ferande Peters, Pinhas Sareli, Adamu J. Bamaiyi, Grace Tade, Angela J. Woodiwiss, Nonhlanhla Mthembu, Suraj M. Yusuf, Patrick H Dessein, Ravi Naran, Carlos D. Libhaber, Vernice R. Peterson, and Gavin R. Norton
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Adult ,Male ,medicine.medical_specialty ,Brachial Artery ,Age dependent ,Blood Pressure ,Coronary Artery Disease ,Pulse Wave Analysis ,Vascular Stiffness ,Heart Rate ,Internal medicine ,Heart rate ,Internal Medicine ,medicine ,Humans ,Arterial Pressure ,Aged ,Heart Failure ,Chemistry ,Age Factors ,Hemodynamics ,Stroke volume ,Middle Aged ,medicine.disease ,Pulse pressure ,Peripheral ,Blood pressure ,Heart failure ,Hypertension ,Cardiology ,Time to peak ,Female - Abstract
Through both backward (Pb) and forward (Pf) wave effects, a lower heart rate (HR) associates with increased central (PPc), beyond brachial pulse pressure (PP). However, the relative contribution to Pf of aortic flow (Q) versus re-reflection of Pb, has not been determined. Using central pressure, aortic velocity and diameter measurements in the outflow tract (echocardiography), we constructed central pressure waveforms that account for the relative contribution of Q versus re-reflection to Pf. We thus evaluated the mechanisms of HR-PPc relations in a community sample (n=824) and the impact of age thereon. Inverse HR-PPc ( P P =0.064) relations were noted. The slope of HR-PPc relation was increased in older adults ( P P P P P P
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- 2021
29. Risk associated with forward and backward arterial pulse waves
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Angela J, Woodiwiss and Gavin R, Norton
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Advanced and Specialized Nursing ,Internal Medicine ,Humans ,Blood Pressure ,General Medicine ,Assessment and Diagnosis ,Cardiology and Cardiovascular Medicine - Published
- 2022
30. Potential determinants of the E/e' ratio in non-dialysis compared with dialysis patients
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Hon-Chun Hsu, Chanel Robinson, Gavin R. Norton, Angela J. Woodiwiss, and Patrick H Dessein
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Volume overload ,Blood Pressure ,Pulse Wave Analysis ,Ventricular Function, Left ,Afterload ,Diastole ,Renal Dialysis ,Diabetes mellitus ,Internal medicine ,Natriuretic Peptide, Brain ,medicine ,Humans ,Protein Precursors ,Renal Insufficiency, Chronic ,Dialysis ,business.industry ,Confounding ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Echocardiography, Doppler ,Peptide Fragments ,Pulse pressure ,Preload ,ROC Curve ,Nephrology ,Cardiovascular Diseases ,Echocardiography ,Cardiology ,Female ,business ,Kidney disease - Abstract
AIM We hypothesized that arterial function and N-terminal natriuretic peptide (NT-proBNP) levels as a marker of volume overload, relate differently to E/e' as an index of diastolic function in dialysis compared with non-dialysis patients with chronic kidney disease. We further examined whether cardiovascular risk factors attenuated these relationships. METHODS We assessed cardiovascular risk factors and determined arterial function indices by applanation tonometry using SphygmoCor software and E/e' by echocardiography in 103 (62 non-dialysis and 41 dialysis) patients. RESULTS In established confounder adjusted analysis, dialysis status impacted the pulse wave velocity-E/e' relationship (interaction p = .01) but not the NT-proBNP level-E/e' association (interaction p = .1). Upon entering arterial function measures and NT-proBNP levels simultaneously in regression models, arterial function measures were associated with E/e' (p = .008 to .04) in non-dialysis patients whereas NT-proBNP levels were related to E/e' in dialysis patients (p = .009 to .04). Bivariate associations were found between diabetes (p
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- 2021
31. Impact of stroke work on the ability of left ventricular mass to account for pressure effects on function in a community with prevalent systemic flow-dependent hypertension
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Daniel Da Silva Fernandes, Pinhas Sareli, Hamza Bello, Keneilwe N. Mmopi, Mohlabani Masiu, Adamu J. Bamaiyi, Ravi Naran, Angela J. Woodiwiss, Vernice R. Peterson, Carlos D. Libhaber, Gavin R. Norton, Ferande Peters, and Nonhlanhla Mthembu
- Subjects
medicine.medical_specialty ,Myocardial tissue ,Physiology ,business.industry ,Confounding ,Hemodynamics ,Blood Pressure ,Doppler imaging ,Ventricular Function, Left ,Left ventricular mass ,Stroke ,Stroke work ,Blood pressure ,Echocardiography ,Internal medicine ,Wave pressure ,Hypertension ,Internal Medicine ,Cardiology ,Medicine ,Humans ,Hypertrophy, Left Ventricular ,Cardiology and Cardiovascular Medicine ,business - Abstract
AIMS To determine whether the confounding influence of stroke work on left ventricular mass (LVM) limits the ability of LVM to detect hypertensive LV dysfunction in systemic flow-dependent hypertension. METHODS In a community with prevalent systemic flow-dependent hypertension (n = 709), arterial haemodynamics, LVM and LV function were determined using central arterial pressure, aortic velocity and diameter measurements in the outflow tract, and echocardiography with tissue Doppler imaging. RESULTS In multivariate models, stroke work showed markedly stronger relations with LVM index (LVMI) than blood pressure load [central arterial SBP (SBPc), backward wave pressure (Pb), 24-h SBP] (P
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- 2021
32. Limited contribution of left ventricular mass and remodelling to the impact of blood pressure on diastolic function in a community sample
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Pinhas Sareli, Adamu J. Bamaiyi, Angela J. Woodiwiss, Gavin R. Norton, Carlos D. Libhaber, and Vernice R. Peterson
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Adult ,Male ,medicine.medical_specialty ,Physiology ,Diastole ,Blood Pressure ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Left ventricular mass ,Ventricular Dysfunction, Left ,03 medical and health sciences ,0302 clinical medicine ,Left atrial ,Internal medicine ,Internal Medicine ,Humans ,Medicine ,Diastolic function ,030212 general & internal medicine ,LV hypertrophy ,Aged ,Ventricular Remodeling ,business.industry ,Confounding ,Blood flow ,Middle Aged ,Blood pressure ,Echocardiography ,Hypertension ,Cardiology ,Female ,Hypertrophy, Left Ventricular ,Cardiology and Cardiovascular Medicine ,business - Abstract
AIMS Although the development of left ventricular (LV) dysfunction in hypertension has traditionally been viewed as a transition process from a phase of structural LV remodelling to dysfunction, the extent to which LV mass (LVM) and remodelling account for blood pressure (BP)-associated alterations in LV diastolic function is uncertain. In product of coefficient mediation analysis, we aimed to determine the extent to which LVM index (LVMI) or relative wall thickness (RWT) account for relations between BP and LV diastolic function. METHODS In 709 randomly selected participants from a community sample with a high prevalence of hypertension (49.6%), we determined BP and LVMI, RWT and several indices of diastolic function from transmitral blood flow and myocardial tissue Doppler (E/A, e'/a', e' and E/e') and left atrial volume using standard echocardiographic techniques. RESULTS With adjustments for confounders, LVMI (P
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- 2019
33. Carotid intima–media thickness, but not chronic kidney disease independently associates with noncardiac arterial vascular events in South Africa
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Chanel Robinson, Girish Modi, Martin Veller, Philanathi Mabena, Ravi Naran, Taalib Monareng, Angela J. Woodiwiss, Pitchou Z. Gazwa, Eitzaz Sadiq, Olebogeng H.I. Majane, Andrea Kolkenbeck-Ruh, Talib Abdool-Carrim, Nomvuyo Manyatsi, Gavin R. Norton, and Tshegofatso H Motau
