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Pierre Boutouyrie - One of the best experts on this subject based on the ideXlab platform.
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Arterial Stiffness and Hypertension in the Elderly.
Frontiers in cardiovascular medicine, 2020Co-Authors: Stéphane Laurent, Pierre BoutouyrieAbstract:Hypertension prevalence increases with age. Age and high blood pressure are the two main determinants of Arterial Stiffness. In elderly hypertensives, large arteries stiffen and systolic and pulse pressures increase, due to wave reflections. A major reason for measuring Arterial Stiffness in clinical practice in elderly hypertensive patients comes from the repeated demonstration that Arterial Stiffness and wave reflections have a predictive value for CV events. A large body of evidence has been published during the last two decades, concerning the epidemiology, pathophysiology, and pharmacology of large arteries in hypertension in various settings of age. Particularly, two expert consensus documents have reviewed the methodological agreements for measuring Arterial Stiffness. The concepts of Early Vascular Ageing (EVA) and Supernormal Vascular Ageing (SUPERNOVA) help to better understand on which determinants of Arterial Stiffness it is possible to act, in order to limit target organ damage and cardiovascular complications. This review will address the issues of the cellular and molecular mechanisms of Arterial stiffening in elderly hypertensives, the consequences of Arterial stiffening on central systolic and pulse (systolic minus diastolic, PP) pressures and target organs, the methodology for measuring Arterial Stiffness, central pulse pressure and wave reflection, the epidemiological determinants of Arterial stiffening in elderly hypertensives, the pharmacology of Arterial destiffening, and how the concepts of EVA and SUPERNOVA apply to the detection of organ damage and prevention of CV complications.
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Arterial Stiffness as an Early Marker of Organ Damage
Special Issues in Hypertension, 2012Co-Authors: Stéphane Laurent, Pierre BoutouyrieAbstract:Classical risk scores may underestimate the risk of cardiovascular events in specific risk groups suitable for early prevention, such as asymptomatic hypertensive subjects. Arterial Stiffness and wave reflection are now well accepted as the most important determinants of increasing systolic and pulse pressures in aging societies, thus affording a major contribution to stroke and myocardial infarction. One of the main reasons for measuring Arterial Stiffness in hypertensive patients comes from the demonstration that Arterial Stiffness has a predictive value for cardiovascular events, beyond classical cardiovascular risk factors. Aortic stiffening also gives direct evidence of target organ damage and improves the determination of the overall cardiovascular risk of asymptomatic hypertensive subjects. In clinical practice, the measurement of aortic Stiffness may avoid patients being mistakenly classified at either low or moderate risk, when they actually have an abnormally high aortic Stiffness placing them within a higher risk group. This chapter successively addresses the concept of imaging biomarker, applies it to Arterial Stiffness, describes the methodology of its measurement, provides some pathophysiological links between Arterial Stiffness and organ damage, and raises the issue of whether Arterial Stiffness is a surrogate end point.
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Ambulatory Arterial Stiffness index does not accurately assess Arterial Stiffness.
Journal of hypertension, 2012Co-Authors: Jan Kips, Sebastian Vermeersch, Philippe Reymond, Pierre Boutouyrie, Nikos Stergiopulos, Stéphane Laurent, Luc M. Van Bortel, Patrick SegersAbstract:Introduction: The ambulatory Arterial Stiffness index (AASI), derived from ambulatory blood pressure monitoring (ABPM) recordings, has been proposed as a surrogate marker of Arterial Stiffness. However, there is controversy to what extent it reflects Stiffness or is affected by other parameters. Using a previously validated one-dimensional computer model of the Arterial circulation, the relative importance of the different determinants of the AASI was explored.
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Pharmacological Modulation of Arterial Stiffness
Drugs, 2011Co-Authors: Pierre Boutouyrie, Stéphane Laurent, Patrick Lacolley, Marie Briet, Véronique Regnault, Alice Stanton, Azra MahmudAbstract:Arterial Stiffness has emerged as an important marker of cardiovascular risk in various populations and reflects the cumulative effect of cardiovascular risk factors on large arteries, which in turn is modulated by genetic background. Arterial Stiffness is determined by the composition of the Arterial wall and the arrangement of these components, and can be studied in humans non-invasively. Age and distending pressure are two major factors influencing large artery Stiffness. Change in Arterial Stiffness with drugs is an important endpoint in clinical trials, although evidence for Arterial Stiffness as a therapeutic target still needs to be confirmed. Drugs that independently affect Arterial Stiffness include antihypertensive drugs, mostly blockers of the renin-angiotensin-aldosterone system, hormone replacement therapy and some antidiabetic drugs such as glitazones. While the quest continues for ‘de-stiffening drugs’, so far only advanced glycation endproduct cross-link breakers have shown promise.
