2.2 Transfer Function-Derived Central Pressure and Cardiovascular Events: The Framingham Heart Study

Gp, Mitchell; Hwang, Shih‐Jen; Larson, Martin; Hamburg, Naomi M.; Benjamin, Emelia J.; Vasan, Ramachandran S.; Levy, Daniel; Vita, Joseph A.

doi:10.1016/j.artres.2013.10.008

Cited by 13 publications

(22 citation statements)

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“…A different more muscular brachial conduit artery arterial path was studied there. However, whether currently measured central BP has clinical impact beyond peripheral BP in the general population, as some claim, remains uncertain, as recently reported from Framingham, in part related to calibration issues . However, central aortic pressure may be especially relevant in specific populations, such as those with heart failure with preserved ejection fraction …”

Section: Discussionmentioning

confidence: 99%

A randomised, factorial trial to reduce arterial stiffness independently of blood pressure: Proof of concept? The VaSera trial testing dietary nitrate and spironolactone

Mills

Govoni

Faconti

et al. 2020

Brit J Clinical Pharma

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Aims:To test if spironolactone or dietary nitrate from beetroot juice could reduce arterial stiffness as aortic pulse wave velocity (PWVart), a potential treatment target, independently of blood pressure. Methods:Daily spironolactone (≤50 mg) vs doxazosin (control ≤16 mg) and 70 mL beetroot juice (Beet-It ≤11 mmol nitrate) vs nitrate-depleted juice (placebo; 0 mmol nitrate) were tested in people at risk or with type-2 diabetes using a double-blind, 6-month factorial trial. Vascular indices (baseline, 12, 24 weeks) were cardiac-ankle vascular index (CAVI), a nominally pressure-independent stiffness measure (primary outcome), PWVart secondary, central systolic pressure and augmentation. Analysis was intention-to-treat, adjusted for systolic pressure differences between trial arms.Results: Spironolactone did not reduce stiffness, with evidence for reduced CAVI on doxazosin rather than spironolactone (mean difference [95% confidence interval]; 0.25 [−0.3, 0.5] units, P = .080), firmer for PWVart (0.37 [0.01, 0.7] m/s, P = .045). There was no difference in systolic pressure reduction between spironolactone and doxazosin (0.7 [−4.8, 3.3] mmHg, P = .7). Circulating nitrate and nitrite increased on active vs placebo juice, with central systolic pressure lowered −2.6 [−4.5, − 0.8] mmHg, P = .007 more on the active juice, but did not reduce CAVI, PWVart or peripheral pressure. Change in nitrate and nitrite concentrations were 1.5-fold [1.1-2.2] and 2.2-fold [1.3, 3.6] higher on spironolactone than on doxazosin respectively; both P < .05.Conclusion: Contrary to our hypothesis, in at-risk/type 2 diabetes patients, spironolactone did not reduce arterial stiffness, rather PWVart was lower on doxazosin.Dietary nitrate elevated plasma nitrite, selectively lowering central systolic pressure, observed previously for nitrite.PI statement: The authors confirm that the Principal Investigator for this paper is Professor J.K. Cruickshank and that he had direct clinical responsibility for patients.Clinical trial registration: ISRCTN registry: ISRCTN25003627

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Section: Discussionmentioning

confidence: 99%

A randomised, factorial trial to reduce arterial stiffness independently of blood pressure: Proof of concept? The VaSera trial testing dietary nitrate and spironolactone

Mills

Govoni

Faconti

et al. 2020

Brit J Clinical Pharma

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“…Despite that central BP may be better than brachial BP in predicting cardiovascular outcomes, it is arguable that the inconsistent superiority of central BP over brachial BP may reflect a true pathophysiological issue or is potentially biased by methodological weakness . It should be acknowledged that most outcome studies were conducted in the elderly in whom brachial and central pressures are similar, and no outcome studies have been conducted in younger patients, in whom a much greater difference between brachial and central pressures is expected.…”

Section: Future Perspectives On the Use Of Central Bp To Manage Hypermentioning

confidence: 99%

Central blood pressure for the management of hypertension: Is it a practical clinical tool in current practice?

