Increased brachial–ankle pulse wave velocity is independently associated with risk of cerebral ischemic small vessel disease in elderly hypertensive patients

Kim, Dae-Hyun; Kim, Jei; Kim, Jae-Moon; Lee, Ae Young

doi:10.1016/j.clineuro.2008.03.009

Cited by 46 publications

(64 citation statements)

References 38 publications

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“…23 This is consistent with the literature relating hypertension to cerebral hypoperfusion 24 and arterial stiffness to cerebral small vessel disease. 9 There were no apparent differences between normotensives and hypertensives. This could be due to the confounding effect of medications not only on mean arterial pressure, but also on arterial stiffness.…”

Section: Discussionmentioning

confidence: 91%

“…To date, examination into the haemodynamic impact of elevated arterial stiffness has been focused within the coronary 7 and peripheral circulations. 8 Despite an observed correlation between pulse wave velocity (PWV) and the severity of disease in small cerebral vessels, 9 the relationship between arterial stiffness, cerebrovascular resistance and cerebral blood flow (CBF) remains largely unexplored.…”

Section: Introductionmentioning

confidence: 99%

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Association between arterial stiffness and cerebrovascular resistance in the elderly

2009

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Arterial stiffness is an established cardiovascular risk factor influencing haemodynamic properties in the microcirculation. We tested the hypothesis that increased arterial stiffness is associated with an increase in cerebrovascular resistance in the elderly. Brachialankle pulse wave velocity (baPWV), using arterial tonometry, and anterior cerebral blood flow (aCBF), using extracranial ultrasound, were measured in 26 participants (67-92 years). Non-parametric statistics examined relationships between age, blood pressure, baPWV, cerebrovascular resistance (CVRi) and aCBF. Bivariate analysis suggested that baPWV was the only vascular characteristic associated with CVRi (r s ¼ 0.59; P ¼ 0.002). CVRi was strongly correlated with aCBF (r s ¼ À0.89; Po0.001). Furthermore, compared with participants in the lower three quartiles of baPWV (LO) ; P ¼ 0.09). This study found a positive correlation between baPWV and CVRi in the elderly, suggesting that haemodynamic characteristics associated with arterial aging influence cerebral circulation.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Association between arterial stiffness and cerebrovascular resistance in the elderly

2009

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“…Cross-sectional studies have reported an association between high baPWV and prevalence of cardiovascular risk factors, 11,12 presence of coronary artery disease in male patients, 13 presence of cerebrovascular disease in asymptomatic community-dwelling older persons 14 and in hypertensive patients aged 50 years or older. 15 However, there have been few longitudinal reports about the relationship between baPWV and mortality. [16][17][18] One study suggested that increases in baPWV were associated with an elevated risk of cardiovascular mortality in 298 community-dwelling older adults, but the optimal cutoff value of baPWV was not shown.…”

Section: Introductionmentioning

confidence: 99%

Association between brachial–ankle pulse wave velocity and 3-year mortality in community-dwelling older adults

et al. 2010

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With aging, arterial stiffness increases and results in cardiovascular diseases. Recently, high brachial-ankle pulse wave velocity (baPWV), measured using a new noninvasive device to estimate arterial stiffness, was reported to be associated with the prevalence of cardiovascular diseases. The purpose of this study was to clarify the association between baPWV with 3-year mortality in community-dwelling older adults and to determine the cutoff value of baPWV in terms of mortality. A total of 530 subjects aged 65 years or older (men/women, 207:323; mean age, 76 years) participated. They were dichotomized by the median value of baPWV. Within 3 years, 30 deaths occurred, including 11 cardiovascular deaths. The high-baPWV group had a higher incidence of total deaths (high-baPWV group vs. low-baPWV group, 8.3 vs. 3.0%, respectively) and cardiovascular deaths (high-baPWV group vs. lowbaPWV group, 3.8 vs. 0.4%, respectively). A high-baPWV level was associated with an increased risk of 3-year total mortality after adjustment for age, sex and systolic blood pressure (hazard ratio for high baPWV vs. low baPWV¼2.98, 95% CI¼1.25-7.07) and with an increased risk of 3-year cardiovascular mortality (hazard ratio for high baPWV vs. low baPWV¼10.01, 95% CI¼1.21-82.49). A receiver-operating characteristic curve showed that the optimal cutoff value of baPWV for total mortality was 19.63 m s À1 , and for cardiovascular mortality it was 19.63 m s À1 . This study provides a preliminary finding that assessment of arterial stiffness by baPWV might be a useful method to predict mortality risk in community-dwelling older adults. Large longitudinal studies for extended periods of time are necessary to confirm the association.

