measuring-carotid-to-femoral-pulse-wave-velocity-cf-pwv-to-evaluate

Measuring the Carotid to Femoral Pulse Wave Velocity (Cf-PWV) to Evaluate Arterial Stiffness

For the elderly, arterial stiffening is a good marker for aging evaluation and it is recommended that the arterial stiffness be determined noninvasively ...

The authors aimed to investigate the superiority of angiotensin system blockade (angiotensin-converting enzyme [ACE] inhibitor/angiotensin receptor blocker [ARB]) plus a calcium channel blocker (CCB) (A+C) over other combination therapies in antihypertensive treatment. A meta-analysis in 20,451 hypertensive patients from eight randomized controlled trials was conducted to compare the A+C treatment with other combination therapies in terms of blood pressure (BP) reduction, clinical outcomes, and adverse events. The results showed that BP reduction did not differ significantly among the A+C therapy and other combination therapies in systolic and diastolic BP (P=.87 and P=.56, respectively). However, A+C therapy, compared with other combination therapies, achieved a significantly lower incidence of cardiovascular composite endpoints, including cardiovascular mortality, nonfatal myocardial infarction, and nonfatal stroke (risk ratio [RR], 0.80; 95% confidence interval [CI], 0.70-0.91; P<.001), but similar all-cause mortality (RR, 0.90; 95% CI, 0.77-1.04; P=.15) and stroke rates (RR, 0.90; 95% CI, 0.77-1.04; P=.09). Moreover, A+C therapy yielded a 4.21 mL/min/1.73 m(2) lower estimated glomerular filtration rate reduction than other combinations (P<.001). Finally, A+C therapy showed a similar incidence of adverse events as other combination therapies (P=.34) but presented a significantly lower incidence of serious adverse events (RR, 0.85; 95% CI, 0.73-0.98; P=.03). In conclusion, A+C therapy is superior to other combinations of antihypertensive treatment as it shows a lower incidence of cardiovascular events and adverse events, while it has similar effects in lowering BP and preserving renal function. 

Angiotensin System Blockade Combined With Calcium Channel Blockers Is Superior to Other Combinations in Cardiovascular Protection With Similar Blood Pressure Reduction: A Meta-Analysis in 20,451 Hypertensive Patients.

Carotid-femoral pulse-wave velocity (cf-PWV) and brachial-ankle PWV (ba-PWV) are the 2 most frequently applied PWV measurements. However, little is known about the comparison of hypertensive target organ damage (TOD) with cf-PWV and ba-PWV.

Comparison of Carotid-Femoral and Brachial-Ankle Pulse-Wave Velocity in Association With Target Organ Damage in the Community-Dwelling Elderly Chinese: The Northern Shanghai Study.

Cardiovascular (CV) diseases are the leading cause of death and disability in the world. Increasing lifespans and ageing populations also contribute to an increasing CV burden. However, in China, there were few well-designed cohort studies focusing on the elderly population, let alone an established CV risk score. The objective of this study is to establish a CV risk score based on a community-dwelling Chinese elderly population, determining the profile of the associated CV risk factors and target organ damages (TODs), so as to guide the later intervention.

Northern Shanghai Study: cardiovascular risk and its associated factors in the Chinese elderly-a study protocol of a prospective study design.

The aim of the study was to investigate the association of left ventricular diastolic dysfunction (LVDD) with central and peripheral hemodynamics. A total of 1599 community-based senior residents (aged ≥ 65 years) in northern Shanghai, China, were recruited as of August 2015. Echocardiography was performed for each participant using the MyLab30 Gold CV system. According to the recommendations from the American Society of Echocardiography, the ratio of E (peak early diastolic transmitral flow velocity) to E' (early diastolic lateral mitral annulus velocity) was assessed for the evaluation of LVDD. Central blood pressure (BP) components were measured using the SphygmoCor system. In community older population (72.7 ± 6.01 years), brachial systolic BP (mm Hg) was higher than central systolic BP (141.9 ± 19.5 vs. 130.3 ± 20.1 mm Hg). A total of 214 subjects (13.4%) showed LVDD, and female showed higher prevalence of diastolic dysfunction than male (17.3% vs. 8.4%, P < .01). After adjustment for confounding variables, only central systolic BP, not brachial systolic BP, was significantly associated with E/E' in the total population. Similar result was found in the subgroup analysis (participants without antihypertensive agents treatment, man, woman). Similar findings were obtained for the pulse pressure (PP) analysis. Within central hemodynamics, only central PP, but not central systolic BP or augmentation pressure, was significantly associated with E/E' after adjustment. When LVDD was defined by E/E' and other echocardiographic parameters, our findings remained unaltered in the multivariate logistic regression with similar adjustment in the total population and subgroup analysis. In the Chinese elderly cohort, central hemodynamics, especially central PP, is superior to other BP components in identifying LVDD (NCT02368938).

