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BACKGROUND Wide pulse pressure (PP) is associated with cardiovascular events and the progression of chronic kidney disease (CKD) to kidney failure. PP naturally widens with age, but it is unclear whether the risks associated with greater PP are the same across all ages. METHODS We used Cox proportional hazards models to investigate the association of PP with (i) atherosclerotic cardiovascular disease (ASCVD) events or death and (ii) a 50% reduction in estimated glomerular filtration rate or kidney failure in the chronic renal insufficiency cohort (CRIC). We evaluated the association of time-updated PP with these outcomes, accounting for time-updated confounders using inverse probability weighting. RESULTS Among 5,621 participants with CKD, every 10-mmHg greater PP was associated with a 6% higher risk of an ASCVD event or death (hazard ratio [HR] = 1.06, 95% CI 1.04, 1.08) and 17% higher risk of the composite kidney outcome (HR = 1.17, 95% CI 1.16, 1.18). Greater PP was associated with a higher risk of ASCVD events or death among participants in the lowest age tertile (21–61 years), but a higher risk of the composite kidney outcome in the oldest age tertile (71–79 years). While wide PP in participants that experienced the primary outcomes was predominantly driven by elevated SBP, PP remained significantly associated with the composite kidney outcome across all ages and with ASCVD events or death in the first age tertile when SBP was added to the Cox regression model. CONCLUSIONS Our findings suggest that the mechanism by which PP is associated with adverse outcomes may differ by age. [ABSTRACT FROM AUTHOR]

Chunxia Yan,1 Juan Hao,2 Xiaoqian Sun,1 Yanan Ding,1 Taofeng Tan,2 Xiaoqian Yang,1 Jun Tu,2– 4 Xianjia Ning,2– 4 Jinghua Wang,2– 4 Lingling Bai1 1Department of Neurology, Liaocheng People’s Hospital, Liaocheng, Shandong Province, 252000, People’s Republic of China; 2Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China; 3Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People’s Republic of China; 4Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of ChinaCorrespondence: Lingling Bai, Department of Neurology, Liaocheng People’s Hospital, No. 67, Dongchang West Road, Liaocheng, Shandong Province, 252000, People’s Republic of China, Tel +86 0635 8272374, Fax +86 0635 8212052, Email bailingling911@163.comObjective: This study aimed to investigate the association between these Blood pressure (BP) components examined in this study, including systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP), with the presence of multiple carotid plaques in a low-income rural Chinese population.Methods: This population-based cross-sectional study was conducted from April 2014 to January 2015, involving participants from the Tianjin Brain Study. Participants aged 45 years and older with diagnosed carotid plaques were included. Data on demographics, medical history, and lifestyle factors were collected through interviews and existing records. Blood pressure measurements were taken in a quiet room, following the standard procedures recommended by the American Hypertension Association (AHA), and ultrasonographic examinations were performed to identify and quantify carotid plaques. Multivariate logistic regression model was used to explore the association between blood pressure components and multiple plaques. The blood pressure component with a positive univariate analysis was included in different models, each adjusted for age, sex, body mass index (BMI), and the ratio of high-density lipoprotein cholesterol (HDL-C) to low-density lipoprotein cholesterol (LDL-C).Results: The study found that 41.8% of participants had multiple carotid plaques, with a higher prevalence in men compared to women. Multivariate logistic regression analysis revealed that each 1-mmHg increase in systolic BP (SBP) was associated with a 0.9% increase in the prevalence of multiple carotid plaques (OR = 1.009; 95% CI 1.004– 1.014; P < 0.001). Each 1-mmHg increase in pulse pressure (PP) was associated with a 1.2% increase (OR = 1.012; 95% CI 1.006– 1.018; P < 0.001), and each 1-mmHg increase in mean arterial pressure (MAP) was associated with a 1.1% increase (OR = 1.011; 95% CI 1.003– 1.019; P = 0.005). Participants with a history of hypertension had a significantly higher prevalence of multiple carotid plaques compared to normotensive individuals. Notably, grade 2 hypertension showed a significant association with multiple carotid plaques (OR = 1.554; 95% CI 1.135– 2.127; P = 0.006). In addition, male sex, older age, and low BMI were all associated with a higher risk of multiple carotid plaques (P all< 0.05).Conclusion: This study provides critical evidence on the relationship between BP components and multiple carotid plaques, with significant implications for patients, physicians, and society. By prioritizing BP management, particularly focusing on PP, which demonstrates the strongest association with carotid plaques, as well as targeting higher-risk populations such as males, older individuals, and those with low BMI, preventive measures against carotid atherosclerosis can be enhanced. This will ultimately contribute to better cardiovascular health outcomes and reduce the societal burden of stroke and related diseases.Keywords: carotid plaques, blood pressure components, pulse pressure, hypertension, atherosclerosis

Hailong Hu,1,&ast; Zhican Liu,2,&ast; Jianping Zeng,1 Mingyan Jiang2 1Department of Cardiology, Xiangtan Central Hospital, The Affiliated Hospital of Hunan University, Xiangtan, 411100, People’s Republic of China; 2Department of Pulmonary and Critical Care Medicine, Xiangtan Central Hospital, The Affiliated Hospital of Hunan University, Xiangtan, 411100, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Mingyan Jiang, Director of Department of Pulmonary and Critical Care Medicine, Xiangtan Central Hospital, The Affiliated Hospital of Hunan University, Xiangtan, 411100, People’s Republic of China, Email jiangmingyan1979@163.com Jianping Zeng, Director of Heart Center, Xiangtan Central Hospital, Xiangtan, 411100, People’s Republic of China, Email 571725929@qq.comBackground: Heart rate, diastolic pressure, and pulse pressure are key modifiable factors influencing heart failure prognosis. While heart failure with mildly reduced ejection fraction (HFmrEF) is a distinct subgroup of heart failure, the prognostic impact of these hemodynamic parameters in this population remains unclear, necessitating focused investigation. This study aims to elucidate their effects on HFmrEF patient outcomes.Methods: We retrospectively analyzed 1,653 hFmrEF patients treated at Xiangtan Central Hospital (2015– 2020). Using decision tree classification, patients were categorized based on initial heart rate (≤ 77 bpm and > 77 bpm). The ≤ 77 bpm group was further divided by pulse pressure (≤ 37 mmHg and > 37 mmHg), and the > 77 bpm group by diastolic pressure (≤ 63 mmHg, 63– 100 mmHg, and > 100 mmHg). Multivariate COX regression assessed mortality associations.Results: With a median follow-up of 33 months, overall mortality was 21.7% for heart rates ≤ 77 bpm and 30.4% for > 77 bpm. Multivariate COX regression showed that among patients with heart rates ≤ 77 bpm, those with pulse pressure > 37 mmHg had a higher mortality risk than those with pulse pressure ≤ 37 mmHg (HR 3.184; 95% CI 1.008– 10.058; p=0.048). For patients with heart rates > 77 bpm, those with diastolic pressure 63– 100 mmHg had a lower mortality risk compared to ≤ 63 mmHg (HR=0.652, 95% CI: 0.450– 0.943, p=0.023), with the lowest risk in patients with diastolic pressure > 100 mmHg (HR=0.370, 95% CI: 0.205– 0.666, p=0.001).Conclusion: This study highlights that HFmrEF patients with heart rates ≤ 77 bpm and pulse pressure ≤ 37 mmHg had the lowest mortality risk, while those with heart rates > 77 bpm and diastolic pressure ≤ 63 mmHg faced the highest risk. These findings provide valuable insights for risk stratification and may guide personalized management of HFmrEF patients.Keywords: heart failure with mildly reduced ejection fraction (HFmrEF), initial heart rate, diastolic pressure, pulse pressure, decision tree classification

Adults with Down syndrome are less likely to have hypertension than neurotypical adults. However, whether blood pressure measures are associated with brain health and clinical outcomes in this population has not been studied in detail. Here, we assessed whether pulse pressure is associated with markers of cerebrovascular disease and is linked to a diagnosis of dementia in adults with Down syndrome via structural imaging markers of cerebrovascular disease and atrophy. The study included participants with Down syndrome from the Alzheimers Disease - Down Syndrome study (n = 195, age = 50.6 ± 7.2 years, 44% women, 18% diagnosed with dementia). Higher pulse pressure was associated with greater global, parietal and occipital white matter hyperintensity volume but not with enlarged perivascular spaces, microbleeds or infarcts. Using a structural equation model, we found that pulse pressure was associated with greater white matter hyperintensity volume, which in turn was related to increased neurodegeneration, and subsequent dementia diagnosis. Pulse pressure is an important determinant of brain health and clinical outcomes in individuals with Down syndrome despite the low likelihood of frank hypertension.

