Arteriovenous Shunt, Surgical ; adverse effects ; Brachial Artery ; diagnostic imaging ; Diabetic Nephropathies ; complications ; therapy ; Hematoma ; complications ; diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Male ; Median Neuropathy ; diagnostic imaging ; etiology ; physiopathology ; Middle Aged ; Neural Conduction ; Renal Dialysis ; Ultrasonography

OBJECTIVETo assess the relationship between visit-to-visit blood pressure (BP) variability (BPV) and vascular endothelial function in a cohort of elderly hypertensive patients.

METHODSA total of 174 elderly patients with essential hypertension were included in the study. The participants had their office BP measured during the 12-month follow-up. Right brachial artery diameter was assessed at rest, during reactive hyperemia (flow-mediated dilation, FMD), and after nitroglycerin administration (nitroglycerin-mediated dilation, NMD). The participants were divided into two groups according to FMD% or FMD/NMD ratio. The correlations between BPV and endothelial function were analyzed by univariate analysis and multiple linear regression analysis.

RESULTSThe participants classified as having a decreased endothelial function according to FMD/NMD ratio had significantly lower FMD% and higher BPV and NMD% (P<0.05). The percentage of CCBs use in normal endothelial function group was significantly higher than that in decreased endothelial function group (79.55% vs 63.95%, P<0.05). Multiple linear regression analysis revealed a significant negative association between FMD/NMD ratio and BPV, and this association remained significant after adjustment for age, body mass index, and mean BP levels.

CONCLUSIONSFMD/NMD ratio is a better marker of endothelial function than FMD, and an increased visit-to-visit variability of BP is associated with a decreased endothelial function.

Aged ; Blood Pressure ; Brachial Artery ; Endothelium, Vascular ; physiopathology ; Essential Hypertension ; Humans ; Hypertension ; Multivariate Analysis ; Nitroglycerin ; Regression Analysis ; Vasodilation

Microalbuminuria is a marker of generalized endothelial dysfunction resulting from arterial stiffness or insulin resistance, and brachial-ankle pulse wave velocity (baPWV) is a good measure of arterial stiffness. We aimed to investigate whether elevated baPWV is independently associated with microalbuminuria. This study included 1,648 individuals aged over 40 who participated in the baseline Multi-Rural Cohort Study conducted in Korean rural communities between 2005 and 2006. Participants were classified into less than 30 mg/g as normoalbuminuria or 30-300 mg/g as microalbuminuriausing urinary albumin creatinine ratio (UACR). The median and Q1-Q3 baPWV values were significantly higher in the microalbuminuric group both in men (1,538, 1,370-1,777 cm/s vs. 1,776, 1,552-2,027 cm/s, P < 0.001) and women (1,461, 1,271-1,687 cm/s vs. 1,645, 1,473-1,915 cm/s, P < 0.001). BaPWV was independently associated with microalbuminuria in both genders after adjusting for pulse rate; fasting blood glucose; triglyceride; homeostatic model assessment insulin resistance (HOMA(IR)) and, history of hypertension and diabetes. Fasting blood sugar and HOMA(IR) were judged as having nothing to do with multicolinearity (r = 0.532, P < 0.001). Elevated baPWV was independently associated with microalbuminuria regardless of insulin resistance among rural subjects over 40 yr.
Adult ; Aged ; Albuminuria/*diagnosis/etiology/metabolism ; Ankle Brachial Index ; Ankle Joint/*physiopathology ; Blood Chemical Analysis ; Blood Glucose/analysis ; Brachial Artery/*physiopathology ; Cohort Studies ; Diabetes Mellitus, Type 2/complications/diagnosis ; Female ; Humans ; Hypertension/complications/diagnosis ; Male ; Middle Aged ; *Pulse Wave Analysis ; Risk Factors ; *Rural Population ; Serum Albumin/analysis ; Triglycerides/blood ; Vascular Stiffness