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Adult ,Male ,medicine.medical_specialty ,Physiology ,Black People ,Renal function ,030204 cardiovascular system & hematology ,Carotid Intima-Media Thickness ,Odds ,South Africa ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Ischemia ,Internal medicine ,Epidemiology ,Odds Ratio ,Internal Medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Renal Insufficiency, Chronic ,Stroke ,Aged ,Ultrasonography ,Creatinine ,business.industry ,Arteries ,Odds ratio ,Middle Aged ,medicine.disease ,chemistry ,Intima-media thickness ,Hypertension ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Glomerular Filtration Rate ,Kidney disease - Abstract
Although chronic kidney disease (CKD) as determined from estimated glomerular filtration rate (eGFR) is recommended for risk prediction by current hypertension guidelines, the equations to derive eGFR may not perform well in black Africans. We compared whether across the adult lifespan, eGFR or CKD are as closely associated with noncardiac arterial vascular events, as carotid intima-media thickness (IMT), in Africa.In 1152 black South Africans [480 with noncardiac arterial events (294 with critical lower limb ischemia, 186 with stroke) of which 37% were premature] and 672 age, sex and ethnicity-matched controls from a randomly selected community sample, we assessed relations between eGFR, CKD or carotid IMT (B-mode ultrasound) and arterial events.From 20 years until old age, with or without adjustments, IMT was increased in those with as compared with without events (P 0.01 at each decade of age). However, at any decade of age across the adult lifespan neither creatinine concentrations, nor eGFR were altered in those with arterial events (P 0.28). Although IMT was strongly and independently associated with the odds of an event [odds ratio per 1 SD (0.171 mm) effect = 2.19, confidence interval = 1.75-2.78, P 0.0001], neither creatinine concentrations (P = 0.89), modification of diet in renal disease-derived (P = 0.07), nor Chronic Kidney Disease Epidemiology Collaboration-derived [odds ratio per 1 SD (22.5 ml/min per 1.73 m) effect = 1.06, confidence interval = 0.89-1.27, P = 0.51] eGFR were independently associated with the odds of an event. Although many with premature events had an increased IMT (63%), few with either premature events (8%) or with events at an older age (21%) had CKD and CKD had a poor performance (0.539 ± 0.011) and low sensitivity (16%) for event detection.In black South Africans, despite carotid IMT strongly associating with noncardiac arterial vascular events (stroke and critical lower limb ischaemia) consistently across the adult lifespan, few with events have CKD and CKD fails to associate with events.
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- 2019
34. Insulin resistance influences the impact of hypertension on left ventricular diastolic dysfunction in a community sample
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Adamu J. Bamaiyi, Carlos D. Libhaber, Angela J. Woodiwiss, Vernice R. Peterson, Monica Gomes, Gavin R. Norton, and Pinhas Sareli
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Adult ,Male ,obesity ,medicine.medical_specialty ,hypertension ,Heart Ventricles ,medicine.medical_treatment ,Clinical Investigations ,Diastole ,Blood Pressure ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Ventricular Dysfunction, Left ,03 medical and health sciences ,0302 clinical medicine ,Insulin resistance ,Risk Factors ,insulin resistance ,Internal medicine ,medicine ,Humans ,left ventricular diastolic function ,030212 general & internal medicine ,Adiposity ,business.industry ,Insulin ,Confounding ,General Medicine ,Odds ratio ,Middle Aged ,medicine.disease ,Obesity ,Confidence interval ,Echocardiography ,Cardiology ,Female ,Left ventricular diastolic dysfunction ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Although obesity‐associated metabolic abnormalities (insulin resistance‐IR) may not play as marked a role in determining left ventricular (LV) diastolic dysfunction (DD) as hypertension, the impact of combinations of these risk factors on DD is unknown. Hypothesis We hypothesized that IR influences the impact of hypertension on DD. Methods In 704 randomly selected participants from a community sample with a high prevalence of hypertension (50.6%) and obesity (46.5%), we determined adiposity indices, IR from the homeostasis model (HOMA‐IR) and LV diastolic function using standard echocardiographic techniques. Results HOMA‐IR was independently associated with lateral wall e' and E/e' (P < 0.05 to P < 0.005) as well as a diagnosis of DD (P < 0.02). Importantly, however, an enhanced relationship between HOMA‐IR and E/e' in hypertensives (n = 356, partial r = 0.15, P < 0.005) as compared to normotensives (n = 348, partial r = 0.02 P = 0.75) was noted. Consequently, as compared to normotensives, with adjustments for confounders, hypertension was independently associated with DD only in those with the highest tertile of HOMA‐IR (odds ratio = 2.65, 95% confidence interval = 1.29‐5.42, P < 0.01), while in those with the lowest tertile of HOMA‐IR, hypertension failed to show a higher prevalence of DD (P = 0.22). Conclusions Insulin resistance enhances the impact of hypertension on LV DD. Thus, DD is more likely to occur with the combination of hypertension and IR.
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- 2019
35. Independent of left ventricular mass, circulating inflammatory markers rather than pressure load are associated with concentric left ventricular remodelling
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Chanel Robinson, Angela J. Woodiwiss, Gavin R. Norton, Glenda Norman, Monica Gomes, Carlos D. Libhaber, Pinhas Sareli, Vernice R. Peterson, and Elena Libhaber
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Adult ,Male ,Cardiac function curve ,medicine.medical_specialty ,Heart Ventricles ,Blood Pressure ,Enzyme-Linked Immunosorbent Assay ,030204 cardiovascular system & hematology ,Concentric ,Ventricular Function, Left ,Left ventricular mass ,03 medical and health sciences ,0302 clinical medicine ,Diastole ,Risk Factors ,Internal medicine ,Ventricular Pressure ,medicine ,Humans ,Mass index ,030212 general & internal medicine ,Inflammation ,Ventricular Remodeling ,business.industry ,Confounding ,Middle Aged ,Blood pressure ,Echocardiography ,Pressure load ,Cardiology ,Cytokines ,Female ,Hypertrophy, Left Ventricular ,Cardiology and Cardiovascular Medicine ,Wall thickness ,business ,Biomarkers ,Follow-Up Studies - Abstract
A reason for concentric left ventricular (LV) remodelling predicting cardiovascular outcomes independent of conventional risk factors and LV mass (LVM) has not been provided. We hypothesized that independent of LVM, concentric LV remodelling is associated with inflammatory changes rather than a pressure load on the LV.In 764 randomly selected community participants, we assessed relations between several inflammatory markers (ELISA) and LV relative wall thickness (RWT) (echocardiography), LV mass index (LVMI), and indexes of diastolic function.No independent relations were noted between circulating concentrations of inflammatory markers and LVM index (LVMI) (p 0.13 for all). However, independent of confounders including LVMI and blood pressure (BP), circulating tumour necrosis factor-α (TNF-α) (partial r = 0.14, p 0.0005) and to a lesser degree interleukin-6 (partial r = -0.09, p 0.02) were associated with RWT. The impact (standardized β-coefficient) of TNF-α on RWT (0.12 ± 0.03, p 0.0005) was at least as strong as age (0.13 ± 0.05, p 0.005), and second only to LVMI (0.27 ± 0.04, p 0.0001), whilst neither office, 24-hour, central aortic BP, nor aortic stiffness were associated with RWT independent of LVMI. With adjustments, as compared to participants with a normal LVMI and geometry (12.7 ± 0.8), circulating TNF-α concentrations (pg/ml) were increased as much in participants with concentric LV remodelling (16.8 ± 1.5, p 0.05) as in those with concentric LV hypertrophy (LVH) (17.0 ± 1.3, p 0.005), whilst eccentric LVH (13.7 ± 0.9) was not. No independent relations between inflammatory markers and LV diastolic function (trans-mitral and tissue Doppler) were noted.Independent of LVMI, a pro-inflammatory state rather than BP load is strongly associated with LV concentric remodelling.