This study assessed whether the effect of vascular risk on cerebral blood flow (CBF) varies by gene dose of apolipoprotein (APOE) ε4 alleles. 144 older adults without dementia from the Alzheimers Disease Neuroimaging Initiative underwent arterial spin labeling and T1-weighted MRI, APOE genotyping, fluorodeoxyglucose positron emission tomography (FDG-PET), lumbar puncture, and blood pressure (BP) assessment. Vascular risk was assessed using pulse pressure (systolic BP - diastolic BP). CBF was examined in six AD-vulnerable regions: entorhinal cortex, hippocampus, inferior temporal cortex, inferior parietal cortex, rostral middle frontal gyrus, and medial orbitofrontal cortex. Linear regressions tested the interaction between APOE ε4 dose and pulse pressure on CBF in each region, adjusting for age, sex, cognitive classification, antihypertensive medication use, FDG-PET, reference CBF region, and AD biomarker positivity. There was a significant interaction between pulse pressure and APOE ɛ4 dose on CBF in the entorhinal cortex, hippocampus, and inferior parietal cortex, such that higher pulse pressure was associated with lower CBF only among ε4 homozygous participants. These findings demonstrate that the association between pulse pressure and regional CBF differs by APOE ε4 dose, suggesting that targeting modifiable vascular risk factors may be particularly important for those genetically at risk for AD.

Abstract Background Hypertension is a common, long-term condition that tends to be associated with age and can lead to significant cardiovascular complications. This study aimed to identify factors influencing the longitudinal Pulse Pressure of hypertensive patients treated at Assosa General Hospital (AGH), Western Ethiopia. Methods A retrospective study design was conducted from 325 randomly selected HTN patients in the outpatient department (OPD) clinic at AGH during the follow-up period from January 2022 to January 2024. The analysis included exploratory data analysis and the application of a linear mixed model. This model was used to analyze the longitudinally measured pulse pressure in patients with hypertension. The appropriate variance-covariance structure chosen for this analysis was the unstructured (UN) format. Result Among the 325 patients included in the study, 51.5% were female, and 54.2% were from urban areas. The variables: Age (p-value

Abstract Aims This study evaluated how well serial pulse pressure (PP) and PP adjusted by the vasoactive inotropic score (VIS) predicted venoarterial extracorporeal membrane oxygenation (VA‐ECMO) weaning success and clinical outcomes in acute myocardial infarction complicated by cardiogenic shock (AMI‐CS) patients. Methods and results A total of 213 patients with AMI‐CS who received VA‐ECMO between January 2010 and August 2021 were enrolled in the institutional ECMO registry. Serial PP and VIS were measured immediately, 12, 24, and 48 h after VA‐ECMO insertion. PP adjusted by VIS was defined as PP/√VIS. The primary outcome was successful VA‐ECMO weaning. Successful weaning from VA‐ECMO was observed in 151 patients (70.9%). Immediately after VA‐ECMO insertion, PP [successful vs. failed weaning, 26.0 (15.5–46.0) vs. 21.0 (12.5–33.0), P = 0.386] and PP/√VIS [11.1 (5.1–25.0) vs. 6.0 (3.1–14.2), P = 0.118] did not differ between the successful and failed weaning groups. Serial PP and PP adjusted by VIS at 12, 24, and 48 h after VA‐ECMO insertion were significantly higher in patients with successful weaning than those with failed weaning [successful vs. failed weaning, 24.0 (4.0–38.0) vs. 12.5 (6.0–25.5), P = 0.007 for 12 h PP, and 10.1 (5.7–22.0) vs. 2.9 (1.7–5.9), P 7). Conclusions PP adjusted by VIS taken 12 h following VA‐ECMO initiation can predict weaning from VA‐ECMO more successfully than PP alone, and its low value was associated with a higher risk of mortality in AMI‐CS patients.

Introduction: The processes of atherosclerosis, inflammation, and carbamylation are closely linked in cardiovascular (CV) disease, but the potential of carbamylation burden as a CV mortality predictor is unclear, especially in patients with no or mild chronic kidney disease (CKD). This study aimed to investigate whether elevated carbamylated albumin (C-Alb), as a surrogate marker for carbamylation burden, is associated with mortality and arterial stiffness/atherosclerotic burden in patients with no or mild CKD, using pulse pressure (PP) as a marker for arterial stiffness. Methods: We measured C-Alb in 3,193 participants of the Ludwigshafen Risk and Cardiovascular Health study who had been referred for coronary angiography and followed up for 10 years. Results: The mean age was 62.7 years, and 30.4% were female. Mean blood pressure was 141/81 mm Hg, and mean C-Alb was 5.54 mmol/mol. Increase in C-Alb levels was associated with older age; female sex; increased PP, high-sensitivity C-reactive protein, and interleukin-6 levels; and increased incidence of coronary artery disease (CAD), peripheral artery disease (PAD), and carotid stenosis. In contrast, BMI, diastolic blood pressure (DBP), albumin, and the proportion of active smokers decreased with increasing C-Alb levels. In particular, C-Alb showed a highly significant correlation with CAD severity: Friesinger (Pearson correlation coefficient [r] = 0.082, p < 0.001) and Gensini score (r = 0.066, p < 0.001). The area under the curve (AUC) for all-cause mortality prediction by the European Society of Cardiology Heart Score (ESC-HS) significantly improved from 0.719 to 0.735, and the AUC for CV mortality prediction based on C-Alb increased from 0.726 to 0.750 in patients without previously known CV disease. C-Alb correlated directly and significantly with PP (r = 0.062, p < 0.001), which was consistently the strongest predictor of mortality across all C-Alb tertiles. The hazard ratios (HRs) for all-cause mortality per 10 mm Hg increase (or 1,000 mm Hg/min increase for double product [DP]) in the 1st tertile of C-Alb were 1.18, 1.13, 1.11, and 1.11 for PP, mean arterial pressure (MAP), systolic blood pressure (SBP), and DP, respectively, but the HR for DBP did not reach significance. In the 3rd tertile of C-Alb, the HRs were 1.13, 1.05, and 1.09, for PP, SBP, and DP, respectively, but the HR for MAP did not reach significance. Conclusion: C-Alb may be a valuable biomarker for assessing CV risk and improving mortality prediction even in patients with no or mild CKD. The findings support the notion of a crosslink between carbamylation, inflammation, atherosclerosis, and mortality. While these results are promising, further research is needed to fully elucidate the role of C-Alb in CV disease progression and risk stratification. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a common, long-term condition that tends to be associated with age and can lead to significant cardiovascular complications. This study aimed to identify factors influencing the longitudinal Pulse Pressure of hypertensive patients treated at Assosa General Hospital (AGH), Western Ethiopia. Methods: A retrospective study design was conducted from 325 randomly selected HTN patients in the outpatient department (OPD) clinic at AGH during the follow-up period from January 2022 to January 2024. The analysis included exploratory data analysis and the application of a linear mixed model. This model was used to analyze the longitudinally measured pulse pressure in patients with hypertension. The appropriate variance-covariance structure chosen for this analysis was the unstructured (UN) format. Result: Among the 325 patients included in the study, 51.5% were female, and 54.2% were from urban areas. The variables: Age (p-value < 0.0001), Urban (p-value = 0.012), FHHTN (p-value < 0.0238), Stage-I HTN (p-value = 0.0403), Stage-II HTN (p-value = 0.0022), DM (p-value < 0.0001), CKD (p-value < 0.0001), Smoking (p-value < 0.0001), Enalapril + Nifedipine (p-value = 0.0249), and follow-up time (p-value < 0.0001) were significant factors for the progression of pulse pressure. Conclusion: The profile plot showed that the patient's pulse pressure decreases slowly as follow-up time increases. Age, Residence, FHHTN, DM, CKD, Smoking status, and Stages of HTN were positively associated with pulse pressure, whereas Treatment type and follow-up time were negatively associated with pulse pressure. So, Healthcare providers should prioritize addressing the modifiable risk factors mentioned above to help mitigate the progression of blood pressure specifically pulse pressure in hypertensive patients. [ABSTRACT FROM AUTHOR]

