Comparison of Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors in the Management of Arterial Stiffness and Target Organ Damage in Patients with Hypertension

Abstract Background Arterial stiffness and hypertension are strong predictors of cardiovascular disease and mortality. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are first-line antihypertensive agents in reducing blood pressure and arterial stiffness. Objective The objective of this study was to compare the effects of ACEI and ARB in reducing arterial stiffness and preventing target organ damage in patients with hypertension. Methods This observational study included 654 participants who attend routine consultations at an outpatient hypertension clinic in 2 university hospitals. Patients were interviewed, and they underwent central and peripheral blood pressure measurements. Doppler echocardiography, carotid ultrasound, biochemical tests, and anthropometric parameters were carried out. Shapiro-Wilk, chi-square, and Fisher's exact test were used. A significance level of 5% was adopted. Results A total of 659 participants were evaluated in the study (398 from the ARB group and 256 from the ACEI group). Age, body mass index (BMI), central and peripheral blood pressure measurements, pulse wave velocity (PWV), left ventricular mass index, and carotid intima-media thickness did not show differences between the groups (p > 0.05). After linear regression analysis, the ACEI group had lower values of total vascular resistance (TVR) (p = 0.003) and augmentation pressure (p = 0.008), when compared to the ARB group. Conclusion This study showed that the ACEI group had a greater reduction in augmentation pressure and PWV. There were no differences between the groups regarding the improvement of outcomes related to central arterial pressure, PWV, and cardiac and vascular target organ damage.

Primary study on recognition of vascular stiffness based on wavelet scattering neural network / 生物医学工程学杂志

Cardiovascular disease is the leading cause of death worldwide, accounting for 48.0% of all deaths in Europe and 34.3% in the United States. Studies have shown that arterial stiffness takes precedence over vascular structural changes and is therefore considered to be an independent predictor of many cardiovascular diseases. At the same time, the characteristics of Korotkoff signal is related to vascular compliance. The purpose of this study is to explore the feasibility of detecting vascular stiffness based on the characteristics of Korotkoff signal. First, the Korotkoff signals of normal and stiff vessels were collected and preprocessed. Then the scattering features of Korotkoff signal were extracted by wavelet scattering network. Next, the long short-term memory (LSTM) network was established as a classification model to classify the normal and stiff vessels according to the scattering features. Finally, the performance of the classification model was evaluated by some parameters, such as accuracy, sensitivity, and specificity. In this study, 97 cases of Korotkoff signal were collected, including 47 cases from normal vessels and 50 cases from stiff vessels, which were divided into training set and test set according to the ratio of 8 : 2. The accuracy, sensitivity and specificity of the final classification model was 86.4%, 92.3% and 77.8%, respectively. At present, non-invasive screening method for vascular stiffness is very limited. The results of this study show that the characteristics of Korotkoff signal are affected by vascular compliance, and it is feasible to use the characteristics of Korotkoff signal to detect vascular stiffness. This study might be providing a new idea for non-invasive detection of vascular stiffness.

Anthropometric measurements and their association with endothelial function and arterial stiffness of eutrophic individuals and with overweight

ABSTRACT Objective: The objective of the study was to assess the association of anthropometric measurements with endothelial function and arterial stiffness of eutrophic individuals and with overweight. Subjects and methods: A cross-sectional study was carried out with individuals with body mass index (BMI) between 18.5 kg/m² and < 30 kg/m², low to intermediate global cardiovascular risk scores, and aged ≥ 18 and < 60 years. We assessed the sociodemographic data, anthropometric variables (body weight, height, circumferences of the waist [WC], neck [NC], hip [HC], sagittal abdominal diameter [SAD], [BMI], waist-to-hip ratio [WHR], and waist-to-height ratio [WHtR]), biochemical parameters (lipid profile and nitric oxide), endothelial function (flow-mediated dilation [FMD], by ultrasound), and arterial stiffness (pulse wave velocity [PWV] and the amplification index [AIx@75] by oscillometry). Thirty-six individuals were included, 18 eutrophic and 18 with overweight, with a mean age of 37.5 ± 10.2 years, mostly at low cardiovascular risk (86.1%), female (80.6%), single (52.8%), employed with formal contracts (44.4%), and with over twelve years of education (88.9%). Results: The PWV presented positive and moderate correlation with the WC (r = 0.584; P = 0.001), WHR (r = 0.513; P = 0.001), and WHtR (r = 0.590; P = 0.001), and positive and low correlation with the NC (r = 0.372; P = 0.013) and SAD (r = 0.356; P = 0.033). Moreover, no anthropometric parameter presented a correlation with the AIx@75 or the FMD percentage in the total sample. Conclusion: Our findings show that in eutrophic individuals and with overweight the WC, WHR, WHtR, SAD, and NC were positively correlated with the PWV but not to the endothelial function in the overall sample. These are hypothesis-generating findings and they should be replicated in other studies.