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- 2019
36. Organ-Specific, Age-Dependent Associations of Steady-State Pressures and Pulsatile Pressure Wave Components With End-Organ Measures
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Ravi Naran, Carlos D. Libhaber, Andrea Kolkenbeck-Ruh, Pinhas Sareli, Angela J. Woodiwiss, Tshegofatso H Motau, and Gavin R. Norton
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Adult ,Male ,medicine.medical_specialty ,Mean arterial pressure ,Pulsatile flow ,Blood Pressure ,Pulse Wave Analysis ,030204 cardiovascular system & hematology ,Carotid Intima-Media Thickness ,03 medical and health sciences ,0302 clinical medicine ,Commentaries ,Internal medicine ,medicine.artery ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Pulse wave velocity ,Aged ,Aorta ,business.industry ,Confounding ,Age Factors ,Middle Aged ,Pulse pressure ,Cross-Sectional Studies ,Blood pressure ,Cardiology ,Female ,Hypertrophy, Left Ventricular ,Aortic stiffness ,business - Abstract
BACKGROUND The contribution of steady-state pressures and the forward (Pf) and backward (reflected) (Pb) wave pressure components of pulse pressure to risk prediction have produced contrasting results. We hypothesized that the independent contribution of steady-state pressures (mean arterial pressure [MAP]), Pf and Pb, to cardiovascular damage is organ specific and age dependent. METHODS In 1,384 black South Africans from a community sample, we identified independent relations between MAP, Pf, or Pb (applanation tonometry and SphygmoCor software) and left ventricular mass index (LVMI) (n = 997) (echocardiography), carotid intima-media thickness (IMT) (n = 804) (B-mode ultrasound), or aortic pulse wave velocity (PWV) (n = 1,217). RESULTS Independent of risk factors, relations between Pf and IMT were noted in those over 50 years (P < 0.02), whereas in those less than 50 years, MAP (P < 0.005) was independently associated with IMT. Pb failed to show independent relations with IMT at any age (P > 0.37) In contrast, independent relations between Pb and LVMI were noted in those less than (P < 0.0001), and greater than (P < 0.02) 50 years, whereas MAP was not independently associated with LVMI at any age (P > 0.07) and Pf tended to show significant relations only in the elderly (P = 0.05). Moreover, although MAP (P < 0.005) and Pb (P < 0.01) showed independent relations with PWV at any age, Pf failed to show independent relations (P > 0.10). CONCLUSION Independent of confounders, steady-state and aortic Pf and Pb show associations with end-organ measures that are organ specific and age dependent.
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- 2018
37. Hemodynamic and Functional Correlates of Concentric vs. Eccentric LVH in a Community-Based Sample With Prevalent Volume-Dependent Hypertension
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Pinhas Sareli, Ferande Peters, Keneilwe N. Mmopi, Nonhlanhla Mthembu, Adamu J. Bamaiyi, Gavin R. Norton, Hamza Bello, Angela J. Woodiwiss, Vernice R. Peterson, Mohlabani Masiu, Daniel Da Silva Fernandes, and Carlos D. Libhaber
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medicine.medical_specialty ,Ventricular Remodeling ,business.industry ,Heart Ventricles ,Volume overload ,Hemodynamics ,Blood Pressure ,Stroke volume ,Left ventricular hypertrophy ,medicine.disease ,Blood pressure ,medicine.anatomical_structure ,Internal medicine ,Hypertension ,Internal Medicine ,medicine ,Cardiology ,Vascular resistance ,End-diastolic volume ,Eccentric ,Humans ,Hypertrophy, Left Ventricular ,business - Abstract
BACKGROUND Whether in volume-dependent primary hypertension, concentric left ventricular (LV) remodeling beyond hypertrophy (LVH) represents the impact of a pressure rather than a volume overload, is unclear. METHODS Using central arterial pressure, and aortic velocity and diameter measurements in the outflow tract (echocardiography), we determined the factors that associate with concentric LVH or remodeling in a community of African ancestry (n = 709) with prevalent volume-dependent primary hypertension. RESULTS Both left ventricular mass index (LVMI) and relative wall thickness (RWT) were positively and independently associated with end diastolic volume (EDV), stroke volume (SV), and peak aortic flow (Q) (P < 0.05 to CONCLUSIONS In volume-dependent primary hypertension, concentric LVH is determined as much by volume-dependent increases in systemic flow and an enhanced BP as eccentric LVH. Concentric remodeling nevertheless reflects decreases in systolic function beyond LVH.
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- 2021
38. Relations of aortic stiffness with arterial damage beyond brachial pressure are both dependent and independent of central arterial pulsatile load
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Hamza Bello, Ismail Cassimjee, Taalib Monareng, Pinhas Sareli, Nonhlanhla Mthembu, Gavin R. Norton, Vernice R. Peterson, Mohlabani Masiu, Angela J. Woodiwiss, Eitzaz Sadiq, Martin Veller, Ravi Naran, Girish Modi, Talib Abdool-Carrim, Ferande Peters, Keneilwe N. Mmopi, Carlos D. Libhaber, Tshegofatso H Motau, Daniel Da Silva Fernandes, and Monica Gomes
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medicine.medical_specialty ,Brachial Artery ,Physiology ,End organ damage ,Pulsatile flow ,Hemodynamics ,Blood Pressure ,030204 cardiovascular system & hematology ,Pulse Wave Analysis ,Carotid Intima-Media Thickness ,03 medical and health sciences ,0302 clinical medicine ,Vascular Stiffness ,Internal medicine ,Internal Medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Pulse wave velocity ,Stroke ,business.industry ,medicine.disease ,Pulse pressure ,Blood pressure ,cardiovascular system ,Cardiology ,Aortic stiffness ,Cardiology and Cardiovascular Medicine ,business ,circulatory and respiratory physiology - Abstract
AIM We aimed to determine whether the impact of aortic stiffness on atherosclerotic or small vessel end organ damage beyond brachial blood pressure depends in-part on stiffness-induced increases in central arterial pressures produced by an enhanced resistance to flow (characteristic impedance, Zc). METHODS We studied 1021 participants, 287 with stroke or critical limb ischaemia, and 734 from a community sample with atherosclerotic or small vessel end organ measures. Central arterial haemodynamics were determined from arterial pressure (SphygmoCor) and velocity and diameter assessments in the outflow tract (echocardiography). RESULTS Although Zc and carotid-femoral pulse wave velocity (PWV) were correlated (P
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- 2020
39. The Optimal Haemoglobin Target in Dialysis Patients May Be Determined by Its Contrasting Effects on Arterial Stiffness and Pressure Pulsatility
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Hon-Chun Hsu, Patrick H Dessein, Angela J. Woodiwiss, Gavin R. Norton, and Chanel Robinson
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medicine.medical_specialty ,medicine.medical_treatment ,International Journal of Nephrology and Renovascular Disease ,030232 urology & nephrology ,haemoglobin target ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,pressure pulsatility ,medicine ,Pulse wave velocity ,Dialysis ,Original Research ,biology ,business.industry ,Angiotensin-converting enzyme ,medicine.disease ,Pulse pressure ,Blood pressure ,arterial stiffness ,Nephrology ,Heart failure ,Cardiology ,Arterial stiffness ,biology.protein ,dialysis ,business ,Kidney disease - Abstract