Insulin resistance (IR) is a major risk factor for cardiovascular disease. Recently, a novel index (triglyceride-glucose index-TyG) has been proposed as a surrogate marker of IR and a better expression of IR than the Homeostatic Model Assessment of IR (HOMA-IR) index. Few and heterogeneous data are so far available on the relationship between vascular damage and this novel index. Therefore, we aimed to estimate the predictive role of TyG, in comparison with the HOMA-IR, on the development of arterial stiffening (AS), defined as a pulse pressure>60 mmHg, in an 8-year follow-up observation of a sample of non-diabetic adult men (the Olivetti Heart Study). The analysis included 527 non-diabetic men, with normal arterial elasticity at baseline and not on antihypertensive or hypolipidemic treatment. TyG was significantly greater in those who developed AS than those who did not (p = 0.006). On the contrary, the HOMA-IR index was not different between the two groups (p = 0.24). Similar trends were shown by logistic regression analysis adjusting for main confounders. After the stratification by the optimal cut-off point, values of TyG >4.70 were significantly associated with the development of AS, also after adjustment for main confounders. On the contrary, the HOMA-IR index >1.90 was not associated with the risk of AS development in multivariate models. The results of this study indicate a predictive role of TyG on AS, independently of the main potential confounders. Moreover, the predictive power of TyG seems to be greater than that of the HOMA-IR index. • Insulin resistance is a major risk factor for cardiovascular disease. • Triglyceride-glucose index was proposed as a surrogate marker of insulin resistance. • We found a predictive role of the triglyceride-glucose index on arterial stiffening. • This predictive role seems to be greater than that of HOMA-IR. [ABSTRACT FROM AUTHOR]

According to the 2018 Basic Health Research Data (RISKESDAS), the prevalence of hypertension in West Java was 39.6%, while in Cimahi City it was 41.83%. The composition of the Mediterranean diet contains a high proportion of MUFA and PUFA which act as anti-inflammatory, antioxidant, and cardioprotective with a potential to lower blood pressure. The aim of this study is to determine the impact of Mediterranean diet components on blood pressure in patients with hypertension. The study uses observational analytic methods as the design and also employs a prospective cohort sample of 36 patients with hypertension for three months, using a systematic random sampling technique. The research subjects were checked for blood pressure in the first month (T1) and the last month of the study (T2). The relative Mediterranean Diet (rMED) was used as a source of data on component intakes by administering the Food Frequency Questionnaire (FFQ) 12 times within three months. The differences in Mediterranean diet composition and blood pressure in all Mediterranean diet adherence groups were examined using the ANOVA test and Tuckey's post-hoc test, as well as to test comparisons of proportions between rMED adherence groups. The impact of each component of the Mediterranean Diet on blood pressure was evaluated using a linear regression analysis test. The results showed that the average age of hypertensive patients who underwent the Mediterranean diet was 57.94 years and 69.44% were female. The components of fruit and nuts, vegetables, and fish have a significant effect on systolic blood pressure. Fish components have a significant effect on diastolic blood pressure. The components of vegetables and fish have a significant effect on the mean arterial pressure (MAP). Fruit and nut components have a significant effect on pulse pressure. The limitations of this study are the short research time, the absence of salt consumption restrictions on the Mediterranean diet, and the presence of smoking and physical activity as confounding activities. [ABSTRACT FROM AUTHOR]

• Patients experiencing loss of pulse pressure (LOPP) during high-risk percutaneous coronary intervention (HR-PCI) are transiently dependent on mechanical circulatory support (MCS) devices. • LOPP during HR-PCI with Impella was common and occurred more frequently in patients with cardiomyopathy and low systolic blood pressure. LOPP was strongly associated with higher 90-day major adverse cardiac and cerebrovascular events, acute kidney injury, and mortality. • The ongoing randomized PROTECT-IV trial will determine whether Impella CP support during HR-PCI improves early and late clinical outcomes compared with the standard of care. The trial includes a right heart catheterization substudy that should help to define the role of invasive hemodynamics in stratifying and managing patients undergoing HR-PCI. Patients experiencing loss of pulse pressure (LOPP) during high-risk percutaneous coronary intervention (HR-PCI) are transiently dependent on mechanical circulatory support devices. We sought to define the frequency and clinic outcomes of patients who experience LOPP during HR-PCI. Patients enrolled in the PROTECT III study and had automated Impella controller logs capturing real-time hemodynamics were included in this analysis. A LOPP event was defined as a mean pulse pressure on Impella of <20 mm Hg for ≥5 seconds during PCI. Clinical characteristics and outcomes were then compared between those with and without LOPP. Logistic regression identified clinical and hemodynamic predictors of LOPP. We included 302 patients, of whom 148 patients (49%) experienced LOPP. Age, sex, and comorbidities were similar in patients with and without LOPP. Mean baseline systolic blood pressure (118.6 mm Hg vs 129.8 mm Hg; P <.001) and mean arterial pressure (86.9 mm Hg vs 91.6 mm Hg; P =.011) were lower in patients with LOPP, whereas heart rate (78 bpm vs 73 bpm; P =.012) was higher. Anatomical complexity was similar between groups. Patients with LOPP were more likely to experience major adverse cardiac and cerebrovascular events (23.5% vs 8.8%; P =.002), acute kidney injury (10.1% vs 2.6%; P =.030), and death (20.2% vs 7.9%; P =.008) within 90 days. A low baseline systolic blood pressure and cardiomyopathy were the strongest predictors of LOPP (P =.003 and P =.001, respectively). LOPP on Impella during HR-PCI was common and occurred more frequently in patients with cardiomyopathy and a low systolic blood pressure. LOPP was strongly associated with higher 90-day major adverse cardiac and cerebrovascular events, acute kidney injury, and mortality. Condensed Abstract We sought to define the frequency and clinic outcomes of patients who experience LOPP during high-risk percutaneous coronary intervention (HR-PCI). We included 302 patients, of whom 148 (49%) experienced LOPP. Patients with LOPP were more likely to experience major adverse cardiac and cerebrovascular events (23.5% vs 8.8%; P =.002), acute kidney injury (10.1% vs 2.6%; P =.030), and death (20.2% vs 7.9%; P =.008) within 90 days. A low baseline systolic blood pressure and cardiomyopathy were the strongest predictors of LOPP (P =.003 and P =.001, respectively). [ABSTRACT FROM AUTHOR]

