Non-invasive 24 hour ambulatory monitoring of aortic wave reflection and arterial stiffness by a novel oscillometric device

Non-invasive 24 hour ambulatory monitoring of aortic wave reflection and arterial stiffness by a novel oscillometric device: The first feasibility and reproducibility study☆

Theodore G. Papaioannou , Antonios Argyris, Athanase D. Protogerou, Dimitrios Vrachatis, Efthymia G. Nasothimiou, Petros P. Sfikakis, George S. Stergiou, Christodoulos I. Stefanadis

Received 13 March 2013; received in revised form 29 June 2013; accepted 28 August 2013. published online 23 September 2013.

Abstract Background Surrogates of aortic wave reflection and arterial stiffness, such as augmentation index (AIx), augmentation pressure, pulse wave velocity (PWV) and pulse pressure amplification (PPampl) are independent predictors of cardiovascular risk. A novel ambulatory, brachial cuff-based oscillometric device has been recently developed and validated, yielding 24-h assessment of the aforementioned parameters (Mobilo-O-Graph). Aim of this study was to investigate the feasibility and reproducibility of wave reflection and arterial stiffness estimation by pulse wave analysis using this device. Methods Thirty treated or untreated hypertensives (mean age: 53.6 ± 11.6 years, 17 men) had test–retest 24-h monitoring one week apart using the test device. Results Mean numbers of valid aortic readings per subject, between test and retest, were comparable. Approximately 12 aortic readings per subject (17%) were not feasible or valid. No differences were observed for any 24-h parameter between the two assessments. Bland–Altman plots showed no systemic difference, while the limits of agreement for each parameter indicated high reproducibility (AIx: −7.2 to 8.2%, AP: −3.7 to 4.1 mm Hg, PWV: −0.39 to 0.41 m/s, PPampl: −0.08 to 0.06). This was further verified by intraclass correlation coefficients which were >0.8 for each parameter. Conclusions Non-invasive 24-h estimation of wave reflection and arterial stiffness indices, derived by the test device, appear to be highly reproducible. Future studies should investigate whether these measurements have additive prognostic value for cardiovascular risk stratification, beyond common brachial blood pressure measurements or single estimations of wave reflection and PWV at office settings.

. Early dual versus mono antiplatelet therapy for acute non-cardioembolic ischemic stroke or transient ischemic attack: an updated systematic review and meta-analysis

Circulation. 2013 Oct 8;128(15):1656-66. doi: 10.1161/CIRCULATIONAHA.113.003187. Epub 2013 Sep 12. Early dual versus mono antiplatelet therapy for acute non-cardioembolic ischemic stroke or transient ischemic attack: an updated systematic review and meta-analysis. Wong KS, Wang Y, Leng X, Mao C, Tang J, Bath PM, Markus HS, Gorelick PB, Liu L, Lin W, Wang Y. Division of Neurology, Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China (K.S.L.W., X.L., W.L.); the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.W., L.L., Y.W.); the Hong Kong Branch of the Chinese Cochrane Center, Division of Epidemiology, School of Public Health and Primary Care, Shatin, Hong Kong SAR, China (C.M., J.T.); the Stroke Trials Unit, University of Nottingham, Nottingham, UK (P.M.W.B.); the Stroke and Dementia Research Centre, St. George's, University of London, London, UK (H.S.M.); and the Department of Translational Science and Molecular Medicine, Michigan State University College of Medicine and Saint Mary's Health Care, Grand Rapids, MI (P.B.G.).

Abstract Emerging studies suggest that early administration of dual antiplatelet therapy may be better than monotherapy for prevention of early recurrent stroke and cardiovascular outcomes in acute ischemic stroke and transient ischemic attack (TIA). We performed a meta-analysis of randomized, controlled trials evaluating dual versus mono antiplatelet therapy for acute noncardioembolic ischemic stroke or TIA.

We assessed randomized, controlled trials investigating dual versus mono antiplatelet therapy published up to November 2012 and the CHANCE trial (Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events), for efficacy and safety outcomes in adult patients with acute noncardioembolic ischemic stroke or TIA with treatment initiated within 3 days of ictus. In total, 14 studies of 9012 patients were included in the systematic review and meta-analysis. Dual antiplatelet therapy significantly reduced risk of stroke recurrence (risk ratio, 0.69; 95% confidence interval, 0.60-0.80; P<0.001) and the composite outcome of stroke, TIA, acute coronary syndrome, and all death (risk ratio, 0.71; 95% confidence interval, 0.63-0.81; P<0.001) when compared with monotherapy, and nonsignificantly increased risk of major bleeding (risk ratio, 1.35; 95% confidence interval, 0.70-2.59, P=0.37). Analyses restricted to the CHANCE Trial or the 7 double-blind randomized, controlled trials showed similar results.

