Miklos Illyes

A new oscillometric method for assessment of arterial stiffness: comparison with tonometric and piezo-electronic methods.

Introduction Pulse wave velocity (PWV) and augmentation index (AIx) are parameters of arterial stiffness and wave reflection. PWV and AIx are strong indicators for cardiovascular risk and are used increasingly in clinical practice. Previous systems for assessment of PWV and AIx are investigator dependent and time consuming. The aim of this study was to validate the new oscillometric method (Arteriograph) for determining PWV and AIx by comparing it to two clinically validated, broadly accepted tonometric and piezo-electronic systems (SphygmoCor and Complior). Design and method PWV and AIx were measured up to five times in 51 patients with the SphygmoCor, Complior and Arteriograph. In 35 patients, the measurements were repeated after 1 week in a second session using the same protocol. Results The correlations of the PWV as assessed with the Arteriograph with the values obtained using the SphygmoCor (r = 0.67, P < 0.001) and the Complior (r = 0.69, P < 0.001) were highly significant. Variability and reproducibility for PWV were best for the Arteriograph, followed by Complior and SphygmoCor. AIx (SphygmoCor versus Arteriograph) were very closely correlated (r = 0.92, P < 0.001). Perspectives The Arteriograph is a new, easy-to-use and time-effective method for assessing arterial stiffness and wave reflection.

Reference values of aortic pulse wave velocity in a large healthy population aged between 3 and 18 years.

Objective: The measurement of aortic pulse wave velocity (PWVao) is an accepted marker in stratifying individual cardiovascular risk in adults. There is an increasing volume of evidence concerning impaired vascular function in different diseases in paediatric populations, but, unfortunately, only a few studies are available on the measurement of normal PWVao values in children. The aim of our study was to determine the reference values of PWVao in a large healthy population using a newly developed technique. Methods: Three thousand, three hundred and seventy-four healthy individuals (1802 boys) aged 3–18 years were examined by an invasively validated, occlusive, oscillometric device. Results: The mean PWVao values increased from 5.5 ± 0.3 to 6.5 ± 0.3 m/s (P < 0.05) in boys and from 5.6 ± 0.3 to 6.4 ± 0.3 m/s (P < 0.05) in girls. The increase, however, was not constant, and the values exhibited a flat period between the ages of 3 and 8 years in both sexes. The first pronounced increase occurred at the age of 12.1 years in boys and 10.4 years in girls. Moreover, between the ages of 3 and 8 years, the brachial SBP and mean blood pressures increased continuously and gradually, whereas the PWVao remained unchanged. By contrast, beyond the age of 9 years, blood pressure and aortic stiffness trends basically moved together. Conclusion: Our study provides the largest database to date concerning arterial stiffness in healthy children and adolescents between the ages of 3 and 18 years, and the technology adopted proved easy to use in large paediatric populations, even at a very young age.

Tele-monitoring of home blood pressure.

Received 27 August 2001 Accepted 04 September 200

Blood pressure measurement in research.

ObjectiveThe aim of this paper is to summarize the issues raised during a consensus conference on the role of different blood pressure (BP) monitoring techniques in research, including pathophysiological studies, clinical outcome trials and clinical pharmacology trials. MethodsThis review includes the contribution of the participants in a task force at the Eighth Consensus Conference on Ambulatory BP Monitoring (October 28–31, 2001, Sendai, Japan) and the results of a discussion open to all conference participants. Individual contributions have been summarized together with the points raised during the subsequent discussion, and the main statements are also presented in a table format. Points of consensus(1) BP monitoring in pathophysio-logical studies. The essential role played by continuous BP monitoring in this field had been acknowledged, and further development of non-invasive beat-by-beat monitoring techniques has been advocated.(2) BP monitoring in clinical trials. In clinical trials automated ambulatory BP monitoring (ABPM) and self BP measurements (SBPM) at home share similar advantages, with specific features that make these approaches not alternative solutions but rather approaches able to complement each other. A few examples of application of ABPM and SBPM in clinical trials include the Treatment of Hypertension according to Home or Office Blood Pressure (THOP) trial and the Trial of Preventing Hypertension (TROPHY).(3) Use of ABPM in clinical pharmacology studies. Use of ABPM is now an established routine, aimed at describing the 24-h effect of new antihypertensive drugs. An example of these applications that was discussed in the conference is the use of ABPM in the evaluation of a new long-acting calcium channel blocker (Barnidipine) (J-MUBA study).(4) Specific models for the analysis of BP fluctuations. The features characterizing the chronobiological approach to description of 24-h BP profiles and its limitations (mainly consisting of the high risk of data over-modelling) are discussed. Also the possible occurrence of a circaseptan (approximately with a 7-day period) rhythm in BP has been addressed, although repeated performance of 24-h ABPM over a week obviously faces a number of practical problems.(5) Progress in technology:BP monitoring and telemedicine. The possibility to implement an interactive telemonitoring system of home SBPM values and the perspectives for a clinical application of this technology in the Hypertension Objective treatment based on Measurement by Electrical Devices of Blood Pressure (HOMED-BP) trial is discussed.

Evaluation of arterial stiffness for predicting future cardiovascular events in patients with ST segment elevation and non-ST segment elevation myocardial infarction.