Efeitos do Treinamento Intervalado de Alta Intensidade sobre a Pressão Arterial Central: Uma Revisão Sistemática e Metanálise / Effects of High-Intensity Interval Training on Central Blood Pressure: A Systematic Review and Meta-Analysis

Resumo A pressão arterial central (PAc) é considerada um preditor independente de lesão de órgão, eventos cardiovasculares e mortalidade por todas as causas. Evidências mostram que o treino intervalado de alta intensidade (HIIT) é superior ao treino contínuo de intensidade moderada (MICT) na melhoria da aptidão cardiorrespiratória e da função vascular. No entanto, os efeitos dessas modalidades de treino aeróbico sobre a PAc não foram propriamente revisados. Esta metanálise tem como objetivo investigar os efeitos do HIIT versus MICT sobre a PAc.Conduzimos uma metanálise de ensaios controlados randomizados que compararam HIIT versus MICT sobre a PAc. Os desfechos primários foram Pressão Arterial Sistólica (PAS) central (PASc) e Pressão Arterial Diastólica central (PADc). A PAS periférica (PASp), a PAD periférica (PADp), a Velocidade de Onda de Pulso (VOP) e a captação máxima de oxigênio (VO2max) foram analisadas como desfechos secundários. A metanálise das diferenças médias (DM) foi conduzida usando modelos de efeitos aleatórios.Nosso estudo incluiu 163 pacientes recrutados em seis ensaios. Encontramos que HIIT foi superior ao MICT em reduzir PASc (DM = -3,12 mmHg, IC95% -4,75 - 1,50, p = 0,0002) e PAS (DM = -2,67 mmHg, IC95% -5,18 - -0,16, p = 0,04) e aumentar VO2max (DM = 2,49 mL/Kg/min, IC95% 1,25 - 3,73, p = 0,001). No entanto, não foram relatadas diferenças quanto à PADc, PAD ou VOP. O HIIT foi superior ao MICT em reduzir PASc, sugerindo seu potencial papel como uma terapia não farmacológica para a pressão arterial elevada.

Abstract Central blood pressure (cBP) is considered an independent predictor of organ damage, cardiovascular events and all-cause mortality. Evidence has shown that high intensity interval training (HIIT) is superior to moderate-intensity continuous training (MICT) for improving cardiorespiratory fitness and vascular function. However, the effects of these aerobic training modalities on cBP have not yet been properly reviewed.This meta-analysis aims to investigate to effects of HIIT versus MICT on cBP.We conducted a meta-analysis of randomized controlled trials that compared HIIT versus MICT on cBP. Primary outcomes were measures of central systolic blood pressure (cSBP) and central diastolic blood pressure (cDBP). Peripheral systolic blood pressure (pSBP) and diastolic blood pressure (pDBP), pulse wave velocity (PWV) and maximal oxygen uptake (VO2max) were analyzed as second outcomes. Meta-analysis of mean differences (MD) was conducted using the random effects model.Our study included 163 patients enrolled in six trials. We found that HIIT was superior to MICT in reducing the cSBP (MD = -3.12 mmHg, 95% CI: -4.75 to -1.50, p = 0.0002) and SBP (MD = -2.67 mmHg, 95% CI: -5.18 to -0.16, p = 0.04), and increasing VO2max(MD = 2.49 mL/kg/min, 95% CI: 1.25 to 3.73, p = 0.001). However, no significant differences were reported for cDBP, DBP and PWV.HIIT was superior to MICT in reducing the cSBP, which suggests its potential role as a non-pharmacological therapy for high blood pressure.

Velocidade de Onda de Pulso de 8,2m/s como Limiar Associado à Presença de Lesão de Órgão Alvo Cardiovascular / Pulse Wave Velocity of 8.2 m/s as a Threshold Associated with Cardiovascular Target Organ Damage Presence

Resumo Fundamento Estudos prévios estabeleceram valores de normalidade e de referência da Velocidade de Onda de Pulso (VOP). Porém, qual valor de VOP que apresenta a associação mais forte com biomarcadores cardiovasculares ainda é pouco conhecido. Objetivo Identificar o valor de VOP com maior possibilidade de estar associado com hipertrofia ventricular esquerda (HVE), aumento da espessura íntima-média carotídea (EIMC), e presença de placas carotídeas em pacientes hipertensos. Métodos Este é um estudo transversal de 119 pacientes. Análise de curvas características de operação do receptor (ROC) foi realizada para cada biomarcador cardiovascular. A diferença estatística foi estabelecida em p<0,05. Resultados Segundo análises das curvas ROC, valores de VOP de 8,1m/s para HVE, 8,2m/s para EMIC aumentada e 8,7m/s para a presença de placa carotídea foram encontrados, respectivamente. O valor de VOP de 8,2m/s foi definido como melhor o parâmetro para encontrar os três biomarcadores de LOA. A VOP acima de 8,2m/s associou-se ao aumento da EMIC (p = 0,004), à presença de placas carotídeas (p = 0,003) e à HVE (p < 0,001). A VOP acima de 8,2m/s apresentou maior sensibilidade para EMIC aumentada (AUC = 0,678, sensibilidade 62,2), HVE (AUC = 0,717, sensibilidade 87,2), e presença de placas (AUC = 0,649, sensibilidade 74,51) na análise das curvas ROC. Conclusão O valor de 8,2m/s de VOP foi mais sensível em identificar, precocemente, a existência de biomarcadores cardiovasculares de LOA.

