ABSTRACT
OBJECTIVE: In this analysis of the telehealth-based Vascular health ASsessment Of The hypertENSive patients Registry, we checked how 24-h central and peripheral hemodynamics compare with hypertension-mediated organ damage (HMOD). METHODS: In 646 hypertensive patients (mean age 52â±â16 years, 54% males, 65% treated) we obtained ambulatory brachial and central SBP and pulse pressure (PP), SBP, and PP variability, pulse wave velocity and augmentation index with a validated cuff-based technology. HMOD was defined by an increased left ventricular mass index (cardiac damage, evaluated in 482 patients), an increased intima-media thickness (vascular damage, nâ=â368), or a decreased estimated glomerular filtration rate or increased urine albumin excretion (renal damage, nâ=â388). RESULTS: Ambulatory SBP and PPs were significantly associated with cardiac damage: the largest odds ratio was observed for 24-h central SBP [1.032 (1.012, 1.051), Pâ=â0.001] and PP [1.042 (1.015, 1.069), Pâ=â0.002], the weakest for brachial estimates. The association was less strong for vascular damage with a trend to the superiority of 24-h central [1.036 (0.997, 1.076), Pâ=â0.070] over brachial PP [1.031 (1.000, 1.062), Pâ=â0.052]. No statistically significant association was observed for renal damage. SBP and PP variabilities, pulse wave velocity and augmentation index were not associated with any form of HMOD. In the multivariate analysis, age was associated with any type of HMOD, whereas central SBP and PP were predictive of an increased risk of cardiac damage. CONCLUSION: In hypertensive patients a variable association exists between peripheral and central hemodynamics and various types of HMOD, with the most predictive power being observed for central SBP and PP for cardiac damage.
Subject(s)
Blood Pressure/physiology , Hypertension/physiopathology , Kidney/physiopathology , Adult , Aged , Blood Pressure Determination , Blood Pressure Monitoring, Ambulatory , Carotid Intima-Media Thickness , Female , Glomerular Filtration Rate/physiology , Hemodynamics/physiology , Humans , Male , Middle Aged , Pulse Wave Analysis , RegistriesABSTRACT
The VASOTENS Registry is an international telehealth-based repository of 24-hour ambulatory blood pressure monitorings (ABPM) obtained through an oscillometric upper-arm BP monitor allowing combined estimation of some vascular biomarkers. The present paper reports the results obtained in 1200 participants according to different categories of CV risk. Individual readings were averaged for each recording and 24-hour mean of brachial and aortic systolic (SBP) and diastolic blood pressure (DBP), pulse wave velocity (PWV), and augmentation index (AIx) obtained. Peripheral and central BP, PWV and AIx values were increased in older participants (SBP only) and in case of hypertension (SBP and DBP). BP was lower and PWV and AIx higher in females. PWV was increased and BP unchanged in case of metabolic syndrome. Our results suggest that ambulatory pulse wave analysis in a daily life setting may help evaluate vascular health of individuals at risk for CV disease.
Subject(s)
Blood Pressure Monitoring, Ambulatory/instrumentation , Cardiovascular Diseases/epidemiology , Pulse Wave Analysis/methods , Vascular Stiffness/physiology , Adult , Aged , Aorta/physiopathology , Arterial Pressure/physiology , Blood Pressure Monitoring, Ambulatory/methods , Case-Control Studies , Cross-Sectional Studies , Diastole , Female , Humans , Hypertension/physiopathology , Internet-Based Intervention , Male , Metabolic Syndrome/physiopathology , Middle Aged , Non-Randomized Controlled Trials as Topic , Oscillometry/instrumentation , Prospective Studies , Registries , Risk Factors , Systole , Telemedicine/instrumentationABSTRACT
The aim of our study was to assess the feasibility of using an approach to 24-hour pulse wave velocity (PWV) analysis similar to ambulatory blood pressure monitoring analysis in the management of patients with renal transplantation. Overall, 41 patients aged between 18 and 55 years who had end-stage renal disease resulting from glomerulopathy were recruited from the kidney transplant waiting list. All the measurements were performed before kidney transplantation and at 1 and 20 weeks after transplantation. The Pulse Time Index of Norm (PTIN) was calculated with the Vasotens® technology for the estimation of the 24-hour PWV, defined as the percentage of the 24-hour period during which the PWV does not exceed 10 m/second. Before kidney transplantation, the mean PTIN in the whole group was 56.3 (standard deviation, 18.4). Then, a week after the renal transplantation, a decrease in the PTIN was observed in most cases, going to 27.6 (standard deviation, 11.1). After 20 weeks, the mean PTIN in the whole group increased again to 52.0 (standard deviation, 23.6). In our study, we found that the persistence of arterial stiffness disturbances after kidney transplantation appears to be relatively predictable. We determined the cutoff value of PTIN that could predict the two states of PTIN: a state of improvement or a state of decline/without change. The cutoff value of PTIN at 45% had a sensitivity of 69%, specificity of 76%, and area under the curve of 0.65. The analysis of variance showed that in the group with an initial PTIN of 45% or higher, the PTIN in the remote period after transplantation changed significantly (P < 0.05), whereas in the group with an initial PTIN lower than 45%, there were no significant changes. Thus, the analysis of 24-hour pulse wave velocity in the management of patients with renal transplantation using PTIN is feasible.