The aim of this study was to determine the normal value of brachial-ankle pulse wave velocity (baPWV) and carotid-femoral pulse wave velocity (cfPWV) according to age group, gender, and the presence of cardiovascular risk factors in healthy Koreans, and to investigate the association between PWV and risk factors such as prehypertension, dyslipidemia, smoking, and obesity. We measured an arterial stiffness in 110 normal subjects who were 20 to 69 yr-old with no evidence of cardiovascular disease, cerebrovascular accident or diabetes mellitus. The mean values of baPWV and cfPWV were 12.6 (+/-2.27) m/sec (13.1+/-1.85 in men, 12.1+/-2.51 in women; P=0.019) and 8.70 (+/-1.99) m/sec (9.34+/-2.13 in men, 8.15+/-1.69 in women; P=0.001), respectively. The distribution of baPWV (P<0.001) and cfPWV (P=0.006) by age group and gender showed an increase in the mean value with age. Men had higher baPWV and cfPWV than women (P<0.001). There was a difference in baPWV and cfPWV by age group on prehypertension, dyslipidemia, current smoking, or obesity (P<0.001). In multiple linear regression, age and prehypertension were highly associated with baPWV and cfPWV after adjustment for confounding factors (P<0.001). The present study showed that baPWV and cfPWV are associated with age, gender, and prehypertension in healthy Koreans.
Adult ; Age Factors ; Aged ; *Ankle Brachial Index ; Blood Pressure ; Brachial Artery/*physiology ; Cardiovascular Diseases/diagnosis/etiology/physiopathology ; Carotid Arteries/*physiology ; Female ; Femoral Artery/*physiology ; Humans ; Male ; Middle Aged ; Obesity/physiopathology ; Prehypertension/physiopathology ; Pulsatile Flow ; *Pulse Wave Analysis ; Republic of Korea ; Risk Factors ; Sex Factors ; Smoking ; Vascular Stiffness/physiology

BACKGROUNDHigh uric acid (UA) levels and metabolic syndrome (MS) are risk factors for atherosclerotic diseases. Brachial-ankle pulse wave velocity (baPWV) is a valid and reproducible measurement by which to assess arterial stiffness and a surrogate marker of atherosclerosis. However, little is known about the relationship between them, especially in elderly Chinese with MS components who are at high risk for atherosclerotic diseases.

METHODSOne thousand and twenty Chinese subjects (159 women) older than 60 years of age (mean age (70.6 ± 5.7) years) with at least one MS component underwent routine laboratory tests, and baPWV measurements were analyzed.

RESULTSParticipants were divided into four groups by MS components. The mean age did not significantly differ among the MS component groups. We found that not only the diagnostic factors (blood pressure, body mass index (BMI), lipids, glucose) of MS but also baPWV, UA, insulin, homeostasis model of assessment for insulin resistence index (HOMAIR) levels increased, and high density lipoprotein (HDL)-C decreased with an increased number of MS components (test for trend P < 0.05). The association between UA and baPWV was observed after adjustment for gender, age, blood pressure, BMI, serum creatinine and high density lipoprotein, and insulin resistance (r = 0.186, P < 0.0001). There were increases in the odds ratios for the association between the number of components of MS, UA and baPWV, even after adjustment for traditional risk factors. However, after adjustment for insulin or HOMA-IR, there were no significant differences in the multivariate odds ratios among the number of MS components for UA.

CONCLUSIONSThe UA level is positively associated with baPWV and MS, but the association between UA and MS is dependent on insulin resistance. Furthermore, baPWV is independently associated with MS in our study population.

Aged ; Aged, 80 and over ; Body Mass Index ; Brachial Artery ; physiopathology ; Cholesterol, HDL ; blood ; Female ; Humans ; Insulin Resistance ; Male ; Metabolic Syndrome ; physiopathology ; Middle Aged ; Uric Acid ; blood ; Vascular Stiffness ; physiology

BACKGROUNDStatins improve arterial stiffness in patients with coronary artery disease (CAD). Hypertension is a predominant contributor of arterial stiffening. However, the influence of hypertension on the effect of statins for improving arterial stiffness in CAD patients has seldom been investigated. Therefore, in this study, we investigated the relationships between statin use and arterial stiffness in normotensive and hypertensive CAD patients.

METHODSBrachial-ankle pulse wave velocity (ba-PWV) was measured in 437 patients, including 220 hypertensive CAD patients (121 used statins, 99 did not) and 217 normotensive CAD patients (105 used statins, 112 did not). The normotensive and hypertensive CAD patients were matched according to age, sex, and body mass index (BMI).