Abstract Background Previous studies have established normal and reference values for Pulse Wave Velocity (PWV). However, the PWV value that has the strongest association with cardiovascular biomarkers remains poorly understood. Objective This study aimed to determine the PWV value more likely to be associated with left ventricular hypertrophy (LVH), increased intima-media thickness (IMT), and presence of carotid plaques in patients with hypertension. Methods This cross-sectional study included 119 patients. Analysis of receiver operating characteristic (ROC) curves was performed for each cardiovascular biomarker. Statistical significance was set at p < 0.05. Results According to the ROC curve analysis, the PWV values were 8.1 m/s, 8.2 m/s, and 8.7 for the LVH, IMT, and presence of carotid plaques, respectively. A PWV value of 8.2 m/s was identified as the best parameter to determine the three TOD biomarkers. PWV above 8.2 m/s was associated with increased CIMT (p = 0.004) and the presence of carotid plaques (p = 0.003) and LVH (p<0.001). PWV above 8.2 showed greater sensitivity for increased CIMT (AUC = 0.678, sensitivity = 62.2), LVH (AUC = 0.717, sensitivity = 87.2), and the presence of plaques (AUC = 0.649, sensitivity = 74.51) in the ROC curve analysis. Conclusion The PWV value 8.2 m/s was more sensitive in early identifying the existence of cardiovascular biomarkers of TOD.

Associação entre síndrome metabólica e rigidez arterial / Association between metabolic syndrome and arterial stiffness

Introdução: A síndrome metabólica (SM) é considerada um importante fator de risco para doenças cardiovasculares por promover mudanças biomecânicas nas paredes dos vasos que acarretam rigidez arterial (RA). Objetivo: Analisar a associação entre a síndrome metabólica e rigidez arterial. Além de descrever a população de estudo segundo características sociodemográficas e clínicas. Métodos: Estudos transversal de base populacional, na área restrita do Vale do Ogunjá, Salvador-Bahia. Foram obtidos dados sociodemográficos, por meio de questionário e dados clínicos. A VOP foi avaliada por tonometria de aplanação com o aparelho SphygmoCor® (AtCor Medical Pty Ltd, New South Wales, Austrália). Foram obtidas medidas de frequência e descritivas de central e dispersão, e o teste Qui-quadrado para análise estatística. Resultados: A VOP alterada foi mais prevalente em indivíduos que foram diagnosticados com a síndrome metabólica (37,2%), com uma razão de prevalência 2,0 vezes maiores quando comparados aos indivíduos hígidos (IC95%: 0,86 ­ 4,45). Houve também maior prevalência da RA no sexo masculino (30,4%), na faixa etária entre 40 a 74 anos (38,7%), em autodeclarados preto/pardo (27,4%), em divorciados/viúvos (38,9%) e com baixo nível de escolaridade (38,5%). As diferenças proporcionais entre os indivíduos com e sem rigidez arterial foram estatisticamente significantes entre as variáveis escolaridade (p=0,022), faixa etária (p=0,001) e hipertensão arterial (p=0,000). Por outro lado, não foram encontradas diferenças proporcionais estatisticamente significantes (p>0,05) entre as variáveis sexo, cor e estado civil, assim como para a síndrome metabólica e as variáveis que fazem parte da sua definição (hipertrigliceridemia, HDL, glicemia de jejum e obesidade abdominal), com exceção da hipertensão arterial. Conclusão: Apesar da maior prevalência de rigidez arterial em indivíduos com síndrome metabólica, não foi encontrada uma associação estatisticamente significante entre essas duas variáveis. Foi possível verificar uma associação estatisticamente significante entre a hipertensão arterial, indivíduos com idade mais avançada e com baixo nível de escolaridade e a rigidez arterial. (AU)

iomechanical changes in the walls of the vessels that cause arterial stiffness (AR). Objetive: Analyze the association between Metabolic Syndrome (MS) and arterial stiffness and to characterize the study population according to sociodemographic and clinical characteristics. Methods: Cross-sectional population-based studies, in the restricted area of Vale do Ogunjá, Salvador-Bahia. Sociodemographic data, through questionnaire and clinical data were obtained. A PWV was evaluated by applanation tonometry using the device SphygmoCor® (AtCor Medical Pty Ltd, New South Wales, Australia). Frequency and descriptive measurements of central and dispersion were obtained, and the Chi-square test to statistical analysis. Results: The altered PWV was more prevalent in individuals who were diagnosed with the metabolic syndrome (37.2%), with a prevalence ratio 2.0 times higher when compared to healthy individuals (95% CI: 0.86 - 4.45). There was also a higher prevalence of AR in males (30.4%), aged between 40 and 74 years (38.7%), in self-declared black / brown (27.4%), in divorced / widowed (38, 9%) and with a low level of education (38.5%). The proportional differences between individuals with and without arterial stiffness were statistically significant between the variables education (p = 0.022), age group (p = 0.001) and arterial hypertension (p = 0.000). On the other hand, there were no statistically significant proportional differences (p> 0.05) between the variables gender, color and marital status, as well as for the metabolic syndrome and the variables that are part of its definition (hypertriglyceridemia, HDL, blood glucose) fasting and abdominal obesity), with the exception of arterial hypertension. Conclusion: Despite the higher prevalence of arterial stiffness in individuals with metabolic syndrome, no statistically significant association was found between these two variables. It was possible to verify a statistically significant association between arterial hypertension, individuals with older age and with low level of education and arterial stiffness.

