Abstract Background Hypertension is often complicated by increased arterial stiffness and is an independent predictor of adverse cardiovascular (CV) outcome. Beta blockers and angiotensin receptor ...blockers (ARBs) are commonly used antihypertensive agents. The effect of beta blockers and ARBs on arterial stiffness has not been compared adequately. The aim of the present study is to compare the effect of telmisartan with metoprolol on arterial stiffness in hypertensive patients in prospective open label randomized parallel group intervention study. Methods 100 patients of hypertension, not on any antihypertensive agents, were enrolled after obtaining informed consent. Baseline recording of data related to demographics, CV risk factors, anthropometry and BP were made. Arterial stiffness was measured noninvasively by recording pulse wave velocity (PWV) using periscope (Genesis medical system). Left ventricular (LV) mass was measured using 2D guided M-mode echocardiography. Blood sugar, renal function, lipids and uric acid estimations were done in fasting state. Patients were randomized to receive metoprolol and telmisartan using stratified randomization technique. Dose of the study drugs were titrated to achieve target BP of <140/90 mmHg. Data related to PWV, BP, anthropometry and blood biochemistry was repeated after 6 months of treatment with study drugs. Results Telmisartan resulted in significantly greater reduction in arterial stiffness index (ASI) in left and right lower limb arterial bed (39.9 ± 11.7 vs. 46.8 ± 17.0 m/s, p < 0.02) and (36.4 ± 9.6 vs. 44.86 ± 15.1 m/s, p < 0.002) respectively and systolic blood pressure (SBP) (−4.9 mmHg with 95% C.I. of −8.0–1.7 mmHg, p < 0.003) compared to metoprolol. Reduction in diastolic blood pressure (DBP) in telmisartan and metoprolol groups was not different statistically (−1.0 mmHg with 95% C.I. of −3.3–1.2 mmHg, p < 0.3). The change in LV mass was not significantly different between the study groups (135.5 ± 37.6 vs. 143.2 ± 41.5, p < 0.3).
The progression of non-alcoholic fatty liver disease is associated with an increased prevalence of cardiovascular disease.
Aim: to assess the level of cytokines, insulin resistance, arterial wall ...stiffness during the progression of hepatic steatosis in patients with non-alcoholic fatty liver disease.
Material and methods. 87 patients with non-alcoholic fatty liver disease were examined. Group I consisted of 14 patients without steatosis, group II – 32 patients with steatosis grade 1; III – 30 patients with steatosis grade 2, IV group – 11 patients with steatosis grade 3. The control group consisted of 30 apparently healthy individuals. Steatometry with a quantitative assessment of the grade of hepatic steatosis was performed using a Soneus P7 ultrasound machine. The content of cytokines (interleukin-6, interleukin-10, TNF-α) was determined using an enzyme-linked immunosorbent assay using a Stat Fax 303 Plus analyzer. The level of insulin resistance was determined using the HOMA-IR index.
Results. The content of interleukin-6 in the blood serum of patients of group IV was significantly increased relative to the level in the control group (by 1.8 times, P < 0.05), patients of group I (by 3.2 times, P < 0.05), II group (by 3.0 times, P < 0.05) and group III (2.3 times, P < 0.05). The level of TNF-α increased with the progression of structural changes in the liver and at grade 4 of steatosis its content was increased by 6.4 times (P < 0.05) relative to the level in the control group, by 8.0 times (P < 0.05) relative to group I patients, by 3.4 times (P < 0.05) – group II patients and by 1.8 times (P < 0.05) – group III patients. An increase in the HOMA-IR index by 3.2 times (P < 0.05) was found in patients with moderate steatosis and 3.9 times (P < 0.05) in patients with severe steatosis compared to controls. A correlation was established between the intima-media thickness of the left common carotid artery and the level of TNF-α (r = 0.438; P = 0.006) and the HOMA-IR index (r = 0.557; P = 0.0008).
Conclusions. In patients with non-alcoholic fatty liver disease with progression of the grade of hepatic steatosis, a significant increase in proinflammatory cytokines, insulin resistance and intima-media thickness of the left common carotid artery was found.