Hon-Chun Hsu,1,2 Chanel Robinson,1 Gavin R Norton,1 Angela J Woodiwiss,1 Patrick H Dessein1,3,4 1Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Nephrology Unit, Milpark Hospital, Johannesburg, South Africa; 3Internal Medicine Department, University of the Witwatersrand, Johannesburg, South Africa; 4Free University and University Hospital, Brussels, BelgiumCorrespondence: Patrick H Dessein 80 Scholtz Road, Norwood, Johannesburg 2117, South AfricaEmail patrick.dessein22@gmail.comIntroduction: It remains unclear why the optimal haemoglobin target is lower in patients with chronic kidney disease (CKD) than in non-CKD persons. Arteriosclerosis and consequent impaired arterial function comprise a central cardiovascular risk mechanism in CKD. We hypothesized that the optimal haemoglobin target depends on its opposing effects on arterial stiffness and pressure pulsatility in CKD.Methods: Arterial stiffness (aortic pulse wave velocity), wave reflection (augmentation index, reflected wave pressure and reflection magnitude), and pressure pulsatility (central systolic and pulse pressure, peripheral pulse pressure, pressure amplification and forward wave pressure) were assessed in 48 dialysis patients.Results: In established confounder and diabetes adjusted linear regression models, haemoglobin levels were directly associated with arterial stiffness (partial R=0.366, p=0.03) and inversely with central systolic pressure (partial R=− 0.344, p=0.04), central pulse pressure (partial R=− 0.403, p=0.01), peripheral pulse pressure (partial R=− 0.521, p=0.001) and forward wave pressure (partial R=− 0.544, p=0.001). The presence of heart failure and use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers and erythropoietin stimulating agents did not materially alter these relationships upon further adjustment for the respective characteristics in the models, and in sensitivity analyses. In receiver operator characteristic curve analysis, the optimal haemoglobin concentration cut-off values in predicting arterial stiffness and increased central pulse pressure were remarkably similar at 10.95 g/dl and 10.85 g/dl, respectively, and with clinically useful sensitivities, specificities and positive and negative predictive values. In logistic regression models, a haemoglobin value of > 10.9 mg/dl was associated with both arterial stiffness (> 10 m/sec; OR (95% CI) = 10.48 (1.57– 70.08), p=0.02) and normal central pulse pressure (> 50 mmHg; OR (95% CI) = 7.55 (1.58– 36.03), p=0.01).Conclusion: This study suggests that the optimal haemoglobin target in dialysis patients is ∼ 11g/dl and determined by its differential and contrasting effects on arterial stiffness and pressure pulsatility.Keywords: haemoglobin target, dialysis, arterial stiffness, pressure pulsatility
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- 2020
40. Contribution of systemic blood flow to untreated or inadequately controlled systolic--diastolic or isolated systolic hypertension in a community sample of African ancestry
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Carlos D. Libhaber, Keneilwe N. Mmopi, Vernice R. Peterson, Pinhas Sareli, Ferande Peters, Angela J. Woodiwiss, Gavin R. Norton, and Hamza Bello
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medicine.medical_specialty ,Cardiac output ,Physiology ,Systole ,Diastole ,Hemodynamics ,Blood Pressure ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Internal Medicine ,Medicine ,Humans ,030212 general & internal medicine ,business.industry ,Confounding ,Stroke volume ,Compliance (physiology) ,medicine.anatomical_structure ,Blood pressure ,Hypertension ,Vascular resistance ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
AIMS Age-related increases in systemic blood flow [stroke volume (SV), cardiac output (CO), and aortic flow (Q)] contribute substantially to untreated or inadequately controlled (uncontrolled) blood pressure (BP) in Africa. We aimed to identify the haemodynamic determinants of uncontrolled systolic--diastolic (Syst--diast HT) versus uncontrolled isolated systolic (ISH) or diastolic (IDH) hypertension. METHODS Using central arterial pressure and aortic outflow tract velocity and diameter measurements (echocardiography), the haemodynamic correlates of BP were determined in 725 community participants of African ancestry (19.6% uncontrolled Syst--diast HT, 9.2% uncontrolled ISH, 11.3% uncontrolled IDH). RESULTS Independent of confounders, compared with those with a normotensive BP, those with uncontrolled Syst--diast HT had increases in SV, CO, Q, systemic vascular resistance (SVR) and aortic characteristic impedance (Zc) and decreases in total arterial compliance (TAC) (P
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- 2020
41. Marked Arterial Functional Changes in Patients With Arterial Vascular Events Across the Early Adult Lifespan
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Gavin R. Norton, Chanel Robinson, Olebogeng H.I. Majane, Taalib Monareng, Andrea Kolkenbeck-Ruh, Angela J. Woodiwiss, Martin Veller, Philanathi Mabena, Ismail Cassimjee, Pinhas Sareli, Girish Modi, Eitzaz Sadiq, Grace Tade, Ferande Peters, Ravi Naran, Nomvuyo Manyatsi, Tshegofatso H Motau, Talib Abdool-Carrim, and Vernice R. Peterson
- Subjects
Adult ,Male ,medicine.medical_specialty ,Aging ,Arteriosclerosis ,Black People ,Blood Pressure ,030204 cardiovascular system & hematology ,Pulse Wave Analysis ,03 medical and health sciences ,South Africa ,0302 clinical medicine ,Vascular Stiffness ,Ischemia ,Risk Factors ,Internal medicine ,medicine ,Humans ,In patient ,Arterial Pressure ,030212 general & internal medicine ,Stroke ,Aorta ,Aged ,business.industry ,Extremities ,Arteries ,Middle Aged ,medicine.disease ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective: The age at which arteriosclerosis begins to contribute to events is uncertain. We determined, across the adult lifespan, the extent to which arteriosclerosis-related changes in arterial function occur in those with precipitous arterial events (stroke and critical limb ischemia). Approaches and Results: In 1082 black South Africans (356 with either critical limb ischemia [n=238] or stroke [n=118; 35.4% premature], and 726 age, sex, and ethnicity-matched randomly selected controls), arterial function was evaluated from applanation tonometry and velocity and diameter measurements in the outflow tract. Compared with age- and sex-matched controls, over 10-year increments in age from 20 to 60years, multivariate-adjusted (including steady-state pressures) aortic pulse wave velocity, characteristic impedance (Zc), forward wave pressures (Pf), and early systolic pulse pressure amplification were consistently altered in those with arterial events. Increases in Zc were accounted for by aortic stiffness (no differences in aortic diameter) and Pf by changes in Zc and not aortic flow or wave re-reflection. Multivariate-adjusted pulse wave velocity (7.48±0.30 versus 5.82±0.15 m/s, P P P P P Conclusions: Arteriosclerosis-related changes in arterial function are consistently associated with arterial events beyond risk factors from as early as 20 years of age.
