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PubMed2000

The Relationship Between Body Weight and the Prevalence of Isolated Systolic Hypertension in Older Subjects.

The rise in systolic blood pressure and the increasing risk of isolated systolic hypertension with advancing age have been attributed, in part, to increased peripheral vascular resistance. Available evidence also suggests that at any given level of arterial pressure, overweight patients with hypertension have a higher cardiac output and a lower total peripheral vascular resistance than lean patients. The lower peripheral resistance associated with overweight patients may attenuate the rise in systolic blood pressure and modify the prevalence of isolated systolic hypertension with age. Using data from the third National Health and Nutrition Examination Survey we examined the relationship between body weight and the age-related rise in systolic blood pressure, and determined the implication of this relationship for the prevalence of isolated systolic hypertension in the older adult population. The age-related rise in systolic blood pressure and the prevalence of isolated systolic hypertension were higher among the lean than in the overweight (odds ratio 1.29 and p value 0.039). The prevalence of isolated systolic hypertension increased by 56% from 6.2% in the fourth to 9.7% in the first body mass index quartile. Among the overweight subjects the prevalence of isolated systolic hypertension continued to decrease until the body mass index exceeded 31.6. OBJECTIVE: To examine the relationship between body weight and the age-related rise in systolic blood pressure, and determine the implication of this relationship for the prevalence of isolated systolic hypertension in the older adult population. DESIGN: A cross-sectional study. SETTING: The study began with a 1-hour home visit for a household interview and ended a few weeks later with a 4-hour physical examination at a mobile examination center. PARTICIPANTS: A sample of the civilian, non-institutionalized population of the U.S. MAIN OUTCOME MEASURES: Age-related rise in systolic blood pressure and the prevalence of isolated systolic hypertension. RESULTS: The age-related rise in systolic blood pressure and the prevalence of isolated systolic hypertension were higher among the lean than in the overweight. The prevalence of isolated systolic hypertension decreased with increased body mass index of 31.6. Systolic blood pressures increased in obese than nonobese subjects. CONCLUSIONS: Body mass index less than 25 is associated with an increase in the age-related rise in systolic blood pressure and the prevalence of isolated systolic hypertension in the older population. (c)2000 by Le Jacq Communications, Inc.

Journal Article↗
PubMed2006

Peak systolic blood pressure on a graded maximal exercise test and the blood pressure response to an acute bout of submaximal exercise.

Blood pressure (BP) is immediately reduced after aerobic exercise (postexercise hypotension [PEH]). Whether peak systolic BP on a maximal graded exercise stress test (GEST) relates to PEH is not known. This study examined associations between peak systolic BP on a GEST and PEH. Subjects were 50 men (mean +/- SEM age 43.8 +/- 1.3 years) with elevated BP (145.3 +/- 1.5/85.9 +/-1.1 mm Hg). Men completed a GEST and 3 experiments: nonexercise control and 2 cycle bouts at 40% (LIGHT) and 60% (MODERATE) of maximal oxygen consumption. After the experiments, subjects left the laboratory wearing ambulatory BP monitors. Peak systolic BP on a GEST was categorized into tertiles: low (n = 17, 197.4 +/- 2.0 mm Hg), medium (n = 16, 218.4 +/- 1.4 mm Hg), and high (n = 17, 248.9 +/- 2.8 mm Hg). Repeated-measures analysis of variance tested if BP differed over time and among experimental conditions and peak systolic BP groups. In men with high peak systolic BP, systolic BP was reduced by 7.3 +/- 2.6 mm Hg after LIGHT and by 5.0 +/- 2.2 mm Hg after MODERATE compared with nonexercise control over 10 hours, with the more apparent effects seen after LIGHT (p <0.05). In men with low peak systolic BP, systolic BP was reduced by 6.3 +/- 2.3 mm Hg after MODERATE compared with nonexercise control over 10 hours (p <0.05). In men with medium peak systolic BP, systolic BP was not different after exercise compared with nonexercise control over 10 hours (p >or=0.05). Men with high peak systolic BP had decreased systolic BP to the greatest extent after LIGHT, whereas men with low peak systolic BP reduced systolic BP after MODERATE. In conclusion, the findings of this study suggest that peak systolic BP on a GEST may be used to characterize which men with hypertension will have decreased systolic BP after acute submaximal aerobic exercise.