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New techniques for assessing Arterial Stiffness.
Diabetes & Metabolism, 2008Co-Authors: Pierre BoutouyrieAbstract:Arterial Stiffness is now included in the guidelines of the European Society of Hypertension. In this paper, we review the evidence for the predictive value of Arterial Stiffness. More than 11 longitudinal trials have proven the predictive value of aortic Stiffness measured through carotid to femoral pulse wave velocity, beyond and above classical risk factors. Such evidence is scarcer for central pressure and local Arterial Stiffness. If we add this evidence to the easiness of performing such measure, carotid to femoral pulse wave velocity is the reference technique for assessing Arterial Stiffness. Its place in the investigation of patients remains to be precised.
Stéphane Laurent - One of the best experts on this subject based on the ideXlab platform.
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Arterial Stiffness and Hypertension in the Elderly.
Frontiers in cardiovascular medicine, 2020Co-Authors: Stéphane Laurent, Pierre BoutouyrieAbstract:Hypertension prevalence increases with age. Age and high blood pressure are the two main determinants of Arterial Stiffness. In elderly hypertensives, large arteries stiffen and systolic and pulse pressures increase, due to wave reflections. A major reason for measuring Arterial Stiffness in clinical practice in elderly hypertensive patients comes from the repeated demonstration that Arterial Stiffness and wave reflections have a predictive value for CV events. A large body of evidence has been published during the last two decades, concerning the epidemiology, pathophysiology, and pharmacology of large arteries in hypertension in various settings of age. Particularly, two expert consensus documents have reviewed the methodological agreements for measuring Arterial Stiffness. The concepts of Early Vascular Ageing (EVA) and Supernormal Vascular Ageing (SUPERNOVA) help to better understand on which determinants of Arterial Stiffness it is possible to act, in order to limit target organ damage and cardiovascular complications. This review will address the issues of the cellular and molecular mechanisms of Arterial stiffening in elderly hypertensives, the consequences of Arterial stiffening on central systolic and pulse (systolic minus diastolic, PP) pressures and target organs, the methodology for measuring Arterial Stiffness, central pulse pressure and wave reflection, the epidemiological determinants of Arterial stiffening in elderly hypertensives, the pharmacology of Arterial destiffening, and how the concepts of EVA and SUPERNOVA apply to the detection of organ damage and prevention of CV complications.
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Arterial Stiffness in Early Phases of Prehypertension
Updates in Hypertension and Cardiovascular Protection, 2018Co-Authors: Stéphane Laurent, Pedro CunhaAbstract:Children, adolescent, and adults with prehypertension have a high risk for developing hypertension. Modifiable cardiovascular risk factors, such as prediabetes and diabetes mellitus, overweight and obesity, high lipid diet, high salt intake, and lack of regular physical activity play a crucial role in the transition between prehypertension and hypertension. Because these cardiovascular risk factors are key determinants of increased Arterial Stiffness, and because increased Arterial Stiffness is a determinant of incident hypertension, the question arises as to whether Arterial Stiffness plays a crucial role in the transition between early phases of prehypertension and hypertension. In this review, we will analyze the epidemiological and hemodynamic evidences that increased Arterial Stiffness is a determinant of incident hypertension. We will also address the complexity of this relationship by discussing the hemodynamic and biomechanical pathways involved in the bidirectional influence between Arterial Stiffness and blood pressure. And then, we will discuss (a) the predictive value of Arterial Stiffness not only for incident hypertension, but also for cardiovascular events, (b) the influence of low-grade inflammation associated with chronic diseases in the development of Arterial Stiffness and subsequently hypertension, (c) how the concept of Early Vascular Ageing can help understanding the relationship between Arterial Stiffness and prehypertension, and (d) the relationships between metabolic syndrome, Arterial Stiffness, and prehypertension in children.