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- 2020
42. Increased Aortic Characteristic Impedance Explains Relations Between Urinary Na
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Keneilwe N, Mmopi, Gavin R, Norton, Hamza, Bello, Carlos, Libhaber, Mohlabani, Masiu, Daniel, Da Silva Fernandes, Pinhas, Sareli, Vernice, Peterson, and Angela J, Woodiwiss
- Subjects
Adult ,Brachial Artery ,Systole ,Sodium Chloride Symporter Inhibitors ,Sodium ,Middle Aged ,Overweight ,Recommended Dietary Allowances ,Renin-Angiotensin System ,Hypertension ,Diabetes Mellitus ,Electric Impedance ,Potassium ,Humans ,Arterial Pressure ,Vascular Resistance ,Sodium Chloride, Dietary ,Antihypertensive Agents ,Aorta ,Aged - Abstract
Alterations in sodium (Na
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- 2020
43. May Measurement Month 2019: The Global Blood Pressure Screening Campaign of the International Society of Hypertension
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Beaney, Thomas, Schutte, Aletta E, Stergiou, George S, Borghi, Claudio, Burger, Dylan, Charchar, Fadi, Cro, Suzie, Diaz, Alejandro, Damasceno, Albertino, Espeche, Walter, Jose, Arun Pulikkottil, Khan, Nadia, Kokubo, Yoshihiro, Maheshwari, Anuj, Marin, Marcos J, More, Arun, Neupane, Dinesh, Nilsson, Peter, Patil, Mansi, Prabhakaran, Dorairaj, Ramirez, Agustin, Rodriguez, Pablo, Schlaich, Markus, Steckelings, Ulrike M, Tomaszewski, Maciej, Unger, Thomas, Wainford, Richard, Wang, Jiguang, Williams, Bryan, Poulter, Neil R, Michael H Olsen, Kristin T West-Gustave, Phillip D Levy, Vivian W. Y. Lee, Kenneth L Connell, Naima N. H. Hammoudi, Pascal Bovet, Bharathi Viswanathan, Sabine Perl, Bernard K Kramer, Adrian J. B. Brady, Olulola O Oladapo, Jephat Chifamba, Dejuma Y Goshu, Desalew M Kassie, Sintayehu A Gebru, Toure A Ibrahim, Soumana Kabirou, Elham Tavassoli, Mahsa Zolfaghari, Vahideh Yavari, Larysa Mishchenko, Olena Matova, Tetiana Kolenyk, Liliiya Zelenenka, Sergiy Fedorov, Maria Dorobantu, Alexandra Paval, Jesse Bittman, Biri Mangat, Sarah Melville, Alexander Leung, Neusa Jessen, Eamon Dolan, Hiroshi N. A. Itoh, Atul Pathak, Tine L. M. De Backer, Arman S Postadzhiyan, Osiris V Valoy-Tiburcio, Angel R Gonzalez-Medina, Laura G Valdez-Valoy, Fernando S Wyss, Erkin Mirrakhimov, Sunil K Nadar, Ana I Barrientos, Chukwuemeka R Nwokocha, Magdalene I Nwokocha, Dean Picone, Jun Yang, Yook C Chia, Siew M Ching, Bertrand F Ellenga Mbolla, Christian M Kouala Landa, Corine Y Houehanou, Kolawole W Wahab, Ayodele B Omotoso, Jose Ortellado, Graciela Gonzales, Luis M Ruilope, Enrique Rodilla, Ana Molinero, Angela J Woodiwiss, Ane Orchard, Ruan Kruger, Jana Brguljan, Nina Bozic, Aleksandra O Konradi, Oxana P Rotar, Irian Chazova, Tiny K Masupe, John T Tlhakanelo, Keneilwe Motlhatlhedi, George Stergiou, Michalis Doumas, Pantelis Zebekakis, Francesco P Cappuccio, Carolina Barciela, Tricia Tay, Naranjargal Dashdorj, Khulan Tuvdendarjaa, Khatantuul Boldbaatar, Fernando T Lanas, Melanie Paccot, Mohammed Ishaq, Saulat Sidique, Feroz Memon, Robert N Najem, Ali K Abu Alfa, Samir M. J. Mallat, Jacek J Jozwiak, Maciej Banach, Piotr Janowski, Betty Twumasi-Ankrah, Gustavus A Myers-Hansen, Elliot K Tannor, Marisa F Neto, Sudhirsen Kowlessur, Bhooshun Ori, Jaysing Heecharan, Hatem A Fageh, Hawa A Derbi, Omara M Msalam, Fastone M Goma, Charity Syatalimi, Penias Jr Tembo, Musawa Mukupa, Henry L Ndhlovu, Maureen L Chirwa, Mary M Mbeba, Parounak H Zelveian, Zoya N Hakobyan, Svetlana Gourgenyan, Myeong-Chan Cho, Hae-Young Lee, Jinho Shin, Gianfranco Parati, Guido Grassi, Claudio Ferri, Bezhan Tsinamdzgvrishvili, Amiran Gamkrelidze, Dali Trapaidze, Eduardo C. D. Barbosa, Weimar S Barroso, Audes M Feitosa, Vanda M Azevedo, Luis A Dias, Glenda N Garcia, Isaulina Delgado, Genc Burazeri, Gentiana Qirjako, Alban Ylli, Rudina Cumashi, Antonieta P Costantini-Olmos, Igor Morr, Elias Chuki, Tzung-Dau Wang, Wen-Jone Chen, Hung-Ju Lin, Fazila-Tun-Nesa Malik, Sohel R Choudhury, Mohammad Abdullah Al Mamun, Mir Ishraquzzaman, Ghadeer S Aljuraiban, Fatima Y Al Slail, Shatha K Aldhwailea, Ann A Badawi, Nguyen L Viet, Hoang A Tien, Nguyen T. A. Dong, Cao T Sinh, Huynh V Minh, Tran K Son, Fortunat K Katamba, Nathan B Buila, Anastase Dzudie, Samuel Kingue, Njume Epie, Armel Njomou, Marie S Ndom, Afzalhussein M Yusufali, Nooshin M Bazargani, Buthaina A. Bin Belaila, Amrish Agrawal, Aisha M Suhail, Elijah N Ogola, Bernard M Gitura, Lilian Mbau, Hellen K Nguchu, Felix A Barasa, Enrique Gomez, Luis A Alcocer, Martin Rosas, Silvia Palomo, Alfredo J Estrada, Patricio Lopez-Jaramillo, Gregorio Sanchez-Vallejo, Maria E Casanova, Edgar Arcos, Gustavo Aroca, Bhagawan Koirala, Harikrishna Bhattarai, Ghanashyam Pandey, Surya Devkota, Sweta Koirala, Kamal Ranabhat, Pratik Khanal, Tara B Adhikari, Dolores D Bonzon, Deborah Ignacia D Ona, Leilani M Asis, Benjamin A Balmores Jr, Rafael C Castillo, Diego J Stisman, Walter G Espeche, Marcos J Marin, Irene L Ennis, Xin Chen, Hongyu Wang, Min Liu, Xinhua Yin, Xiaolong Wang, Sandeep Bhalla, Priyanka Gupta, Narsingh Verma, Bal K Gupta, Shehla Sheikh, Gregoire Wuerzner, Laura Garré, José Boggia, Dédonougbo M Houenassi, José A OctavioSeijas, Jean-René M'buyamba-Kabangu, Trésor M Tshiswaka, Dénes Páll, Zoltán Járai, Rafael Hernández, Fortunato Garcia Vásquez, Jesús A Lopez-Rivera, Monica L Gúzman-Franolic, Savarino Victoria Pereira, Mário J Fernandes, Maria S Garcia, Teresa Gijon, Vitoria V. B. Meira Da Cunha, Beaney T, Schutte AE, Stergiou GS, Borghi C, Burger D, Charchar F, Cro S, Diaz A, Damasceno A, Espeche W, Jose AP, Khan N, Kokubo Y, Maheshwari A, Marin MJ, More A, Neupane D, Nilsson P, Patil M, Prabhakaran D, Ramirez A, Rodriguez P, Schlaich M, Steckelings UM, Tomaszewski M, Unger T, Wainford R, Wang J, Williams B, Poulter NR, Thomas, B, Aletta E, S, George S, S, Claudio, B, Dylan, B, Fadi, C, Suzie, C, Alejandro, D, Albertino, D, Walter, E, Arun Pulikkottil, J, Nadia, K, Yoshihiro, K, Anuj, M, Marcos J, M, Arun, M, Dinesh, N, Peter, N, Mansi, P, Dorairaj, P, Agustin, R, Pablo, R, Markus, S, Ulrike M, S, Maciej, T, Thomas, U, Richard, W, Jiguang, W, Bryan, W, Neil R, P, H Olsen, M, T West-Gustave, K, D Levy, P, Lee, V, L Connell, K, Hammoudi, N, Bovet, P, Viswanathan, B, Perl, S, K Kramer, B, Brady, A, O Oladapo, O, Chifamba, J, Y Goshu, D, M Kassie, D, A Gebru, S, A Ibrahim, T, Kabirou, S, Tavassoli, E, Zolfaghari, M, Yavari, V, Mishchenko, L, Matova, O, Kolenyk, T, Zelenenka, L, Fedorov, S, Dorobantu, M, Paval, A, Bittman, J, Mangat, B, Melville, S, Leung, A, Jessen, N, Dolan, E, Itoh, H, Pathak, A, De Backer, T, S Postadzhiyan, A, V Valoy-Tiburcio, O, R Gonzalez-Medina, A, G Valdez-Valoy, L, S Wyss, F, Mirrakhimov, E, K Nadar, S, I Barrientos, A, R Nwokocha, C, I Nwokocha, M, Picone, D, Yang, J, C Chia, Y, M Ching, S, F Ellenga Mbolla, B, M Kouala Landa, C, Y Houehanou, C, W Wahab, K, B Omotoso, A, Ortellado, J, Gonzales, G, M Ruilope, L, Rodilla, E, Molinero, A, J Woodiwiss, A, Orchard, A, Kruger, R, Brguljan, J, Bozic, N, O Konradi, A, P Rotar, O, Chazova, I, K Masupe, T, T Tlhakanelo, J, Motlhatlhedi, K, Stergiou, G, Doumas, M, Zebekakis, P, P Cappuccio, F, Barciela, C, Tay, T, Dashdorj, N, Tuvdendarjaa, K, Boldbaatar, K, T Lanas, F, Paccot, M, Ishaq, M, Sidique, S, Memon, F, N Najem, R, K Abu Alfa, A, Mallat, S, J Jozwiak, J, Banach, M, Janowski, P, Twumasi-Ankrah, B, A