Escore SAGE em Normotensos e Pré-Hipertensos: Uma Prova de Conceito / SAGE Score in Normotensive and Pre-Hypertensive Patients: A Proof of Concept

Resumo Fundamento O SAGE foi desenvolvido para identificar hipertensos com chance de velocidade de onda de pulso (VOP) aumentada. Até o momento, as publicações do escore foram em hipertensos. Objetivo Verificar a capacidade do SAGE de identificar os normotensos ou pré-hipertensos com chance de aumento da VOP. Métodos Transversal retrospectivo, incluiu exames de normotensos e pré-hipertensos que realizaram a medida central da pressão arterial e apresentavam os parâmetros para o cálculo do escore. Para cada pontuação do escore, foi analisada a sensibilidade, especificidade, valor preditivo positivo e negativo utilizando como ponto de corte para o diagnóstico positivo VOP ≥ 10m/s, ≥9,08 m/s (percentil 75) e ≥7,30 m/s (percentil 50). Um valor de p<0,05 foi adotado como estatisticamente significante. Resultados A amostra foi de 100 participantes normotensos ou pré-hipertensos, com média (DP) de 52,64 (14,94) anos e VOP mediana de 7,30 m/s (6,03 - 9,08). O SAGE apresentou correlação com idade (r=0,938, p<0,001), glicemia (r=0,366, p<0,001) e taxa de filtração de glomerular (r=-0,658, p<0,001). A área sob a curva ROC foi de 0,968 (p<0,001) para VOP≥10 m/s, 0,977 (p<0,001) para VOP≥9,08 m/s e 0,967 (p<0,001) para VOP≥7,30 m/s. O escore 7 apresentou especificidade de 95,40% e sensibilidade de 100% para VOP≥10 m/s. O ponto de corte seria cinco para VOP≥9,08 m/s (s=96,00%, e= 94,70%), e dois para VOP≥7,30 m/s. Conclusão O SAGE foi capaz de identificar indivíduos com maior chance de apresentar rigidez arterial, utilizando diferentes pontos de corte de VOP. Entretanto, o desenvolvimento de um escore específico para normontensos e pré-hipertensos faz-se necessário.

Abstract Background The SAGE score was developed to detect individuals at risk for increased pulse wave velocity (PWV). So far, studies have been focused on hypertensive patients. Objective To assess the ability of the score to detect non-hypertensive and pre-hypertensive patients at risk for increased PWV. Methods Retrospective cross-sectional study of analysis of central blood pressure data and calculation of the SAGE score of non-hypertensive and pre-hypertensive patients. Each score point was analyzed for sensitivity, specificity, positive and negative predictive values, using the cut-off point for positive diagnosis a PVW ≥ 10m/s, ≥9.08 m/s (75thpercentile) and ≥7.30 m/s (50thpercentile). A p<0.05 was considered statistically significant. Results The sample was composed of 100 normotensive and pre-hypertensive individuals, with mean age of 52.64 ± 14.94 years and median PWV of 7.30 m/s (6.03 - 9.08). The SAGE score was correlated with age (r=0.938, p<0.001), glycemia (r=0.366, p<0.001) and glomerular filtration rate (r=-0.658, p<0.001). The area under the ROC curve was 0.968 (p<0.001) for PWV ≥ 10 m/s, 0.977 (p<0.001) for PWV ≥ 9.08 m/s and 0.967 (p<0.001) for PWV ≥ 7.30 m/s. The score 7 showed a specificity of 95.40% and sensitivity of 100% for PWV≥10 m/s. The cut-off point would be of five for a PWV≥9.08 m/s (sensitivity =96.00%, specificity = 94.70%), and two for a PWV ≥ 7.30 m/s. Conclusion The SAGE score could identify individuals at higher risk of arterial stiffness, using different PWV cutoff points. However, the development of a specific score for normotensive and pre-hypertensive subjects is needed.

Association of coronary artery calcium with heart rate variability in the Brazilian Longitudinal Study of Adult Health - ELSA-Brasil

Current data shows that the autonomic and vascular systems can influence each other. However, only a few studies have addressed this association in the general population. We aimed to investigate whether heart rate variability (HRV) was associated with coronary artery calcium (CAC) in a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We examined baseline data from 3138 participants (aged 35 to 74 years) without previous cardiovascular disease who underwent CAC score assessment and had validated HRV recordings. Prevalent CAC was defined as a CAC score>0, and HRV analyses were performed over 5-min segments. We detected CAC score>0 in 765 (24.4%) participants. Subgroup analyses in older participants (≥49 years) adjusted for sociodemographic and clinical variables revealed that CAC score>0 was associated with lower values of standard deviation of NN intervals (SDNN) (odds ratio [OR]=1.32; 95%CI: 1.05,1.65), root mean square of successive differences between adjacent NN intervals (RMSSD) (OR=1.28; 95%CI: 1.02,1.61), and low frequency (LF) (OR=1.53, 95%CI: 1.21,1.92). Interaction analysis between HRV indices and sex in age-stratified groups revealed significant effect modification: women showed increased OR for prevalent CAC in the younger group, while for men, the associations were in the older group. In conclusion, participants aged ≥49 years with low SDNN, RMSSD, and LF values were more likely to present prevalent CAC, suggesting a complex interaction between these markers in the pathogenesis of atherosclerosis. Furthermore, our results suggested that the relationship between CAC and HRV might be sex- and age-related.

