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Bruno Pannier

Publications and source records attributed to Bruno Pannier.

At least 19 recordsLinked to original sources
PubMed2007

Local shear stress and brachial artery functions in end-stage renal disease.

Physiologic laminar shear stress (SS) is crucial for normal vascular structure and function. As a result of anemia-related lower whole-blood viscosity (WBV), SS could be reduced in patients with ESRD and might be associated with arterial functional alterations. In 44 patients with ESRD and 25 control subjects, brachial artery (BA) compliance and BA diameter changes (flow-mediated dilation [FMD[) were evaluated in response to local shear rate and SS changes during hand warming-induced hyperemia. Patients with ESRD and control subjects had similar BA blood flow, but SS was lower in patients with ESRD (P < 0.001), with lower shear rate (P < 0.01) and lower WBV (P < 0.0001). In control subjects, SS was positively (and physiologically) correlated with arterial diameter (P < 0.001). In contrast, in patients with ESRD, larger arterial diameter was associated with low SS (P < 0.05) and increased arterial wall elastic modulus (P < 0.001). Anemia-associated low WBV aggravates low shear rate, further contributing to SS reduction. These abnormalities were associated with decreased vasodilating response to endothelial mechanical stimulation. Compared with control subjects, BA compliance and FMD increases in response to hand warming-induced increased SS were lower in ESRD patients (P < 0.01), whereas their BA diameter response to glyceryl trinitrate did not differ. The long-term WBV and SS increases after anemia correction improved FMD (P < 0.01) and BA compliance (P < 0.05) and heightened arterial wall sensitivity to mechanical stimulation. Maintenance low SS as a result of anemia could play an indirect role in arterial dysfunction in patients with ESRD.

Adult↗
PubMed2007

Mineral metabolism and arterial functions in end-stage renal disease: potential role of 25-hydroxyvitamin D deficiency.

In ESRD, arterial function is abnormal, characterized by decreased capacitive function (arterial stiffening) and reduced conduit function, shown by diminished flow-mediated dilation (FMD). The pathophysiology of these abnormalities is not clear, and this cross-sectional study analyzed possible relationships among arterial alterations and cardiovascular risk factors, including mineral metabolism parameters, such as serum parathormone, and vitamin D "nutritional" and "hormonal" status by measuring serum 25-hydroxyvitamin D [25(OH)D(3)] and 1,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)] levels. Aortic stiffness (pulse wave velocity), brachial artery (BA) distensibility (echotracking; n = 42), BA FMD (hand-warming; n = 37), and arterial calcification scores (echography and plain x-rays) were measured in 52 stable and uncomplicated patients who were on hemodialysis. 25(OH)D(3) and 1,25(OH)(2)D(3) serum levels were low and weakly correlated (r = 0.365, P < 0.05). After adjustment for BP and age, multivariate analyses indicated that 25(OH)D(3) and 1,25(OH)(2)D(3) were negatively correlated with aortic pulse wave velocity (P < 0.001) and positively correlated with BA distensibility (P < 0.01) and FMD (P < 0.001). Arterial calcification scores were not independently associated with 25(OH)D(3) and 1,25(OH)(2)D(3) serum concentrations. These results suggest that nutritional vitamin D deficiency and low 1,25(OH)(2)D(3) could be associated with arteriosclerosis and endothelial dysfunction in patients who have ESRD and are on hemodialysis.

Adolescent↗
PubMed2006

Expert consensus document on arterial stiffness: methodological issues and clinical applications.

In recent years, great emphasis has been placed on the role of arterial stiffness in the development of cardiovascular diseases. Indeed, the assessment of arterial stiffness is increasingly used in the clinical assessment of patients. Although several papers have previously addressed the methodological issues concerning the various indices of arterial stiffness currently available, and their clinical applications, clinicians and researchers still report difficulties in selecting the most appropriate methodology for their specific use. This paper summarizes the proceedings of several meetings of the European Network for Non-invasive Investigation of Large Arteries and is aimed at providing an updated and practical overview of the most relevant methodological aspects and clinical applications in this area.

