Responses of the ambulatory arterial stiffness index and other measures of arterial function to antihypertensive drugs

Jin, Yu; Thijs, Lutgarde; Richart, Tom; Li, Yan; Dolan, Eamon; Wang, Ji‐Guang; Protogerou, Athanase D.; O’Brien, Eoin; Staessen, Jan A.; Safar, Michel E.

doi:10.1038/hr.2010.256

Cited by 21 publications

(16 citation statements)

References 37 publications

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“…Recent data show that antihypertensive treatment, which is well-known to improve prognosis in hypertensive patients, does not modify ASDPRI. 24 In contrast, arterial stiffness, an important predictor of events in hypertensive patients, 20,21 improved significantly with antihypertensive drugs in that study. 24 Taken together, although no direct pathophysiological explanation exists, these data imply that ASDPRI may not be an ideal risk predictor in hypertensive patients.…”

Section: Discussionmentioning

confidence: 74%

Ambulatory Systolic–Diastolic Pressure Regression Index as a Predictor of Clinical Events

Aznaouridis

Vlachopoulos²,

Protogerou³

et al. 2012

Stroke

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Background and Purpose-Blood pressure variables derived by ambulatory monitoring are important prognostic markers in hypertensive patients. Recent studies showed that ambulatory systolic-diastolic pressure regression index (ASDPRI), also known as ambulatory arterial stiffness index, may correlate with cardiovascular (CV) outcomes. Methods-We explored the predictive value of ASDPRI for future CV events, stroke, and all-cause mortality by meta-analyses of 7 longitudinal studies that had evaluated ASDPRI and had followed 20 505 subjects for a mean follow-up of 7.8 years. Results-The pooled relative risk of total CV events (including CV mortality), stroke, and all-cause mortality was 1.51 (95% CI, 1.18 -1.93; Pϭ0.001; 5 studies), 2.01 (95% CI, 1.60 -2.52; PϽ0.001; 4 studies), and 1.25 (95% CI, 1.10 -1.41; Pϭ0.001; 4 studies), respectively, for high ASDPRI versus low ASDPRI subjects. An increase of ASDPRI by 1 standard deviation was associated with an age-adjusted, sex-adjusted, and risk factor-adjusted relative risk increase of total CV events and stroke by 15% and 30%, respectively. ASDPRI predicted stroke better than total CV events, predicted stroke better in normotensive subjects than in hypertensive patients, and also predicted total CV events better in females than in males. There was not significant publication bias. Conclusions-ASDPRI is an ambulatory blood pressure-derived biomarker that strongly predicts future CV events, stroke, and all-cause mortality. These findings suggest that this index may be useful for risk stratification purposes. (Stroke. 2012;43:733-739.)

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Section: Discussionmentioning

confidence: 74%

Ambulatory Systolic–Diastolic Pressure Regression Index as a Predictor of Clinical Events

Aznaouridis

Vlachopoulos²,

Protogerou³

et al. 2012

Stroke

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“…In contrast, the perindopril plus indapamide group failed to show a favorable effect on arterial stiffness rather than atenolol: for both aortic PWV and AASI, the between-group differences in the treatment-induced changes were not statistically significant. 8 Despite the low power of this analysis (to detect a significant two-tailed difference of 0.5 ± 1.2 m s À1 in aortic PWV with 95% power, the required number of subjects was estimated to be 300), the results are in keeping with those obtained in the entire trial cohort, where the two agents lowered PWV equally. 9 Although it is conceivable that reduction of arterial stiffness may become a major primary goal of treatment, only few other clinical trials specifically investigated the effects of different BP-lowering drugs on arterial wall.…”

Section: P Revention Of Cardiovascular (Cv) Diseasementioning

confidence: 73%

mentioning

confidence: 92%

More than a REASON to use arterial stiffness as risk marker and therapeutic target in hypertension