Myers-Hansen, G, K Tannor, E, F Neto, M, Kowlessur, S, Ori, B, Heecharan, J, A Fageh, H, A Derbi, H, M Msalam, O, M Goma, F, Syatalimi, C, Jr Tembo, P, Mukupa, M, L Ndhlovu, H, L Chirwa, M, M Mbeba, M, H Zelveian, P, N Hakobyan, Z, Gourgenyan, S, Cho, M, Lee, H, Shin, J, Parati, G, Grassi, G, Ferri, C, Tsinamdzgvrishvili, B, Gamkrelidze, A, Trapaidze, D, Barbosa, E, S Barroso, W, M Feitosa, A, M Azevedo, V, A Dias, L, N Garcia, G, Delgado, I, Burazeri, G, Qirjako, G, Ylli, A, Cumashi, R, P Costantini-Olmos, A, Morr, I, Chuki, E, Wang, T, Chen, W, Lin, H, Malik, F, R Choudhury, S, Abdullah Al Mamun, M, Ishraquzzaman, M, S Aljuraiban, G, Y Al Slail, F, K Aldhwailea, S, A Badawi, A, L Viet, N, A Tien, H, Dong, N, T Sinh, C, V Minh, H, K Son, T, K Katamba, F, B Buila, N, Dzudie, A, Kingue, S, Epie, N, Njomou, A, S Ndom, M, M Yusufali, A, M Bazargani, N, Bin Belaila, B, Agrawal, A, M Suhail, A, N Ogola, E, M Gitura, B, Mbau, L, K Nguchu, H, A Barasa, F, Gomez, E, A Alcocer, L, Rosas, M, Palomo, S, J Estrada, A, Lopez-Jaramillo, P, Sanchez-Vallejo, G, E Casanova, M, Arcos, E, Aroca, G, Koirala, B, Bhattarai, H, Pandey, G, Devkota, S, Koirala, S, Ranabhat, K, Khanal, P, B Adhikari, T, D Bonzon, D, D Ona, D, M Asis, L, A Balmores Jr, B, C Castillo, R, J Stisman, D, G Espeche, W, J Marin, M, L Ennis, I, Chen, X, Wang, H, Liu, M, Yin, X, Wang, X, Bhalla, S, Gupta, P, Verma, N, K Gupta, B, Sheikh, S, Wuerzner, G, Garré, L, Boggia, J, M Houenassi, D, A OctavioSeijas, J, M'buyamba-Kabangu, J, M Tshiswaka, T, Páll, D, Járai, Z, Hernández, R, Garcia Vásquez, F, A Lopez-Rivera, J, L Gúzman-Franolic, M, Victoria Pereira, S, J Fernandes, M, S Garcia, M, Gijon, T, Meira Da Cunha, V, and RS: CARIM other
- Subjects
Male ,Population level ,Comorbidity ,030204 cardiovascular system & hematology ,0302 clinical medicine ,Prevalence ,adults ,Medicine ,Mass Screening ,awareness ,030212 general & internal medicine ,1102 Cardiorespiratory Medicine and Haematology ,Aged, 80 and over ,Aspirin ,treatment ,adults, awareness, blood pressure, hypertension, risk factor, screening, treatment ,blood pressure ,Middle Aged ,Lifestyle factors ,risk factor ,Female ,Life Sciences & Biomedicine ,medicine.drug ,Adult ,medicine.medical_specialty ,hypertension ,Adolescent ,awarene ,Opportunistic Sampling ,Elevated blood ,1117 Public Health and Health Services ,03 medical and health sciences ,Young Adult ,Internal Medicine ,Humans ,Risk factor ,Antihypertensive Agents ,Aged ,Science & Technology ,business.industry ,screening ,Blood Pressure Determination ,1103 Clinical Sciences ,Mean blood pressure ,Blood pressure ,Peripheral Vascular Disease ,Cardiovascular System & Hematology ,Emergency medicine ,Cardiovascular System & Cardiology ,business ,MMM Investigators - Abstract
Elevated blood pressure remains the single biggest risk factor contributing to the global burden of disease and mortality. May Measurement Month is an annual global screening campaign aiming to improve awareness of blood pressure at the individual and population level. Adults ({greater than or equal to}18 years) recruited through opportunistic sampling were screened at sites in 92 countries during May 2019. Ideally three blood pressure readings were measured for each participant, and data on lifestyle factors and co-morbidities were collected. Hypertension was defined as a systolic BP {greater than or equal to} 140 mmHg, and/or a diastolic BP {greater than or equal to} 90 mmHg (mean of the second and third readings) or taking antihypertensive medication. When necessary, multiple imputation was used to estimate participants' mean blood pressure. Mixed-effects models were used to evaluate associations between blood pressure and participant characteristics. Of 1,508,130 screenees 482,273 (32.0%) had never had a blood pressure measurement before and 513,337 (34.0%) had hypertension, of whom 58.7% were aware and 54.7% were on antihypertensive medication. Of those on medication, 57.8% were controlled to
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- 2020
44. Associations of inflammatory markers with impaired left ventricular diastolic and systolic function in collagen-induced arthritis
- Author
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Monica Gomes, Aletta M.E. Millen, Lebogang Mokotedi, Frederic S. Michel, Angela J. Woodiwiss, Conrad Mogane, and Gavin R. Norton
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Male ,Physiology ,Interleukin-1beta ,Hemodynamics ,Arthritis ,Blood Pressure ,Speckle tracking echocardiography ,030204 cardiovascular system & hematology ,Pathology and Laboratory Medicine ,Systemic inflammation ,Biochemistry ,Vascular Medicine ,Ventricular Function, Left ,Rats, Sprague-Dawley ,0302 clinical medicine ,Immune Physiology ,Medicine and Health Sciences ,Medicine ,030212 general & internal medicine ,Immune Response ,Innate Immune System ,Multidisciplinary ,Ejection fraction ,Physics ,Classical Mechanics ,Deformation ,C-Reactive Protein ,Physical Sciences ,Cardiology ,Cytokines ,Collagen ,medicine.symptom ,Research Article ,medicine.medical_specialty ,Science ,Immunology ,Diastole ,Rheumatoid Arthritis ,Inflammation ,Autoimmune Diseases ,03 medical and health sciences ,Signs and Symptoms ,Rheumatology ,Diagnostic Medicine ,Internal medicine ,Animals ,Collagen Type II ,Echocardiography, Doppler, Pulsed ,Damage Mechanics ,Tumor Necrosis Factor-alpha ,business.industry ,Myocardium ,Body Weight ,Biology and Life Sciences ,Proteins ,Molecular Development ,medicine.disease ,Arthritis, Experimental ,Rats ,Blood pressure ,Immune System ,Cattle ,Clinical Immunology ,Clinical Medicine ,business ,Collagens ,Biomarkers ,Developmental Biology ,Ejection Fraction - Abstract
Background High-grade inflammation may play a pivotal role in the pathogenesis of left ventricular (LV) dysfunction. Evidence to support a role of systemic inflammation in mediating impaired LV function in experimental models of rheumatoid arthritis (RA) remains limited. The aim of the present study was to determine the effects of high-grade systemic inflammation on LV diastolic and systolic function in collagen-induced arthritis (CIA). Methods To induce CIA, bovine type-II collagen emulsified in incomplete Freund’s adjuvant was injected at the base of the tail into 21 three-month old Sprague Dawley rats. Nine-weeks after the first immunisation, LV function was assessed by pulsed Doppler, tissue Doppler imaging and Speckle tracking echocardiography. Cardiac collagen content was determined by picrosirius red staining; circulating inflammatory markers were measured using ELISA. Results Compared to controls (n = 12), CIA rats had reduced myocardial relaxation as indexed by lateral e’ (early diastolic mitral annular velocity) and e’/a’ (early-to-late diastolic mitral annular velocity) and increased filling pressures as indexed by E/e’. No differences in ejection fraction and LV endocardial fractional shortening between the groups were recorded. LV global radial and circumferential strain and strain rate were reduced in CIA rats compared to controls. Higher concentrations of circulating inflammatory markers were associated with reduced lateral e’, e’/a’, radial and circumferential strain and strain rate. Greater collagen content was associated with increased concentrations of circulating inflammatory markers and E/e’. Conclusion High-grade inflammation is associated with impaired LV diastolic function and greater myocardial deformation independent of haemodynamic load in CIA rats.