RESULTSIn the normotensive and hypertensive CAD patients, lipid profiles were significantly improved in the statin group compared with the non-statin group. No significant differences in the administered statins (i.e., atorvastatin, simvastatin, rosuvastatin, and pravastatin) and statin therapy duration were found between normotensive and hypertensive CAD patients (all P > 0.05). No significant correlation of ba-PWV and statin therapy duration was found in all CAD patients, normotensive CAD patients, or hypertensive CAD patients (all P > 0.05). ba-PWV in the statin group was significantly lower than that in the non-statin group in normotensive CAD patients ((1331.68 ± 167.52) cm/s vs. (1468.61 ± 244.54) cm/s, P = 0.002) but not in hypertensive CAD patients (P > 0.05). In multiple linear regression analyses, statin therapy was significantly associated with ba-PWV after adjusting for confounding variables in normotensive CAD patients (P = 0.018) but not in hypertensive CAD patients (P > 0.05).

CONCLUSIONSStatins may significantly improve arterial stiffness in CAD patients, and hypertension may probably influence the effectiveness of statin therapy in improving arterial stiffness in this population. Further studies are required to investigate the effect of statins on arterial stiffness in normotensive and hypertensive CAD patients.

Aged ; Ankle Brachial Index ; Coronary Artery Disease ; physiopathology ; Cross-Sectional Studies ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; pharmacology ; Hypertension ; physiopathology ; Male ; Middle Aged ; Pulse Wave Analysis ; Vascular Stiffness ; drug effects ; physiology

PURPOSE: The aim of this study was to evaluate the effects of a smoking cessation education on endothelial function and carboxyhemoglobin levels in smokers with variant angina. METHODS: A nonequivalent control group pretest-posttest design was used. Participants were 60 male smokers with variant angina admitted to one hospital: the control group (30) between September and December, 2009, and the experimental group (30) between February and May, 2010. Endothelial function, as defined by flow-mediated vasodilation (FMD) of the brachial artery, and serum carboxyhemoglobin (COHb) were determined at baseline and at 3 months after the initiation of education in both groups. RESULTS: Three months after the program, smoking cessation was successful in 22 of the 30 smokers in the experimental group, but only in 4 of 30 smokers in the control group (p<.001). After the education, the experimental group showed a significant increase in FMD, and a significant decreased in serum COHb compared with the control group. CONCLUSION: The findings indicate that this smoking cessation education program is effective for hospitalized smokers with variant angina.
Adult ; Angina Pectoris, Variant/blood/*physiopathology ; Brachial Artery/physiology ; Carboxyhemoglobin/*analysis ; Endothelium, Vascular/*physiology ; Humans ; Male ; Middle Aged ; *Program Evaluation ; Smoking/psychology ; *Smoking Cessation ; Vasodilation

BACKGROUNDCarotid artery intima-media thickness (CIMT) and brachial artery flow-mediated dilation percentage (FMD%) are common parameters used for detecting subclinical atherosclerosis. This study compared subclinical atherosclerosis of the carotid and brachial arteries in rheumatoid arthritis (RA) patients and healthy controls using high resolution ultrasonography. We also investigated their correlation with clinical factors and the association between FMD% and CIMT.

METHODSOne hundred and two RA patients and 46 age-gender matched healthy controls were included in the study. FMD of the brachial artery and CIMT were measured ultrasonographically. Patients with diabetes mellitus, hypertension, renal failure, history of cardiovascular or cerebrovascular disease were excluded. Subjects who were receiving or used high dose steroids were also excluded.

RESULTSThe CIMT was significantly higher in patients than that in the control group ((0.697±0.053) vs. (0.554±0.051) mm, P<0.001), whereas brachial artery FMD% was lower in patients than that in the controls ((5.454±2.653)% vs. (8.477±2.851)%, P<0.001). CIMT was related to age, disease duration, tender and swollen joint score, C-reactive protein, systolic blood pressure and high-density lipoprotein. However, FMD% was only association with systolic blood pressure. There was no significant correlation between CIMT and FMD%.