Aims: This study evaluated how well serial pulse pressure (PP) and PP adjusted by the vasoactive inotropic score (VIS) predicted venoarterial extracorporeal membrane oxygenation (VA‐ECMO) weaning success and clinical outcomes in acute myocardial infarction complicated by cardiogenic shock (AMI‐CS) patients. Methods and results: A total of 213 patients with AMI‐CS who received VA‐ECMO between January 2010 and August 2021 were enrolled in the institutional ECMO registry. Serial PP and VIS were measured immediately, 12, 24, and 48 h after VA‐ECMO insertion. PP adjusted by VIS was defined as PP/√VIS. The primary outcome was successful VA‐ECMO weaning. Successful weaning from VA‐ECMO was observed in 151 patients (70.9%). Immediately after VA‐ECMO insertion, PP [successful vs. failed weaning, 26.0 (15.5–46.0) vs. 21.0 (12.5–33.0), P = 0.386] and PP/√VIS [11.1 (5.1–25.0) vs. 6.0 (3.1–14.2), P = 0.118] did not differ between the successful and failed weaning groups. Serial PP and PP adjusted by VIS at 12, 24, and 48 h after VA‐ECMO insertion were significantly higher in patients with successful weaning than those with failed weaning [successful vs. failed weaning, 24.0 (4.0–38.0) vs. 12.5 (6.0–25.5), P = 0.007 for 12 h PP, and 10.1 (5.7–22.0) vs. 2.9 (1.7–5.9), P < 0.001 for 12 h PP/√VIS]. The 12 h PP/√VIS showed better discriminative function for successful weaning than 12 h PP alone [area under the curve (AUC) 0.80, 95% confidence interval (CI) 0.72–0.88, P < 0.001 vs. AUC 0.67, 95% CI 0.57–0.77, P = 0.002]. Patients with a low 12 h PP/√VIS (≤7) had higher rates of in‐hospital mortality (44.4% vs. 19.8%, P < 0.001) and 6 month follow‐up mortality (hazard ratio 2.41, 95% CI 1.49–3.90, P < 0.001) than those with a high 12 h PP/√VIS (>7). Conclusions: PP adjusted by VIS taken 12 h following VA‐ECMO initiation can predict weaning from VA‐ECMO more successfully than PP alone, and its low value was associated with a higher risk of mortality in AMI‐CS patients. [ABSTRACT FROM AUTHOR]

ABSTRACT Vascular compliance is an important predictor of cardiovascular disease and mortality. Pulse pressure index (PPI) is a reliable indicator for evaluating vascular compliance. However, the association between PPI, all‐cause mortality (ACM), and cardiovascular mortality (CVM) in patients with hypertension is still unclear. In this study, we aimed to investigate the association of PPI with ACM and CVM in patients with hypertension. Kaplan–Meier survival curves, Cox proportional hazards regression models, restricted cubic splines, and subgroup and interaction analyses were used to investigate the association of PPI with ACM and CVM. U‐shaped associations were observed between PPI and both ACM and CVM, and the inflection points for ACM and CVM were at PPI values of 0.327 and 0.363, respectively. Time‐dependent receiver operating characteristic curves indicated that PPI showed good predictive value for both ACM and CVM occurrence at 1, 3, 5, and 10 years, and its predictive value was higher than PP for ACM and CVM at 5 and 10 years. These results showed that PPI can be used to identify patients with hypertension who are at a high risk of mortality and can guide more aggressive anti‐hypertensive treatment strategies. Moreover, these findings demonstrate that PPI is a superior vascular compliance indicator than PP.

The article explores the relationship between pulse pressure (PP) and adverse outcomes, particularly in relation to age and comorbidities. It discusses how widened PP can impact cardiovascular and kidney health, with elevated PP being associated with negative outcomes. The study by Fischman et al. focuses on participants with chronic kidney disease and highlights the importance of considering age and health status when assessing the risks associated with high PP. The findings suggest that the presence of comorbidities and older age may influence the impact of PP on adverse outcomes, emphasizing the need for further research in this area. [Extracted from the article]

Abstract Background Hypertension is the leading risk factor for subclinical target-organ damage (TOD) and cardiovascular disease (CVD). Little is known about the relationship between different pressure measures and subclinical TOD, especially in young populations. We compared the strength of associations of subclinical TOD markers with perfusion and pulsatile pressure in young adults. Methods A total of 1 187 young adults from the African-PREDICT study were included. Ambulatory mean arterial pressure (MAP) and pulse pressure (PP) was obtained. Markers of subclinical TOD were measured and included left ventricular mass index (LVMi), carotid intimamedia thickness (cIMT), carotidfemoral pulse wave velocity (cfPWV), central retinal arteriolar equivalent (CRAE) and albumin to creatinine ratio (ACR). Results Measures of sub-clinical TOD (cIMT, cfPWV and CRAE), associated stronger with perfusion pressure (all p

Abstract Elevated levels of the gut pro-hormone Proneurotensin (proNT) have been found to predict development of cardiovascular disease. However, it is still unknown whether higher proNT levels are associated with subclinical vascular damage. Herein, we investigated the relationship between higher proNT concentrations and augmented pulse pressure (PP) and carotid intima-media thickness (cIMT), indicators of increased arterial stiffness and subclinical atherosclerosis, respectively. Clinical characteristics, PP and cIMT were evaluated in 154 non-diabetic individuals stratified into tertiles according to fasting serum proNT concentrations. We found that, subjects with higher proNT levels exhibited a worse lipid profile and insulin sensitivity, increased C-reactive protein levels, along with higher values of PP and cIMT as compared to the lowest proNT tertile. Prevalence of elevated PP (≥ 60 mmHg) and subclinical carotid atherosclerosis (IMT > 0.9 mm) was increased in the highest tertile of proNT. In a logistic regression analysis adjusted for several confounders, subjects with higher proNT levels displayed a fivefold raised risk of having elevated PP values (OR 5.36; 95%CI 1.04–27.28; P = 0.05) and early carotid atherosclerosis (OR 4.81; 95%CI 1.39–16.57; P = 0.01) as compared to the lowest proNT tertile. In conclusion, higher circulating levels of proNT are a biomarker of subclinical vascular damage independent of other atherosclerotic risk factors.

Abstract Background Dynamic arterial elastance (Eadyn) has been investigated for its ability to predict hypotension during the weaning of vasopressors. Our study focused on assessing Eadyn’s performance in the context of critically ill adult patients admitted to the intensive care unit, regardless of diagnosis. Main body Our study was conducted in accordance with the Preferred Reported Items for Systematic Reviews and Meta-Analysis checklist. The protocol was registered in PROSPERO (CRD42023421462) on May 26, 2023. We included prospective observational studies from the MEDLINE and Embase databases through May 2023. Five studies involving 183 patients were included in the quantitative analysis. We extracted data related to patient clinical characteristics, and information about Eadyn measurement methods, results, and norepinephrine dose. Most patients (76%) were diagnosed with septic shock, while the remaining patients required norepinephrine for other reasons. The average pressure responsiveness rate was 36.20%. The synthesized results yielded an area under the curve of 0.85, with a sensitivity of 0.87 (95% CI 0.74–0.93), specificity of 0.76 (95% CI 0.68–0.83), and diagnostic odds ratio of 19.07 (95% CI 8.47–42.92). Subgroup analyses indicated no variations in the Eadyn based on norepinephrine dosage, the Eadyn measurement device, or the Eadyn diagnostic cutoff to predict cessation of vasopressor support. Conclusions Eadyn, evaluated through subgroup analyses, demonstrated good predictive ability for the discontinuation of vasopressor support in critically ill patients.

