Central pulse pressure but not brachial blood pressure is the predominant factor affecting aortic arterial stiffness / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the differences in central hemodynamic indices between hypertensive and normotensive subjects and identify the blood pressure index that the most strongly correlate with arterial stiffness and vascular damage markers.</p><p><b>METHODS</b>A cohort of 820 hypertensive patients and 820 normotensive individuals matched for age and gender were enrolled in this study. We measured carotid-femoral and carotid-radial pulse wave velocity (PWV), aortic augmentation index (AIx) and central blood pressures using pulse wave analysis and applanation tonometry. Plasma homocysteine (HCY), high-sensitivity C-reactive protein (hsCRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were also tested in these subjects.</p><p><b>RESULTS</b>In both hypertensive and normotensive subjects, the central systolic blood pressure (SBP) and pulse pressure (PP) were significantly lower than brachial SBP and PP; this PP amplification was significantly lower in the normotensives (9.85∓6.55 mmHg) than in the hypertensives (12.64∓6.69 mmHg), but the amplification ratios were comparable between the two groups. Blood pressure and age were closely related with aortic arterial stiffness. Compared with normotensive subjects, hypertensive subjects had higher carotid-femoral PWV and AIx, and showed significantly lowered PP amplification ratio with age. Central PP was more strongly related to arterial stiffness and vascular damage markers than the other pressure indices. Multivariate analyses revealed that carotid-femoral PWV and aortic AIx were strongly influenced by central PP but not by the mean blood pressure or brachial PP.</p><p><b>CONCLUSION</b>The central PP is a more direct indicator of central arterial stiffness and a better marker of vascular aging than other blood pressure variables. These findings support the use of central blood pressure as a treatment target in future trials.</p>

Relationship between serum N-terminal pro-brain natriuretic peptide and metabolic syndrome: a cross-sectional study / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and metabolic syndrome (MS).</p><p><b>METHODS</b>A total of 1323 Beijing residents (559 male) were investigated. MS was defined by the modified 2004 Chinese Diabetes Society criteria and 439 cases were diagnosed as MS according to this criteria. Multivariate logistic regression analysis was used to estimate the odds ratios (OR) of MS. Multiple linear regression analysis was performed to analyze the association between NT-proBNP and characteristic variables.</p><p><b>RESULTS</b>NT-proBNP was significantly lower in MS group compared to non-MS group [32.51 (29.17, 36.14) ng/L vs.38.55 (35.73, 41.50) ng/L, P = 0.012] after adjusted for age and gender. NT-proBNP level decreased with the presence of MS components (from 0 to 4 or 5) (45.92, 37.24, 35.40, 31.55 and 33.65 ng/L respectively, P = 0.043 for linear trend). Among the components, groups with larger waist circumference, higher fasting glucose and triglycerides were associated with lower NT-proBNP level. After adjustment for potential confounders, compared with the lowest NT-proBNP quartile, the adjusted odds ratio of the second, third and fourth quartile for having MS were 0.782 (95%CI: 0.544 - 1.122, P > 0.05), 0.709 (95%CI: 0.489 - 1.028, P > 0.05), 0.604 (95%CI: 0.405 - 0.900, P < 0.05), respectively. Multiple linear regression analysis showed that female gender (β = 0.248, P < 0.001), age (β = 0.167, P < 0.001), systolic blood pressure (β = 0.154, P < 0.001) were positively related to NT-proBNP level while waist circumference (β = -0.082, P = 0.004), diastolic blood pressure (β = -0.085, P = 0.015), triglycerides (β = -0.101, P < 0.001), total cholesterol (β = -0.078, P = 0.004), eGFR (β = -0.150, P < 0.001) were negatively correlated to NT-proBNP level.</p><p><b>CONCLUSION</b>In this cohort, higher serum NT-proBNP concentration is associated with lower incidence of metabolic syndrome.</p>

