Aortic pulse wave morphology in individuals after chronic stroke: interarm comparison wave morphology after chronic stroke.

CONTEXT: Vascular changes can be a risk factor for recurrent and new events of stroke. However, few information is known regarding the variables related to aortic pulse wave morphology in stroke individuals. OBJECTIVE: To analyze aortic pulse wave morphology (arterial stiffness indices, hemodynamics and vascular variables) and to compare the paretic and non-paretic sides in individuals after chronic stroke. DESIGN: In this cross-sectional study stroke individuals had arterial stiffness indices, hemodynamics and vascular variables assessed with brachial artery oscillometry. T-test (CI95%) was used in order to compare the variables between the paretic and non-paretic sides. RESULTS: Twenty individuals were included, 65% men (60.3 SD 16.7 years). The following variables: (mean difference [CI95%]): coefficient of reflection (-2.33 [-4.60 to -0.07]), peak of ejection wave, P1 (5.32 [2.75 to 7.90] and peak of ejection wave, P2 (6.17 [2.55 to 9.78]), central diastolic blood pressure (mean difference [IC95%]): (-3.75 [-6.09 to -1.40]), central systolic blood pressure (-6.17 [-9.74 to -2.59]), mean arterial pressure (-4.46 [-7.08 to -1.84]), peripheral diastolic blood pressure (-3.48 [-5.94 to -1.02]) and peripheral systolic blood pressure (-5.53 [-9.54 to -1.52]) were higher in paretic than non-paretic side. Hemodynamics parameters were similar in both sides. CONCLUSIONS: In this study we demonstrated, for the first time, that many parameters from aortic pulse wave were higher in paretic compared with non-paretic side in individuals after chronic stroke, suggesting that peripheral vascular changes affect heart-vascular coupling in these individuals.

Interarm Blood Pressure Difference in Young Healthy Adults.

BACKGROUND: Inter-arm difference in blood pressure is the difference in the systolic and the diastolic blood pressure between arms of an individual. According to American heart association, interarm Blood Pressure difference of more than 10 mm of Hg are associated with peripheral vascular disease. The present study aims to determine the magnitude of interarm difference in young healthy individuals and to assess whether family history of hypertension, age, sex and Body mass index is related to higher interarm difference Methods: A cross-sectional study was carried out among 270 students of Manipal College of Medical Sciences, Pokhara, Nepal. Blood pressure was measured in both the arms using a mercury sphygmomanometer. (Elko 300) Statistical analysis was done using paired t test, chi-square and Pearson's correlation test using SPSS 23. RESULTS: The absolute mean Inter-arm difference for systolic blood pressure was 11.03±0.67mm Hg and for diastolic blood pressure was 6.020 ±0.21 mm Hg. There is significant inter-arm difference for systolic blood pressure and diastolic blood pressure (p<0.001). Inter-arm systolic blood pressure difference was significantly associated with family history of hypertension, age and Body Mass Index (p<0.001) Meanwhile, there was no statistically significant association of sex, family history of hypertension, age and Body Mass Index with inter-arm difference for diastolic blood pressure. CONCLUSIONS: Significant inter-arm systolic and diastolic blood pressure differences was found in the young, healthy population. Positive correlation of increased Inter-arm difference in Blood Pressure with family history of hypertension was confirmed. This emphasizes the importance of measuring blood pressure in both arms to be a routine practice as we aim for early diagnosis and prompt treatment of hypertensive disorders.

Interarm blood pressure differences predict target organ damage in type 2 diabetes.

Patients with type 2 diabetes mellitus are at high risk for atherosclerotic disease, and proper blood pressure measurement is mandatory. The authors examined the prevalence of an interarm difference (IAD) in blood pressure and its association with cardiovascular risk factors and organ damage (nephropathy, retinopathy, left ventricular hypertrophy, and vascular damage) in a large diabetic population. A total of 800 consecutive patients with type 2 diabetes mellitus were evaluated with an automated simultaneous bilateral device (men: 422 [52.8%]; mean age: 68.1±12.2 years). Diabetic patients with systolic IAD ≥5 and systolic IAD ≥10 mm Hg showed an increased risk of having vascular damage (adjusted odds ratios: 1.73 and 2.49, respectively) and higher pulse pressure. IAD is highly prevalent in patients with diabetes, is associated with vascular damage, even for IAD ≥5 mm Hg, and should be accurately obtained to avoid underdiagnosis and undertreatment of hypertension.