Adolescent↗
PubMed1997

Systolic function, readmission rates, and survival among consecutively hospitalized patients with congestive heart failure.

We sought to describe the relation between left ventricular systolic function and rates of hospital readmission and survival among consecutively hospitalized patients with congestive heart failure. Medical records were reviewed for these patients at an academic medical center between Jan. 1, 1992, and Dec. 31, 1993. Left ventricular systolic function assessments performed within 6 months before discharge were used to classify left ventricular systolic function. Hospital readmission rates and survival through Dec. 31, 1994, were compared between patients with systolic dysfunction and those with preserved systolic function. Among 412 patients hospitalized with a primary diagnosis of congestive heart failure, 224 had undergone a left ventricular function assessment during the 6 months before hospital discharge. In-hospital mortality and readmission rates were higher among patients without a recent assessment of left ventricular systolic function. Of patients with systolic dysfunction, 55% versus 41% of patients with preserved systolic function were either readmitted or had an emergency room visit within 6 months after discharge (p = 0.06). At 27 months' follow-up, cumulative survival probabilities were 65% for patients with preserved systolic function, 65% for patients with systolic dysfunction, and 60% for patients without a left ventricular systolic function assessment (p = 0.24). Patients without a recent left ventricular systolic function assessment have significantly higher hospital readmission rates than patients with a recent systolic function assessment. Among hospitalized patients, mortality rates are comparable between patients with systolic dysfunction and those with preserved systolic function. However, patients with heart failure with systolic dysfunction may have higher readmission rates.

Aged↗
PubMed1982

Sensitivity of end-systolic pressure-dimension and pressure-volume relations to the inotropic state in humans.

The value for the slope of the left ventricular (LV) end-systolic pressure-dimension and pressure-volume relations has been proposed as a quantitative measure of the LV inotropic state. This measure of LV inotropic state is attractive because it is independent of preload and incorporates afterload. To investigate the sensitivity of the slope of these relations to alterations in contractile state, 10 normal subjects were studied using M-mode echocardiographic, phonocardiographic and indirect carotid pulse recordings during infusion of methoxamine to alter end-systolic pressure and during infusion of dobutamine (5 micrograms/kg/min) to increase LV inotropic state. Heart rate was maintained within a narrow range for each subject. End-systolic volume was calculated from end-systolic echocardiographic dimension by standard methods. End-systolic pressure was estimated from the dicrotic notch pressure determined from a calibrated carotid pulse recording; peak systolic pressure was also measured. Regardless of the method of approximating end-systolic pressure, the positive inotropic intervention caused a leftward shift in the end-systolic pressure-dimension and pressure-volume lines. With the dobutamine infusion, the value for the slope of the end-systolic pressure-dimension relation increased by 25% (range 16-46%, p less than 0.001), while the slope of the end-systolic pressure-volume relation increased by 55% (range 37-85%, p less than 0.001). In all cases, the curves were linear and became steeper with the positive inotropic intervention. In contrast, the value of the slope of the peak systolic pressure-end-systolic dimension relation showed a variable response to the dobutamine infusion (mean change 13%, range -77% to 73%; NS). Although the position of the peak systolic pressure-end-systolic dimension curve is consistently shifted with an alteration in inotropic state, the values of the slope of these curves are not reliable indicators of change in LV contractility. The values for the slope of the line relating end-systolic pressure (estimated by dicrotic notch pressure) to end-systolic dimension or volume, however, are highly sensitive to a change in inotropic state in human subjects.