Association between peroxisome proliferator-activated receptor gene single nucleotide polymorphisms and arterial stiffness in adult Chinese population / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the association between single nucleotide polymorphisms (SNPs) of peroxisome proliferator-activated receptor(PPAR) and arterial stiffness in adult Chinese population (> 50 years).</p><p><b>METHODS</b>Cardiovascular risk factors from participants of Beijing epidemiological investigation were analyzed. Carotid-femoral pulse wave velocity (cfPWV) was measured by Complior system. The subjects were divided into normal arterial stiffness group (cfPWV < 12 m/s, n = 844) and increased arterial stiffness group (cfPWV > 12 m/s, n = 530). Three valid SNPs including rs1053049, rs1800234 and rs8192678 in the PPAR and PPARγC1a gene were genotyped by TaqMan allelic discrimination assays.</p><p><b>RESULTS</b>The age [(67.9 ± 8.8) years vs. (58.0 ± 9.7) years], prevalence of hypertension [71.1% (377/530) vs. 30.5% (257/844)] and diabetes mellitus [21.7% (115/530) vs. 11.0% (93/844)] were all significantly higher in increased arterial stiffness group than in normal group (all P < 0.05). The frequencies of CC, CT and TT type of rs8192678 [CC: 32.2% (272/844) vs. 30.8% (163/530), CT: 48.7% (411/844) vs. 52.1% (276/530), TT: 19.1% (161/844) vs. 17.2% (91/530)], rs1053049 [CC: 55.7% (470/844) vs. 51.3% (272/530), CT: 36.7% (310/844) vs. 39.1% (207/530), TT: 7.6% (64/844) vs. 9.6% (51/530)] and rs1800234 [CC: 88.4% (746/844) vs. 90.4% (479/530), CT + TT: 11.6% (98/844) vs. 9.6% (51/530)] were similar between the two groups. There was also no association between haplotypes and the increased arterial stiffness in this cohort.</p><p><b>CONCLUSIONS</b>In this community-based population, we found that aging, hypertension and diabetes mellitus were associated but SNPs of PPAR and PPARγC1a were not associated with arterial stiffness.</p>

Relationship between serum homocysteine and metabolic syndrome: a cross-sectional study / 中华流行病学杂志

Objective To explore the relationship between serum homocysteine and metabolic syndrome (MS).Methods A cohort with 1680 people involved in a community-based population in Beijing was investigated.Metabolic syndrome was defined by NCEP-ATP Ⅲ criteria.Multivariate logistic regression analysis was used to estimate the odds ratios (OR) of MS.Multiple linear regression analysis was performed to analyze the association between Hcy and characteristic variables.Results Homocysteine was higher in MS population compared to those without MS ( 17.99 μmol/L vs.17.18 μmol/L,P=0.007) after adjusted for age and sex.Levels of homocysteine increased with the presence of MS components (from 0 to 4 or 5) (16.71,16.94,17.62,18.20,17.82 μmol/L respectively,P=0.044 for linear trend).Among the components,groups with larger waist circumference,higher blood pressure and triglycerides showed significantly higher Hcy level than their counterparts.Results from multiple logistic regression analysis revealed that the highest Hcy quartile (Hcy Ⅳ ) was significantly associated with MS.Compared with the lowest Hcy quartile (Hcy Ⅰ ),the adjusted odds ratio of having MS in HcyⅣ was 1.379(1.005-1.892) after adjusting for age,sex,levels on creatinine/estimated glomerular filtration rate (eGFR)/low-density lipoprotein cholesterol (LDL-C) and uric acid,smoking,alcohol intake and exercise.In the partial correlation analyses,Hcy was positively associated with body mass index (BMI),waist circumsternece,blood pressure,LDL-C,triglycerides (TG),uric acid,serum creatinine,eGFR,but inversely associated with high-density lipoprotein cholesterol (HDL-C) and independently with age and sex.In multiple linear regression analysis,age,male sex,BMI,LDL-C,creatinine and uric acid were found to be independently associated with Hcy level.Conclusion There was an association noticed between the MS using NCEP-ATP Ⅲ criteria and the highest quartile level of Hcy in this study.Factors as age and being male,the levels of BMI,LDL-C,creatinine and uric acid were independently associated with the Hcy level.

Associations of plasma homocysteine and high-sensitivity C-reactive protein levels with arterial stiffness in Chinese population: a community-based study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Arterial stiffness increases with age and is also associated with traditional cardiovascular risk factors. Little is known about the relations of homocysteine and high-sensitivity C-reactive protein (hs-CRP) to arterial stiffness in the Chinese community. The aim of the present study was to investigate the association of plasma homocysteine and hs-CRP levels with arterial stiffness in a community-based cohort.</p><p><b>METHODS</b>We related levels of homocysteine and hs-CRP to four measures of arterial stiffness (carotid-femoral pulse wave velocity (PWV), carotid-radial PWV, carotid-ankle PWV and heart rate corrected augmentation index) in 1680 participants from two communities of Beijing, China. Arterial stiffness was measured within two days of the time of biomarker measurement.</p><p><b>RESULTS</b>In univariate analysis, homocysteine was positively associated with the carotid-femoral PWV (r = 0.211, P < 0.0001), carotid-radial PWV (r = 0.120, P < 0.0001) and carotid-ankle PWV (r = 0.148, P < 0.0001), whereas it was inversely related to the augmentation index (r = -0.052, P = 0.016). Hs-CRP was positively associated with the carotid-femoral PWV (r = 0.074, P = 0.001) and carotid-ankle PWV (r = 0.050, P = 0.02). In multiple-adjusted models (R(2) = 0.57), homocysteine levels remained a significant determinant of the carotid-femoral PWV (standardized β = 0.065, P = 0.007), whereas the association of hs-CRP with measurements of arterial stiffness was not present.</p><p><b>CONCLUSIONS</b>In the Chinese population, plasma homocysteine levels are associated with alterations of aortic stiffness, whereas plasma levels of hs-CRP are not independently related to artery stiffening.</p>

