Pulse pressure amplification and its determinants

Pichler, Gernot; Martínez, Fernando; Vicente, António; Solaz, E.; Calaforra, Oscar; Redón, Josep

doi:10.3109/08037051.2015.1090713

Cited by 28 publications

(15 citation statements)

References 34 publications

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“…The difference between the ambulatory brachial SBP and CSBP was about 10 mmHg and the resultant mean APPA appears to be consistent with findings of a previous study done for single measurements [31]. However, the change in APPA was negligible with 20-week treatment, even with the changes in BP and AcfPWV.…”

Section: Discussionsupporting

confidence: 90%

The association of smoothness index of central blood pressure with ambulatory carotid femoral pulse wave velocity after 20-week treatment with losartan in combination with amlodipine versus hydrochlorothiazide

Shin

Lee

Chung

et al. 2019

Journal of Hypertension

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The aim of this study was to identify associations between the smoothness index of central SBP (CSBP) and changes of ambulatory carotid femoral pulse wave velocity in response to 20-week treatments with losartan and amlodipine vs. losartan and hydrochlorthiazide combinations.Methods: For 142 (losartan and hydrochlorthiazide: 72, losartan and hydrochlorthiazide: 70) patients examined with ambulatory central blood pressure (BP) monitoring device, we calculated smoothness indices and trough-topeak ratios of brachial SBP, CSBP, ambulatory pulse pressure amplification (APPA), ambulatory augmentation index at heart rate 75 beats per minute (AAIx75) and ambulatory carotid femoral pulse wave velocity (AcfPWV).Results: Mean age was 58.9 AE 12.3 years, and women accounted for 25.9%. Changes in office SBP/DBP were not different between groups (losartan and hydrochlorthiazide: À15.2 AE 15.0/À7.8 AE 8.0 vs. losartan and amlodipine: À14.9 AE 13.7/À9.2 AE 7.5 mmHg). Reduction of 24-h CSBP was not significantly different (losartan and hydrochlorthiazide: 6.4 AE 1.1 vs. losartan and amlodipine: 9.2 AE 1.1 mmHg, P ¼ 0.074). Reduction in nocturnal AcfPWV was greater in the losartan and amlodipine group (losartan and hydrochlorthiazide: 0.09 AE 0.05 vs. losartan and amlodipine: 0.26 AE 0.05 m/s, P ¼ 0.0216). Intraindividual SIs for CSBP were higher in the losartan and amlodipine group (0.40 AE 0.57 vs. 0.65 AE 0.74, P ¼ 0.022). In multivariable regression analysis, smoothness index of CSBP was independently associated with the losartan and amlodipine group. In model additionally considering the changes in arterial stiffness, decrease in AcfPWV instead of the treatment group was independently associated with smoothness indices. In mediation analysis, smoothness index was fully mediated by reduction in night-time AcfPWV. Conclusion:Losartan and amlodipine combination was superior to the losartan and hydrochlorthiazide combination in terms of achieving higher smoothness index for CSBP after 20-week treatments. The effect of losartan and amlodipine on smoothness index was fully mediated by reduction of night-time AcfPWV.

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Section: Discussionsupporting

confidence: 90%

The association of smoothness index of central blood pressure with ambulatory carotid femoral pulse wave velocity after 20-week treatment with losartan in combination with amlodipine versus hydrochlorothiazide

Shin

Lee

Chung

et al. 2019

Journal of Hypertension

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“…Peripheral PP amplification, PP, is mainly determined by the rate of change of Q in with time, t, in late systole and the radius, r, and length, l, of the brachial artery, as shown in this study. et al, 2004), mass index (Pichler et al, 2016), pulse transit time (Gao et al, 2016;Natarajan et al, 2017), and wave reflection coefficient (Gao et al, 2016), and lower age (Wilkinson et al, 2001;Herbert et al, 2014) and pulse wave velocity (Hashimoto and Ito, 2010;Pierce et al, 2012), and is significantly influenced by cardiovascular risk factors, such as hypertension and obesity (Herbert et al, 2014). Experimental and computational models have been used to study the effect on PP of cardiovascular properties (Karamanoglu et al, 1995;Figueroa and Humphrey, 2014;Mynard and Smolich, 2015;Gaddum et al, 2017) and age (Charlton et al, 2019), showing that PP raises with increasing ventricular inotropy (contractile state of the ventricle), tapering, peripheral load and vessel length; and decreasing wall thickness and age.…”

Section: Introductionmentioning

confidence: 99%

Estimating Central Pulse Pressure From Blood Flow by Identifying the Main Physical Determinants of Pulse Pressure Amplification

et al. 2021

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Several studies suggest that central (aortic) blood pressure (cBP) is a better marker of cardiovascular disease risk than peripheral blood pressure (pBP). The morphology of the pBP wave, usually assessed non-invasively in the arm, differs significantly from the cBP wave, whose direct measurement is highly invasive. In particular, pulse pressure, PP (the amplitude of the pressure wave), increases from central to peripheral arteries, leading to the so-called pulse pressure amplification (ΔPP). The main purpose of this study was to develop a methodology for estimating central PP (cPP) from non-invasive measurements of aortic flow and peripheral PP. Our novel approach is based on a comprehensive understanding of the main cardiovascular properties that determine ΔPP along the aortic-brachial arterial path, namely brachial flow wave morphology in late systole, and vessel radius and distance along this arterial path. This understanding was achieved by using a blood flow model which allows for workable analytical solutions in the frequency domain that can be decoupled and simplified for each arterial segment. Results show the ability of our methodology to (i) capture changes in cPP and ΔPP produced by variations in cardiovascular properties and (ii) estimate cPP with mean differences smaller than 3.3 ± 2.8 mmHg on in silico data for different age groups (25–75 years old) and 5.1 ± 6.9 mmHg on in vivo data for normotensive and hypertensive subjects. Our approach could improve cardiovascular function assessment in clinical cohorts for which aortic flow wave data is available.

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“…PP amplification depends on the pulse wave propagation velocity, which itself is positively but nonlinearly related to BP. Moreover, gender, age, and body composition have a significant impact on PP amplification . However, echocardiography‐derived aortic stiffness data correlate well with those obtained by invasive methods …”

Section: Limitations Of the Studymentioning

confidence: 66%

“…Moreover, gender, age, and body composition have a significant impact on PP amplification. 17 However, echocardiography-derived aortic stiffness data correlate well with those obtained by invasive methods. 8 Controls had higher BP values and PP than CA patients, suggesting better controlled BP in CA patients.…”

Section: Correlationsmentioning

confidence: 76%

Cardiac amyloidosis is associated with increased aortic stiffness

Nemes

Földeák

Domsik

et al. 2017

J of Clinical Ultrasound

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Pulse pressure amplification and its determinants

Abstract: PP amplification is related to BP: the higher the BP, the lower the PP amplification. Gender, age and body composition have a significant impact on PP amplification.

Cited by 28 publications

References 34 publications

The association of smoothness index of central blood pressure with ambulatory carotid femoral pulse wave velocity after 20-week treatment with losartan in combination with amlodipine versus hydrochlorothiazide

The association of smoothness index of central blood pressure with ambulatory carotid femoral pulse wave velocity after 20-week treatment with losartan in combination with amlodipine versus hydrochlorothiazide

Estimating Central Pulse Pressure From Blood Flow by Identifying the Main Physical Determinants of Pulse Pressure Amplification

Cardiac amyloidosis is associated with increased aortic stiffness

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