Comparison of central and peripheral hemodynamics in association with left ventricular diastolic dysfunction in the community-based elderly Chinese.

Vascular abnormality includes two forms, arteriosclerosis (ARS) and atherosclerosis (ATS), which coexist in patients with cardiovascular (CV) diseases. However, whether their combination may lead to a worsening status in those patients remains unclear. We therefore aimed to investigate the association of ARS and/or ATS with hypertensive target organ damage (TOD).

Association of arteriosclerosis and/or atherosclerosis with hypertensive target organ damage in the community-dwelling elderly Chinese: the Northern Shanghai Study.

With increasing age, estimated glomerular filtration rate (eGFR) decline is a frequent manifestation and is strongly associated with other preclinical target organ damage (TOD). In literature, many equations exist in assessing patients' eGFR. However, these equations were mainly derived and validated in the population from Western countries, which equation should be used for risk stratification in the Chinese population remains unclear, as well as their comparison. Considering that TOD is a good marker for risk stratification in the elderly, in this analysis, we aimed to investigate whether the recent eGFR equations derived from Asian and Chinese are better associated with preclinical TOD than the other equations in elderly Chinese.

eGFRs from Asian-modified CKD-EPI and Chinese-modified CKD-EPI equations were associated better with hypertensive target organ damage in the community-dwelling elderly Chinese: the Northern Shanghai Study.

The Eighth Joint National Committee Panel (JNC8) recommended a novel blood pressure (BP) goal for individuals with hypertension, which was less stringent than the Seventh Joint National Committee (JNC7) guideline and is still under debate. In our study, we aimed at finding a better BP goal for the elderly Chinese.

Blood pressure goal for the elderly Chinese: the findings from the Northern Shanghai Study.

To compare central and brachial blood pressure (BP) in the association of target organ damage (TOD) in a community-based elderly population, 1599 (aged 71.4 ± 6.1 years) participants in northern Shanghai were recruited. TOD included left ventricular hypertrophy (n = 1556), left ventricular diastolic dysfunction (n = 1524), carotid plaque (n = 1558), arteriosclerosis (n = 1485), and microalbuminuria (n = 1516). Both central and brachial BP significantly correlated with TOD. In full-model regression, central BP was significantly associated with all TOD (P ≤ .04), whereas brachial BP was only significantly associated with left ventricular hypertrophy and arteriosclerosis (P ≤ .01). Similarly, in stepwise regression, central BP was significantly associated with left ventricular hypertrophy, left ventricular diastolic dysfunction, arteriosclerosis, and microalbuminuria (P ≤ .04), while brachial BP was not associated with any TOD. Receiver operating characteristic analyses indicated that central BP identified arteriosclerosis and microalbuminuria better than brachial BP (P ≤ .01). In conclusion, central BP showed superiority over brachial BP in the association of hypertensive TOD in a community-based elderly population.

Hypertensive target organ damage is better associated with central than brachial blood pressure: The Northern Shanghai Study.

We aimed to investigate the prevalence of central hypertension and its association with target organ damage (TOD). 1983 community-dwelling elderly Chinese people were recruited for this analysis. Brachial and central blood pressure (BP) were measured by an oscillometric device and SphygmoCor (type I device), respectively. Brachial hypertension was defined by brachial systolic BP/diastolic BP ≥140/90 mmHg or using antihypertensive medications. Central hypertension was defined by central systolic BP/diastolic BP ≥130/90 mmHg or using antihypertensive medications. TOD included left ventricular hypertrophy and diastolic dysfunction, carotid-femoral pulse wave velocity, and urinary albumin-creatinine ratio. In this cohort, there were 563 (28.4%) brachial and central consistent normotension, 46 (2.3%) isolated brachial hypertension, 27 (1.4%) isolated central hypertension, and 1347 (67.9%) brachial and central combined hypertension (BCCH). In analysis of variance, BCCH showed significantly higher levels in all TOD than brachial and central consistent normotension. In multiple logistic regression, all TOD were significantly associated with BCCH (left ventricular hypertrophy: adjusted odds ratios [95% confidence interval] = 2.03 [1.55, 2.68]; left ventricular diastolic dysfunction: 2.29 [1.53, 3.43]; carotid-femoral pulse wave velocity >10 m/s: 3.41 [2.55, 4.58]; urinary albumin-creatinine ratio >30 mg/g: 1.97 [1.58, 2.44]), rather than isolated brachial hypertension or isolated central hypertension. In conclusion, central hypertension was prevalent (69.3%) in this elderly cohort. BCCH was independently and significantly associated with cardiac, arterial, and renal damage. This finding implies that both brachial and central BPs need to be considered for managing hypertension.

The prevalence of central hypertension defined by a central blood pressure type I device and its association with target organ damage in the community-dwelling elderly Chinese: The Northern Shanghai Study.