Background. Arterial stiffness parameters in patients who experienced MACE after acute MI have not been studied sufficiently. We investigated arterial stiffness parameters in patients with ST segment elevation (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI). Methods. Ninety-four patients with acute MI (45 STEMI and 49 NSTEMI) were included in the study. Arterial stiffness was assessed noninvasively by using TensioMed Arteriograph. Results. Arterial stiffness parameters were found to be higher in NSTEMI group but did not achieve statistical significance apart from pulse pressure (P = 0.007). There was no significant difference at MACE rates between two groups. Pulse pressure and heart rate were also significantly higher in MACE observed group. Aortic pulse wave velocity (PWV), aortic augmentation index (AI), systolic area index (SAI), heart rate, and pulse pressure were higher; ejection fraction, the return time (RT), diastolic reflex area (DRA), and diastolic area index (DAI) were significantly lower in patients with major cardiovascular events. However, PWV, heart rate, and ejection fraction were independent indicators at development of MACE. Conclusions. Parameters of arterial stiffness and MACE rates were similar in patients with STEMI and NSTEMI in one year followup. The independent prognostic indicator aortic PWV may be an easy and reliable method for determining the risk of future events in patients hospitalized with acute MI.

The virtual hypertension clinic

Despite increasing financial and human resources invested, the disappointing rate of hypertension (HT) control continues to pose a challenge to health care providers in the civilized world. Low HT control is associated with the poor patient compliance. Nowadays, SBPM is an accepted method to improve the patient compliance as well as HT control. However SBPM has several limitations such as: - only few devices are validated according to BHS/AAMI- unreliable data recorded by the patient (under/over reporting)- extra work load to the physician in the assessment of the log-book entries of the patient. By using telemedicine in the SBPM, a virtual HT clinic can be built up. In our developed system (TensioPhone/TensionCare) we remind the patient the BP measurement and pill intake, and SBP data are automatically transferred to the center for analysis. The analysed and structured data are then sent to the physician and the patient as a printed report. Regular communication between the health care team and the patient can contribute to make the virtual hypertension clinic become a reality and to substantiallly improve HT control rates.

DIURNAL RHYTHM OF CENTRAL HEMODYNAMICS DURING TWENTY-FOUR-HOUR AMBULATORY MONITORING

Objective: 24-hour ABPM is a better method for diagnosing hypertension and predicting BP-related complications than office-based measurements. In addition increasing amount of evidences supports that central (aortic) BP is stronger predictor of cardiovascular risk than the conventional brachial BP. Dipping status of subjects can be easily assessed according to night-to-day brachial BP ratio provided by ABPM. However there is no data in the literature whether the diurnal rhythm of central aortic systolic blood pressure (CASP) follows the same pattern as the brachial one (BrSP). The aim of our study was to compare the 24-hour pattern of peripherial and central blood pressure in the same individuals. Design and method: 24-hour monitoring of aortic and brachial blood pressure was performed with Arteriograph24, a newly developed upper-arm cuff oscillometric device in 55 hypertensive and normotensive subjects, 36 males and 19 females. The 24-hour systolic pressure amplification, the difference of brachial and aortic cystic pressures measured simultaneously was calculated. Augmentation index (AIx) which is one of the main determinants of central blood pressure was also assessed. Results: The nocturnal fall of CSP was significantly lower than the peripheral pressure fall in 47 subjects of 55. 24-hour systolic pressure amplification was significantly lower during the night than during the day. In contrast to the nighttime decrease of central-to-peripherial systolic pressure Augmentation index was increased during the night. Conclusions: Central hemodynamic parameters (AIx, cSBP) also have diurnal rhythm but in contrast to peripherial BP the circadian variation of central BP is not necessarily parallel with the corresponding peripherial values. Theoretically elevated peripherial vascular resistance (which is represented by the augmentation index) during nighttime helps to maintain the appropriate central systolic pressure which is mandatory for the perfusion of the brain, heart and kidneys.

Prevalence of Overweight and Obesity in Hungarian Children and Adolescents

Background/Aims: The prevalence of overweight and obesity in children and adolescents is increasing worldwide, and this condition is a risk factor for cardiovascular mortality. The aim of this study was to assess the prevalence of overweight and obesity among the 3–18-year-old population in Szolnok City and the surrounding areas. Methods: Anthropometric data from healthy, white individuals recruited from nursery, elementary, and secondary schools were used to assess the prevalence of obesity and overweight in Szolnok City and the surrounding area, Jász-Nagykun-Szolnok county, Hungary. Healthy subjects numbering 6,824 (54% boys) were included; overweight and obesity were defined according to the relevant guidelines. Results: Overweight individuals constituted 13.4% of the population and 6.6% were obese. The total prevalence was higher in boys (21.6%) than in girls (18.1%). The peak of the prevalence was observed at age 10 in both sexes (boys 33%, girls 27%) followed by a gradual decrease, which was more significant in the case of girls. Conclusions: On the basis of the recent Hungarian data, we have not detected any changes in overweight and obesity in the age group 3–9 years and we have found a significant decrease in the age group 7–14 years. Prevention of overweight and obesity in early childhood is essential.