Adult↗
PubMed2006

Brachial pressure-independent reduction in carotid stiffness after long-term angiotensin-converting enzyme inhibition in diabetic hypertensives.

Hypertension and diabetes are associated with an increased arterial stiffness. A direct blood pressure-independent effect of angiotensin-converting enzyme inhibitors on arterial stiffness has never been unequivocally demonstrated. In this mechanistic study, we used an experimental design in which patients responding to 1 month treatment with 4 mg perindopril were randomized double-blind to either 4 mg perindopril or 8 mg perindopril for 6 months. We determined carotid distensibility with echotracking and applanation tonometry at baseline and after the 7-month treatment period in 57 essential hypertensive patients with type 2 diabetes (age 63+/-7 years). We monitored ambulatory blood pressure at baseline and after treatment. After 7 months treatment, 24-hour ambulatory blood pressure significantly decreased, with no significant difference between 4 mg and 8 mg perindopril. Carotid distensibility increased more after 8 mg perindopril compared with 4 mg perindopril (8 mg: from 13.1+/-5.9 to 16.0+/-6.7 kPa(-1)x10(-3); 4 mg: from 13.2+/-5.2 to 12.7+/-5.9 kPa(-1)x10(-3); ANOVA, dose-period interaction, P<0.05). Carotid internal diameter and elastic modulus were significantly lower after 8 mg perindopril compared with 4 mg perindopril, independent of blood pressure reduction. These results indicate a dose-dependent and blood pressure-independent reduction in carotid stiffness under chronic treatment with an angiotensin-converting enzyme inhibitor. They suggest that arterial distensibility was increased through an inward remodeling, leading to a reduction in wall stress, thus reducing elastic modulus. They also suggest that long-term administration of high doses (8 mg) of perindopril is required to improve carotid structure and function in hypertensive patients with type 2 diabetes.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2006

Cardiovascular disease in the dialysis population: prognostic significance of arterial disorders.

PURPOSE OF REVIEW: Cardiovascular disease is a major factor in the high mortality of patients with end-stage renal disease, and this population is particularly appropriate to analyse the impact of cardiovascular risk markers on outcome. RECENT FINDINGS: Cardiovascular risk markers in end-stage renal disease include age, left ventricular mass, carotid intima-media thickness, blood pressure and aortic stiffness (pulse wave velocity). Aortic pulse wave velocity has been shown to be an independent predictor of cardiovascular mortality in patients with end-stage renal disease and the general population. Aortic pulse wave velocity has the highest sensitivity and specificity as a predictor of cardiovascular death in end-stage renal disease patients. Pulse wave velocity is an integrated index of vascular function and structure, and is a major determinant of systolic hypertension, thereby increasing left ventricular afterload, left ventricular hypertrophy and left ventricular oxygen consumption. Decreased diastolic blood pressure, another consequence of arterial stiffening, is associated with decreased coronary perfusion contributing to ischaemic heart disease and evolution of adaptive into maladaptive left ventricular hypertrophy. SUMMARY: Aortic stiffness measurements could serve as an important tool in identifying end-stage renal disease patients at higher risk of cardiovascular disease. The ability to identify these patients would lead to better risk stratification and earlier and more cost-effective preventive therapy.

Adult↗
PubMed2006

[Metabolic syndrome: prevalence, risk factors and mortality in a French population of 62 000 subjects].

