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Abstracts of the American Society of Hypertension, Inc.

 

28th Annual Scientific Meeting and Exposition, San Francisco, USA May 15-18, 2013

 

The Journal of Clinical Hypertension, 2013, Volume 15,
May 2013 Abstract Supplement

 

28th Annual Scientific Meeting and Exposition
San Francisco, USA May 15-18, 2013.

 

 

Acute Coronary Syndrome Patients: How Stiff are their Arteries?

 

Deaconu   Alexandru Ioan 1 , Tautu Oana Florentina 1 , Fruntelata Ana Gabriela 2 , Dorobantu Maria 1

 

1 Emergency Hospital of Bucharest, Bucharest, Romania;
2 Monza Cardiovascular Center, Bucharest, Romania

 

Several non-invasive methods are currently used to assess vascular stiffness. Pulse wave velocity (PWV) and the augmentation index (AIx) are the two major non-invasive methods of assessing arterial stiffness. A large amount of evidence indicates that carotid-femoral PWV is an intermediate endpoint for cardiovascular (CV) events, either fatal or non-fatal. Central AIx and pulse pressure have shown an independent predictive value for CV events in hypertensives and patients with coronary disease. Studies of arterial stiffness in patients with cardiovascular emergencies and acute coronary syndromes, respectively, are missing.

 

We performed measurements of arterial stiffness parameters using the TensioMed Arteriograph in 34 patients admitted for acute coronary syndromes (ACS), 24 hours after admission. The study group included 28 males (82.4%) and mean age was 61.7 ± 14.07 years. Arterial stiffness parameters as aortic PWV, aortic AIx, central systolic blood pressure (aortic SBP), central pulse pressure (aortic PP) were analyzed in relation to clinical, historical and paraclinical parameters in order to describe particularities in this patient population. We compared the results with an age and sex adjusted population of 34 controls randomly selected from the most recent Romanian cross-populational statistical survey, SEPHAR II.

 

In our group, 45.7% of patients were hypertensive and 37.1% were diabetic. Most of the patients were on treatment with ACE inhibitors (91.4%) and beta-blockers (80%), while 71.1% were on intravenous or oral nitrates. Mean stiffness parameters in this group were: aortic AIx=28.51 + 10.81, with only 14.8% of patients showing normal values; aortic PWV = 9.71 ± 1.82 m/s; aortic SBP = 121.71 ± 21.07 mm Hg; aortic PP = 44.39 ± 13.74 mm Hg. No correlations were identified in this small group between arterial stiffness parameters and treatment, history of hypertension or diabetes, type of ACS and angiographic coronary anatomy. While aortic AIx was clearly abnormal, reflecting changes in endothelial function and waves’ reflection, the other parameters of arterial stiffness were not different from other patient populations.

 

Aortic AIx is abnormally increased in patients with acute coronary syndromes. Parameters of arterial stiffness in patients with ACS are not related to treatment, type of coronary disease or previous patient history.

 

 

 

 

Invasive Validation of Arteriograph Estimates of Central Blood Pressure in Patients With Type 2 Diabetes

 

  1. Niklas Blach Rossen1,2,

  2. Esben Laugesen2,

  3. Christian Daugaard Peters3,

  4. Eva Ebbehøj2,

  5. Søren Tang Knudsen2,

  6. Per Løgstrup Poulsen2,

  7. Hans Erik Bøtker4 and

  8. Klavs Würgler Hansen1

    + Author Affiliations

 

  1. 1 Department of Medicine, Silkeborg Regional Hospital, Silkeborg, Denmark;

  2. 2 Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark;

  3. 3 Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark;

  4. 4 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.

 

  1. Correspondence: Niklas Blach Rossen (niklas.rossen@rm.dk).

 

  1. Received April 15, 2013.

  2. Revision received August 6, 2013.

  3. Accepted August 7, 2013.

    Abstract

    BACKGROUND Central blood pressure (BP) has attracted increasing interest because of a potential superiority over brachial BP in predicting cardiovascular morbidity and mortality. Several devices estimating central BP noninvasively are now available. The aim of our study was to determine the validity of the Arteriograph, a brachial cuff-based, oscillometric device, in patients with type 2 diabetes.

    METHODS We measured central BP invasively and compared it with the Arteriograph-estimated values in 22 type 2 diabetic patients referred to elective coronary angiography.

    RESULTS The difference (invasively measured BP minus Arteriograph-estimated BP) in central systolic BP (SBP) was 4.4±8.7mm Hg (P = 0.03). The limits of agreement were ±17.1mm Hg.

