Lower-extremity arterial stiffness vs. aortic stiffness in the general population.

While determinants of aortic pulse wave velocity (aPWV) are well known, much less is known about factors affecting lower-extremity pulse wave velocity (lePWV). Unlike aPWV, increased lePWV does not predict cardiovascular risk, but limits lower-extremity blood flow and is associated with increased left ventricular mass. The aim of this study was to compare the effect of cardiovascular risk factors on aPWV and lePWV. A total of 911 individuals from the Czech post-MONICA study (a randomly selected 1% representative population sample, mean age 54±13.5 years, 47% men) were examined. Pulse wave velocity was measured using the SphygmoCor device. Aging had a large effect on aPWV, but only a small effect on lePWV. After adjustment for covariates, we observed that hypertension, diabetes, chronic kidney disease and dyslipidemia were positively and significantly associated with aPWV. However, only hypertension had a significant effect on lePWV. Increased ankle systolic blood pressure was associated with increased aPWV independently of brachial blood pressure. Ankle systolic blood pressure was more closely related to aPWV than lePWV. Subjects with an ankle-brachial index <1.0 had higher aPWV and lower lePWV compared with individuals with a normal ankle-brachial index. Lower-extremity arterial stiffness is affected by age and cardiovascular risk factors to a lesser extent than aortic stiffness. Increased ankle systolic blood pressure is linked not only to increased lower-extremity arterial stiffness, but also increased aortic stiffness. In subjects with a low ankle-brachial index, lower-extremity arterial stiffness is spuriously decreased.

A high ankle-brachial index is associated with increased aortic pulse wave velocity: the Czech post-MONICA study.

BACKGROUND: Ankle brachial index (ABI) has been increasingly used in general practice to identify individuals with low ABI at high cardiovascular risk. However, there has been no consensus on the clinical significance of high ABI. The aim of our study was to compare aortic stiffness as a marker of cardiovascular risk in individuals with low (<1.0), normal (1.0-1.4), and high ABI (>1.4). METHODS: A total of 911 individuals from the Czech post-MONICA study (a randomly selected 1% representative population sample, aged 54 ± 13.5 years, 47% of men) were examined. ABI was measured using a handheld Doppler and aortic pulse wave velocity (aPWV) using the Sphygmocor device. RESULTS: Of the 911 individuals, 28 (3.1%) had low ABI and 23 (2.5%) high ABI. There was a U-shaped association between aPWV and ABI. aPWV was significantly higher in individuals with low and high ABI compared with the normal ABI group (11.1 ± 2.8, 8.3 ± 2.3, p < 0.001; 10.8 ± 2.5, 8.3 ± 2.3 m/s, p < 0.001, respectively). In a model adjusted for age, sex, systolic, diastolic, mean blood pressure and examiner, aPWV remained increased in both extreme ABI groups compared with the normal ABI group. In logistic regression analysis, aPWV together with glucose level, male sex, and a history of deep venous thrombosis were independent predictors of high ABI, while cholesterol was not. CONCLUSION: This is the first study showing increased aortic stiffness in individuals with high ABI, presumably responsible for increased left ventricular mass described previously in this group. These findings suggest increased cardiovascular risk of high ABI individuals.

Longitudinal trends in cardiovascular mortality and blood pressure levels, prevalence, awareness, treatment, and control of hypertension in the Czech population from 1985 to 2007/2008.

OBJECTIVES: To assess longitudinal trends in cardiovascular mortality and population mean blood pressure, prevalence, awareness, treatment, and control of hypertension in a representative Czech population sample from 1985 to 2007/2008. METHODS: Source data on mortality rates were provided by the Czech Statistical Office and further processed by the Institute for Health Information and Statistics of the Czech Republic. Six independent cross-sectional population surveys were conducted in 1985, 1988, 1992, 1997/1998, 2000/2001, and 2007/2008 with randomly selected men and women aged 25-64 years and resident in six districts of the Czech Republic (Praha-východ, Benesov, Pardubice, Chrudim, Cheb, and Jindrichuv Hradec). The total number of participants was 13 972. RESULTS: Since 1985, there has been a significant continuous, almost linear decline in standardized total, cardiovascular disease, ischemic heart disease, and stroke mortality (P < 0.001).There was a significant downward trend in the population mean SBP (from 133.6 ± 20.2 to 129.5 ± 18.5 mmHg; P < 0.001) and DBP (from 84.1 ± 11.3 to 82.5 ± 10.0 mmHg; P < 0.001) from 1985 to 2007/2008. This was associated with a significant decrease in the prevalence of hypertension only in women (from 42.5 to 37.2%; P < 0.001). Awareness of hypertension increased in both sexes (men, from 41.4 to 68.4%; women, from 58.9 to 71.4%; both P < 0.001) as did the number of individuals on antihypertensive medication (men, from 21.1 to 58.2%, women: from 38.9 to 58.9%; both P < 0.001). Control of hypertension improved significantly (from 3.9 to 24.6%) over the same period. CONCLUSION: The reduction in population blood pressure and improved hypertension control may have contributed substantially to the decrease in cardiovascular disease mortality in the Czech Republic.