Angeli

Reboldi

Verdecchia³

2011

Hypertens Res

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P revention of cardiovascular (CV) diseaseis largely based on a strict control of traditional risk factors, such as hypertension, smoking, dyslipidemia and diabetes. These factors are detrimental to arterial integrity by way of altering its structure, properties and function. 1 In particular, changes in the stiffness of the large arteries may largely account for the changes in systolic blood pressure (BP), diastolic BP and pulse pressure (PP) that occur from 50 years of age onward. Hence, there is a strong rationale for understanding the mechanisms of arterial stiffness to improve CV risk stratification and to better treat hypertension.During the past few years, arterial stiffness has been widely investigated. Several noninvasive methods to assess arterial stiffness have become available. 2 Although office and ambulatory PP are the simplest surrogate measures of arterial stiffness, other quantitative methods and indices have been developed, namely: pulse transit time and pressure pulse waveform (aortic pulse wave velocity (PWV), central BP and augmentation index), local mechanical properties (arterial compliance and distensibility) and the correlation between ambulatory diastolic and systolic BP (ambulatory arterial stiffness index (AASI)). 2 Most of them showed a significant association with poor CV outcome over and above classical CV risk factors. 2-6 However, consistent data support the measurement of PWV as the most simple, non-invasive, robust and reproducible method to determine arterial stiffness. 2,7 A recent systematic review and meta-analysis 7 of 17 longitudinal studies evaluated the predictive value of aortic PWV for future CV events and all-cause mortality. The pooled relative risk of clinical events increased in a stepwise, linear-like fashion from the first to the third tertile of aortic PWV. The pooled relative risk of total CV events, CV mortality and all-cause mortality were 2.26 (95% confidence interval (CI): 1.89-2.70), 2.02 (95% CI: 1.68-2.42) and 1.90 (95% CI: 1.61-2.24), respectively, for high vs. low aortic PWV subjects. In particular, each increase in aortic PWV by 1 m s À1 corresponded to an age-, sex-and risk factor-adjusted risk increase of 14, 15 and 15% in total CV events, CV mortality and all-cause mortality, respectively.In this exciting and challenging area, the ancillary analysis of the REASON (Preterax in Regression of Arterial Stiffness in a Controlled Double-Blind Study) trial reported in the current issue of this journal 8 focused on two key aspects regarding estimate and treatment of arterial stiffness. In particular, this study compared the influence of a pharmacological intervention on PP, aortic PWV and AASI.This new analysis included patients enrolled in 32 of the 52 REASON (Preterax in Regression of Arterial Stiffness in a Controlled Double-Blind Study) centers, which opted to perform ambulatory blood pressure monitoring. Arterial stiffness was estimated using ambulatory PP, AASI and aortic PWV in 201 out of 471 patients originally enrolled. Interestingly, baseline ao...

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“…Lower heart rate is associated with reduced HRV. The lesser decrease in systolic blood pressure on the old-drug combination (18) is probably the consequence of the beta–blocker-induced reduction of heart rate, which is responsible for a later return of the reflected waves in the central arteries during systole and more pronounced systolic augmentation (24,25). Furthermore, under treatment with inhibitors of the renin system, but not under treatment with beta–blockers, the structural arteriolar abnormalities associated with hypertension regress.…”

Section: Discussionmentioning

confidence: 99%

Heart rate variability on antihypertensive drugs in black patients living in sub-Saharan Africa

et al. 2013

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BackgroundCompared with Caucasians, African Americans have lower heart rate variability (HRV) in the high-frequency domain, but there are no studies in blacks born and living in Africa.MethodsIn the Newer versus Older Antihypertensive agents in African Hypertensive patients trial (NCT01030458), patients (30–69 years) with uncomplicated hypertension (140–179/90–109 mmHg) were randomized to single-pill combinations of bisoprolol/hydrochlorothiazide (R) or amlodipine/valsartan (E). 72 R and 84 E patients underwent 5-min ECG recordings at randomization and 8, 16 and 24 weeks. HRV was determined by fast Fourier transform and autoregressive modelling.ResultsHeart rate decreased by 9.5 beats/min in R patients with no change in E patients (− 2.2 beats/min). R patients had reduced total (− 0.13 ms²; p = 0.0038) and low-frequency power (− 3.6 nu; p = 0.057), higher high-frequency (+ 3.3 nu; p = 0.050) and a reduced low- to high-frequency ratio (− 0.08; p = 0.040). With adjustment for heart rate, these differences disappeared, except for the reduced low-frequency power in the R group (− 4.67 nu; p = 0.02). Analyses confined to 39 R and 47 E patients with HRV measurements at all visits or based on autoregressive modelling were confirmatory.ConclusionIn native black African patients, antihypertensive drugs modulate HRV, an index of autonomous nervous tone. However, these effects were mediated by changes in heart rate except for low-frequency variability, which was reduced on beta blockade independent of heart rate.

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Responses of the ambulatory arterial stiffness index and other measures of arterial function to antihypertensive drugs

Cited by 21 publications

References 37 publications

Ambulatory Systolic–Diastolic Pressure Regression Index as a Predictor of Clinical Events

Ambulatory Systolic–Diastolic Pressure Regression Index as a Predictor of Clinical Events

More than a REASON to use arterial stiffness as risk marker and therapeutic target in hypertension

Heart rate variability on antihypertensive drugs in black patients living in sub-Saharan Africa

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