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Determinants of arterial stiffness and central blood pressure in the very elderly
Journal of the American Society of Hypertension 9(4S) (2015) e35–e48
BLOOD PRESSURE MEASUREMENT/MONITORING P-35 Determinants of arterial stiffness and central blood pressure in the very elderly Ashraful Alam,2 Nadezhada Ezhova,1 Yulia Kotovskaya,2 Olesia Dogotar,2 Zhanna Kobalava.2 1MSU, Moscow, Russian Federation; 2PFUR, Moscow, Russian Federation Objective: The systolic blood pressure (SBP) and age are the main factors which influence arterial stiffness. Data on the interrelation of arterial stiffness with other cardiovascular risk factors is controversial. The aim of this study was to evaluate relationship of arterial stiffness, SBP and cardiovascular risk factors in very elderly subjects . Methods: Routine investigations, aortic pulse wave velocity (PWV) measurement and central pulse wave analysis (PWA) was done in 32 subjects older than 80 years (mean age 83,40,8 years, 34,4% male, mean brachial SBP 132,66,96 mm Hg) with BPLab Vasotens system (‘‘Petr Telegin’’, Russia). Patients with ejection fraction <40%, atrial fibrillation, aortic stenosis and severe comorbidities were not included. KruskalWallis test was used for comparison PWV and PWA results in subgroups by brachial SBP tertiles (I from 94 to 127,3 mmHg , II from 127,4 to 140 mmHg and III from 140,1 to 174 mmHg). Pearson test was used for correlation analysis. Results: By brachial SBP tertiles central SBP was 102,35,7, 124,53,2, 138,88,5 mm Hg (p<0,0001), respectively. There was no significant increase of augmentation index (AI) from I to III tertiles of brachial SBP: 34,68,3, 40,97,1, 40,17,4% (p¼0,43), respectively. No significant difference in PWV was observed also: 12,00,89, 11,10,78, 11,11,3 m/s (p¼0,27), respectively. Central SBP was associated with body mass index (BMI) (r¼0,42, p<0,05), waist circumference (r ¼ 0,52, p<0,005), triglycerides level (r¼0,45, p<0,05). No significant correlation of PWV and AI was observed neither with age nor with SBP (both brachial and central).
medicines like ProAmatine (midodrine hydrochloride)and fludrocortisone (Florinef Acetate) can be counterproductive. Methods: ECP was done in 6 Patients with orthostatic intolerance .The patient relaxes on the padded mattress of the ECP bed, and pneumatic cuffs (similar to blood-pressure cuffs) are applied to the patient’s calves, thighs, and buttocks. Hoses connect the cuffs to an air-pressure/vacuum pump. Electrodes are fastened to the patient’s chest so the computer console can monitor the heart rate. The pump rapidly inflates the cuffs in time with the patient’s heartbeat, which helps pump blood and increases oxygenation to the heart. Results: Out of 6 patients,4 were women (average age 44.25 ) and 2 were men (average age 73).Before doing ECP,all the patients had Orthostatic Hypotension,Autonomic Dysfunction,Syncope and Fatigue.2 Patients had POTS and EDS.4 patients had HTN.3 had COPD.Patients had CAD, cerebral ischemia,SOB,CHF,Hypercholesterolemia ,Chestpain,Myocardial Infarction,Aortc root and valve sclerosis and 2 patients had Atrial Fibrillation.Peripheral venous insufficiency is observed in 1 patient.EECP was helping the Patients symptoms and were very satisfied. They denied chest pain or pressure, syncope, dizziness, palpitations, tiredness and shortness of breath after EECP. Patients had more energy every time they got EECP treatment and actually the following treatment, they felt better. There had been a significant improvement in the lightheadedness spells from the baseline. Orthostatic Hypotension improved after ECP in all the 6 patients. Conclusions: ECP is a novel therapy in the treatment of Orthostatic Hypotension. Keywords: treatment of Orthostatic Intolerance; EECP treatment of Orthostatic Intolerance; Enhanced External counterpulsation therapy (EECP)
Conclusion: In the very elderly there is dissociation between PWV, AI and central SBP changes with increasing brachial SBP. Central SBP increase is associated neither with AI nor aortic PWV. Keywords: Arterial Stiffness; Central Blood Pressure; in the Very Elderly
P-36 Enhanced external counter pulsation therapy (EECP) for the treatment of orthostatic intolerance Chandralekha Ashangari, Amer Suleman. The Heartbeat Clinic, Mckinney, TX, United States Background: External counterpulsation therapy (ECP, also known as EECP) is a simple, noninvasive, outpatient treatment for small vessel Coronary artery Disease (CAD). Over time, ECP therapy encourages restricted blood vessels to open small channels that become an alternative route, becoming ‘‘natural bypass’’ vessels to provide blood flow to the heart. In patients with Coronary Artery Disease (CAD), refractory angina who have orthostatic hypotension,ECP represent a challenge because the
1933-1711/$ - see front matter Ó 2015 American Society of Hypertension. All rights reserved.