Adult↗
PubMed2006

Left ventricular chamber and myocardial systolic function reserve in patients with type 1 diabetes mellitus: insight from traditional and Doppler tissue imaging echocardiography.

OBJECTIVE: We sought to evaluate in patients with type 1 diabetes mellitus (DM1): (1) whether myocardial afterload correlates with left ventricular (LV) circumferential and longitudinal systolic function at rest and during low-dose dobutamine (LDD) infusion, and whether longitudinal and circumferential LV systolic function reserves are correlated; and (2) to explore relations between LV systolic mechanics and LV chamber output reserves. METHODS: A total of 20 patients with DM1 underwent echocardiography to assess LV systolic function at rest and at peak LDD (7.5 microg/kg/min). At rest, echocardiographic data of patients with DM1 were compared with those from 24 healthy control subjects. LV afterload was estimated by computing circumferential end-systolic stress (ESS). LV chamber systolic function was assessed by computing ejection fraction and ESS/end-systolic volume index; LV circumferential myocardial contractility was explored by computing midwall fractional shortening (MWS) and ESS-corrected MWS. Longitudinal LV systolic function was assessed using color Doppler tissue (DTI) to assess peak systolic velocities and maximal displacement of the lateral and medial mitral annulus in apical 4-chamber view; regional deformation analyses were computed at the midportion of the posterior interventricular septum (peak strain and peak strain rate); strain/ESS was assessed as an alternative indicator of longitudinal myocardial contractility. LV chamber output was assessed by computing stroke index. RESULTS: DM1 and control groups did not differ in terms of sex distribution, mean age, blood pressure, LV mass index and geometry, and at-rest parameters of LV systolic function (all P > .1), whereas body mass index was higher and systolic lateral mitral annulus velocity was lower in the DM1 than control group (both P < .01). At rest, in both groups, higher ESS correlated with lower ejection fraction and lower MWS; ESS did not show significant correlation with longitudinal systolic function parameters. At peak LDD in DM1, heart rate changed minimally; ESS decreased significantly (P < .01); circumferential and longitudinal LV systolic functions increased significantly but did not show intercorrelation; higher ESS correlated with lower ejection fraction; longitudinal LV systolic function parameters did not show correlation with ESS. In a multivariate analysis, percent increase in stroke index correlated with percent change of MWS (beta = 0.74, P < .01), and to a lesser extent with the percent increase of systolic lateral mitral annulus velocity (beta = 0.47, P = .04), independent to age, sex, percent change of ESS, and heart rate. CONCLUSIONS: LV longitudinal systolic function (DTI) parameters did not fall into the paradigm of the stress-shortening relationship used to describe LV contractility. However, both LV circumferential contractility and longitudinal systolic function reserves correlated with stroke index reserve during LDD.

Adult↗
PubMed2001

Supine and exercise systolic blood pressure predict cardiovascular death in middle-aged men.

AIM AND METHODS: The outcome of 1999 apparently healthy men, aged 40-59 years, initially investigated in the period 1972-1975, has previously been ascertained at 7 and 16 year follow-ups. This has now been repeated after 21 years, to determine whether seated systolic blood pressure (BP) during a bicycle ergometer exercise test adds prognostic information on cardiovascular (CV) mortality beyond that of systolic BP measured after 5 min of supine rest. RESULTS: After 21 years, 41 979 years of observation, 470 patients had died, 255 from CV causes. Supine systolic BP [2 SD increase: relative risk (RR) 1.6, 95% confidence interval (CI) 1.3-2.0, P < 0.0001], 6 min exercise systolic BP (2 SD increase: RR 1.6, 95% CI 1.3-2.0, P < 0.0001) on the starting workload of 600 kpm/min (approximately 100 W, 5880 J/min) and maximal systolic BP (2 SD increase: RR 1.5, 95% CI 1.2-1.9, P = 0.0005) during work were all related to CV mortality when adjusting for a large number of variables measured in the present study including age, exercise capacity, heart rates, smoking habits, glucose tolerance and serum cholesterol. When including other systolic BPs in the continuous multivariate analysis, supine systolic BP (2 SD increase: RR 1.4, 95% CI 1.04-1.9, P = 0.029) and 6 min systolic BP at 600 kpm/min (2 SD increase: RR 1.4, 95% CI 1.06-1.9, P = 0.017) were independent predictors of CV death but not maximal systolic BP during exercise (2 SD increase: RR 1.0, 95% CI 0.7-1.2, P = 0.95). CONCLUSION: These results are different from the mortality data at 16 years, when the independent predictive effect of supine systolic BP was cancelled out by 6 min exercise systolic BP at 600 kpm/min. Twenty-one years of follow-up of 1999 apparently healthy men disclose independently predictive information on CV death, of both supine systolic BP and 6 min exercise systolic BP taken at an early moderate workload. The influence of maximal exercise systolic BP on CV death is however cancelled out by the two other systolic BPs.