Sclerostin and TNF-related weak inducer of apoptosis: can they be important in the patients with glomerulonephritis?

SUMMARY OBJECTIVE: Sclerostin is a protein produced by osteocytes, kidneys, and vascular cells and has many effects on kidney and vascular structures. Soluble TNF-related weak inducer of apoptosis is a proinflammatory cytokine that may cause glomerular and tubular injury and increase sclerostin expression. This study aimed to investigate serum sclerostin and soluble TNF-related weak inducer of apoptosis levels in patients with glomerulonephritis and the effects they may be associated with. METHODS: This cross-sectional study included 93 patients, 63 of whom were glomerulonephritis and 30 were healthy controls. Serum sclerostin, soluble TNF-related weak inducer of apoptosis, and 24-h urinary protein excretion were measured, and pulse wave velocity was calculated for arterial stiffness. RESULTS: Serum sclerostin and soluble TNF-related weak inducer of apoptosis were higher in glomerulonephritis patients than in the control group, and serum sclerostin and soluble TNF-related weak inducer of apoptosis levels were correlated with both proteinuria and pulse wave velocity. In addition, in the regression analysis, serum sclerostin and soluble TNF-related weak inducer of apoptosis levels were found to be independent predictors of proteinuria in patients with glomerulonephritis. CONCLUSION: This is the first study to show that serum sclerostin and soluble TNF-related weak inducer of apoptosis are elevated in glomerulonephritis patients, and these two markers correlate with arterial stiffness and proteinuria in these patients. Considering the effects of sclerostin and soluble TNF-related weak inducer of apoptosis in patients with glomerulonephritis, we think these mechanisms will be the target of both diagnosis and new therapies.

Envelhecimento Vascular e Rigidez Arterial / Vascular Aging and Arterial Stiffness

Resumo O envelhecimento biológico é reflexo da interação entre genética, idade cronológica e fatores externos; é a base para novos conceitos em envelhecimento vascular, cuja progressão é determinada pela diferença entre idade biológica e cronológica. Do ponto de vista estrutural, os efeitos do envelhecimento vascular são mais evidentes na camada média das grandes artérias elásticas e resultam em aumento da rigidez arterial, da dilatação do lúmen e da espessura da parede. Esses efeitos são descritos no continuum de envelhecimento cardiovascular (proposto por Dzau em 2010) em que as etapas progressivas de lesões da microvasculatura de coração, rins e cérebro, têm início a partir do processo de envelhecimento. O aumento da rigidez arterial pode ser verificado de forma não invasiva por vários métodos. Os eventos cardiovasculares têm sido tradicionalmente previstos utilizando escores que combinam fatores de risco convencionais para aterosclerose. No continuum cardiovascular clássico (Dzau, 2006), é desafiador avaliar o peso exato da contribuição de cada fator de risco; entretanto, por refletir o dano precoce e cumulativo desses fatores de riscos cardiovascular, a rigidez arterial reflete o verdadeiro dano à parede arterial. Este artigo fornece uma visão geral dos mecanismos da fisiopatogenia, alterações estruturais das artérias e consequências hemodinâmicas do envelhecimento arterial; métodos não invasivos para a avaliação da rigidez arterial e da medida central da pressão arterial; o continuum de envelhecimento cardiovascular, e aplicação do conceito de rigidez arterial na estratificação de risco cardiovascular.

Abstract Biological aging occurs as a result of the interaction between genetics, chronological age and external factors. It is the basis for new concepts of vascular aging, whose progression is determined by the difference between biological and chronological age. From the structural point of view, the effects of vascular aging are more evident in the tunica media of large elastic arteries, marked by increased arterial stiffness, lumen dilation and wall thickness. These effects are described in the continuum of cardiovascular aging (proposed by Dzau in 2010), in which the progressive steps of microvasculature lesions of the heart, kidney and brain are initiated from the aging process. The increase of arterial stiffness can be detected by several non-invasive methods. Cardiovascular events have been traditionally described using scores that combine conventional risk factors for atherosclerosis. In the classic cardiovascular continuum (Dzau, 2006), to determine the exact contribution of each risk factor is challenging; however, since arterial stiffness reflects both early and cumulative damage of these cardiovascular risk factors, it is an indicator of the actual damage to the arterial wall. This article provides a general overview of pathophysiological mechanisms, arterial structural changes, and hemodynamic consequences of arterial stiffness; non-invasive methods for the assessment of arterial stiffness and of central blood pressure; the cardiovascular aging continuum, and the application of arterial stiffness in cardiovascular risk stratification.