This study aimed to investigate the association between fruit and vegetable intake and arterial stiffness.
We conducted a cohort-based study comprising 6,628 participants with arterial stiffness ...information in the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project. A semi-quantitative food-frequency questionnaire was used to assess baseline (2007-2008) and recent (2018-2021) fruit and vegetable intake. We assessed changes in fruit and vegetable intake from 2007-2008 to 2018-2021 in 6,481 participants. Arterial stiffness was measured using the arterial velocity-pulse index (AVI) and arterial pressure-volume index (API). Elevated AVI and API values were defined according to diverse age reference ranges.
Multivariable-adjusted linear regression models revealed that every 100 g/d increment in fruit and vegetable intake was associated with a 0.11 decrease in AVI (
= -0.11; 95% confidence interval
: -0.20, -0.02) on average, rather than API (
= 0.02; 95%
: -0.09, 0.13). The risk of elevated AVI (odds ratio
= 0.82; 95%
: 0.70, 0.97) is 18% lower in individuals with high intake (≥ 500 g/d) than in those with low intake (< 500 g/d). Furthermore, maintaining a high intake in the past median of 11.5 years of follow-up was associated with an even lower risk of elevated AVI compared with a low intake at both baseline and follow-up (
= 0.64; 95%
: 0.49, 0.83).
Fruit and vegetable intake was negatively associated with arterial stiffness, emphasizing recommendations for adherence to fruit and vegetable intake for the prevention of arterial stiffness.
Objectives:
Growing evidence showed involvement of vascular oxidative stress in the development of endothelial dysfunction, arterial stiffness and hypertension. Many clinical trials of antioxidants ...have proven unsuccessful in prevention of atherosclerosis and cardiovascular events. There is a need of new therapies that reduce age- and hypertension associated arterial stiffness in elderly individuals. We aimed to determine if shilajit (
Asphaltum punjabianum
), a natural phytocomplex which is immunomodulator, anti-inflammatory, antioxidant and antiaging, can reduce oxidative stress and improve arterial function in the elderly with hypertension.
Materials and Methods:
A parallel arm, open-label randomised controlled study was conducted on 60 elderly patients with hypertension. Study-group participants received shilajit (500 mg-twice/day for 30 days) with antihypertensives while control-group participants received only antihypertensive therapy. Oxidative stress, arterial stiffness and endothelial function markers were assessed at baseline and after 30 days of treatment.
Results:
Between-group analysis showed a significant decrease in oxidative stress markers: Malondialdehyde (
P
< 0.001) and oxidised-low-density lipoproteins (
P
= 0.015); and increase in total antioxidant capacity (
P
= 0.002), superoxide dismutase (
P
< 0.001) and reduced glutathione (
P
< 0.001) with complementary therapy of shilajit. There was no change in the markers of arterial stiffness and endothelial function.
Conclusion:
These findings suggest that shilajit may be of value as a natural antioxidant to reduce oxidative stress in elderly hypertension patients.
The benefits of exercise on vascular health are inconsistent in postmenopausal females. We investigated if blood pressure and markers of vascular function differ between physically active early post- ...and late premenopausal females.
We performed a cross-sectional comparison of 24-h blood pressure, brachial artery flow-mediated dilation, microvascular reactivity (reactive hyperemia), carotid-femoral pulse wave velocity, and cardiac baroreflex sensitivity between physically active late premenopausal (n = 16, 48 ± 2 yr) and early postmenopausal (n = 14, 53 ± 2 yr) females.