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- 2020
45. Effects of High Salt-Low Potassium Diet on Blood Pressure and Vascular Reactivity in Male Sprague Dawley Rats
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Frédéric Michel, Aletta M.E. Millen, Gavin R. Norton, Lebogang Mokotedi, and Angela J. Woodiwiss
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Male ,0301 basic medicine ,medicine.medical_specialty ,Contraction (grammar) ,Potassium ,Sodium ,Diastole ,chemistry.chemical_element ,Blood Pressure ,030204 cardiovascular system & hematology ,Rats, Sprague-Dawley ,Phenylephrine ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Animals ,Vasoconstrictor Agents ,Sodium Chloride, Dietary ,Mesenteric arteries ,EC50 ,Pharmacology ,Dose-Response Relationship, Drug ,Potassium, Dietary ,Mesenteric Arteries ,Dose–response relationship ,030104 developmental biology ,Blood pressure ,medicine.anatomical_structure ,Endocrinology ,chemistry ,Vasoconstriction ,Hypertension ,Adrenergic alpha-1 Receptor Agonists ,Cardiology and Cardiovascular Medicine - Abstract
Sodium (Na) intake increases vascular reactivity. Whether low potassium (K) intake affects vascular reactivity-associated blood pressure (BP) changes is uncertain. This study aimed to determine whether Na-induced increases in BP and vascular reactivity are altered by low K intake. Male Sprague Dawley rats were assigned to 3 dietary groups for 6 weeks: a standard Na-K diet (control, n = 12), a high Na-normal K diet (HS-NormK, n = 12), and a high Na-low K diet (HS-LowK, n = 12). BP was measured at baseline and after the dietary intervention. Na and K excretions and vascular reactivity were measured after the dietary intervention. The Na/K ratio was significantly higher in the HS-LowK compared with the other groups. Systolic and diastolic BPs increased significantly in the HS-NormK and HS-LowK groups. In mesenteric arteries, the dose-response curves for phenylephrine-induced contractions shifted to the left and the EC50 (mean ± SD) was significantly lower in the HS-NormK (0.51 ± 0.17 μM, P = 0.003) and HS-LowK (0.69 ± 0.14 μM, P = 0.005) groups compared with the control (3.24 ± 0.79 μM). Systolic (r = -0.58 P = 0.002) and diastolic (r = -0.61 P = 0.001) BPs were associated with the EC50 of phenylephrine-induced contraction in mesenteric arteries. High Na intake induces increased alpha-1 receptor responsiveness in mesenteric arteries, which may be responsible for the increase in BP and is not affected by low dietary K intake.
- Published
- 2018
46. Impact of aortic rather than brachial pulsatile haemodynamics on variations in end-organ measures across the full adult blood pressure range
- Author
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Carlos D. Libhaber, Pinhas Sareli, Bryan Hodson, Gavin R. Norton, Angela J. Woodiwiss, and Imraan Ballim
- Subjects
Adult ,Male ,Mean arterial pressure ,medicine.medical_specialty ,Physiology ,Pulsatile flow ,Renal function ,Hemodynamics ,Blood Pressure ,Pulse Wave Analysis ,030204 cardiovascular system & hematology ,Left ventricular hypertrophy ,Carotid Intima-Media Thickness ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Arterial Pressure ,030212 general & internal medicine ,Pulse wave velocity ,Aged ,business.industry ,Blood Pressure Determination ,Middle Aged ,medicine.disease ,Pulse pressure ,Blood pressure ,Cardiovascular Diseases ,Echocardiography ,Hypertension ,cardiovascular system ,Cardiology ,Female ,Hypertrophy, Left Ventricular ,Cardiology and Cardiovascular Medicine ,business ,Glomerular Filtration Rate - Abstract
AIMS To determine the extent to which the adverse effects of blood pressure (BP) are mediated by pulsatile haemodynamic changes across the normotensive as compared with the hypertensive adult brachial BP range, and whether aortic rather than brachial pulsatile changes best index these effects. METHODS In 1307 community participants, the contribution of pulsatile haemodynamics (applanation tonometry and SphygmoCor software) to variations in left ventricular mass index (LVMI) (echocardiography) (n = 920), carotid intima-media thickness (IMT) (n = 712) and estimated glomerular filtration rate (eGFR) (n = 1164) were assessed. RESULTS In normotensive participants (50.5%) independent of steady-state pressure (mean arterial pressure), significant relations between aortic backward wave pressure and LVMI (partial r = 0.16, P
- Published
- 2017
47. Enhanced Aortic Reflected Wave Magnitude Accounts for the Impact of Female Gender on Aortic Pressure Augmentation in a Group of African Ancestry
- Author
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Pinhas Sareli, Angela J. Woodiwiss, Grace Tade, Gavin R. Norton, Hendrik L. Booysen, Moekanyi J. Sibiya, and Imraan Ballim
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Adult ,medicine.medical_specialty ,Manometry ,Black People ,Hemodynamics ,Blood Pressure ,Pulse Wave Analysis ,030204 cardiovascular system & hematology ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine.artery ,Internal medicine ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Aorta ,Aged ,Sex Characteristics ,Anthropometry ,business.industry ,Middle Aged ,Aortic Augmentation Index ,Surgery ,Blood pressure ,Regional Blood Flow ,Hypertension ,Cardiology ,Aortic pressure ,Female ,business ,Body mass index ,Sex characteristics - Abstract
BACKGROUND Aortic reflected wave magnitude (RM) may not account for sex-specific differences in aortic pressure augmentation in Caucasians. However, aortic reflected waves are greater in groups of African descent than other ethnic groups. We determined whether RM or alternative factors explain the impact of sex on aortic augmented pressure (Pa) in participants of African ancestry. METHODS We assessed aortic function (radial applanation tonometry, SphygmoCor) in 1,197 randomly recruited community participants of African ancestry (age ≥ 16 years). Aortic forward (Pf) and backward (Pb) wave separation was performed assuming an aortic triangular flow wave validated against aortic velocity measurements. RESULTS Across the adult lifespan, women had greater multivariate-adjusted augmentation index (AIx) and Pa. This was associated with multivariate-adjusted age-related increases in Pb, RM (Pb/Pf), and time to the peak of Pf and decreases in backward wave foot time; but not increases in Pf. With adjustors, Pa was associated with female gender (β-coefficient = 3.81 ± 0.34), a relationship which was markedly attenuated by adjustments for RM (β-coefficient = 1.78 ± 0.31, P < 0.0001 vs. without adjustments for RM), and Pb (β-coefficient = 2.05 ± 0.19, P < 0.0001 vs. without adjustments for Pb), but not by adjustments for Pf, time to the peak of Pf, or backward wave foot time. Similarly, AIx was associated with female gender, a relationship which was markedly attenuated by adjustments for RM, Pb, and backward wave foot time, but not alternative factors. CONCLUSIONS In contrast to reports in alternative populations, the relationship between aortic pressure augmentation and female gender in participants of African descent is accounted for mainly by increases in RM.
