Mechanisms underlying elevated SBP differ with adiposity in young adults

Middlemiss, Jessica; Miles, K.; McDonnell, Barry J.; Yasmin, Yasmin; Mäki-Petäjä, Kaisa; Cockcroft, John R.; Wilkinson, Ian B.; McEniery, Carmel M.

doi:10.1097/hjh.0000000000000798

Cited by 35 publications

(16 citation statements)

References 41 publications

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“…49 Cardiac output is also elevated in overweight or obese subjects, and weight gain in childhood is associated with both an increase in stroke volume and sBp. 50 However, more recently, we have shown that in overweight individuals, cardiac output is elevated irrespective of the level of Bp, and it is actually the level of peripheral vascular resistance that distinguishes between individuals with elevated versus normal brachial sBp 51 ( Figure 2). these data suggest that the mechanisms underlying elevated sBp in young adults depend on body size, which may hold important, additional implications for treating isH in young people.…”

Section: Mechanisms Of Ish In Young Peoplementioning

confidence: 96%

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Isolated Systolic Hypertension in Young People Is Not Spurious and Should Be Treated

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Section: Mechanisms Of Ish In Young Peoplementioning

confidence: 96%

“…Algunas personas obesas mantienen la PAS baja a través de una resistencia vascular periférica notablemente menor. Datos provenientes de Middlemiss et al 51 Figura 3. Esquema descriptivo de la serie de adaptaciones hemodinámicas propuesta mediante la cual el gasto cardíaco elevado deriva en hipertensión sostenida.…”

Section: Mecanismos De La Hsa En Personas Jóvenesunclassified

Isolated Systolic Hypertension in Young People Is Not Spurious and Should Be Treated

et al. 2016

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“…13 In the same group of patients, the influence of cardiac output on SBP was more important in normal-weight adults, as compared with overweight patients, where peripheral resistance was more important. 14 In the elderly ARIC population reported by Tanaka and colleagues, 4 the increase in ET contributed most to the model predicting PP, outnumbering aortic stiffness and wave reflections. This effect is most pronounced in the oldest age group (≥80 years) and is somewhat surprising, challenging the traditional view that the increase of PP with aging is mostly related to a combined effect of unfavorable alterations of the arterial system.…”

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“…In young relatively healthy untreated individuals, sex, stroke volume, wave reflections (AIx), and aortic stiffness (cfPWV) explained 37%, 6%, 2%, and 2% of the variability of brachial PP, respectively . In the same group of patients, the influence of cardiac output on SBP was more important in normal‐weight adults, as compared with overweight patients, where peripheral resistance was more important . In the elderly ARIC population reported by Tanaka and colleagues, the increase in ET contributed most to the model predicting PP, outnumbering aortic stiffness and wave reflections.…”

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Which Mechanisms Determine Blood Pressure?