Physical activity level was similar between premenopausal (490 ± 214 min·wk-1) and postmenopausal (550 ± 303 min·wk-1) females (P = 0.868). Brachial artery flow-mediated dilation (pre, 4.6 ± 3.9, vs post, 4.7% ± 2.2%; P = 0.724), 24-h systolic (+5 mm Hg, 95% confidence interval CI = -1 to +10, P = 0.972) and diastolic (+4 mm Hg, 95% CI = -1 to +9, P = 0.655) blood pressures, total reactive hyperemia (pre, 1.2 ± 0.5, vs post, 1.0 ± 0.5 mL·mm Hg-1; P = 0.479), carotid-femoral pulse wave velocity (pre, 7.9 ± 1.7, vs post, 8.1 ± 1.8 m·s-1; P = 0.477), and cardiac baroreflex sensitivity (-8 ms·mm Hg-1, 95% CI = -20.55 to 4.62, P = 0.249) did not differ between groups. By contrast, peak reactive hyperemia (-0.36 mL·min-1⋅mm Hg-1, 95% CI = -0.87 to +0.15, P = 0.009) was lower in postmenopausal females.
These results suggest that blood pressure and markers of vascular function do not differ between physically active late pre- and early postmenopausal females.
Aim: This study aims to explore the association of cumulative exposure to cardiovascular health behaviors and factors with the onset and progression of arterial stiffness. Methods: In this study, ...24,110 participants were examined from the Kailuan cohort, of which 11,527 had undergone at least two brachial-ankle pulse wave velocity (baPWV) measurements. The cumulative exposure to cardiovascular health behaviors and factors (cumCVH) was calculated as the sum of the cumCVH scores between two consecutive physical examinations, multiplied by the time interval between the two. A logistic regression model was constructed to evaluate the association of cumCVH with arterial stiffness. Generalized linear regression models were used to analyze how cumCVH affects baPWV progression. Moreover, a Cox proportional hazards regression model was used to analyze the effect of cumCVH on the risk of arterial stiffness. Results: In this study, participants were divided into four groups, according to quartiles of cumCVH exposure levels, namely, quartile 1 (Q1), quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4). Logistic regression analysis showed that compared with the Q1 group, the incidence of arterial stiffness in terms of cumCVH among Q2, Q3, and Q4 groups decreased by 16%, 30%, and 39%, respectively. The results of generalized linear regression showed that compared with the Q1 group, the incidence of arterial stiffness in the Q3 and Q4 groups increased by −25.54 and −29.83, respectively. The results of Cox proportional hazards regression showed that compared with the Q1 group, the incidence of arterial stiffness in cumCVH among Q2, Q3, and Q4 groups decreased by 11%, 19%, and 22%, respectively. Sensitivity analyses showed consistency with the main results. Conclusions: High cumCVH can delay the progression of arterial stiffness and reduce the risk of developing arterial stiffness.
To investigate early indicators of cardiovascular disease (CVD) in children and adolescents with type 1 diabetes mellitus (T1DM), focusing on pulse wave velocity (PWV) and its associations with ...various anthropometric and glycemic parameters.
A total of 124 children and adolescents with T1D (mean age 10.75 ± 3.57 years) were included in this cross-sectional study. Anthropometric data, including height, weight, body mass index (BMI), glycemic parameters, such as HbA1c and time in range (TIR) were assessed. PWV was assessed by oscillometric method using the Mobil-O-Graph PWA device. Univariate and multivariate linear regression were used to explore the association of PWV z-score with anthropometric, demographic, and glycaemic variables.
Significant negative association between PWV and age and height (β = −0.336, 95 % CI -0.44 to −0.25, p < 0.001 and β = −0.491, 95 % CI -0.62 to −0.36, p < 0.001, respectively), while gender showed a significant positive association with PWV, with females displaying higher PWV values compared to males (β = 0.366, 95 % CI 0.17 to 0.56, p < 0.001). TIR was positively associated with PWV (β = 0.092, 95 % CI 0.01 to 0.16, p = 0.017 only for patients having TIR ≤ 50 %. Finally, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were positively associated with PWV (β = 0.086, 95 % CI 0.02 to 0.14, p = 0.007 and β = 0.152, 95 % CI 0.07 to 0.23, p < 0.001, respectively).
Youth with T1DM who spend <50 % of time in range exhibit uniquely increased signs of arterial stiffness, indicating that poor glycemic control may contribute to early vascular damage. Differences related to age, gender and height should be considered.