Adult↗
PubMedDate not supplied

[Aortic wall distensibility and the structure and function of the left ventricle in aged persons with isolated systolic hypertension].

UNLABELLED: The number of old persons (over 65 years) with arterial hypertension is in a steady increase [1]. Such finding is mainly related to patients with isolated systolic hypertension. They present more than 60% of old persons with arterial hypertension [2]. Isolated systolic hypertension can be defined as increased systolic blood pressure to the value more than 160 mmHg and diastolic pressure to 90-95 mmHg [4, 5]. It has been suggested that the pathologic basis of this entity is in a decreased distensibility of aorta and great arteries. In patients with isolated systolic hypertension we studied the correlation between decreased aortic distensibility and systolic arterial blood pressure value. We also evaluated changes in the left ventricular structure and function during this type of hypertension. PATIENTS AND METHODS: We examined 59 patients older than 65 years. They were divided in two subgroups. First subgroup: 38 patients (74 +/- 11 years) with isolated systolic hypertension (ISH) and the second subgroup: 21 normotensive persons (NT) (73 +/- 6 years). Aortic distensibility was calculated by the formula: Aortic dystensibility = difference between aortic diameters/diameter aortae in diastole x pulse pressure. The ascending aortic diameters were measured 4 cm above the aortic valve by two dimensional echocardiography and pulse pressure was measured simultaneously by sphingomanometry. Using M-mod and two-dimensional echocardiography we measured end-diastolic (EDD) and end-systolic (ESD) left ventricular diameters and thickness of interventricular septum (IVS) and posterior wall (ZZ). We calculated the ejection fraction (EF) using Teichole formula. Changes in left ventricular structure were expressed by sum of interventricular septum and posterior wall thickness and left ventricular mass. We calculated left ventricular mass using the following formula: MLK = /EDD + IVS + ZZ)3 - EDD/ x 1.05. By pulse Doppler echocardiography we measured the peak velocity of the left ventricular filling (VE) and calculated the ratio between early and late peak velocity (VE/VA). RESULTS: Aortic distensibility was significantly lower in patients with isolated systolic hypertension than in normotensive subjects (0.10 +/- 0.02 x 1/100 1/mmHg vs 0.24 +/- 0.04 x 1/100 1/mmHg; p < 0.05). Such findings are presented in Table 1. At the same time, we found a significantly inversed correlation between aortic distensibility and systolic blood pressure value in patients with isolated systolic hypertension (r = 0.67; p < 0.05). From Table 2 it is visible that there were no significant differences between left ventricular diameter and mass in hypertensive patients. The sum of interventricular septum and posterior wall thickness was significantly greater in patients with isolated systolic hypertension than in normotensive patients (2.19 +/- 0.5 cm v.s. 1.93 +/- 0.4 cm; p < 0.05). This finding is also presented in Table 2. We found no statistically significant differences among the ejection fraction values in the studied subgroups (Table 3). The peak velocity of early filling and the ratio of early to late peak velocities were significantly lower in the hypertensive subgroup (0.4 m/s v.s. 0.54 m/s; p < 0.05; 0.69 v.s. 0.76; p < 0.05) (Table 3). DISCUSSION: In old persons with isolated systolic hypertension we found that aortic distensibility was significantly lower in comparison to normotensive subjects of the same age. Such finding supports the hypothesis that the reduced aortic distensibility is the cause of isolated systolic hypertension. At the same time, we found the inversed correlation between aortic distensibility and the mean systolic blood pressure value. Aging has an effect on reduction of aortic and great vessels distensibility. Thus, it causes arterial hypertension which changes the elastic properties of aorta. It is still questionable in which degree the systolic blood pressure value compromises the elastic properties of aorta. (ABSTRACT TRUNCATED)