We evaluated the prevalence, risk factors and impact on all-cause mortality of the metabolic syndrome (MetS) and its components in a large French population. The study population consisted of subjects aged 40 years or more who volunteered for a free health check-up at the IPC Center (Investigations Préventives et Cliniques, Paris) between 1999 and 2002. There were 40 977 men (53.2 +/- 9.1 years) and 21 277 women (55.9 +/- 10.3 years). The cutoff date for mortality data was March 2004. The mean follow-up period was 3.57 +/- 1.12 years. During this period, 271 men and 87 women died. MetS was defined according to NCEP-ATP III criteria. Cox regression models were used to evaluate the risk of death [hazards ratio (95% CI)]. MetS was present at baseline in 11.8% of men and 7.6% of women. The prevalence of MetS increased from 9% in men aged 40 to 49 years to 12.5% in men aged 70 years. In women, the prevalence rose from 4.9% to 11.3%, respectively. From 1999 to 2002, the prevalence of MetS increased from 11.0% to 12.8% in men and from 7.2% to 8.8% in women. The following clinical and biological parameters were significantly associated with MetS in men and women, after adjustment for age: lower physical activity, lower vital capacity ratio, higher pulse pressure and heart rate, higher gamma-glutamyl transpeptidase, ASA and ALA transaminase and alkaline phosphatase levels, higher uricemia, leukocyte and globulin levels, dental and gingival inflammation, and higher stress and depression scores. After adjustment for age, the excess risk of all-cause mortality in subjects with MetS compared to subjects without MetS was 1.82 (1.35-2.43) in men and 1.80 (1.01-3.19) in women. After adjustment for age, gender, smoking, cholesterol, physical activity, socioeconomic status and prior cardiovascular disease, the risk of all-cause mortality was 1.69 (1.28-2.22) in the entire population. In order to evaluate the impact of each Mets component, and combinations of three MetS components, on all-cause mortality, a control group of subjects with no MetS components was used. After adjustment for age and gender, the risk of death associated with each MetS component was 2.36 (1.65-3.37) for high waist circumference, 2.08 (1.44-3.01) for elevated triglyceride levels, 1.71 (1.07-2.72) for low HDL-cholesterol levels, 1.75 (1.29-2.38) for elevated arterial pressure, and 2.93 (2.04-4.22) for elevated glucose levels. Waist circumference + elevated triglycerides + elevated glucose was the three-component combination with the strongest impact [HR = 4.95 (2.92-8.37)]. In this large French population, in which MetS was moderate, MetS was associated with other hemodynamic, hepatic, inflammatory and psychological risk factors, and with a 70% increase in all-cause mortality. The three-component combination most strongly associated with mortality was high waist circumference + elevated glucose + elevated triglycerides.

Adult↗
PubMed2005

Metabolic syndrome and age-related progression of aortic stiffness.

UNLABELLED: Aortic stiffness measured from pulse wave velocity (PWV) was studied during a six-year period in a population of subjects with zero to three and more cardiovascular (CV) factors involving hypertension, body mass index, dyslipidemia, hypertriglyceridemia, and hyperglycemia. During the follow-up, the increase in PWV was significantly higher in subjects with three and more CV risk factors (i.e., in subjects with metabolic syndrome) than in subjects with zero, one, or two factors, even after adjustments for confounding factors. Metabolic syndrome involves an increased progression of arterial stiffness with age and, thus, favors premature senescence. OBJECTIVES: The purpose of the study was to evaluate whether a clustering of metabolic risk factors might accelerate the progression of arterial stiffness with age in subjects with metabolic syndrome (MS). BACKGROUND: Arterial stiffness is increased in MS, but the genetic and environmental factors that might influence its progression are unknown. METHODS: Four hundred seventy-six subjects were classified at baseline according to their number of cardiovascular (CV) risk factors (from zero to three and more), after adjustment for smoking habits. The CV risk factors were: hypertension, body mass index, dyslipidemia, hypertriglyceridemia, and hyperglycemia, classified according to traditional criterions. Subjects were followed for six years and had, at the beginning and end of the survey, determinations of blood pressure (BP), heart rate (HR), and aortic pulse wave velocity (PWV). RESULTS: At baseline, BP, HR, plasma creatinine, and PWV were significantly higher (p < 0.001) in the group with three and more CV risk factors than in groups with zero to two risk factors. During the follow-up, the increase in PWV, but not in pulse pressure, was significantly higher (p < 0.01) in the group with three and more risk factors (i.e., metabolic syndrome) than in other groups. Results were unmodified after adjustments for age, gender, baseline values, drug treatment, smoking habits, and mean arterial pressure. CONCLUSIONS: Metabolic syndrome is associated with an increased progression of aortic stiffness with age, supporting premature senescence in these patients.