Introduction: Transcatheter aortic valve implantation (TAVI) has emerged as a common and effective treatment for patients with severe aortic stenosis. Changes in systemic blood pressure after TAVI have been described, yet their prognostic value is not established. Thus, we aimed to examine the association of the periprocedural changes in systolic blood pressure (SBP) and in pulse pressure on clinical outcomes after the procedure. Methods: A retrospective study of consecutive patients who underwent TAVI procedure in our medical center. We assessed the effect of the periprocedural changes in blood pressure measurements on mortality, acute myocardial infarction, stroke and hospitalizations at 1 year and on the combined outcome of death, myocardial infarction, and stroke 1 year following the procedure. Results: Our cohort included 455 patients (44% males). Of them, 343 patients (75.4%) had raised SBP immediately after the procedure. Patients with raised SBP had a significantly higher rate of the 1-year composite outcome, compared to patients who did not have a raise in SBP following the procedure (43 [13%] vs. 6 [5.4%], respectively, p = 0.033). After adjustment for age and sex, the postprocedural increase in SBP was significantly associated with the composite outcome, with a hazard ratio of 2.42, 95% CI: 1.03–5.7. Conclusion: An immediate increase in SBP after TAVI is associated with worse 1-year clinical cardiovascular outcomes.

IntroductionEffects of chronic arterial stiffness on brain aging remain unclear. We, therefore, examined whether long-term trajectories of pulse pressure (PP) predicted brain microstructure, microstructure mediated PP-executive function associations, and APOE genotype modified PP-microstructure associations.MethodsWe examined associations of PP trajectories with brain microstructure measured using restriction spectrum imaging in 146 community-dwelling older adults, whether microstructure mediated PP trajectory-executive function associations, and whether PP-restriction spectrum imaging correlations were modified by APOE-ε4 status.ResultsParticipants with trajectories of high PP had lower restricted isotropic diffusion (RI) compared to those with low PP trajectories and PP-executive function associations were mediated by subcortical and white matter RI. High PP more strongly correlated with lower RI and higher hindered diffusion among APOE-ε4 carriers than non-carriers.DiscussionProlonged elevated PP predicts microstructural abnormalities which may contribute to impaired executive function. APOE-ε4 carriers may be most vulnerable to the adverse effects of PP on brain microstructure.

Objective: To explore the relationship between rs1410996 polymorphism of CFH gene and essential hypertension (EH) in the Yunnan Han population. Methods: rs1410996 of CFH gene was genotyped based on the collected clinical phenotypes of the EH patients (n = 520) and healthy people (n = 494). Results: On the genotype model and dominance model, there was no relationship between rs1410996 of CFH gene and EH after adjustment (P > 0.05). On the dominance model of male EH patients, the pulse pressure (PP) level of CC genotype carriers was higher than that of (CT + TT) genotype carriers after adjustment (P < 0.05). Conclusion: rs1410996 of CFH gene has no correlation with the genetic susceptibility to EH in the Yunnan Han population, but it is related to the PP level in male patients. [ABSTRACT FROM AUTHOR]

Background: Modern management of preeclampsia can be optimized by tailoring the targeted treatment of hypertension to an individual's hemodynamic profile. Growing evidence suggests different phenotypes of preeclampsia, including those with a hyperdynamic profile and those complicated by uteroplacental insufficiency. Fetal growth restriction (FGR) is believed to be a result of uteroplacental insufficiency. There is a paucity of research examining the characteristics of patients with severe preeclampsia who do and who do not develop FGR. We aimed to elucidate which hemodynamic parameters differed between these two groups. Methods: All patients admitted to a single referral center with severe preeclampsia were identified. Patients were included if they had a live birth at 23 weeks of gestation or higher. Multiple gestations and pregnancies complicated by fetal congenital anomalies and/or HELLP syndrome were excluded. FGR was defined as a sonographic estimation of fetal weight (EFW) < 10th percentile or abdominal circumference (AC) < 10th percentile. Results: There were 76% significantly lower odds of overall pulse pressure upon admission for those with severe preeclampsia comorbid with FGR (aOR = 0.24, 95% CI = 0.07–0.83). Advanced gestational age on admission was associated with lower odds of severely abnormal labs and severely elevated diastolic blood pressure in preeclampsia also complicated by FGR. Conclusions: Subtypes of preeclampsia with and without FGR may be hemodynamically evaluated by assessing pulse pressure on admission. [ABSTRACT FROM AUTHOR]

Background: Hypertension is the leading risk factor for subclinical target-organ damage (TOD) and cardiovascular disease (CVD). Little is known about the relationship between different pressure measures and subclinical TOD, especially in young populations. We compared the strength of associations of subclinical TOD markers with perfusion and pulsatile pressure in young adults. Methods: A total of 1 187 young adults from the African-PREDICT study were included. Ambulatory mean arterial pressure (MAP) and pulse pressure (PP) was obtained. Markers of subclinical TOD were measured and included left ventricular mass index (LVMi), carotid intimamedia thickness (cIMT), carotidfemoral pulse wave velocity (cfPWV), central retinal arteriolar equivalent (CRAE) and albumin to creatinine ratio (ACR). Results: Measures of sub-clinical TOD (cIMT, cfPWV and CRAE), associated stronger with perfusion pressure (all p < 0.001) than pulsatile pressure in unadjusted models. Stronger associations were found between cfPWV (adjusted R2 = 0.26), CRAE (adjusted R2 = 0.12) and perfusion pressure (all p ≤ 0.001) than pulsatile pressure independent of several non-modifiable and modifiable risk factors. Conclusions: In young, healthy adults, perfusion pressure is more strongly associated with subclinical TOD markers than pulsatile pressure. These findings contribute to the understanding of the development of early cardiovascular changes and may guide future intervention strategies. [ABSTRACT FROM AUTHOR]

BACKGROUND A novel method for estimating central systolic aortic pressure (cSAP) has emerged, relying solely on the peripheral mean (MBP) and diastolic (DBP) blood pressures. We aimed to assess the accuracy of this Direct Central Blood Pressure estimation using cuff alone (DCBPcuff = MBP2/DBP) in comparison to the use of a generalized transfer function to derive cSAP from radial tonometry (cSAPtono). METHODS This retrospective analysis involved the International Database of Central Arterial Properties for Risk Stratification (IDCARS) data (Aparicio et al. Am J Hypertens 2022). The dataset encompassed 10,930 subjects from 13 longitudinal cohort studies worldwide (54.8% women; median age 46.0 years; office hypertension: 40.1%; treated: 61.0%), documenting cSAPtono via SphygmoCor calibrated against brachial systolic BP (SBP) and DBP. Our analysis focused on aggregate group data from 12/13 studies (89% patients) where a full BP dataset was available. A 35% form factor was used to estimate MBP = (DBP + (0.35 × (SBP-DBP)), from which DCBPcuff was derived. The predefined acceptable error for cSAPtono estimation was set at ≤ 5 mm Hg. RESULTS The cSAPtono values ranged from 103.8–127.0 mm Hg (n  = 12). The error between DCBPcuff and cSAPtono was 0.2 ± 1.4 mm Hg, with no influence of the mean. Errors ranged from −1.8 to 2.9 mm Hg across studies. No significant difference in errors was observed between BP measurements obtained via oscillometry (n  = 9) vs. auscultation (n  = 3) (P  = 0.50). CONCLUSIONS Using published aggregate group data and a 35% form factor, DCBPcuff demonstrated remarkable accuracy in estimating cSAPtono, regardless of the BP measurement technique. However, given that individual BP values were unavailable, further documentation is required to establish DCBPcuff's precision. [ABSTRACT FROM AUTHOR]