For patients with acute noncardioembolic ischemic stroke or TIA, dual therapy was more effective than monotherapy in reducing risks of early recurrent stroke. The results of the CHANCE study are consistent with previous studies done in other parts of the world.

Anxiety disorder is associated with nocturnal and early morning hypertension with or without morning surge: ambulatory blood pressure monitoring.

Circ J. 2012;76(7):1670-7. Epub 2012 Apr 6. Anxiety disorder is associated with nocturnal and early morning hypertension with or without morning surge: ambulatory blood pressure monitoring. Kayano H, Koba S, Matsui T, Fukuoka H, Toshida T, Sakai T, Akutsu Y, Tanno K, Geshi E , Kobayashi Y. Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan. h-kayano@med.showa-u.ac.jp

Abstract Nocturnal and early

BACKGROUND:

morning hypertension are both significant risk factors for cardiovascular events. It remains unclear whether anxiety disorder affects nocturnal blood pressure (BP), early morning BP, or BP pattern in hypertensive patients.

METHODS AND RESULTS:

One hundred and twenty consecutive hypertensive outpatients (77 men and 43 women; mean age, 66±11 years) were divided into 2 groups based on Hospital Anxiety and Depression Scale (HADS) score: a control group (n=78; HADS ≤10) and an anxiety group (42 patients; HADS ≥11). Nocturnal BP, early morning BP, morning BP surge (defined as BP rise ≥50 mmHg), and BP pattern (extreme-dipper/dipper/non-dipper/riser) were measured on ambulatory BP monitoring. Clinical characteristics and BP were also evaluated at physician check-up. There was no significant difference between the 2 groups for BP check-up, but nocturnal and early morning BP were significantly higher in the anxiety group (142±16 mmHg and 152±21 mmHg) than in the control group (126±14 mmHg and 141±18 mmHg). With regard to patients with morning BP surge, nocturnal and early morning BP were also significantly higher in the anxiety group. The relative risk of existing anxiety disorders in riser-type hypertension was 4.48-fold higher (95% confidence interval: 1.58-12.74; P<0.005) than in dipper-type hypertension.

CONCLUSIONS:

Anxiefy disorder is associated with nocturnal and early morning hypertension, and may be a risk factor for cardiovascular events.

SSRIs for Hot Flashes: A Systematic Review and Meta-Analysis of Randomized Trials

J Gen Intern Med. 2013 Jul 26. [Epub ahead of print] SSRIs for Hot Flashes: A Systematic Review and Meta-Analysis of Randomized Trials. Shams T, Firwana B, Habib F, Alshahrani A, Alnouh B, Murad MH, Ferwana M. National and Gulf Center for Evidence-Based Health Practice, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, ShamsT@ngha.med.sa.

Abstract Hot flashes are the most commonly reported vasomotor symptom during the peri- and early post-menopausal period.

To systematically review, appraise and summarize the evidence of the impact of different SSRIs on peri-menopausal hot flashes in healthy women in randomized, controlled trials.

A comprehensive literature search was conducted of MEDLINE™, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science and Scopus through March 2013. Two independent reviewers selected studies and extracted data. Random effects meta-analysis was used to pool outcomes across studies, and Bayesian mixed treatment methods were used to rank SSRIs in terms of effectiveness.

We included a total of 11 randomized controlled trials with good methodological quality enrolling 2,069 menopausal and post-menopausal women (follow-up 1-9 months, mean age 36-76 years, mean time since menopause 2.3-6.6 years). Compared with placebo, SSRIs were associated with a statistically significant decrease in hot flash frequency (difference in means -0.93; 95 % CI -1.46 to -0.37; I = 21 %) and severity assessed by various scales (standardized difference in means -0.34; 95 % CI -0.59 to -0.10; I = 47 %). Adverse events did not differ from placebo. Mixed treatment comparison analysis demonstrated the superiority of escitalopram compared to other SSRIs in terms of efficacy.

SSRI use is associated with modest improvement in the severity and frequency of hot flashes but can also be associated with the typical profile of SSRI adverse effects

La nuez ¿Amiga o enemiga para el corazón?

La nuez ¿Amiga o enemiga para el corazón? Escrito por Registro Moderador Jueves, 18 Julio 2013 Muchas personas que sufren de diabetes y problemas cardíacos condicionan en exceso su forma de comer y en algunos casos se cohíben enormemente. Sin embargo existe una gran variedad de alimentos que consumen sin saber si en realidad los pueden o no comer. La nuez es una excelente aliada para los diabéticos y personas con insuficiencias cardíacas ya que los frutos secos, en especial los de cáscara dura, son nutritivos y buenos para la salud del corazón. Una investigación analizó el nivel de antioxidantes que contienen. Ahora, un nuevo estudio centrado en los frutos de cáscara dura encontró que, entre ellos, la nuez es un producto natural “casi perfecto” por su alto nivel de antioxidantes y proteínas. Incluso contiene altos niveles de polifenoles que ayudan al organismo a contrarrestar los efectos de las moléculas que causan oxidación y dañan a las células. Estudios pasados sugieren que el consumo regular de estos frutos secos puede reducir el riesgo de enfermedades cardiovasculares, determinadas clases de cáncer y diabetes tipo 2. Fuente: Cardioenlace.com

Chlorthalidone: mechanisms of action and effect on cardiovascular events.