Aging↗
PubMed2005

Cardiovascular mortality in overweight subjects: the key role of associated risk factors.

The role of obesity and overweight as independent risk factors for cardiovascular disease is still debated. The aim of this study was to evaluate the impact of overweight on cardiovascular mortality according to the presence or absence of associated risk factors. This study included 139,562 men and 104,236 women, aged 18 to 95 years, who had a standard health checkup at the IPC Center between 1972 and 1988. The follow-up period for mortality ended in December 1997. In both genders, the prevalence of hypertension, diabetes, and hypercholesterolemia increased with body mass index (P<0.001). When compared with subjects with a body mass index <25 kg/m2 without associated risk factors, overweight subjects without associated risk factors did not have an increased risk of cardiovascular mortality. Risk of cardiovascular death increased significantly when overweight was associated with hypertension alone [hazard ratio: 2.05 (1.71 to 2.46) in men; 2.15 (1.48 to 3.11) in women]. In both genders, the association of overweight with diabetes alone or hypercholesterolemia alone did not increase the risk. By contrast, in the presence of hypertension, cardiovascular mortality dramatically increased in overweight subjects with hypercholesterolemia [hazard ratio: 2.65 (2.20 to 3.19) in men, 2.57 (1.80 to 3.68) in women] or diabetes [hazard ratio: 3.01 (2.29 to 3.95) in men; 4.50 (2.67 to 7.58) in women]. The data suggest that the presence of high blood pressure in overweight subjects is the key factor leading to a significant increase in cardiovascular mortality. Because overweight significantly increases the prevalence of associated risk factors, especially hypertension, it should be considered as a major cardiovascular risk determinant.

Adolescent↗
PubMed2005

Stiffness of capacitive and conduit arteries: prognostic significance for end-stage renal disease patients.

The aorta is the principal capacitive element of the arterial tree and its increased stiffness, determined by measurement of aortic pulse wave velocity (PWV), is a strong independent predictor of cardiovascular mortality in the general population and end-stage renal disease (ESRD) patients. Whether stiffness of ESRD patients' peripheral arteries has the same prognostic value has never been investigated. A cohort of 305 ESRD patients was followed for 70+/-49 months (mean+/-SD). Ninety-six deaths of cardiovascular origin occurred. At entry into the study, together with standard clinical and biochemical analyses, patients' aortic, brachial artery, and femorotibial PWV were determined. Based on Kaplan-Meier survival curve analyses and Cox proportional hazards analyses, adjusted for age, pulse pressure, and clinical data, aortic PWV was a significant and independent predictor of outcome. Neither brachial artery nor femotibial artery stiffness was able to predict cardiovascular outcome. Receiver operating characteristic curve analysis of aortic PWV indicated the cutoff value of 10.75 m/s, with 84% sensitivity, 73% specificity, 87% negative predictive value, and 72% positive predictive value. These results provide evidence that, in ESRD, increased stiffness of capacitive arteries, like the aorta, is an independent strong predictor of cardiovascular mortality, whereas stiffness of peripheral conduit arteries had no prognostic value.

Adult↗
PubMed2005

Role of modifiable risk factors in life expectancy in the elderly.

OBJECTIVE: The aim of the present study was to evaluate the role of 'modifiable' risk factors, assessed between the ages of 60 and 70 years, in late survival. DESIGN: The study population included subjects aged 60-70 years, who had a standard health examination at the IPC Center, and who could potentially reach the age of 80 years for men and 85 years for women at the end of the follow-up period. METHODS: The role of 'modifiable' risk factors was assessed by comparing subjects who died before the age of 80 years for men (n=1333) and before 85 years for women (n=543) to subjects who survived beyond these ages (3681 men, 1910 women). Multivariate analyses were conducted to determine which parameters were independently associated with survival to an advanced age. RESULTS: The multivariate analysis showed a decreased probability of late survival with higher pulse pressure (P<0.0001), higher heart rate (P<0.002), higher glycemia (P<0.0034), and an increased probability with regular physical activity (P<0.0001). A significant interaction between heart rate and gender (P<0.01) was observed, indicating that heart rate was a predictor of late survival in men but not in women. Body mass index, cholesterol and triglyceride levels, and diastolic blood pressure and tobacco smoking were not associated with late survival in this population. CONCLUSIONS: A systematic search for certain risk factors in an elderly patient can have a significant impact on late survival and can lead to the establishment of priority goals, such as increasing physical activity and reducing blood pressure, heart rate and glycemia.