Aged↗
PubMed1996

Assessment of left atrial pressure and volume changes during atrial systole with transesophageal pulsed Doppler echocardiography of transmitral and pulmonary venous flow velocities.

To determine whether transmitral and pulmonary venous flow velocity patterns can be used to evaluate left atrial pressure and volume changes during atrial systole, we performed transesophageal pulsed Doppler echocardiography and right heart catheterization in 85 patients (20 with hypertrophic cardiomyopathy, 20 with dilated cardiomyopathy, 30 with prior myocardial infarction, and 15 with mitral regurgitation), and 35 normal subjects. Pulsed Doppler variables from transmitral and pulmonary venous flow velocities during atrial systole were compared with mean pulmonary capillary wedge pressure (mean PCWP), pressure rise during atrial systole (PCWP-A), and left atrial volume change during atrial systole (delta LAV). The mean PCWP correlated significantly with the peak atrial systolic transmitral flow (r = -0.38, p < 0.05) and pulmonary venous flow (r = 0.40, p < 0.05) velocities in all patients. The PCWP-A correlated significantly with the peak atrial systolic transmitral flow (r = -0.39, p < 0.05) and pulmonary venous flow (r = 0.68, p < 0.0001) velocities in all patients. There was a particularly close correlation between the PCWP-A and the peak atrial systolic pulmonary venous flow velocities. The sum of the time-velocity integral of the atrial systolic transmitral and pulmonary venous flow velocities (TAI) correlated closely with the delta LAV (r = 0.70, p < 0.0001) in all patients. Thus, the peak atrial systolic pulmonary venous flow velocity correlated well with left atrial pressure changes during atrial systole. Furthermore, the sum of the time-velocity integral of the atrial systolic transmitral and pulmonary venous flow velocities correlated well with left atrial volume changes during atrial systole. Therefore, transesophageal echocardiographic measurements of atrial systolic transmitral and pulmonary venous flow velocities are reasonable indicators of left atrial pressure and volume changes during atrial systole.

Adult↗
PubMed2005

Systolic blood pressure does not reliably identify vasoactive status in chronic heart failure.

BACKGROUND: In chronic heart failure (CHF), titration of vasodilating medications is often guided by monitoring of systolic blood pressure (BP). However, systolic BP may not indicate the patient's true vasoactive status-best approximated by systemic vascular resistance-because cardiac output is also a contributing factor. Impedance cardiography (ICG) is a validated noninvasive method of measuring cardiac output and systemic vascular resistance. METHODS: To evaluate the relationship between systolic BP and systemic vascular resistance index (SVRI) in patients with CHF, we retrospectively evaluated the systolic BP and SVRI from 71 consecutive patients during 615 CHF clinic visits. Measurement of systolic BP was through the oscillometric method and SVRI through ICG (BioZ ICG Monitor, CardioDynamics, San Diego, CA). Absolute values and relative changes in systolic BP and SVRI were compared and characterized by systolic BP grouping. RESULTS: The 71 patients were an average of 69.3 +/- 12.2 years, New York Heart Association functional class 2.52 +/- 0.6, 46.5% men, and 47.8% ischemic etiology. Frequency by systolic BP grouping was: <100 mm Hg in 67 subjects (10.9%), 100 to 119 mm Hg in 245 subjects (39.8%), and >/=120 mm Hg in 303 subjects (49.3%). The correlation (R(2) value) of systolic BP to SVRI was 0.21 (N = 615), and change in systolic BP to change in SVRI from previous visit was 0.27 (N = 547). In 138 visits in which systolic BP did not change by 5 mm Hg or more, SVRI changed by 20% or more in 41 (29.7%). In the 67 visits in which systolic BP was below 100, only 6 (9.0%) had low SVRI and 57 (85.1%) had normal SVRI. In the 245 visits with systolic BP 100 to 119, 58 (23.7%) had high SVRI. CONCLUSIONS: Measurement of systolic BP alone does not reliably indicate the degree of vasoconstriction or vasodilation that exists in patients with CHF. Measurement of SVRI by ICG may help guide determination of need and tolerance for vasodilating medications in CHF.