Background: Dynamic arterial elastance (Eadyn) has been investigated for its ability to predict hypotension during the weaning of vasopressors. Our study focused on assessing Eadyn's performance in the context of critically ill adult patients admitted to the intensive care unit, regardless of diagnosis. Main body: Our study was conducted in accordance with the Preferred Reported Items for Systematic Reviews and Meta-Analysis checklist. The protocol was registered in PROSPERO (CRD42023421462) on May 26, 2023. We included prospective observational studies from the MEDLINE and Embase databases through May 2023. Five studies involving 183 patients were included in the quantitative analysis. We extracted data related to patient clinical characteristics, and information about Eadyn measurement methods, results, and norepinephrine dose. Most patients (76%) were diagnosed with septic shock, while the remaining patients required norepinephrine for other reasons. The average pressure responsiveness rate was 36.20%. The synthesized results yielded an area under the curve of 0.85, with a sensitivity of 0.87 (95% CI 0.74–0.93), specificity of 0.76 (95% CI 0.68–0.83), and diagnostic odds ratio of 19.07 (95% CI 8.47–42.92). Subgroup analyses indicated no variations in the Eadyn based on norepinephrine dosage, the Eadyn measurement device, or the Eadyn diagnostic cutoff to predict cessation of vasopressor support. Conclusions: Eadyn, evaluated through subgroup analyses, demonstrated good predictive ability for the discontinuation of vasopressor support in critically ill patients. [ABSTRACT FROM AUTHOR]

Background and aims. The non-dipper status represented by blood pressure reduction by less than 10 percent during sleep is present in about 50 percent of patients with type 2 diabetes (T2D) and hypertension, a pattern associated with more frequent cardiovascular complications and reserved prognosis. This study analyzed the predictive risk factors associated with the different dipper profiles, especially with the nocturnal pattern, following the mean arterial pressure (MAP), the mean heart rate (MHR), and the mean pulse pressure (MPP) in patients with T2D and hypertension, established by ambulatory blood pressure monitoring (ABPM). Method. 166 consecutive patients with type 2 diabetes mellitus and hypertension were included in a cross-sectional study, and they underwent 24-hour ABPM. We excluded patients with secondary hypertension, acute coronary disease and heart failure, with oncologic or endocrine disease. The simple and multiple linear regression models were performed predicting 24-hour, day and night MAP, MHR, and MPP according to various predictors, using software R version 4.3.1. Results. There were 80 non-dippers (48.20%), 57 dippers (34.34%), 22 reversedippers (13.25%) and seven extreme-dippers (4.21%). A statistically significant association was observed between MAP 24-hour and total cholesterol (TC) (higher TC values were associated with higher MAP /24 h values): adjusted coefficient B of the regression slope: 0.09, 95% confidence interval CI (0.04- 0.15), p=0.003. In the multivariate analysis: adjusted B: 8.64, 95% CI (-14.67- -2.61), p=0.006, beta-blockers reached the threshold of statistical significance in relation to MHR/24 h, their presence decreasing the heart rate. PP/24 hours was associated in the multivariate analysis with age: adjusted B: 0.45, 95% CI (0.05- 0.85), p=0.28; abdominal circumference: 0.26, 95% CI (0.03-0.49), p=0.028, and total cholesterol: 0.1, 95% CI (0.02-0.17), p=0.013. Diabetic nephropathy was statistically significantly associated with PP/24 h: adjusted B: 10.19, 95% CI (1.24- 19.14), p=0.027. Conclusions. High cholesterol was associated with higher values of MAP and PP. Beta-blocker treatment lowered non-dipper MHR. Age and AC were correlated with increased PP values. These are predictive risk factors associated with the status of non-dippers established by ABPM, and they represent a veritable link to the non-dipper pattern in patients with T2D and hypertension. [ABSTRACT FROM AUTHOR]

Background: Reliable assessment of fluid responsiveness with pulse pressure variation (PPV) depends on certain ventilation-related preconditions; however, some of these requirements are in contrast with recommendations for protective ventilation. Objective: The aim of this study was to evaluate the applicability of PPV in patients undergoing non-cardiac surgery by retrospectively analyzing intraoperative ventilation data. Material and methods: Intraoperative ventilation data from three large medical centers in Germany and Switzerland from January to December 2018 were extracted from electronic patient records and pseudonymized; 10,334 complete data sets were analyzed with respect to the ventilation parameters set as well as demographic and medical data. Results: In 6.3% of the 3398 included anesthesia records, patients were ventilated with mean tidal volumes (mTV) > 8 ml/kg predicted body weight (PBW). These would qualify for PPV-based hemodynamic assessment, but the majority were ventilated with lower mTVs. In patients who underwent abdominal surgery (75.5% of analyzed cases), mTVs > 8 ml/kg PBW were used in 5.5% of cases, which did not differ between laparoscopic (44.9%) and open (55.1%) approaches. Other obstacles to the use of PPV, such as elevated positive end-expiratory pressure (PEEP) or increased respiratory rate, were also identified. Of all the cases 6.0% were ventilated with a mTV of > 8 ml/kg PBW and a PEEP of 5–10 cmH2O and 0.3% were ventilated with a mTV > 8 ml/kg PBW and a PEEP of > 10 cmH2O. Conclusion: The data suggest that only few patients meet the currently defined TV (of > 8 ml/kg PBW) for assessment of fluid responsiveness using PPV during surgery. [ABSTRACT FROM AUTHOR]

One of the diagnostic tool for clinical evaluation and disease diagnosis is a pulse waveform analysis. High fidelity radial artery pulse waveforms have been investigated in clinical research to compute central aortic pressure, which has been demonstrated to be predictive of cardiovascular diseases. The radial artery must be inspected from several angles in order to obtain the best pulse waveform for estimate and diagnosis. In this study, we present the design and experimental testing of an optical sensor based on Fiber Bragg Gratings (FBG). A 3D printed device along with the FBG is used to measure the radial artery pulses. The proposed sensor is used for the purpose of quantifying the radial artery pulse waveform across major pulse position point. The suggested optical sensing system can measure the pulse signal with good accuracy. The main characteristic parameters of the pulse can then be retrieved from the processed signal for their use in clinical applications. By conducting experiments under the direction of medical experts, the pulse signals are measured. In order to experimentally validate the sensor, we used it to detect the pulse waveforms at Guan position of the wrist's radial artery in accordance with the diagnostic standards. The findings show that combining optical technologies for physiological monitoring and radial artery pulse waveform monitoring using FBG in clinical applications are highly feasible. [ABSTRACT FROM AUTHOR]

Elevated levels of the gut pro-hormone Proneurotensin (proNT) have been found to predict development of cardiovascular disease. However, it is still unknown whether higher proNT levels are associated with subclinical vascular damage. Herein, we investigated the relationship between higher proNT concentrations and augmented pulse pressure (PP) and carotid intima-media thickness (cIMT), indicators of increased arterial stiffness and subclinical atherosclerosis, respectively. Clinical characteristics, PP and cIMT were evaluated in 154 non-diabetic individuals stratified into tertiles according to fasting serum proNT concentrations. We found that, subjects with higher proNT levels exhibited a worse lipid profile and insulin sensitivity, increased C-reactive protein levels, along with higher values of PP and cIMT as compared to the lowest proNT tertile. Prevalence of elevated PP (≥ 60 mmHg) and subclinical carotid atherosclerosis (IMT > 0.9 mm) was increased in the highest tertile of proNT. In a logistic regression analysis adjusted for several confounders, subjects with higher proNT levels displayed a fivefold raised risk of having elevated PP values (OR 5.36; 95%CI 1.04–27.28; P = 0.05) and early carotid atherosclerosis (OR 4.81; 95%CI 1.39–16.57; P = 0.01) as compared to the lowest proNT tertile. In conclusion, higher circulating levels of proNT are a biomarker of subclinical vascular damage independent of other atherosclerotic risk factors. [ABSTRACT FROM AUTHOR]