Correlations between different obese indexes and arterial stiffness among populations at the community level / 中华流行病学杂志

Objective The aim of this study was to investigate the relationship between obesity [measured by body mass index(BMI), waist circumference(WC), waist-to-hip ratio(WHR)]and arterial stiffness on community populations in Beijing area. Methods In a cross-sectional study of 2664 subjects(1379 men and 1285 women)aged(53.19 ± 15.73 years, mean±standard deviation), BMI, WC, WHR and other cardiovascular risk factors, were measured and carotidfemoral pulse wave velocity(cfPWV)was measured to assess the arterial stiffness. All the data were analyzed with linear correlation analysis, univariate analysis and stepwise regression method to explore the relationship between obese indexes and arterial stiffness. Results We noticed that a showed the existence of positive correlations between BMI(r=0.0829,P＜0.01)and cfPWV, WC(r=0.2659, P＜0.01)and cfPWV, WHR(r=0.2749, P＜0.01)and cfPWV, in univariate analysis,cfPWV was associated with WC≥85 cm(male)or ≥80 cm(famale)(P＜0.01), WHR≥0.90(male)or≥ 0.85(famale)(P＜ 0.01). Stepwise regression analysis revealed that WC was an independent risk factor of cfPWV, other than age, gender, systolic blood pressure, HDL-C, OGTT2h etc. Conclusion Our findings indicated that obesity was an independent risk factor of cfPWV, which was an early marker of cardiovascular and renal diseases, among community population in Beijing area. There were different relationships between obesity measurement parameters(BMI, WC, WHR)and cfPWV.

Pressure wave reflections and central blood pressure in treated hypertensive subjects / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the differences in pressure wave reflections and central blood pressure between brachial BP classification and the effect of antihypertensive drugs.</p><p><b>METHOD</b>In 1371 chronically treated hypertensive subjects aged 33 - 87 years [679 males and 692 females, mean age (47.2 ± 11.5) years], radial arterial augmentation index (rAI) and central systolic blood pressure were measured using an automated tonometric method.</p><p><b>RESULTS</b>rAI gradually increased from the subgroup with the lower blood pressure to the higher blood pressure (P < 0.01), for each given brachial value, central systolic blood pressure was lower than the corresponding brachial pressure (P < 0.01). In multivariable linear regression models analysis revealed that the application of angiotensin converting enzyme inhibitor (β = -0.09, P < 0.05), AT1 receptor blockade (β = -0.07, P = 0.01), calcium channel blocker (β = -0.12, P < 0.01) and diuretic (β = 0.14, P = 0.04) were independent determinants of rAI. Central SBP significantly correlated to the application of ACEI (β = -0.07, P = 0.02), ARB (β = -0.08, P = 0.01) and CCB (β = -0.15, P < 0.05).</p><p><b>CONCLUSIONS</b>In chronically treated hypertensive individuals, tight blood pressure control would be effective in reducing the reflection wave and central BP. Antihypertensive treatment strategies with more beneficial effects on arterial properties are needed.</p>

Evaluation on left ventricular function by non-invasive transient deceleration wave intensity (W2) of carotid artery / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To evaluate transient deceleration wave intensity (W2) of carotid artery on left ventricular diastolic function.</p><p><b>METHODS</b>40 patients with hypertension and 43 healthy volunteers were enrolled and W2 of carotid artery of the both sides were measured. The parameters of left ventricular diastolic function by traditional and tissue Doppler imaging and NT-proBNP (N-terminal probrain natriuretic peptide) were measured.</p><p><b>RESULTS</b>(1) W2 is not different between two sides of carotid artery. W2 in hypertension was lower than the control, especially in left side(1126 +/- 996 mmHg x m/s3 vs 1690 +/- 1126 mmHg x m/s3, P < 0.01). (2) The correlation of W2 and else parameters were analyzed. There were notably decreasing in left ventricular diastolic function of the hypertensive group than the control, for example, the ratio of peak velocity of early filling of mitral flow to peak early diastolic motion velocity of mitral annulus (E/Em, 9.37 +/- 3.32 vs 7.39 +/- 1.83, P < 0.01) and NT-proBNP (94.6 +/- 48.5 vs 45.2 +/- 13.8, P < 0.01). (3) The correlation analysis showed negative relation between W2 and E/Em (r = - 0.46, P < 0.05) and negative relation between W2 and NT-proBNP (r = -0.21, P < 0.05).</p><p><b>CONCLUSION</b>New carotid W2 by non-invasive technology for hemodynamics is a deserving parameter in early evaluating left ventricular diastolic function.</p>