A Associação de TWEAK com Calcificação da Artéria Coronária em Pacientes com Doença Renal Crônica / The Association of TWEAK with Coronary Artery Calcification in Patients with Chronic Kidney Disease

Resumo Fundamento O receptor fraco indutor de apoptose semelhante a fator de necrose tumoral solúvel (sTWEAK) é um membro da superfamília de TNF que tem um papel crítico na proliferação e inflamação na circulação arterial. Objetivos Este estudo prospectivo tem o objetivo de mostrar a relação entre os níveis de sTWEAK e calcificação da artéria coronária (CAC) em pacientes com doença renal crônica (DRC). Métodos Este estudo prospectivo incluiu 139 pacientes consecutivos que passaram por angiografia coronariana por tomografia computadorizada, por qualquer motivo, para síndromes coronarianas agudas, de agosto de 2020 a fevereiro de 2021. Um total de 12 pacientes foi excluído do estudo devido aos critérios de exclusão. Os pacientes foram divididos em dois grupos com base em terem um escore CAC menor que 400 (n=84) ou um escore de 400 ou mais (n=43). A significância foi presumida em p-valor bilateral <0,05. Resultados À medida que o escore CAC aumentou, os níveis de sTWEAK diminuíram de forma estatisticamente significativa e detectou-se uma relação forte entre níveis de sTWEAK e escore CAC (r: -0,779, p<0,001). A análise ROC revelou que o nível de corte ideal de sTWEAK para prever o escore CAC de 400 era 761 pg/mL com uma sensibilidade de 71% e especificidade de 73% (AUC: 0,78; IC 95%: 0,70-0,85; p <0,001). Conclusões Embora os estudos em larga escala tenham demonstrado uma correlação positiva entre os níveis de TFGe e sTWEAK, alguns estudos detectaram que o aumento nos níveis de sTWEAK estão associados a mortalidade e gravidade do sistema da artéria coronária em pacientes com DRC. Nossos resultados comprovam nossa hipótese de que os níveis de sTWEAK mostram calcificação coronária em vez de outros tipos de placas ateroscleróticas.

Abstract Background The soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) is a member of the TNF superfamily that plays a critical role in proliferation and inflammation in the arterial circulation. Objectives This prospective study aimed to show the relationship between the sTWEAK levels and coronary artery calcification (CAC) in patients with chronic kidney disease (CKD). Methods This prospective study included 139 consecutive patients undergoing computed coronary angiography for any reason except for acute coronary syndromes from August 2020 to February 2021. A total of 12 patients were excluded from the study due to exclusion criteria. Patients were divided into two groups with regard to having a CAC score of less than 400 (n=84) and 400 or more (n=43). Significance was assumed at a 2-sided p<0.05. Results As the CAC score increased, sTWEAK levels presented a statistically significant decrease, and a strong relationship between sTWEAK levels and the CAC score (r: -0.779, p<0.001) was observed. The ROC analysis revealed that the optimal cut-off level of sTWEAK for predicting the CAC score of 400 was 761 pg/mL with a sensitivity of 71% and a specificity of 73% (AUC: 0.78; 95% CI:0.70-0.85; p < 0.001) Conclusions Even though the large-scale studies showed a positive correlation between eGFR and the sTWEAK levels, some studies found the increased sTWEAK levels to be associated with mortality and the severity of the coronary artery system in patients with CKD. Our results support our hypothesis that the sTWEAK level shows coronary calcification rather than other types of atherosclerotic plaques.

Correlação entre a Circunferência de Cintura e Medidas Centrais da Pressão Arterial / Correlation among Waist Circumference and Central Measures of Blood Pressure

Resumo Fundamento: A rigidez arterial é um forte preditor de doença cardiovascular (DCV). Medidas de gordura corporal, como a circunferência da cintura (CC), têm sido associadas à DCV na idade adulta. Objetivos: O objetivo deste estudo foi avaliar a associação da rigidez arterial, medida por tonometria de aplanação-Sphygmocor, com a CC. Métodos: Estudo observacional com 240 participantes que fazem consultas de rotina no ambulatório de clínica médica de um hospital universitário. Os participantes foram entrevistados e tiveram as medidas centrais da pressão arterial (MCPA), parâmetros antropométricos, gordura abdominal e gordura visceral mensurados. Foram u tilizados os testes t pareado e não pareado e qui-quadrado. Foi a dotado nível de significância de 5%. Resultados: Dos 240 participantes, 51,82% era do sexo masculino com idade média de 59,71(±14,81) anos e CC média de 99,87 (±11,54) cm. Os valores médios das MCPA foram: Pressão arterial central (PAC) = 130,23 (91-223) mmHg, velocidade de onda de pulso (VOP) = 9,8 (5,28-19,6)m/s e Augmentation Index [Índice de amplificação (AI)] = 29,45 (-14-60). A VOP e a PAC foram altamente correlacionadas com uma CC com p<0,001 e p=0,02, respectivamente; porém, a mesma correlação positiva não foi encontrada entre a CC e o AI (p=0,06). Conclusão: O presente estudo mostrou uma associação positiva entre a CC e a rigidez arterial, através da velocidade de onda de pulso carotídeo femoral (VOP-cf) e o AI, sendo mais forte com a VOP-cf, sugerindo a avaliação do efeito da CC na saúde vascular como método de auxílio no tratamento precoce das DCV e na prevenção de desfechos clínicos.