This study aimed to investigate the discrepancy between pulse wave velocity (PWV) and pulse pressure amplification (PPA) in association with hypertensive target organ damage (TOD) in the elderly. From June 2014 to August 2015, 1599 participants aged >65 years old from communities located in northern Shanghai were recruited. Carotid-femoral pulse wave velocity (cfPWV), peripheral blood pressure (BP), central BP and other TOD indicators, including the ratio of the early ventricular filling velocity (E) to the peak velocity of the tissue Doppler velocity of septal mitral annulus (E/Ea), left ventricular mass index (LVMI), carotid intima-medium thickness (CIMT), estimated glomerular filtration rate (eGFR), and urinary albumin-creatinine ratio (ACR), were determined for each participant. PPA was defined as the peripheral-to-central pulse pressure ratio. In multivariable linear regression analysis, cfPWV was significantly associated with CIMT (β = 12.83 ± 4.28 μm per SD; P = 0.003) and eGFR (β = -1.85 ± 0.69 ml/min/1.73 m per SD; P = 0.007), whereas PPA was significantly associated with E/Ea (β = -0.25 ± 0.10 per SD; P = 0.01) and LVMI (β = -3.00 ± 0.78 g/m per SD; P < 0.001). Similarly, in multivariable logistic regression analysis, cfPWV was significantly associated with arterial plaque (odds ratio [OR], 1.21 [95% confidence interval [CI], 1.05-1.39]; P = 0.007), peripheral artery disease (OR, 1.22 [95% CI, 1.06-1.42]; P = 0.007), chronic kidney diseases (OR, 1.24 [95% CI, 1.01-1.54]; P = 0.04) and microalbuminuria (OR, 1.21 [95% CI, 1.07-1.37]; P = 0.002), while PPA was tightly associated with left ventricular hypertrophy (OR, 0.85 [95% CI, 0.72-0.99]; P = 0.04) and diastolic dysfunction (OR, 0.78 [95% CI, 0.64-0.96]; P = 0.02). In conclusion, cfPWV is a vessel-related and renal-related biomarker, while PPA is a cardiac-related biomarker in community-based elderly.

Comparison of pulse wave velocity and pulse pressure amplification in association with target organ damage in community-dwelling elderly: The Northern Shanghai Study.

Secreted frizzled related protein 5 (SFRP5) is a novel anti-inflammatory adipokine that is implicated in metabolic and cardiovascular disease (CVD). However, little is known about the relevance of SFRP5 with asymptomatic hypertensive target organ damages (TODs). We aimed to investigate the association between SFRP5 and TOD in a large population.

Article	Year
Angiotensin System Blockade Combined With Calcium Channel Blockers Is Superior to Other Combinations in Cardiovascular Protection With Similar Blood Pressure Reduction: A Meta-Analysis in 20... Journal of clinical hypertension (Greenwich, Conn.)\| PubMed ID: 26778747	2016
Comparison of Carotid-Femoral and Brachial-Ankle Pulse-Wave Velocity in Association With Target Organ Damage in the Community-Dwelling Elderly Chinese: The Northern Shanghai Study. Journal of the American Heart Association\| PubMed ID: 28219916	2017
Northern Shanghai Study: cardiovascular risk and its associated factors in the Chinese elderly-a study protocol of a prospective study design. BMJ open\| PubMed ID: 28360242	2017
Comparison of central and peripheral hemodynamics in association with left ventricular diastolic dysfunction in the community-based elderly Chinese. Journal of the American Society of Hypertension : JASH\| PubMed ID: 28528875	2017
Association of arteriosclerosis and/or atherosclerosis with hypertensive target organ damage in the community-dwelling elderly Chinese: the Northern Shanghai Study. Clinical interventions in aging\| PubMed ID: 28652715	2017
eGFRs from Asian-modified CKD-EPI and Chinese-modified CKD-EPI equations were associated better with hypertensive target organ damage in the community-dwelling elderly Chinese: the Northern ... Clinical interventions in aging\| PubMed ID: 28860731	2017
Blood pressure goal for the elderly Chinese: the findings from the Northern Shanghai Study. Clinical and experimental hypertension (New York, N.Y. : 1993)\| PubMed ID: 28952815	2017
Hypertensive target organ damage is better associated with central than brachial blood pressure: The Northern Shanghai Study. Journal of clinical hypertension (Greenwich, Conn.)\| PubMed ID: 29067767	2017
The prevalence of central hypertension defined by a central blood pressure type I device and its association with target organ damage in the community-dwelling elderly Chinese: The Northern ... Journal of the American Society of Hypertension : JASH\| PubMed ID: 29396106	2018
Comparison of pulse wave velocity and pulse pressure amplification in association with target organ damage in community-dwelling elderly: The Northern Shanghai Study. Hypertension research : official journal of the Japanese Society of Hypertension\| PubMed ID: 29535455	2018
Association of asymptomatic target organ damage with secreted frizzled related protein 5 in the elderly: the Northern Shanghai Study. Clinical interventions in aging\| PubMed ID: 29551893	2018

Bin Bai

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