•Youngs with T1DM who spend ≤ 50% of time in range exhibit uniquely increased signs of arterial stiffness•Poor glycemic control in children and adolescents with type 1 diabetes mellitus may contribute to early vascular damage•Females with type1 diabetes mellitus showed higher PWV values compare to males
OBJECTIVE:Carotid–femoral pulse wave velocity (PWV) is considered the gold standard for arterial stiffness assessment in clinical practice. A large number of devices to measure PWV have been ...developed and validated. We reviewed different validation studies of PWV estimation techniques and assessed their conformity to the Artery Society Guidelines and the American Heart Association recommendations.
METHODS:Pubmed and Medline (1995–2017) were searched to identify PWV validation studies. Of the 96 article retrieved, 26 met the inclusion criteria.
RESULTS:Several devices had been developed and validated to noninvasively measure arterial stiffness, using applanation tonometry (SphygmoCor, PulsePen), piezoelectric mechanotransducers (Complior), cuff-based oscillometry (Arteriograph, Vicorder and Mobil-O-Graph), photodiode sensors (pOpmètre) and devices assessing brachial-ankle pulse wave velocity and cardiac-ankle PWV. Ultrasound technique and MRI remain confined to clinical research. Good agreement was found with the Artery Society Guidelines. Two studies (Complior, SphygmoCor Xcel) showed best adherence with the guidelines. In Arteriograph, MRI, ultrasound and SphygmoCor Xcel validation studies sample size was smaller than the minimum suggested by the guidelines. High discrepancies between devices were shown in distance estimationin two studies (Arteriograph, Complior) path length was estimated in conformity to the guidelines. Transit time was calculated using the intersecting tangent method, but in two studies (Vicorder, pOpmètre) best agreement was found using the maximum of the second derivative. Six studies reached the accuracy level ‘excellent’ defined in the Artery guidelines.
CONCLUSION:Method to assess transit time and path length need validation in larger populations. Further studies are required in different risk population to implement clinical applicability of every device.
RATIONALE:Previous studies on the relationship between diabetes and arterial stiffness were mostly cross-sectional. A few longitudinal studies focused on one single direction. Whether the association ...between arterial stiffness and diabetes is bidirectional remains unclear to date.
OBJECTIVE:To explore the temporal relationship between arterial stiffness and fasting blood glucose (FBG) status.
METHODS AND RESULTS:Included were 14 159 participants of the Kailuan study with assessment of brachial-ankle pulse wave velocity (baPWV) from 2010 to 2015, and free of diabetes, cardiovascular and cerebrovascular diseases, and chronic kidney disease at baseline. FBG and baPWV were repeatedly measured at baseline and follow-ups. Cox proportional hazard regression model was used to estimate hazard ratios and 95% confidence intervals (CIs) of incident diabetes across baseline baPWV groups<1400 cm/s (ref), 1400≤ baPWV <1800 cm/s, and ≥1800 cm/s. Path analysis was used to analyze the possible temporal causal relationship between baPWV and FBG, among 8956 participants with repeated assessment of baPWV and FBG twice in 2010 to 2017. The mean baseline age of the observed population was 48.3±12.0 years. During mean 3.72 years of follow-up, 979 incident diabetes cases were identified. After adjusting for potential confounders, the hazard ratio (95% CI) for risk of diabetes was 1.59 (1.34–1.88) for the borderline arterial stiffness group and 2.11 (1.71–2.61) for the elevated arterial stiffness group, compared with the normal ideal arterial stiffness group. In the path analysis, baseline baPWV was associated with follow-up FBG (the standard regression coefficient was 0.09 95% CI, 0.05–0.10). In contrast, the standard regression coefficient of baseline FBG for follow-up baPWV (β=0.00 95% CI, −0.02 to 0.02) was not significant.
CONCLUSIONS:Arterial stiffness, as measured by baPWV, was associated with risk of developing diabetes. Arterial stiffness appeared to precede the increase in FBG.
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