Age Factors↗
PubMed2004

Validation of a new non-invasive portable tonometer for determining arterial pressure wave and pulse wave velocity: the PulsePen device.

OBJECTIVE: To validate a new, small portable tonometer (PulsePen) that is able to assess carotid artery pressure and to measure pulse wave velocity (PWV) non-invasively. Its software provides absolute arterial pressure values, an assessment of arterial pulse wave contours, an estimation of reflection waves and measurements of PWV. DESIGN AND METHODS: Two validation studies were carried out. The aim of the first study was to compare arterial pressure values and pulse wave contours recorded in the carotid artery using the PulsePen versus intra-arterial simultaneous measurements in 10 patients undergoing cardiac catheterization. The pulse wave contour was assessed using Fourier analysis. The comparison between the two methods showed no difference in arterial pressure wave spectral moduli from harmonics 1 to 6. The second study compared PWV measurements taken with the PulsePen (one tonometer) and measurements performed with two Millar tonometers in 68 subjects (32 men, 36 women). PulsePen measurements were realized as two consecutive measurements in the carotid and femoral arteries, both synchronized by electrocardiogram. The pulse wave transit time was calculated as the difference between the time delay of the femoral pulse wave and the carotid pulse wave in relation to the R wave of the electrocardiogram. These measurements were compared with PWV obtained by simultaneous carotid and femoral measurements with the two Millar tonometers. No difference between the two methods was found, with a variation coefficient of 7.7%. The variation coefficients of the inter-observer and intra-observer reproducibility for the PulsePen were 7.9 and 7.2%, respectively. CONCLUSIONS: These results show that the PulsePen enables an easy and reliable evaluation of central arterial pressure and stiffness in clinical ambulatory practice, especially in high-risk patients in whom arterial stiffness has been shown to be a significant indicator of morbidity and mortality.

Adult↗
PubMed2004

Forearm reactive hyperemia and mortality in end-stage renal disease.

BACKGROUND: Reports on the general population indicated that decreased endothelial-mediated vasodilation has a prognostic impact on cardiovascular (CV) morbidity and mortality. Flow-dependent vasodilation of conduit arteries and ischemia-induced forearm reactive hyperemia are impaired in end-stage renal disease (ESRD). Whether deterioration of vasodilator function in ESRD patients has a prognostic impact has not been documented. The aim of this study was to determine whether the impaired forearm postischemic vasodilation is an independent predictor of mortality in ESRD patients, independently from CV end-organ damages, which are usually associated with decreased vasodilatory response. METHODS: Common carotid artery intima-media thickness (CCA-IMT), aortic stiffness (pulse wave velocity-PWV), and LV mass (LVM) were determined for 78 stable ESRD patients on hemodialysis. Forearm postischemic vasodilation [flow debt repayment (FDR)] was measured by venous plethysmography. All-cause mortality served as the outcome variable over a median follow-up of 60 +/- 27 months. RESULTS: Twenty-four deaths occurred (16 of CV origin). According to Cox regression adjusted for age, CCA-IMT, LVM, and PWV, all-cause mortality was independently associated with decreased FDR (RR 0.69 for every 10% increase; 95% CI 0.56-0.85; P= 0.0006) and increased aortic PWV (RR 1.16 for 1 m/s increase; 95% CI 1.04-1.29; P= 0.0091). CONCLUSION: Our data indicate that lower postischemic forearm reactive hyperemia is associated with all-cause mortality of ESRD patients, independently of the presence of end-organ damage such as LVH or arteriosclerosis.

Adolescent↗
PubMed2003

Aortic pulse wave velocity index and mortality in end-stage renal disease.