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Since the heart and blood network are the most delicate and dangerous organs in a living organism, the cardiovascular system is the most complex system overall. The number of patients has been steadily rising due to the disorders it causes, and in recent years, the instability of this system has been responsible for the greatest proportion of deaths globally. Therefore, a prior understanding of the cardiovascular system's function and the search for its abnormalities are required to develop methods that can detect the disease at an early stage and identify the most effective treatments. Sensitivity analysis-based mathematical modelling is a helpful tool for assessing and forecasting this system, enabling the development of mitigation techniques for these disruptions. This paper aims to define the concept of sensitivity analysis (SA) and use this theory to analyses five parameters of the dynamic cycle of both pulse pressure (PP) and mean arterial pressure (Pm). These parameters are: 1) stroke volume (ΔV), 2) peripheral resistance (R), 3) heart rate (T), 4) ejection period (The), and 5) arterial compliance (C), to determine the most important factor that affects both mean arterial pressure and pulse pressure to control heart and stroke diseases. By creating a condensed laboratory model that represented a patient without hypertension and simulating the cardiovascular system using the necessary mathematical formulas, this was possible. The test results showed that stroke volume and arterial compliance were the main factors that most affected pulse pressure. Mean arterial pressure, stroke volume, and total circumferential resistance of the artery wall were the two most principal factors. The reasons were explained in more detail in the practical aspect of this paper. Illustrative graphs will also support these findings. In the end, this topic will be discussed in a medical manner by presenting ways to control both pulse pressure, mean arterial pressure, and reduce the occurrence of heart attacks and strokes. [ABSTRACT FROM AUTHOR]

BackgroundThe prognostic significance of utilizing both the systemic inflammatory response index (SIRI) and pulse pressure (PP) collectively in assessing cardiovascular mortality (CVM) across populations remains to be elucidated.MethodsMultivariate Cox proportional hazards analysis investigated the SIRI, PP, and CVM association. Receiver operating characteristic (ROC) curves evaluated the predictive performance of the combined SIRI and PP for CVM in the broader demographic. Subsequently, the area under the ROC curve (AUC) was compared using the Z-test, and a novel nomogram was developed to assess its accuracy in predicting CVM. Restricted cubic spline (RCS) was used to evaluate the association between SIRI and PP.ResultsThe study involved 19,086 NHANES database individuals, with 9,531 males (49.94%). During the follow-up period, 456 CVM instances (2.39%) occurred. Multivariate Cox proportional hazards analysis revealed both the SIRI [adjusted hazard ratio (HR) 1.16, P

Abstract Community treatment of hypertension in sub‐Saharan Africa is hampered by gaps at several stages of the care cascade. We compared blood pressure (BP) levels (systolic, diastolic and pulse pressures) in four groups of participants by hypertension and treatment status. We conducted a nationally representative survey of adults 35 years and older using a multistage sampling strategy based on the 2013 Gambia Population and Housing Census. The BP measurements were taken in triplicate 5 min apart, and the average of the last two measurements was used for analysis. Systolic and diastolic BP levels and pulse pressure were compared by hypertension status using mean and 95% confidence intervals (CI). 53.1% of the sample were normotensive with mean systolic BP (SBP) of 119.2 mmHg (95% CI, 118.7–119.6) and diastolic BP (DBP) of 78.1 mmHg (77.8–78.3). Among individuals with hypertension, mean SBP was 148.7 mmHg (147.7–149.7) among those unaware of their hypertension, 152.2 mmHg (151.0–153.5) among treated individuals and was highest in untreated individuals at 159.3 mmHg (157.3–161.2). The findings were similar for DBP levels, being 93.9 mmHg (93.4–94.4) among the unaware, 95.1 mmHg (94.4–95.8) among the treated and highest at 99.1 mmHg (98.1–100.2) in untreated participants. SBP and DBP were higher in men, and SBP was as expected higher in those aged ≥55 years. BP level was similar in urban and rural areas. Our data shows high BP levels among participants with hypertension including those receiving treatment. Efforts to reduce the health burden of hypertension will require inputs at all levels of the care cascade.

Abstract Background There is a broad pulse pressure (PP) and a high prevalence of carotid plaques in old adults. Previous studies have indicated that PP is strongly associated with carotid plaque formation. This study aimed to explore this association in old adults with uncontrolled hypertension. Methods 1371 hypertensive patients aged ≥ 60 years with uncontrolled hypertension were enrolled in a community-based screening in Hangzhou, China. Carotid plaques were assessed using ultrasonography. Logistic regression models were used to estimate the association between PP and carotid plaques by odds ratios (ORs) and 95% confidence intervals (CIs). Results Carotid plaques were detected in 639 (46.6%) of subjects. Multiple plaques were found in 408 (63.8%) and soft plaques in 218 (34.1%). Elevated PP was associated with a high prevalence of carotid plaques. After adjusting for traditional risk factors, compared to patients within the lowest tertile of PP, those within the highest tertiles had an increased risk of carotid plaques (OR 2.061, CI 1.547–2.745). For each 1-SD increase, the risk increased by 40.1% (OR 1.401, CI 1.237–1.587). There was a nonlinear association between PP and carotid plaques (P nonlinearity = 0.039). The risk increased rapidly after the predicted PP level reached around 60 mmHg. The associations were stronger among participants with multiple and soft plaques. Conclusions Our findings suggested that PP was independently associated with carotid plaques in old adults with uncontrolled hypertension who have an increased risk of atherosclerosis.

Background Unlike systolic blood pressure (SBP), the prognostic value of diastolic blood pressure (DBP) in kidney function has not been established. We hypothesized that pulse pressure (PP), which is associated with arteriosclerosis, would affect the prognostic value of DBP. Methods This longitudinal study used data from the Japan Specific Health Checkups Study was conducted between 2008 and 2014. The participants were stratified into three PP subgroups (low PP ≤39, normal PP 40–59 and high PP ≥60 mmHg). The exposures of interest were SBP and DBP, and the association between SBP/DBP and kidney outcomes (30% decline in the estimated glomerular filtration rate from baseline) was examined in each PP subgroup using a Cox proportional hazards model. Results Among 725 022 participants, 20 414 (2.8%) developed kidney outcomes during a median follow-up period of 34.6 months. Higher SBP was consistently associated with a higher incidence of kidney outcome in all PP subgroups. Although DBP had a positive linear association with the incidence of kidney outcome in low- and normal-PP subgroups, both lower (≤60 mmHg) and higher (≥101 mmHg) DBP were associated with a higher incidence of kidney outcome in the high-PP subgroup, with a U-shaped curve. Hazard ratios (95% confidence intervals) of ≤60 mmHg (reference: 61–80 mmHg in normal-PP subgroup) and ≥101 mmHg were 1.26 (1.15–1.38) and 1.86 (1.62–2.14), respectively. Conclusions In this large population-based cohort, DBP was differently associated with kidney outcome by PP level; lower DBP was significantly associated with a higher incidence of kidney outcome in the high-PP subgroup but not in the low- and normal-PP subgroups. [ABSTRACT FROM AUTHOR]

Background: There is a broad pulse pressure (PP) and a high prevalence of carotid plaques in old adults. Previous studies have indicated that PP is strongly associated with carotid plaque formation. This study aimed to explore this association in old adults with uncontrolled hypertension. Methods: 1371 hypertensive patients aged ≥ 60 years with uncontrolled hypertension were enrolled in a community-based screening in Hangzhou, China. Carotid plaques were assessed using ultrasonography. Logistic regression models were used to estimate the association between PP and carotid plaques by odds ratios (ORs) and 95% confidence intervals (CIs). Results: Carotid plaques were detected in 639 (46.6%) of subjects. Multiple plaques were found in 408 (63.8%) and soft plaques in 218 (34.1%). Elevated PP was associated with a high prevalence of carotid plaques. After adjusting for traditional risk factors, compared to patients within the lowest tertile of PP, those within the highest tertiles had an increased risk of carotid plaques (OR 2.061, CI 1.547–2.745). For each 1-SD increase, the risk increased by 40.1% (OR 1.401, CI 1.237–1.587). There was a nonlinear association between PP and carotid plaques (P nonlinearity = 0.039). The risk increased rapidly after the predicted PP level reached around 60 mmHg. The associations were stronger among participants with multiple and soft plaques. Conclusions: Our findings suggested that PP was independently associated with carotid plaques in old adults with uncontrolled hypertension who have an increased risk of atherosclerosis. [ABSTRACT FROM AUTHOR]