Curr Hypertens Rep. 2013 Oct;15(5):514-21. doi: 10.1007/s11906-013-0372-1. Chlorthalidone: mechanisms of action and effect on cardiovascular events. Roush GC, Buddharaju V, Ernst ME, Holford TR. UCONN School of Medicine and St. Vincent's Medical Center, 2800 Main Street, Bridgeport, CT, 06606, USA, groush@gcr0.com.

Abstract How chlorthalidone (CTDN) reduces risk for cardiovascular events (CVEs) can be considered in light of its ability to lower blood pressure (BP) and its non-BP related, pleiotropic effects. The mechanism by which CTDN lowers BP is unclear but may include alterations in whole body regulation and vasodilatory actions on vasculature, possibly mediated via its inhibitory effects on carbonic anhydrase. Additionally, CTDN has potentially beneficial, non-BP related, pleiotropic effects that include improvements in endothelial function, anti-platelet activity, and oxidative status. CTDN reduces pulse wave velocity, predictor of CVEs and a measure of central aortic stiffness associated with endothelial dysfunction. On the other hand, CTDN fosters hypokalemia, hyperglycemia, sympathetic discharge, and the renin-angiotensin-aldosterone system, but these potentially harmful effects do not appear to materially reduce CTDN's ability to prevent CVEs. Further, CTDN reduces and regresses left ventricular hypertrophy (LVH), an important BP-dependent predictor of CVEs. Consistent with this finding, CTDN was more effective than amlodipine in reducing congestive heart failure (CHF) in the Anti-hypertensive and Lipid-lowering Treatment to Prevent Heart Attach Trial (ALLHAT). In reducing CVEs, CTDN was superior to lisinopril in ALLHAT and superior to hydrochlorthiazide in observational cohort analyses and in network analyses of randomized trials. A statistical synthesis of randomized trials suggests that the reduction in cardiovascular risk from CTDN can be explained primarily on the basis of its ability to lower blood pressure rather than its influence upon non-BP related, pleiotropic effects.

PMID: 23839110 [PubMed - in process

. Pharmacotherapy of vestibular disorders and nystagmus

Semin Neurol. 2013 Jul;33(3):286-96. doi: 10.1055/s-0033-1354594. Epub 2013 Sep 21. Pharmacotherapy of vestibular disorders and nystagmus. Strupp M, Kremmyda O, Brandt T. Department of Neurology, German Center for Vertigo and Balance Disorders.

Abstract Vertigo and dizziness are with a life-time prevalence of ∼30% among the most common symptoms and are often associated with nystagmus or other oculomotor disorders. The prerequisite for a successful treatment is a precise diagnosis of the underlying disorder. In this overview, the current pharmacological treatment options for peripheral and central vestibular, cerebellar, and oculomotor disorders including nystagmus are described. There are basically seven groups of drugs that can be used (the "7 As"): antiemetics; anti-inflammatory, anti-Menière's, and antimigraine medications; antidepressants, anticonvulsants, and aminopyridines. In acute vestibular neuritis, recovery of the peripheral vestibular function can be improved by treatment with oral corticosteroids. In Menière's disease, a long-term high-dose treatment with betahistine-dihydrochloride (at least 48 mg three times daily) had a significant effect on the frequency of the attacks; the underlying mode of action is evidently an increase in inner-ear blood flow. The use of aminopyridines is a well-established therapeutic principle in the treatment of downbeat and upbeat nystagmus as well as episodic ataxia type 2 and cerebellar gait disorders. As was shown in animal experiments, these potassium channel blockers increase the activity and excitability and normalize irregular firing of cerebellar Purkinje cells. They evidently augment the inhibitory influence of these cells on vestibular and deep cerebellar nuclei. A few studies showed that baclofen improves periodic alternating nystagmus; gabapentin and memantine improve pendular and infantile nystagmus. However, many other eye-movement disorders such as ocular flutter, opsoclonus, central positioning, and see-saw nystagmus are still difficult to treat. Although substantial progress has been made, further state-of-the-art trials must still be performed on many vestibular and oculomotor disorders, namely Menière's disease, vestibular paroxysmia, vestibular migraine, and many forms of central eye-movement disorders.

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PMID: 24057832 [PubMed - in process