Cheng

Chuang

Wang

et al. 2019

J of Clinical Hypertension

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Since noninvasive central blood pressure (BP) measuring devices are readily available, central BP has gained growing attention regarding its clinical application in the management of hypertension. The disagreement between central and peripheral BP has long been recognized. Some previous studies showed that noninvasive central BP may be better than the conventional brachial BP in association with target organ damages and long-term cardiovascular outcomes. Recent studies further suggest that the central BP strategy for confirming a diagnosis of hypertension may be more cost-effective than the conventional strategy, and guidance of hypertension management with central BP may result in less use of medications to achieve BP control.Despite the use of central BP being promising, more randomized controlled studies comparing central BP-guided therapeutic strategies with conventional care for cardiovascular events reduction are required because noninvasive central and brachial BP measures are conveniently available. In this brief review, the rationale supporting the utility of central BP in clinical practice and relating challenges are summarized.

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“…It has been applied as a surrogate measure of arterial stiffness, but it is mainly a measure of wave reflections [7] that is also influenced by systemic vascular resistance (SVR) [8]. The position of AIx as an independent predictor of cardiovascular events is still controversial [9]. Taking into account the aforementioned pathophysiology it can be readily understood why a beneficial effect of beta-blockers on AIx has not been demonstrated [10,11].…”

Section: Introductionmentioning

confidence: 99%

Adverse influence of bisoprolol on central blood pressure in the upright position: a double-blind placebo-controlled cross-over study

Suojanen¹,

Haring²,

Tikkakoski³

et al. 2019

J Hum Hypertens

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Treatment with beta-blockers is characterized by inferior reduction of central versus peripheral blood pressure. We examined changes in blood pressure, cardiac function, and vascular resistance after 3 weeks of bisoprolol treatment (5 mg/day) during passive head-up tilt in 16 never-treated Caucasian males with grade I-II primary hypertension. A double-blind, randomized, placebo-controlled cross-over design was applied, and hemodynamics were recorded using continuous tonometric pulse wave analysis and whole-body impedance cardiography. Bisoprolol decreased blood pressure in the aorta (~8/10 mmHg, p ≤ 0.032) and radial artery (~10/9 mmHg, p ≤ 0.037), but upright aortic systolic blood pressure was not significantly reduced (p = 0.085). Bisoprolol reduced heart rate and left cardiac work, and increased subendocardial viability index in supine and upright positions (p ≤ 0.044 for all). Bisoprolol increased stroke volume in the supine (~11 ml, p = 0.02) but not in the upright position, while only upright (~1 l/min, p = 0.007) but not supine cardiac output was reduced. Upright elevation in systemic vascular resistance was increased 2.7-fold (p = 0.002), while upright pulse pressure amplification was decreased bỹ 20% (p = 0.002) after bisoprolol. Aortic augmentation index, augmentation pressure, and pulse pressure were not changed in the supine position but were increased in the upright position (from 9% to 17%, 3-6 mmHg, and 30-34 mmHg, respectively, p ≤ 0.016 for all). In conclusion, although bisoprolol treatment reduced peripheral blood pressure, central systolic blood pressure in the upright position was not decreased. Importantly, the harmful influences of bisoprolol on central pulse pressure and pressure wave reflection were manifested in the upright position.

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2.2 Transfer Function-Derived Central Pressure and Cardiovascular Events: The Framingham Heart Study

Cited by 13 publications

References 0 publications

A randomised, factorial trial to reduce arterial stiffness independently of blood pressure: Proof of concept? The VaSera trial testing dietary nitrate and spironolactone

A randomised, factorial trial to reduce arterial stiffness independently of blood pressure: Proof of concept? The VaSera trial testing dietary nitrate and spironolactone

Central blood pressure for the management of hypertension: Is it a practical clinical tool in current practice?

Adverse influence of bisoprolol on central blood pressure in the upright position: a double-blind placebo-controlled cross-over study

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