BACKGROUND: Aortic pulse wave velocity (PWV) is a strong independent predictor of overall and cardiovascular mortality in patients with end-stage renal disease (ESRD). Nevertheless, because age, blood pressure, heart rate, and gender are strong determinants of both arterial stiffness and mortality, the individual relevance of PWV measurements remains controversial. METHODS: A cohort of 242 patients with ESRD undergoing hemodialysis was studied for a mean (+/- SD) duration of 78 +/- 46 months. At entry, together with standard clinical and biochemical analyses, PWV was measured using Doppler ultrasonography. On the basis of a nomogram established on 469 nonuremic subjects, a theoretical value of PWV was determined in ESRD patients according to their age, blood pressure, gender, and heart period. The PWV index (measured PWV - theoretical PWV) was then calculated for each individual ESRD patient. RESULTS: Based on Cox analysis, the PWV index, but neither pulse pressure nor cardiac mass, was a strong and independent predictor of both cardiovascular and overall mortality, together with age and time on dialysis before inclusion. Patients with positive (versus negative) PWV index had a twofold adjusted risk of mortality during the follow-up. Per each 1 meter/second PWV index increment, we observed a 34% (crude) and a 14% (adjusted) increase in both cardiovascular and overall mortality (P < 0.02 for all). CONCLUSION: In ESRD patients, the calculation of a PWV index provides information about cardiovascular and overall mortality risk with high predictive power, showing that PWV measurements provide discriminatory prognostic power over and above conventional cardiovascular risk factors.

Adult↗
PubMed2003

Inflammation, arteriosclerosis, and cardiovascular therapy in hemodialysis patients.

BACKGROUND: Aortic stiffness and left ventricular hypertrophy (LVH) are predictors of mortality in hemodialysis (HD) patients. Attenuation of arterial stiffness and regression of LVH had a favorable effect on survival in these patients, but this favorable effect was observed in less than 50% of patients, the rest being resistant to therapeutical interventions. The aim of this study was to analyze the factors associated with this resistance to treatment. METHODS: 138 patients on HD were studied during a follow-up survey. From entry until the end of follow up, the changes of aortic pulse wave velocity (PWV) and of LV mass were measured in response to treatment with antihypertensive drugs and erythropoietin, together with measurements of blood chemistry, including high-sensitive C-reactive protein (CRP). Patients with decreased aortic PWV were considered to be responders (N = 68), the others to be nonresponders (N = 70). RESULTS: Nonresponders were older (P < 0.05) and had persistently higher systolic blood pressure (BP) and pulse pressure. Responders were treated more frequently with an ACE inhibitor (P < 0.001), and had lower serum CRP (P < 0.01). The baseline PWV, as well as the changes of PWV and LV mass during the follow-up were significantly and independently correlated with serum CRP level (P < 0.001). According to logistic regression after adjustment for age, gender, diabetes, history of CVD, and the nonspecific cardiovascular risk factors, the improvement of aortic stiffness and LV hypertrophy was positively associated with prescription of ACE inhibitor (P < 0.0001), and negatively with the serum CRP level (P < 0.01). CONCLUSION: These results indicate that in HD patients, the presence of low-grade inflammation decreases the efficiency of cardiovascular therapeutic interventions and participates in the persistence of cardiovascular hemodynamic overload.

Adult↗
PubMed2003

Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality.