Clinical usefulness of carotid arterial wave intensity in noninvasively assessing left ventricular performance in different hypertensive remodeling hearts / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To evaluate wave intensity (WI) on left ventricular (LV) performance in the different hypertensive remolding hearts.</p><p><b>METHODS</b>105 hypertensive and 98 control subjects were underwent noninvasive evaluation of carotid arterial wave intensity, LV structure and function.</p><p><b>RESULTS</b>(1) There were increasing trends in the levels of blood pressure, LV end-diastolic diameter and LV mass index in the control, normal geometry group, concentric remodeling group, concentric and eccentric hypertrophy group. LV ejection fraction increased in the concentric hypertrophy group and decreased in the eccentric hypertrophy group in which mid-wall fractional shortening showed a decreasing trend. LV diastolic filling pressure presented increased progression accompanied by LV remodeling (P < 0.05). (2) Transient acceleration wave intensity (W1) in hypertensive subjects were higher than that in the control (P < 0.05). Transient deceleration wave intensity (W2) was lower than that in the control (P < 0.05). (3) W1 in the concentric hypertrophy group was higher and lower in the eccentric hypertrophy, compared with that in the control group, normal geometry group and concentric remodeling group (P < 0.05). W2 was lower in concentric hypertrophy group and eccentric hypertrophy group than that in the control, normal geometry group and concentric remodeling group (P < 0.05).</p><p><b>CONCLUSION</b>WI is a noninvasively obtained, clinically useful parameter for evaluation of LV performance.</p>

Association of risk factors for cardiovascular disease and the rate of glomerular filtration: a cross-sectional study in the population from certain areas of Beijing / 中华流行病学杂志

Objective Data from several large prospective studies revealed that a low glomerular filtration rate was independently associated with cardiovascular disease (CVD) events and all-cause mortality in high-risk populations. Much on the association was explained by traditional CVD risk factors. However,findings from population-based studies were scarce and inconsistent. We explored the correlation between risks factors of cardiovascular and chronic kidney disease (CKD) in a general population from certain area of Beijing. Methods A population-based cross-sectional survey was conducted during Sep. 2007 to Oct. 2008 in Beijing. Out of 5100 individuals who were selected,4515 met the inclusion criteria and responded to the investigation. By face to face interview,a questionnaire was used to find out the risk factors of cardiovascular disease. Body height,body weight and blood pressures were measured. Serum creatinine and total cholesterol (TC),triglyceride (TG),low-density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C) were detected. Glomerular filtration rate through using the Modification of Diet in Renal Disease equation was estimated.Participants were grouped into three:≥90,60-89,<60[ml·min~(-1)·(1.73m~2)~(-1)] by eGFR. Univariate and multivariate logistic regression models were used to identify the associated risk factors. Results Exposure rate of cardiovascular disease risk factors increased along with the decrease of level of eGFR. Data from univariate logistic regression analyses suggested that age,smoking,history of hypertension and diabetes,BMI,SBP,LDL-C and TG were risk factors of CKD while results from multiple logistic regression indicated that age,smoking,hypertension,high level of TG appeared to be independent risk factors of CKD. Conclusion Exposure rate of cardiovascular disease risk factors increased along with the decrease of level of eGFR while age,hypertension,high level of TG and smoking were independent risk factors of CKD.