Introduction: A lower ability to buffer pulse pressure (PP) in the face of increasing mean arterial pressure (MAP) may underlie the disproportionate increase in systolic blood pressure (SBP) in women from young adulthood through middle-aged relative to men. Aim: To evaluate the contribution of MAP to the change in PP and pressure wave contour in men and women from young adulthood to middle age. Methods: Central pressure waveform was obtained from radial artery applanation tonometry in 312 hypertensive patients between 16 to 49 years (134 women, mean age 35 ± 9 years), 185 of whom were on antihypertensive treatment. Results: Higher MAP levels (≥ 100 mmHg) were significantly associated with higher brachial and central SBP (P < 0.001), PP (P < 0.001), incident wave (P = 0.005), AP (P < 0.001), and PWV (P < 0.001) compared to lower MAP levels. The relationship between MAP and brachial PP (P < 0.001), central PP (P < 0.001), incident wave (P < 0.001), and AP (P < 0.01), but not PWV, strengthens with age. The age-related increase in the contribution of MAP to brachial PP (P < 0.001), central PP (P < 0.001), and incident wave (P < 0.001) was more prominent in women than in men beginning in the fourth decade. In multiple regression analyses, MAP remained a significantly stronger predictor of central PP and incident wave in women than in men, independent of age, heart rate, and antihypertensive treatment. In turn, age remained a significantly stronger predictor of central PP and incident wave in women than in men, independent of MAP, heart rate, and antihypertensive treatment. Conclusions: Women of reproductive age showed a steeper increase in PP with increasing MAP, despite comparable increases in arterial stiffness in both sexes. The difference was driven by a greater contribution of MAP to the forward component of the pressure wave in women. [ABSTRACT FROM AUTHOR]

Community treatment of hypertension in sub‐Saharan Africa is hampered by gaps at several stages of the care cascade. We compared blood pressure (BP) levels (systolic, diastolic and pulse pressures) in four groups of participants by hypertension and treatment status. We conducted a nationally representative survey of adults 35 years and older using a multistage sampling strategy based on the 2013 Gambia Population and Housing Census. The BP measurements were taken in triplicate 5 min apart, and the average of the last two measurements was used for analysis. Systolic and diastolic BP levels and pulse pressure were compared by hypertension status using mean and 95% confidence intervals (CI). 53.1% of the sample were normotensive with mean systolic BP (SBP) of 119.2 mmHg (95% CI, 118.7–119.6) and diastolic BP (DBP) of 78.1 mmHg (77.8–78.3). Among individuals with hypertension, mean SBP was 148.7 mmHg (147.7–149.7) among those unaware of their hypertension, 152.2 mmHg (151.0–153.5) among treated individuals and was highest in untreated individuals at 159.3 mmHg (157.3–161.2). The findings were similar for DBP levels, being 93.9 mmHg (93.4–94.4) among the unaware, 95.1 mmHg (94.4–95.8) among the treated and highest at 99.1 mmHg (98.1–100.2) in untreated participants. SBP and DBP were higher in men, and SBP was as expected higher in those aged ≥55 years. BP level was similar in urban and rural areas. Our data shows high BP levels among participants with hypertension including those receiving treatment. Efforts to reduce the health burden of hypertension will require inputs at all levels of the care cascade. [ABSTRACT FROM AUTHOR]

Purpose: There has been limited evidence for the association between pulse pressure (PP) and proteinuria in prediabetes. The aim of our study was to explore the association between PP and albuminuria in community-dwelling Chinese adults with prediabetes. Materials and Methods: PP and urinary albumin-to-creatinine ratio (ACR) were measured in 2012 prediabetic patients and 3596 control subjects with normal glucose tolerance. Multivariate logistic regression models were used to evaluate the possible association of PP with the risk of presence of albuminuria. Results: PP was positively associated with the presence of albuminuria, and subjects in the higher PP quartiles had higher urinary ACR and presence of albuminuria as compared with those in the lowest quartile in both prediabetes and control groups (all P < 0.01). Multivariate logistic regression analysis demonstrated that the highest PP quartile was positively associated with increased risk of presence of albuminuria in all prediabetic subjects [odds ratio (OR): 2.289, 95% confidence interval (CI) 1.364–3.842, P < 0.01) and prediabetic subjects without anti-hypertensive drugs (OR: 1.932, 95% CI 1.116–3.343, P < 0.01), whereas higher PP quartile has nothing to do with the risk of presence of albuminuria in control subjects with and without anti-hypertensive drugs after adjustment for potential confounders (all P > 0.01). Consistently, stratified analysis showed that in the prediabetes group, the risks of presence of albuminuria progressively elevated with increasing PP quartiles in men, those aged 60 years or older, and with overweight/obesity, normal high-density lipoprotein cholesterol, and appropriate low-density lipoprotein cholesterol (all P for trend <0.05). Conclusion: Higher PP is independently related to increased risk of presence of albuminuria in community-dwelling Chinese adults with prediabetes. [ABSTRACT FROM AUTHOR]

Systemic hypertension is a strong risk factor for cardiovascular, neurovascular, and renovascular diseases. Central artery stiffness is both an initiator and indicator of hypertension, thus revealing a critical relationship between the wall mechanics and hemodynamics. Mice have emerged as a critical animal model for studying effects of hypertension and much has been learned. Regardless of the specific mouse model, data on changes in cardiac function and hemodynamics are necessarily measured under anesthesia. Here, we present a new experimental-computational workflow to estimate awake cardiovascular conditions from anesthetized data, which was then used to quantify effects of chronic angiotensin II-induced hypertension relative to normotension in wild-type mice. We found that isoflurane anesthesia had a greater impact on depressing hemodynamics in angiotensin II-infused mice than in controls, which led to unexpected results when comparing anesthetized results between the two groups of mice. Through comparison of the awake simulations, however, in vivo relevant effects of angiotensin II-infusion on global and regional vascular structure, properties, and hemodynamics were found to be qualitatively consistent with expectations. Specifically, we found an increased in vivo vascular stiffness in the descending thoracic aorta and suprarenal abdominal aorta, leading to increases in pulse pressure in the distal aorta. These insights allow characterization of the impact of regionally varying vascular remodeling on hemodynamics and mouse-to-mouse variations due to induced hypertension. [ABSTRACT FROM AUTHOR]

BackgroundStudies have demonstrated that both tau and cardiovascular risk are associated with cognitive decline, but the possible synergistic effects of these pathologic markers remain unclear.ObjectiveTo explore the interaction of AD biomarkers with a specific vascular risk marker (pulse pressure) on longitudinal cognition.MethodsParticipants included 139 older adults from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Biomarkers of tau, amyloid-β (Aβ), and vascular risk (pulse pressure) were assessed. Neuropsychological assessment provided memory, language, and executive function domain composite scores at baseline and 1-year follow-up. Multiple linear regression examined interactive effects of pulse pressure with tau PET independent of Aβ PET and Aβ PET independent of tau PET on baseline and 1-year cognitive outcomes.ResultsThe interaction between pulse pressure and tau PET significantly predicted 1-year memory performance such that the combined effect of high pulse pressure and high tau PET levels was associated with lower memory at follow-up but not at baseline. In contrast, Aβ PET did not significantly interact with pulse pressure to predict baseline or 1-year outcomes in any cognitive domain. Main effects revealed a significant effect of tau PET on memory, and no significant effects of Aβ PET or pulse pressure on any cognitive domain.ConclusionResults indicate that tau and an indirect marker of arterial stiffening (pulse pressure) may synergistically contribute to memory decline, whereas Aβ may have a lesser role in predicting cognitive progression. Tau and vascular pathology (particularly in combination) may represent valuable targets for interventions intended to slow cognitive decline.