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Arterial Stiffness as an Early Marker of Organ Damage
Special Issues in Hypertension, 2012Co-Authors: Stéphane Laurent, Pierre BoutouyrieAbstract:Classical risk scores may underestimate the risk of cardiovascular events in specific risk groups suitable for early prevention, such as asymptomatic hypertensive subjects. Arterial Stiffness and wave reflection are now well accepted as the most important determinants of increasing systolic and pulse pressures in aging societies, thus affording a major contribution to stroke and myocardial infarction. One of the main reasons for measuring Arterial Stiffness in hypertensive patients comes from the demonstration that Arterial Stiffness has a predictive value for cardiovascular events, beyond classical cardiovascular risk factors. Aortic stiffening also gives direct evidence of target organ damage and improves the determination of the overall cardiovascular risk of asymptomatic hypertensive subjects. In clinical practice, the measurement of aortic Stiffness may avoid patients being mistakenly classified at either low or moderate risk, when they actually have an abnormally high aortic Stiffness placing them within a higher risk group. This chapter successively addresses the concept of imaging biomarker, applies it to Arterial Stiffness, describes the methodology of its measurement, provides some pathophysiological links between Arterial Stiffness and organ damage, and raises the issue of whether Arterial Stiffness is a surrogate end point.
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Ambulatory Arterial Stiffness index does not accurately assess Arterial Stiffness.
Journal of hypertension, 2012Co-Authors: Jan Kips, Sebastian Vermeersch, Philippe Reymond, Pierre Boutouyrie, Nikos Stergiopulos, Stéphane Laurent, Luc M. Van Bortel, Patrick SegersAbstract:Introduction: The ambulatory Arterial Stiffness index (AASI), derived from ambulatory blood pressure monitoring (ABPM) recordings, has been proposed as a surrogate marker of Arterial Stiffness. However, there is controversy to what extent it reflects Stiffness or is affected by other parameters. Using a previously validated one-dimensional computer model of the Arterial circulation, the relative importance of the different determinants of the AASI was explored.
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Pharmacological Modulation of Arterial Stiffness
Drugs, 2011Co-Authors: Pierre Boutouyrie, Stéphane Laurent, Patrick Lacolley, Marie Briet, Véronique Regnault, Alice Stanton, Azra MahmudAbstract:Arterial Stiffness has emerged as an important marker of cardiovascular risk in various populations and reflects the cumulative effect of cardiovascular risk factors on large arteries, which in turn is modulated by genetic background. Arterial Stiffness is determined by the composition of the Arterial wall and the arrangement of these components, and can be studied in humans non-invasively. Age and distending pressure are two major factors influencing large artery Stiffness. Change in Arterial Stiffness with drugs is an important endpoint in clinical trials, although evidence for Arterial Stiffness as a therapeutic target still needs to be confirmed. Drugs that independently affect Arterial Stiffness include antihypertensive drugs, mostly blockers of the renin-angiotensin-aldosterone system, hormone replacement therapy and some antidiabetic drugs such as glitazones. While the quest continues for ‘de-stiffening drugs’, so far only advanced glycation endproduct cross-link breakers have shown promise.
Julio A. Chirinos - One of the best experts on this subject based on the ideXlab platform.
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Arterial Stiffness in diabetes mellitus.
Atherosclerosis, 2014Co-Authors: Stuart B. Prenner, Julio A. ChirinosAbstract:Arterial Stiffness is an age-related process that is a shared consequence of numerous diseases including diabetes mellitus (DM), and is an independent predictor of mortality both in this population and in the general population. While much has been published about Arterial Stiffness in patients with DM, a thorough review of the current literature is lacking. Using a systematic literature search strategy, we aimed to summarize our current understanding related to Arterial Stiffness in DM. We review key studies demonstrating that, among patients with established DM, Arterial Stiffness is closely related to the progression of complications of DM, including nephropathy, retinopathy, and neuropathy. It is also becoming clear that Arterial Stiffness can be increased even in pre-diabetic populations with impaired glucose tolerance, and in those with the metabolic syndrome (METS), well before the onset of overt DM. Some data suggests that Arterial Stiffness can predict the onset of DM. However, future work is needed to further clarify whether large artery Stiffness and the pulsatile hemodynamic changes that accompany it are involved in the pathogenesis of DM, and whether interventions targeting Arterial Stiffness are associated with improved clinical outcomes in DM. We also review of the potential mechanisms of Arterial Stiffness in DM, with particular emphasis on the role of advanced glycation endproducts (AGEs) and nitric oxide dysregulation, and address potential future directions for research.