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“…Ohmine et al 8 investigated the PWV of 132 elderly people, with the result that PWV values were significantly greater in subjects with PVH than in those without. In contrast, there was no significant association between PWV and PVH in 196 elderly people with hypertension after adjustment for age, according to Kim et al 10 The antipodal results may reflect the differences in the backgrounds of the study subjects. Although both subject groups were older Asian people, one consisted of normal people while the other consisted of hypertensive patients.…”

Section: Discussionmentioning

confidence: 47%

“…Some reports analyzed the presence of an association between WML and pulse wave velocity (PWV), which is the velocity at which a pulse wave travels between two arterial points and is considered to reflect an advanced stage of arteriosclerosis, but the results were controversial. [8][9][10] Henskens emphasized that an important methodological limitation is the lack of information on carotid wave reflection, and it is difficult to interpret hemodynamic profile from the PWV alone, while the carotid augmentation index (AIx) should be determined as an index of the effect of arterial stiffening on cerebral blood flow. 9 AIx is represented as the ratio of the late systolic component, which consists mainly of the pressure wave reflected back from the peripheral arteries, to the early systolic component in the pulse, and is thought to detect a degree of functional arterial stiffening in the distal muscular conduit arteries.…”

Section: Introductionmentioning

confidence: 99%

Augmentation index is related to white matter lesions

et al. 2012

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The augmentation index (AIx) is a measure of pulse wave reflection from peripheral muscular conduit arteries, and is assumed to increase with stiffened arteries. A white matter lesion (WML) is generally regarded as a chronic ischemic lesion, which is associated with cerebral small-vessel arteriosclerosis. The aim of this study is to elucidate the effect of pulse wave reflection on the brain. Carotid AIx was measured in a total of 205 neurologically normal adults. The correlations between AIx and WML were investigated. Two categories of WML were evaluated, periventricular hyperintensity (PVH) and deep and subcortical white matter hyperintensity (DSWMH). On univariate analysis, AIx was significantly correlated with the grades of PVH and DSWMH (P¼0.0001, respectively). On multivariate analysis, AIx was correlated with PVH and DSWMH, independent of other risk factors such as age or blood pressure. Pulse wave reflection from small vessels may influence the genesis of WML. Keywords: augmentation index; endothelial dysfunction; pulse wave velocity; white matter lesion INTRODUCTION White matter lesions (WMLs) have been reported to be a predictive factor in vascular dementia 1-4 and stroke, 5-7 and are generally regarded as chronic ischemic lesions of the brain. Prior attempts to attribute their cause to general arteriosclerosis have been inconclusive. Some reports analyzed the presence of an association between WML and pulse wave velocity (PWV), which is the velocity at which a pulse wave travels between two arterial points and is considered to reflect an advanced stage of arteriosclerosis, but the results were controversial. [8][9][10] Henskens emphasized that an important methodological limitation is the lack of information on carotid wave reflection, and it is difficult to interpret hemodynamic profile from the PWV alone, while the carotid augmentation index (AIx) should be determined as an index of the effect of arterial stiffening on cerebral blood flow. 9 AIx is represented as the ratio of the late systolic component, which consists mainly of the pressure wave reflected back from the peripheral arteries, to the early systolic component in the pulse, and is thought to detect a degree of functional arterial stiffening in the distal muscular conduit arteries. 11-14 Thus, it is hypothesized that the AIx of the carotid artery includes information related to intracranial vascular changes. Based on this hypothesis, we investigated the association between WML and AIx in order to elucidate the effect of pulse wave reflection as an early marker of arterial stiffening on the brain.

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Increased brachial–ankle pulse wave velocity is independently associated with risk of cerebral ischemic small vessel disease in elderly hypertensive patients

Cited by 46 publications

References 38 publications

Association between arterial stiffness and cerebrovascular resistance in the elderly

Association between arterial stiffness and cerebrovascular resistance in the elderly

Association between brachial–ankle pulse wave velocity and 3-year mortality in community-dwelling older adults

Augmentation index is related to white matter lesions

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