Abstract Background: Arterial stiffness is a strong predictor of cardiovascular disease (CVD). Body fat measures such as waist circumference (WC) have been associated with CVD in adulthood. Objectives: The objective of this study was to evaluate the association of arterial stiffness, measured by applanation tonometry-Sphygmocor, with WC. Methods: Observational study with 240 participants who make routine consultations at the outpatient clinic of a university hospital. Participants were interviewed and had central blood pressure measurements (CBPM), anthropometric parameters, abdominal fat and visceral fat measured. Paired and unpaired t and chi-square tests were used. A significance level of 5% was adopted. Results: Of the 240 participants, 51.82% were male with a mean age of 59.71(±14.81) years and a mean WC of 99.87 (11.54) cm. Mean CBPM values were: Central arterial pressure (CAP) = 130.23 (91-223) mmHg, pulse wave velocity (PWV) = 9.8 (5.28-19.6)m/s and Augmentation Index [Amplification Index (AI)] = 29.45 (-14-60). PWV and CAP were highly correlated with WC with p<0.001 and p=0.02, respectively; however, the same positive correlation was not found between WC and AI (p=0.06). Conclusion: The present study showed a positive association between WC and arterial stiffness, through the femoral carotid pulse wave velocity (cf-PWV) and AI, being stronger with cf-PWV, suggesting the evaluation of the effect of WC in vascular health as a method of aid in the early treatment of CVD and in the prevention of clinical outcomes.

Associação da Composição Corporal com Rigidez Arterial em Longevos / Association of Body Composition with Arterial Stiffness in Long-lived People

Resumo Fundamento Pouco se conhece sobre a relação entre sarcopenia e hemodinâmica central em idosos longevos. Objetivo Estudar a relação da rigidez arterial com a composição corporal em idosos longevos. Métodos A composição corporal foi avaliada por meio da absortometria de Raio X de dupla energia (DEXA) e dos parâmetros de circulação central (PCC) obtidos por método oscilométrico não invasivo, com o Mobil-O-Graph 24h PWA Monitor®. Os parâmetros centrais avaliados foram: velocidade da onda de pulso (VOP), augmentation index (AIx), índice de amplificação da pressão de pulso (iAPP) e pressão de pulso central (PPc). Estes foram correlacionados com massa magra total (MM) e apendicular (MA), percentual de gordura corporal e índice de Baumgartner (IB). Aceitou-se nível de significância de 5%. Resultados Participaram 124 longevos, com idade média de 87,1 anos (DP±4,3 anos), sendo 74,2% mulheres e 57,3% brancos. Houve correlação inversa do AIx com as variáveis MM (r = - 0,391, p < 0,001), MA (r= -0,378, p< 0,001) e IB (r = -0,258, p 0,004). A PPc apresentou associação inversa com MM (r= -0,268, p =0,003), MA (r=-0,288, p= 0,001) e IB (r= -0,265, p = 0,003). Houve relação direta apenas entre AIx e percentual de gordura corporal (r= 0,197, p= 0,029). Conclusão Em idosos longevos, o percentual de gordura corporal se associa diretamente com a rigidez arterial e tem associação inversa com a quantidade de MM. Esses achados podem estar associados ao maior risco cardiovascular.

Abstract Background Arterial stiffness, obesity and sarcopenia correlate with each other and with cardiac outcomes in younger adults. However, there is little evidence of the association between body composition and markers of central arteries stiffness in long-lived people. Objective To evaluate the relationship between arterial stiffness and body composition in functionally independent long-lived individuals. Methods This is a cross-sectional analysis of the association between markers of arterial stiffness and body composition among participants in a longitudinal cohort of elderly individuals aged 80 years or older who were functionally independent and lived in the community . Body composition measurements were performed using dual energy X-ray absorptiometry (DEXA) and central circulation parameters (CCP) obtained by a non-invasive oscillometric method through the Mobil-O-Graph 24h PWA Monitor® device. The central parameters evaluated were: pulse wave velocity (PWV), augmentation Index (AIx), pulse pressure amplification index (PPAi) and central pulse pressure (cPP). These were correlated to total lean mass (LM) and appendicular lean mass (aLM), body fat percentage, and Baumgartner's Index (BI). The level of significance was set at 5% for all tests. Results Data from 124 elderly people with a mean age of 87.1 years (SD ± 4.3 years) were analyzed, with 74.2% of women and 57.3% of white. There was a statistically significant inverse correlation of AIx with LM (r = -0.391, p <0.001), aLM (r = -0.378, p <0.001), and BI (r = -0.258, p = 0.004). Also, cPP had an inversely proportional association with LM (r = -0.268, p = 0.003), aLM (r = -0.288, p = 0.001), and BI (r = -0.265, p = 0.003). When assessing the relationship between fat mass and CCP, a statistically significant direct relationship was observed only between AIx and body fat percentage (r = 0.197, p = 0.029). Conclusion In long-lived people, body fat percentage is directly associated with arterial stiffness and inversely associated with the amount of LM. These findings may be associated with increased cardiovascular risk.