BACKGROUND: Cross-sectional and follow-up studies on end-stage renal disease patients showed that arterial calcifications are associated with cardiovascular (CV) morbidity and are an independent predictor of all-cause and CV mortality. However, these studies did not examine the impact on prognosis according to the type of calcification, i.e. intimal vs medial. Arterial media calcification (AMC), a non-occlusive condition, affects haemodynamics differently from arterial intima calcification (AIC), which occurs in atherosclerotic plaques. The aim of this study was to investigate the prognostic value of AMC in relationship to all-cause or CV mortality for stable haemodialysis (HD) patients. METHODS: We included 202 such patients in the present study. At baseline, soft-tissue native radiograms of the pelvis and the thigh were analysed for the presence and type (AMC vs AIC) of arterial calcifications. All patients underwent B-mode ultrasonography of the common carotid artery to determine the presence of atherosclerotic calcified plaques, measurement of aortic pulse wave velocity and echocardiography. RESULTS: AIC was usually observed in older patients with a clinical history of atherosclerosis before starting HD treatment and typical risk factors associated with atherosclerotic disease. AMC was observed in young and middle-aged patients without conventional atherosclerotic risk factors. AMC was closely associated with the duration of HD and calcium-phosphate disorders, including the oral dose of elemental calcium prescribed as phosphate binder (CaCO(3)). Compared to patients with AIC, patients with AMC had a longer survival, but in turn their survival was significantly shorter than that of patients without calcifications. CONCLUSIONS: AMC is a strong prognostic marker of all-cause and CV mortality in HD patients, independently of classical atherogenic factors. The principal effect of AMC on arterial function is increased arterial stiffness.

Adult↗
PubMed2003

Influence of sex on the relation between heart rate and aortic stiffness.

BACKGROUND: Heart rate and aortic pulse wave velocity (PWV) are both cardiovascular risk factors. The aim of this study was to evaluate the influence of sex on the heart rate-PWV relationship in two populations of normotensive and hypertensive men and women. PATIENTS AND METHODS: In a first study, steady-state data describing the heart rate-PWV relationship were determined in 558 normotensive men, 308 normotensive women, 323 hypertensive men and 93 hypertensive women. In a second study, the changes in blood pressure and PWV under atrial pacing at 60, 80 and 100 beats/min were investigated in 15 men and 15 women who were either normotensive or hypertensive. RESULTS: In women in study 1, 26.8% of PWV variance in normotensive patients and 15.4% of PWV variance in hypertensive patients was explained by a multiple regression including only age and systolic blood pressure as covariates. In men in study 1, 27% of PWV variance in normotensive patients and 28.5% of PWV variance in hypertensive patients was explained by a multiple regression including age, systolic blood pressure, weight, and also heart rate, as covariates. In study 2, atrial pacing in the overall population tended to decrease mean blood pressure (P = 0.05) and increase pulse pressure (P = 0.003), with no substantial change in PWV. However, when heart rate increased, PWV tended to decrease in women and to increase in men (interaction: P = 0.07).CONCLUSION Accelerated heart rate influences PWV in both normotensive and hypertensive men and, through this mechanism, could influence cardiovascular risk. However, heart rate does not influence PWV in women.

Adult↗
PubMed2002

Determinants of accelerated progression of arterial stiffness in normotensive subjects and in treated hypertensive subjects over a 6-year period.

BACKGROUND: Elastic artery stiffness, a result of arterial aging, is an independent indicator of cardiovascular risk. The aim of the present longitudinal study was to compare the progression of aortic stiffness over a 6-year period in treated hypertensive subjects and normotensive subjects, and to evaluate the determinants of this progression. METHODS AND RESULTS: Data for the present analysis were gathered from 483 subjects who had 2 health checkups at the Centre d'Investigations Préventives et Cliniques, the first one in 1992--1993 and the second one in 1998--1999. Carotid-femoral pulse wave velocity (PWV) was used to evaluate aortic stiffness in 187 hypertensive subjects who were under treatment at the time of the first visit and throughout the follow-up period, and in 296 subjects who were classified as normotensive during the first visit and who remained treatment-free throughout the follow-up period. In both populations, PWV progression was higher in older subjects. Annual rates of progression in PWV in treated hypertensives were significantly higher than in normotensives. Only treated hypertensives with well-controlled blood pressure levels at the time of both visits had a PWV progression similar to that of normotensives. In treated hypertensives, high heart rate and high creatinine during the first visit were associated with an accelerated progression in PWV. CONCLUSIONS: The presence of high blood pressure, high heart rate, and high serum creatinine were the major determinants of accelerated progression of aortic stiffness in treated hypertensives. This is the first longitudinal study to evaluate the determinants of arterial aging over an extended period of time.

Aging↗