BLOOD PRESSURE MEASUREMENT/MONITORING P-35 Determinants of arterial stiffness and central blood pressure in the very elderly Ashraful Alam,2 Nadezhada Ezhova,1 Yulia Kotovskaya,2 Olesia Dogotar,2 Zhanna Kobalava.2 1MSU, Moscow, Russian Federation; 2PFUR, Moscow, Russian Federation Objective: The systolic blood pressure (SBP) and age are the main factors which influence arterial stiffness. Data on the interrelation of arterial stiffness with other cardiovascular risk factors is controversial. The aim of this study was to evaluate relationship of arterial stiffness, SBP and cardiovascular risk factors in very elderly subjects . Methods: Routine investigations, aortic pulse wave velocity (PWV) measurement and central pulse wave analysis (PWA) was done in 32 subjects older than 80 years (mean age 83,40,8 years, 34,4% male, mean brachial SBP 132,66,96 mm Hg) with BPLab Vasotens system (‘‘Petr Telegin’’, Russia). Patients with ejection fraction <40%, atrial fibrillation, aortic stenosis and severe comorbidities were not included. KruskalWallis test was used for comparison PWV and PWA results in subgroups by brachial SBP tertiles (I from 94 to 127,3 mmHg , II from 127,4 to 140 mmHg and III from 140,1 to 174 mmHg). Pearson test was used for correlation analysis. Results: By brachial SBP tertiles central SBP was 102,35,7, 124,53,2, 138,88,5 mm Hg (p<0,0001), respectively. There was no significant increase of augmentation index (AI) from I to III tertiles of brachial SBP: 34,68,3, 40,97,1, 40,17,4% (p¼0,43), respectively. No significant difference in PWV was observed also: 12,00,89, 11,10,78, 11,11,3 m/s (p¼0,27), respectively. Central SBP was associated with body mass index (BMI) (r¼0,42, p<0,05), waist circumference (r ¼ 0,52, p<0,005), triglycerides level (r¼0,45, p<0,05). No significant correlation of PWV and AI was observed neither with age nor with SBP (both brachial and central).
medicines like ProAmatine (midodrine hydrochloride)and fludrocortisone (Florinef Acetate) can be counterproductive. Methods: ECP was done in 6 Patients with orthostatic intolerance .The patient relaxes on the padded mattress of the ECP bed, and pneumatic cuffs (similar to blood-pressure cuffs) are applied to the patient’s calves, thighs, and buttocks. Hoses connect the cuffs to an air-pressure/vacuum pump. Electrodes are fastened to the patient’s chest so the computer console can monitor the heart rate. The pump rapidly inflates the cuffs in time with the patient’s heartbeat, which helps pump blood and increases oxygenation to the heart. Results: Out of 6 patients,4 were women (average age 44.25 ) and 2 were men (average age 73).Before doing ECP,all the patients had Orthostatic Hypotension,Autonomic Dysfunction,Syncope and Fatigue.2 Patients had POTS and EDS.4 patients had HTN.3 had COPD.Patients had CAD, cerebral ischemia,SOB,CHF,Hypercholesterolemia ,Chestpain,Myocardial Infarction,Aortc root and valve sclerosis and 2 patients had Atrial Fibrillation.Peripheral venous insufficiency is observed in 1 patient.EECP was helping the Patients symptoms and were very satisfied. They denied chest pain or pressure, syncope, dizziness, palpitations, tiredness and shortness of breath after EECP. Patients had more energy every time they got EECP treatment and actually the following treatment, they felt better. There had been a significant improvement in the lightheadedness spells from the baseline. Orthostatic Hypotension improved after ECP in all the 6 patients. Conclusions: ECP is a novel therapy in the treatment of Orthostatic Hypotension. Keywords: treatment of Orthostatic Intolerance; EECP treatment of Orthostatic Intolerance; Enhanced External counterpulsation therapy (EECP)
Conclusion: In the very elderly there is dissociation between PWV, AI and central SBP changes with increasing brachial SBP. Central SBP increase is associated neither with AI nor aortic PWV. Keywords: Arterial Stiffness; Central Blood Pressure; in the Very Elderly
P-36 Enhanced external counter pulsation therapy (EECP) for the treatment of orthostatic intolerance Chandralekha Ashangari, Amer Suleman. The Heartbeat Clinic, Mckinney, TX, United States Background: External counterpulsation therapy (ECP, also known as EECP) is a simple, noninvasive, outpatient treatment for small vessel Coronary artery Disease (CAD). Over time, ECP therapy encourages restricted blood vessels to open small channels that become an alternative route, becoming ‘‘natural bypass’’ vessels to provide blood flow to the heart. In patients with Coronary Artery Disease (CAD), refractory angina who have orthostatic hypotension,ECP represent a challenge because the
1933-1711/$ - see front matter Ó 2015 American Society of Hypertension. All rights reserved.