The therapeutic effects of sports on arterial stiffness / Os efeitos terapêuticos do esporte na rigidez arterial / Los efectos terapéuticos del deporte en la rigidez arterial

ABSTRACT Introduction: Cardiovascular disease has become a significant condition affecting human health. Increased arterial stiffness is a leading stage in the occurrence and development of many cardiovascular diseases. Objective: To observe the effect of different acute exercise programs on arterial stiffness of healthy young people under the same amount of exercise. Methods: We selected 16 healthy boys to conduct a blank control test, continuous exercise test, and intermittent exercise. They were divided into blank schemes. Car plan and running plan. Arterial stiffness was repeatedly measured immediately after exercise and 40 minutes after the end. Results: In the three exercise intervention experiments, the heart-ankle vascular index decreased significantly immediately after exercise. After 60 minutes of rest, the heart-ankle vascular index rebounded. Conclusion: Physical exercise can significantly reduce arterial stiffness. Changing the training intensity in sports with the same target heart rate does not affect arterial stiffness. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: Doenças cardiovasculares tem se tornado uma condição importante afetando a saúde humana. O aumento da rigidez arterial é uma etapa determinante na ocorrência e no desenvolvimento de muitas doenças cardiovasculares. Objetivo: Observar o efeito de diferentes programas de exercício intenso na rigidez arterial de jovens saudáveis praticando a mesma quantidade de exercício. Métodos: Selecionamos 16 rapazes saudáveis para conduzir um ensaio em branco, testes com exercícios e exercícios intermitentes. Os indivíduos foram divididos em amostras em branco, plano xxx e plano de corrida. A rigidez arterial foi medida repetidas vezes imediatamente após o exercício e 40 minutos após. Resultados: nos três experimentos de intervenção, o índice vascular cardíaco-tornozelo diminuiu consideravelmente imediatamente após o exercício. Após 60 minutos de descanso, o índice vascular cardíaco-tornozelo se recuperou. Conclusão: Exercícios físicos podem reduzir a rigidez arterial de forma considerável. Modificar a intensidade do treino nos esportes com a mesma frequência cardíaca alvo não afeta a rigidez arterial. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: Enfermedades cardiovasculares se han convertido en una condición importante que afecta la salud humana. El aumento de la rigidez arterial es una etapa determinante en la ocurrencia y en el desarrollo de muchas enfermedades cardiovasculares. Objetivo: Observar el efecto de diferentes programas de ejercicio intenso en la rigidez arterial de jóvenes saludables practicando la misma cantidad de ejercicio. Métodos: Seleccionamos 16 muchachos saludables para conducir un ensayo en blanco, pruebas con ejercicios y ejercicios intermitentes. Se dividieron los individuos en blanco de muestra, plan de xxx y plan de carrera. Se midió la rigidez arterial repetidas veces inmediatamente tras el ejercicio y 40 minutos después. Resultados: En los tres experimentos de intervención, el índice vascular cardiaco-tobillo disminuyó considerablemente inmediatamente tras el ejercicio. Tras 60 minutos de descanso, el índice vascular cardiaco-tobillo se recuperó. Conclusión: Ejercicios físicos pueden reducir la rigidez arterial de forma considerable. Cambiar la intensidad del entrenamiento en los deportes con la misma frecuencia cardiaca-blanco no afecta la rigidez arterial. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

Carotid Intima and Media Thickness Correlation with Central Blood Pressure Measurements by Tonometric and Oscillometric Methods: A Proof of Concept

Abstract Background The early detection of vascular damage in subclinical stages of hypertensive disease may be the key point in the prevention of cardiovascular outcomes. Objectives to correlate parameters of structural vascular damage (measurement of the carotid intima-media thickness) with parameters of functional vascular damage (central hemodynamic measurements) in pre-hypertensive and hypertensive patients taking up to two classes of anti-hypertensive drugs. Methods This was a cross-sectional descriptive study conducted with a convenience sample of patients attending the Liga de Hipertensão Arterial , a multidisciplinary program for the diagnosis and treatment of systemic hypertension, of the Federal university of Goias. Patients with arrythmia, diabetes, previous cardiovascular or cerebrovascular diseases, and end-stage diseases were excluded. Carotid Doppler test, measurements of peripheral and central blood pressure by applanation tonometry (Sphygmocor®) and oscillometry (Mobil-O-Graph®) were performed. The t-test was used for comparisons and the Pearson correlation test for correlations, considering a p<0.05 statistically significant. Results twenty patients (12 women) were evaluated, mean age 53.8 ± 14.3 years. Higher values of central pulse pressure (42.9±13.9 vs. 34.7±9.6, p=0.01) and pulse wave velocity (PWV) (9.0±1.9 vs. 7.9±1.5, p=0.01) were obtained by applanation tonometry compared with oscillometry. No difference between the methods was observed for the other measures. A significant correlation was found between carotid artery intima-media thickness (CA-IMT) and PWV (r=0.659; p=0.002) by the oscillometric test, but not with applanation tonometry. No correlation was found between central hemodynamic variables and the presence of carotid artery plaques. Conclusion PWV, estimated by oscillometry, was the only central hemodynamic parameter that correlated significantly with CA-IMT in pre-hypertensive and hypertensive patients at low cardiovascular risk. International Journal of Cardiovascular Sciences. 2020; [online].ahead print, PP.0-0