Aged↗
PubMed1983

'Pseudo' systolic anterior motion in patients with hypertensive heart disease.

The systolic motion of the mitral apparatus in patients with hypertensive heart disease and hypertrophic cardiomyopathy was studied in order to quantify the difference. Twelve out of 37 patients with severe systemic hypertension were found to have abnormal systolic anterior motion and had significantly small left ventricular end-systolic dimension (P less than 0.05) and greater ejection fraction and mean velocity of circumferential fibre shortening (P less than 0.01 for each) than the other hypertensive patients without abnormal systolic anterior motion. A comparison between systolic anterior motion in 12 hypertensive patients and mild or moderate systolic anterior motion in 28 patients with hypertrophic cardiomyopathy showed a clear cut difference. 'Pseudo' systole anterior motion reached its peak at end-systole when the posterior wall had contracted fully. 'True' systolic anterior motion, however, reached its peak much earlier than maximum movement of the posterior wall--approximately after two-thirds of systole had been completed. At the time of mitral valve opening, 'pseudo' systolic anterior motion had not yet returned to this initial level, whereas 'true' systolic anterior motion returned prior to the opening of the mitral valve. Anterior chordal motion in hyperdynamic ventricle appears to play a role in the production of 'pseudo' systolic anterior motion.

Adolescent↗
PubMed2003

What is the most important component of blood pressure: systolic, diastolic or pulse pressure?

PURPOSE OF REVIEW: Diastolic blood pressure has traditionally been considered the most important component of blood pressure and the primary target of antihypertensive therapy. However, over 30 years ago important epidemiological studies pointed out the importance of systolic blood pressure, and research during the 1990s has strengthened this view. Unlike diastolic blood pressure, systolic blood pressure increases progressively with age, and in the ageing societies elevated systolic pressure is the most common form of hypertension. The characteristic changes of systolic and diastolic blood pressure with age lead to increases in pulse pressure (systolic minus diastolic), which has emerged as a new, potentially independent risk factor. In this review we compare the relative importance of various blood pressure components. RECENT FINDINGS: Generally, in studies in which readings of systolic and diastolic blood pressure have been compared, systolic blood pressure has been a better predictor of risk. Moreover, isolated systolic hypertension predicts risk better than isolated diastolic hypertension, and the treatment of both isolated systolic hypertension and combined hypertension has reduced cardiovascular events. There are no treatment studies of isolated diastolic hypertension. Pulse pressure reflects stiffening of large arteries and is associated with several cardiovascular risk factors. Pulse pressure also predicts events in epidemiologic studies, but elucidation of an independent role is hampered by the close correlation between pulse pressure and systolic blood pressure. SUMMARY: Epidemiological and treatment studies suggest that systolic blood pressure should be the primary target of antihypertensive therapy, although consideration of systolic and diastolic pressure together improves risk prediction. The greatest practical concern at the moment is the undertreatment of hypertension, especially systolic, and total cardiovascular risk.

Antihypertensive Agents↗