Weber

Wassertheurer

2016

J of Clinical Hypertension

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2Blood pressure (BP) can be conceptually viewed as oscillations between two extremes (systolic blood pressure [SBP] and diastolic blood pressure [DBP]), the axis being mean BP (MBP) and the amplitude being pulse pressure (PP). MBP becomes the so-called steady component of BP, assuming laminar flow in arteries (which occurs under physiological conditions only in the microcirculation). MBP has been traditionally used to describe hemodynamics and the relationship between cardiac work and peripheral resistance. Pulsations around MBP, generated by the pulsatile pump (the heart), lead to PP and SBP. The determinants of PP are more complex, and include aortic properties in early systole (characteristic impedance), the timing and magnitude of wave reflections from peripheral sites, aortic stiffness, and cardiac function. Brachial SBP increases by 25 mm Hg (22%) between ages 20 and 80 years, whereas central SBP and PP increase by 40% and >100%, respectively. 1 In the literature, there is controversy about the relative contribution of aortic impedance/antegrade wave 2 vs wave reflections 1,3 to the age-associated increase in PP.Against this background, in this issue of the Journal, Tanaka and colleagues 4 report correlates of steady and pulsatile BP components in 3762 elderly adults (70-89 years) participating in the Atherosclerosis Risk in Communities (ARIC) study. Brachial BP was measured with an oscillometric automated sphygmomanometer. MBP was calculated with the formula MBP = DBP + 1/3 PP. Central (carotid) SBP was derived from carotid tonometry, calibrated with brachial BP. Participants with arrhythmias and major cardiovascular disease were excluded. After adjustments for age, sex, race, body mass index, diabetes, and smoking status, hemodynamic determinants of brachial SBP were aortic stiffness (carotid-femoral pulse wave velocity [cfPWV], measured with tonometry), stroke volume (measured with two-dimensional echocardiography), arterial wave reflections (augmentation index [AIx], from carotid pressure waveforms), left ventricular ejection time (ET), and upstroke time, with cfPWV, AIx, and ET having the strongest influence, explaining 13.4%, 6.7%, and 4% of the variability, respectively. For central SBP, findings were similar, with cfPWV, AIx, and ET explaining 8.9%, 4.5%, and 7.2% of the variability, respectively. Determinants of PP were roughly the same, with the largest contribution by ET, followed by cfPWV. In the oldest age tertile (≥80 years), the influence of ET increased both for SBP and PP. Determinants of MBP were cardiac index and peripheral resistance, explaining 0.3% and 15.1% of the variance, respectively.The authors have to be applauded for this study. Its major strength is the large sample size and the careful acquisition of tonometric and echocardiographic data. Shortcomings include the cross-sectional design, the performance of BP measurements/tonometry and echocardiography on separate days, and the use of the DBP + 1/3 PP rule to estimate MBP. The latter is not accurate, when compared with invasi...

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“…Prev i ous studies have extensively investigated the predictive value of different adiposity measures for blood pressure (BP), hypertension, and other cardiovascular diseases [10][11][12][13][14][15]. BMI is widely used to estimate the prevalence of obesity within a population.…”

Section: Introductionmentioning

confidence: 99%

Gender-specific associations of anthropometric measures of adiposity with blood pressure and hypertension in young Chinese Medical College Students

Sah¹,

Zhang†²,

Li³

et al. 2020

J Cardiol Cardiovasc Med

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Purpose:There are uncertainties about whether general or central obesity is the more important determinant for blood pressure and hypertension in young Chinese. We aim to investigate the association between adiposity measures and blood pressure and hypertension in young medical students. Methods:A total of 380 medical students were recruited from the 2012 batch in the Clinical College of Dali University. Anthropometric measures and offi ce blood pressure were measured. Blood pressure status was defi ned by Chinese hypertension guidelines and ACC/AHA 2017 hypertension guidelines, respectively. We examined the associations of adiposity measures (body weight, body mass index [BMI], waist circumference, hip circumference, waist-to-hip ratio [WHR], waist-to-height ratio [WHtR], ponderal index [PI], body adiposity index (BAI) and conicity index [CI]) with blood pressure and hypertension by sex. Results:In 380 subjects (women 66.6%, mean age 21.5 years), the prevalence of obesity (BMI ≥ 28 kg/m2) was 2.1%, and the prevalence of hypertension was 2.6% (≥ 140/90 mmHg) and 24.5% (≥ 130/80 mmHg), respectively. In correlation analyses and multivariable-adjusted linear regression analyses, most adiposity measures of central obesity were signifi cantly associated with blood pressure in men, while in women, either adiposity measures of central or general obesity were associated with blood pressure. The predictive power of adiposity measures for hypertension was generally low in men. However, adiposity measures of either general obesity or central obesity were predictive for hypertension defi ned by Chinese hypertension guidelines in women. Conclusion:There are gender-specifi c associations of central and general obesity with blood pressure and hypertension in young Chinese medical students.Gender-specifi c associations of anthropometric measures of adiposity with blood pressure and hypertension in young Chinese Medical College

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Mechanisms underlying elevated SBP differ with adiposity in young adults

Cited by 35 publications

References 41 publications

Isolated Systolic Hypertension in Young People Is Not Spurious and Should Be Treated

Isolated Systolic Hypertension in Young People Is Not Spurious and Should Be Treated

Which Mechanisms Determine Blood Pressure?

Gender-specific associations of anthropometric measures of adiposity with blood pressure and hypertension in young Chinese Medical College Students

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