CONCLUSIONSCompared with the healthy control subjects, RA patients without clinically evident cardiovascular disease had subclinical atherosclerosis in terms of impaired FMD% and increased CIMT. FMD% and CIMT may measure a different stage of subclinical atherosclerosis in RA patients.

Adult ; Arthritis, Rheumatoid ; pathology ; physiopathology ; Atherosclerosis ; pathology ; physiopathology ; Brachial Artery ; physiopathology ; Carotid Intima-Media Thickness ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged

Brachial-ankle pulse wave velocity (baPWV) is simple, noninvasive method which correlates well with arterial stiffness. Herein, we assessed the determinants of baPWV in normotensive young adults with type 2 diabetes. We retrospectively enrolled 103 consecutive type 2 diabetic patients aged between 30 and 39 yr who measured baPWV with noninvasive pulse wave analyzer. The anthropometric parameters, blood pressure, pulse rate, fasting plasma glucose, fasting insulin, fasting C-peptide, HbA1c, lipid profile, hs-CRP, albuminuria status, AST/ALT, gamma-GTP were checked concurrently. Also, we investigated history of smoking, alcohol drinking and medications by questionnaire. We found that maximal baPWV was positively correlated with mean blood pressure (r = 0.404, P < 0.001), heart rate (r = 0.285, P = 0.004), AST (r = 0.409, P < 0.001), ALT (r = 0.329, P = 0.001), gamma-GTP (r = 0.273, P = 0.006), Urine albumin/creatinine ratio (r = 0.321, P = 0.003). By multiple linear regression, mean blood pressure and heart rate were significantly associated with maximal baPWV in male and total group. In female group, mean blood pressure was the only variable associated with maximal baPWV. These factors can be surrogate markers of arterial stiffness in this population.
Adult ; Alanine Transaminase/blood ; Ankle/*physiology ; Aspartate Aminotransferases/blood ; Blood Pressure/physiology ; Brachial Artery/*physiology ; C-Peptide/analysis ; Diabetes Mellitus, Type 2/*physiopathology ; Female ; Heart Rate/physiology ; Hemoglobin A, Glycosylated/analysis ; Humans ; Lipids/analysis ; Male ; Pulse Wave Analysis ; Questionnaires ; Retrospective Studies ; Sex Factors ; gamma-Glutamyltransferase/blood

Brachial-ankle pulse wave velocity (baPWV) is simple, noninvasive method which correlates well with arterial stiffness. Herein, we assessed the determinants of baPWV in normotensive young adults with type 2 diabetes. We retrospectively enrolled 103 consecutive type 2 diabetic patients aged between 30 and 39 yr who measured baPWV with noninvasive pulse wave analyzer. The anthropometric parameters, blood pressure, pulse rate, fasting plasma glucose, fasting insulin, fasting C-peptide, HbA1c, lipid profile, hs-CRP, albuminuria status, AST/ALT, gamma-GTP were checked concurrently. Also, we investigated history of smoking, alcohol drinking and medications by questionnaire. We found that maximal baPWV was positively correlated with mean blood pressure (r = 0.404, P < 0.001), heart rate (r = 0.285, P = 0.004), AST (r = 0.409, P < 0.001), ALT (r = 0.329, P = 0.001), gamma-GTP (r = 0.273, P = 0.006), Urine albumin/creatinine ratio (r = 0.321, P = 0.003). By multiple linear regression, mean blood pressure and heart rate were significantly associated with maximal baPWV in male and total group. In female group, mean blood pressure was the only variable associated with maximal baPWV. These factors can be surrogate markers of arterial stiffness in this population.
Adult ; Alanine Transaminase/blood ; Ankle/*physiology ; Aspartate Aminotransferases/blood ; Blood Pressure/physiology ; Brachial Artery/*physiology ; C-Peptide/analysis ; Diabetes Mellitus, Type 2/*physiopathology ; Female ; Heart Rate/physiology ; Hemoglobin A, Glycosylated/analysis ; Humans ; Lipids/analysis ; Male ; Pulse Wave Analysis ; Questionnaires ; Retrospective Studies ; Sex Factors ; gamma-Glutamyltransferase/blood