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- 2017
48. Time to the peak of the aortic forward wave determines the impact of aortic backward wave and pulse pressure on left ventricular mass
- Author
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Gavin R. Norton, Angela J. Woodiwiss, Pinhas Sareli, Grace Tade, Hendrik L. Booysen, Moekanyi J. Sibiya, Imraan Ballim, Elena Libhaber, and Olebogeng H.I. Majane
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Physiology ,Hemodynamics ,Pulse Wave Analysis ,030204 cardiovascular system & hematology ,Left ventricular mass ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Wave pressure ,Internal Medicine ,medicine ,Humans ,Arterial Pressure ,Forward wave ,030212 general & internal medicine ,Aortic Pulse Pressure ,LV hypertrophy ,Aorta ,business.industry ,Middle Aged ,Wave separation ,Pulse pressure ,Echocardiography ,Hypertension ,cardiovascular system ,Cardiology ,Female ,Hypertrophy, Left Ventricular ,Cardiology and Cardiovascular Medicine ,business - Abstract
AIM To determine the degree to which an extended time to the peak of the aortic forward wave or early wave reflection time enhance associations between aortic backward wave pressure and hence central aortic pulse pressure (PPc) and left ventricular mass index (LVMI). METHODS In 701 adult participants from a community sample either receiving no antihypertensive therapy or receiving low-dose thiazide diuretic monotherapy for at least a year (the major therapy employed), we assessed aortic haemodynamics (SphygmoCor software and wave separation analysis; AtCor Medical, West Ryder, New South Wales, Australia) and LVMI (echocardiography). RESULTS An interaction between time to the peak of the aortic forward wave and aortic backward wave pressure was independently associated with aortic augmented pressure (P
- Published
- 2017
49. Insulin resistance-associated decreases in left ventricular diastolic function are strongly modified by the extent of concentric remodeling in a community sample
- Author
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Angela J. Woodiwiss, Vernice R. Peterson, Carlos D. Libhaber, Andrew R. Raymond, Muzi J. Maseko, Aletta M.E. Millen, Gavin R. Norton, and Olebogeng H.I. Majane
- Subjects
Adult ,Male ,medicine.medical_specialty ,Diastole ,030204 cardiovascular system & hematology ,Concentric ,Ventricular Function, Left ,Random Allocation ,Ventricular Dysfunction, Left ,03 medical and health sciences ,0302 clinical medicine ,Insulin resistance ,Residence Characteristics ,Internal medicine ,medicine ,Humans ,Diastolic function ,Mass index ,Obesity ,030212 general & internal medicine ,Ventricular remodeling ,Ventricular Remodeling ,business.industry ,Confounding ,Blood flow ,Middle Aged ,medicine.disease ,Cross-Sectional Studies ,Endocrinology ,Cardiology ,Female ,Insulin Resistance ,Cardiology and Cardiovascular Medicine ,business - Abstract
Whether excess adiposity, associated metabolic abnormalities or alternative risk factors for left ventricular (LV) diastolic function are modified rather than mediated by geometric LV remodeling, is uncertain.Echocardiographic LV mass index (LVMI), relative wall thickness (RWT) and diastolic function (lateral and septal wall myocardial tissue lengthening at the level of the mitral annulus [e'] [n=430], ratio of early-to-late transmitral blood flow velocity (E/A), and E/e' [n=430]) were determined in 737 randomly recruited participants of a community-based study (43% obese).Independent of LVMI and confounders, indexes of adiposity and the homeostasis model of insulin resistance (HOMA-IR) were independently associated with LV diastolic function (p0.05). In addition, RWT was independently associated with LV diastolic function (p0.002). Importantly, an independent interaction between HOMA-IR and RWT, but not between blood pressure or age and RWT, was related to LV diastolic function (p0.05). This translated into an independent relationship between HOMA-IR and lateral e' (partial r=-0.17, p0.02), septal e' (partial r=-0.14, p=0.05), E/A (partial r=-0.17, p0.005) and E/e' (partial r=0.19, p0.01) in those with RWT above, but a lack of relationship between HOMA-IR and LV diastolic function (p0.59) in those with RWT below the median for the sample. Similarly, HOMA-IR was independently associated with LV diastolic dysfunction in those with RWT above (p0.05) but not below (p0.19) the median for the sample.The relationship between insulin resistance, but not alternative risk factors and LV diastolic function is markedly modified by the presence of a more concentrically remodeled LV.
- Published
- 2016
50. Limited contribution of insulin resistance and metabolic parameters to obesity-associated increases in ambulatory blood pressure in a black African community
- Author
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Pinhas Sareli, Olebogeng H.I. Majane, Glenda Norman, Gavin R. Norton, Adamu J. Bamaiyi, and Angela J. Woodiwiss
- Subjects
medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Ambulatory blood pressure ,Waist ,business.industry ,Diastole ,Insulin resistance ,medicine.disease ,Obesity ,Blood pressure ,lcsh:RC666-701 ,Internal medicine ,Ambulatory ,Internal Medicine ,medicine ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Abdominal obesity ,Research Paper - Abstract
Although accounting for a striking proportion of obesity effects on blood pressure (BP) in other populations, the extent to which obesity-associated increases in BP are explained by insulin resistance and metabolic changes in populations of African ancestry is uncertain. We determined the contribution of insulin resistance and associated metabolic abnormalities to variations in office or ambulatory BP in a black African community with prevalent obesity and hypertension. In 1225 randomly selected participants of black South African ancestry (age>16years, 43.1% obese, 47.4% abdominal obesity), we assessed adiposity indexes, the homeostasis model of insulin resistance (HOMA-IR) and associated metabolic abnormalities and office or ambulatory (n = 798) BP. In separate models, waist circumference (p
- Published
- 2019
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