Longitudinal trends in major cardiovascular risk factors in the Czech population between 1985 and 2007/8. Czech MONICA and Czech post-MONICA.

OBJECTIVE: The aim of our study was to assess longitudinal trends in major CV risk factors in a representative population sample of the Czech Republic. METHODS: Three cross-sectional surveys of CV risk factors were conducted within the WHO MONICA project in six Czech districts in 1985 (n=2570), 1988 (n=2768), and 1992 (n=2343). In 1997/98, 2000/01, and 2007/08, another three screenings for CV risk factors (a 1% random sample, aged 25-64, mean age 45 years) were conducted in the six original districts (n=1990; 2055; and 2246, respectively). RESULTS: Over a period of 22/23 years, there was a significant decrease in the prevalence of smoking in males (from 45.0 to 30.5%; p<0.001) and no change in smoking habits in females. BMI increased in males and did not change in females. Both systolic and diastolic blood pressure decreased significantly in both genders, while the prevalence of hypertension declined only in females. Awareness of hypertension also rose as did the proportion of individuals treated by antihypertensive drugs in both genders. Hypertension control improved in either gender. A remarkable drop in total cholesterol was seen in both sexes (males: from 6.21 + or - 1.29 to 5.29 + or - 1.10 mmol/L; p<0.001; females: from 6.18 + or - 1.26 to 5.30 + or - 1.06 mmol/L; p<0.001). CONCLUSIONS: The striking improvement in CV risk factors documented between 1985 and 2007/8 most likely contributed to the decrease in CV mortality in the Czech Republic.

Trends in blood pressure levels, prevalence, awareness, treatment, and control of hypertension in the Czech population from 1985 to 2000/01.

OBJECTIVE: To assess trends in blood pressure (BP) levels, prevalence, awareness, and control of hypertension in the Czech population from 1985 to 2000/01. DESIGN: Five independent cross-sectional population surveys conducted in 1985, 1988, 1992, 1997/98, and 2000/01. SETTING: Six, mostly rural, districts of the Czech Republic (Praha-východ, Benesov, Pardubice, Chrudim, Cheb, and Jindrichuv Hradec). PARTICIPANTS: Men and women aged 25-64 years randomly selected from six districts using the National Population Register/General Health Insurance Company Register (covering, by law, all citizens). The total number of participants was 11 726. MAIN OUTCOME MEASURES: We assessed the mean systolic BP, diastolic BP and pulse pressure, prevalence of hypertension (systolic BP > or = 140 mmHg and/or diastolic BP > or = 90 mmHg, or current treatment with antihypertensive drugs), awareness, treatment, and control of hypertension. RESULTS: Mean systolic BP, diastolic BP, and pulse pressure decreased significantly over a period of 15/16 years. This was associated with a significant decrease in the prevalence of hypertension (from 47.1 to 39.1%, P < 0.001) and with an increase in its awareness (from 49.5 to 67.2%, P < 0.001), use of antihypertensive medication (from 29.3 to 49.3%, P < 0.001), and hypertension control (from 3.9 to 17.0%, P < 0.001). Despite having lower BP values and prevalence of hypertension, females showed higher awareness of the disease, and were more frequently taking antihypertensive medication, and their hypertension was better controlled. CONCLUSION: The reduction in population BP and improved control of hypertension may have contributed to the decrease in cerebrovascular and coronary heart disease mortality in the Czech Republic. The positive longitudinal changes seen in the MONICA regions need not necessarily reflect the situation in the country as a whole. The situation is far from being optimal; a major problem is inadequate treatment of hypertension