CONCLUSIONS Compared with invasively measured central SBP, we found a systematic underestimation by the Arteriograph. However, the limits of agreement were similar to the previous Arteriograph validation study and to the invasive validation studies of other brachial cuff-based, oscillometric devices. A limitation in our study was the large number of patients (n = 14 of 36) in which the Arteriograph was unable to analyze the pressure curves. In a research setting, the Arteriograph seems applicable in patients with ty

 

Pulse Wave Analysis

 

The pulse wave reflects the condition of the entire arterial system, from the large arteries all the way to the small arteries.

 

Pulse wave analysis is a technique recognized long ago, since doctors in China measured it as part of traditional medicine, using the three fingers on the pulse method, and a long road of experience brought it into scientific knowledge.

 

The first graphic procedures for registration of pulse waves were first demonstrated in Paris (Marey) and then London (Mahomed) in the last century, then for a smaller audience of interested parties. 100 years ago, Mahomed used the sphygmomanometer to show asymptomatic high blood pressure and to test for chronic nephritis.

 

In the 20th century with the high-tech explosion, technologies offering fundamental and detailed information about the condition of the entire arterial system were developed, whose use and analysis is very simple.

 

Thus the non-invasive pulse wave test is now conducted with other methods. High-fidelity sensors, tonometers and piezo-techniques make it possible to observe and record the pulse wave shape more and more accurately. The recognition of changes in pressure makes it easier to understand hemodynamics and the process of arterial aging.

 

The pulse wave, depending on the method, can be felt and registered in areas where arterial pulsation is easily accessible. Measurement can be carried out most easily similarly to blood pressure measurement with tonometry and piezo-electric technologies on the carotid, radial and femoral arteries, and the newest, oscillometric methods on the upper arm.

 

The direct wave traveling toward the heart, the reflective wave and the systolic and diastolic periods can be determined from the pulse wave contour, and from this we can draw conclusions regarding the interaction of the heart and the arterial system, which until now could only be recognized using invasive arterial catheterization. Today, with the help of pulse wave analysis, we can better familiarize ourselves with the physiological and pathological behavior of the arterial wall, and determine a more exact diagnosis and therapy.

 

Pulse wave amplification

The shape of a blood pressure wave (BP) constantly distorts as it travels from the central elastic arteries toward the muscular conduit arteries. This is a physiological phenomenon, that th

 

Hungary's "tensio arteriograph" - a simple way of examining our veins

 

27-01-2006 11:38 | Sándor Laczkó

 

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    Cardio-vascular disease is the leading cause of death in Hungary and much of the rest of the world. Problems are often detected too late because many people do not suffer obvious symptoms. Even suspect cases can be difficult to confirm. But that may soon be history thanks to a new device invented by Hungarian doctor Miklos Illyes.

    http://img.radio.cz/pictures/zdravi/ekgx.jpgThe "tensio arteriograph" is the first and so far only device that provides us with a fast and easy way of obtaining cardiac data that in the past could only be obtained through complicated and sometimes painful screenings.

    "The medical profession was lacking a proper method to determine these data, called 'arterial stiffness parameters', namely, the augmentation index and the pulse rate velocity of the human aorta. So, this method before was determined by very specific procedures, very difficult methods, which needed a lot of time and a lot of expert knowledge of how to perform the examination."

    Tensio arteriographTensio arteriograph Says, doctor Miklos Illyes, the inventor of the tensio arteriograph. So how does it work? It's much simpler than one might expect. The arteriograph detects the condition of our veins in a procedure that's just as easy as taking our blood pressure.

    "We discovered a new method how to assess the so-called arterial stiffness non-invasively with a very fast method, which needs only two minutes to determine the arterial age of the patient. This novelty consists of the fact that we use a simple cough to determine important central human dynamical parameters. This makes it possible for us to use this method for everyday practice and to screen the patient for arteriosclerosis. We do feel that in a few years, this kind of method will be used generally not only to check blood pressure but to have much more information about arterial stiffness beyond blood pressure measurement."

    Dr. Laszlo Tisler of the St. Imre Hospital in Budapest was one of the first physicians to use it:

    http://img.radio.cz/pictures/r/zdravi/mereni_tlaku4x.jpg"My experience over all is very positive. It uses a very new way of assessing the compliance of large blood vessels. This information is substantial because it is associated with the survival of our patients - in particular, with patients of higher cardiovascular risk. The information this device provides is extremely helpful in those with high risk, and this may add new information, information on compliance of the vessel, or stiffness of the vessel, may provide information on those who have no other risk factors and this may be a very early sign of cardiovascular risk."