Mortality and Cardiovascular Events Are Best Predicted by Low Central/Peripheral Pulse Pressure Amplification But Not by High Blood Pressure Levels in Elderly Nursing Home Subjects

Bénétos, Athanase; Gautier, Sylvie; Labat, Carlos; Salvi, Paolo; Valbusa, Filippo; Marino, Francesca; Toulza, Olivier; Agnoletti, Davide; Zamboni, Mauro; Dubail, Delphine; Manckoundia, Patrick; Rolland, Yves; Hanon, Olivier; Perret‐Guillaume, Christine; Lacolley, Patrick; Safar, Michel E.; Guillemin, Françis

doi:10.1016/j.jacc.2012.04.055

Cited by 163 publications

(109 citation statements)

References 27 publications

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“…22 To our knowledge, this the first study to prospectively indicate an association between OHyperT and strong cardiovascular outcome in a old frail institutionalized population. In a previous study involving this population, we showed higher mortality rates in individuals with lower SBP levels, 23 especially in those receiving >1 antihypertensive medications. 24 However, as shown in Table 3 in the present analysis, the observed overmortality in the OHyperT group persisted even after adjustment for sitting SBP levels.…”

Section: Discussionmentioning

confidence: 46%

Evidence for a Prognostic Role of Orthostatic Hypertension on Survival in a Very Old Institutionalized Population

et al. 2016

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Abstract-In old individuals, regulation of blood pressure during postural changes is impaired. Several studies have assessed the clinical impact of orthostatic hypotension (OHypoT) during the aging process. By contrast, the prevalence and prognostic role of the increase in blood pressure in upright position (orthostatic hypertension, OHyperT) in old adults remain unknown. We investigated the association of OHyperT with cardiovascular morbidity and mortality in a population of old institutionalized subjects. A 2-year follow-up longitudinal study was conducted on 972 subjects ( In conclusion, in a old frail population, the increase in systolic blood pressure during upright position occurs frequently and is associated with higher cardiovascular morbidity and mortality independently of sitting blood pressure levels and major comorbidities. Health professional should take into account not only the decrease but also the increase in blood pressure when standing up. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00901355.

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Section: Discussionmentioning

confidence: 46%

Evidence for a Prognostic Role of Orthostatic Hypertension on Survival in a Very Old Institutionalized Population

et al. 2016

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“…by guest on May 9, 2018 http://circimaging.ahajournals.org/ Downloaded from Blood Pressure and Arterial Load After TAVR afterload associated with an elevated SBP, which would contribute to worse post-TAVR heart failure and survival. Instead, we found that lower, not higher, SBP was associated with worse heart failure-related quality of life and higher cardiovascular and all-cause mortality, and lower SBP was associated with worse LV function at 1 year.…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure and Arterial Load After Transcatheter Aortic Valve Replacement for Aortic Stenosis

Lindman

Otto

Douglas

et al. 2017

Circ: Cardiovascular Imaging

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A ortic stenosis (AS) has been conceptualized as a mechanical problem (valve obstruction) requiring a mechanical solution (valve replacement).1 It is often considered to be a disease of fixed left ventricular (LV) afterload because of an obstructed valve, with the theoretical concern that a decrease in vascular resistance due to vasodilator therapy could cause severe hypotension without the ability to augment stroke volume due to fixed obstruction at the valve level.2 Several recent studies show, however, that LV afterload in patients with AS functions like a series circuit, with important contributions from both the valve and vasculature. [3][4][5]

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“…The following points are noteworthy: (1) that nocturnal brachial BP has been shown to be the strongest BP parameter as a predictor of clinical outcomes, 3,9 (2) that data are emerging to suggest that central aortic pressure may be a better predictor of target-organ damage and clinical outcomes than its brachial counterpart, [5][6][7] and (3) that data are emerging, implicating an association between reduced PPA and risk for cardiovascular events. 22,26,27 Thus, it is conceivable that nocturnal CASP or CAPP could represent the most important hemodynamic determinant of BP-related cardiovascular disease risk.…”

Section: Discussionmentioning

confidence: 99%

Novel Description of the 24-Hour Circadian Rhythms of Brachial Versus Central Aortic Blood Pressure and the Impact of Blood Pressure Treatment in a Randomized Controlled Clinical Trial

et al. 2013

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Abstract-Elevated brachial blood pressure (BP) is associated with increased cardiovascular risk and predicts morbidity and mortality in humans. Recently, 24-hour ambulatory BP monitoring and assessment of central aortic BP have been introduced to improve BP phenotyping. The Ambulatory Central Aortic Pressure (AmCAP) study combines these approaches and describes, for the first time, the diurnal patterns of simultaneously measured 24-hour ambulatory brachial and central pressures in a prespecified substudy embedded within a clinical trial of BP lowering in patients with hypertension. Twenty-four-hour ambulatory brachial and central pressure measurements were acquired using a tonometer mounted into the articulating strap of a wristwatch-like device (BPro) in 171 participants with hypertension recruited into the ASSERTIVE (AliSkiren Study of profound antihypERtensive efficacy in hyperTensIVE patients) trial. Participants were randomly assigned to BP lowering with either aliskiren 300 mg QD or telmisartan 80 mg QD for 12 weeks. Ambulatory brachial and central BP was measured in all participants both at baseline and at study end. Brachial and central BP both demonstrated typical diurnal patterns with lower pressures at night. However, night time was associated with smaller reductions in central relative to brachial pressure and decreased pulse pressure amplification (P<0.0001 for both). These effects were not modulated after BP lowering and were maintained after adjustment for day and night-time BP and heart rate (P=0.02

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Mortality and Cardiovascular Events Are Best Predicted by Low Central/Peripheral Pulse Pressure Amplification But Not by High Blood Pressure Levels in Elderly Nursing Home Subjects

Cited by 163 publications

References 27 publications

Evidence for a Prognostic Role of Orthostatic Hypertension on Survival in a Very Old Institutionalized Population

Evidence for a Prognostic Role of Orthostatic Hypertension on Survival in a Very Old Institutionalized Population

Blood Pressure and Arterial Load After Transcatheter Aortic Valve Replacement for Aortic Stenosis

Novel Description of the 24-Hour Circadian Rhythms of Brachial Versus Central Aortic Blood Pressure and the Impact of Blood Pressure Treatment in a Randomized Controlled Clinical Trial

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