Associations and related factors between pulse wave velocity and arterial system and augmentation index measured on different sites in a healthy population / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the associations and related factors between pulse wave velocity (PWV) and arterial system and augmentation index (AI) measured on different sites in a healthy population.</p><p><b>METHODS</b>All subjects were selected from a local community investigation study which included 5116 people living in Haidian District or Daxing District, Beijing, China. A total of 729 healthy subjects [age 17 - 85 years, mean (39.2 ± 12.2) years, 413 men] were included in this study. Carotid-femoral pulse wave velocity (CF-PWV), carotid-radial pulse wave velocity (CR-PWV) and carotid-ankle pulse wave velocity (CA-PWV) were measured using Complior. Pulse wave analysis at the right radial artery was measured and AI was calculated using SphygmoCor device.</p><p><b>RESULTS</b>CF-PWV correlated significantly with CR-PWV or CA-PWV (all P < 0.01) by both Pearson and Partial Correlation analysis adjusted by age, body mass index, waist-hip ratio, systolic blood pressure, diastolic pressure and heart rate. There was no significant correlation between AI and CR-PWV (r = -0.072, P = 0.053) and between AI and CR-PWV (r = 0.024, P = 0.528), AI and CA-PWV (r = 0.068, P = 0.070) while AI was significantly correlated with CF-PWV (r = 0.110, P = 0.003). Multiple stepwise regression analyses showed that age, systolic blood pressure and heart rate were positively while female gender was negatively correlated with CF-PWV. CR-PWV was positively correlated with diastolic blood pressure and negatively correlated with pulse pressure and female gender (R(2) = 0.155). CA-PWV was positively correlated with systolic blood pressure and age while negatively correlated with pulse pressure and female gender. Multiple stepwise regression analysis also demonstrated that AI was positively correlated with age, diastolic blood pressure, low density lipoprotein cholesterol and female gender, and negatively correlated with heart rate, height and serum creatinine level(R(2) = 0.536).</p><p><b>CONCLUSIONS</b>CA-PWV, covering carotid-femoral arterial segment, could partially represent CF-PWV as an indicator of large arterial stiffness. CR-PWV mainly reflects peripheral muscular arterial stiffness and is not suitable to be used interchangeably with CF-PWV or CA-PWV. Component of blood pressure (systolic, diastolic or pulse pressure) may have different influences on CF-PWV, CA-PWV or CR-PWV. AI is affected by multiple factors and poorly correlated with PWV and is not a good indicator for arterial stiffness.</p>

Prevalence of microalbuminuria and its related factors among different genders in general population of Beijing / 中华流行病学杂志

Objective Microalbuminuria (MAU) is generally defined as an early effective index of cardiovascular disease and renal disease. Our study aims to investigate the prevalence of MAU and its related factors among people living in Bcijing. Methods In a cross-sectional study,2080 subjects (810 men and 1270 women) are recruited, with age distribution as 50.87± 13.10 years (mean ± standard deviation). Urine albumin-creatinine ratio (ACR) is used to screen for microalbuminuria. All the data is analyzed with multivariate logistic regression method to explore the related factors for MAU. Results The overall prevalence of MAU in general population of Beijing is 17.50%, with male as 15.43% and female as 18.82% (P＜0.05). Results from the multivariate logistic regression analysis reveal that the independent risk factors of MAU in men are age(OR= 1.02), blood pressure ( OR= 1.02 ), serum creatinine ( OR= 1.04), while age ( OR= 1.04), systolic blood pressure (OR = 1.02), serum creatinine ( OR = 1.08 ), body mass index ( OR= 1.07), total cholesterol ( OR=2.05) in women. The protective factor of MAU in women is H DL-C (OR=0.44). Conclusion Our findings indicate that the prevalence of MAU in Beijing area is higher than those in other areas in China or abroad. The prevalence in females is higher than that in males (P＜0.05). There is a gender difference in the related factors of MAU.

Possible determinants of the radial augmentation index in 4985 Chinese population / 中华流行病学杂志

Objective The augmentation index (AI) derived from central arteries is generally defined as an index of augmentation of central blood pressure in systole derived from the return of pressure waves reflected from the periphery and is an index of arterial stiffness. There is controversy with respect to how to affect AI. Methods In a cross-sectional study of 4985 subjects (2417 men and 2568 women) aged 18-96 years (50.94± 14.73 years,mean±SD) ,AI was measured in the left radial artery using tonometry Colin HEM-9000AI. Results Among the subjects, 39.4% were diagnosed as hypertensive, 11.2% as diabetes mellitus, and 48.7% as hyperlipidemia. Stepwise regression analysis revealed that age, diastolic blood pressure, smoking, heart rate, height, waist circumference and fasting blood glucose were independent determinants of radial AI in women; while in men, it was also determined by total cholesterol. Radial AI was significantly higher in women than in men [(83.18± 12.36)% vs. (71.93±15.22)%, P<0.01]. Conclusion Our findings indicate that AI is determined by arterial stiffness, distance to the reflection point and reflection coefficient. It is necessary to take into account these confounding factors when assessing AI is used as an index for atherosclerosis.