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Inflammation and Arterial Stiffness in humans
Atherosclerosis, 2014Co-Authors: Snigdha Jain, Rohan Khera, Vicente F. Corrales–medina, Raymond R. Townsend, Julio A. ChirinosAbstract:Arterial Stiffness is an established marker of cardiovascular morbidity and mortality and a potential therapeutic target. While hypertension and aging are established factors contributing to Arterial Stiffness, the role of inflammation in stiffening of the arteries is less well understood. We summarize existing literature regarding inflammation and Arterial Stiffness, including a discussion of the potential mechanisms by which inflammation may lead to Arterial stiffening and studies assessing: (1) The association between subclinical inflammation and Arterial Stiffness in the general population; (2) The presence of increased Arterial Stiffness in primary inflammatory diseases; (3) The effect of anti-inflammatory therapy on Arterial Stiffness in primary inflammatory disease including the effect of statins; (4) Experimental evidence of immunization-induced Arterial stiffening in normal adults. We discuss potential opportunities to assess the impact of anti-inflammatory interventions on Arterial Stiffness in subjects without primary inflammatory conditions. We also review the effect of inflammation on wave reflections.
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Arterial Stiffness: Basic Concepts and Measurement Techniques
Journal of Cardiovascular Translational Research, 2012Co-Authors: Julio A. ChirinosAbstract:Arterial Stiffness is highly relevant to cardiovascular disease. Arterial Stiffness is central to the pathogenesis of isolated systolic hypertension and directly impacts left ventricular afterload, pressure pulsatility in the Arterial tree, and its penetration into the microvasculature of target organs such as the brain and kidney. Arterial Stiffness is affected by various risk factors and biologic processes. Measurements of Arterial Stiffness may therefore not only provide information about prevalent processes, but also valuable information regarding the cumulative history of risk factor exposure. Available studies consistently demonstrate that large artery Stiffness, measured via carotid-femoral pulse wave velocity, independently predicts the risk of incident cardiovascular events in clinical and community-based cohorts. Understanding the basic principles and definitions related to Arterial Stiffness is therefore desirable for cardiovascular clinicians and researchers. This introductory paper reviews basic physical principles and definitions regarding Arterial Stiffness and the most important non-invasive methods for its quantification in vivo.
Atanas G Atanasov - One of the best experts on this subject based on the ideXlab platform.
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inflammatory markers for Arterial Stiffness in cardiovascular diseases
Frontiers in Immunology, 2017Co-Authors: Ioana Mozos, Clemens Malainer, J O Horbanczuk, Cristina Gug, Dana Stoian, Constantin Tudor Luca, Atanas G AtanasovAbstract:Arterial Stiffness predicts an increased risk of cardiovascular events. Inflammation plays a major role in large arteries stiffening, related to atherosclerosis, arteriosclerosis, endothelial dysfunction, smooth muscle cell migration, vascular calcification, increased activity of metalloproteinases, extracellular matrix degradation, oxidative stress, elastolysis and degradation of collagen. The present paper reviews main mechanisms explaining the crosstalk between inflammation and Arterial Stiffness and the most common inflammatory markers associated with increased Arterial Stiffness, considering the most recent clinical and experimental studies. Several articles revealed significant correlations between the severity of Arterial Stiffness and inflammatory markers, such as white blood cell count, neutrophil/lymphocyte ratio, adhesion molecules, fibrinogen, C-reactive protein, cytokines, microRNAs and cyclooxygenase-2 in patients with a broad variety of diseases, such as metabolic syndrome, diabetes, coronary heart disease, peripheral Arterial disease, malignant and rheumatic disorders, polycystic kidney disease, renal transplant, familial Mediterranean fever, oral infections and in women with preeclampsia or after menopause. There is strong evidence that inflammation plays an important and, at least, partly reversible role in the development of Arterial Stiffness, and inflammatory markers may be useful additional tools in the assessment of the cardiovascular risk in clinical practice. Combined assessment of Arterial Stiffness and inflammatory markers may improve noninvasive assessment of cardiovascular risk, enabling selection of high-risk patients for prophylactic treatment or more regular medical examination. Development of future destiffening therapies may target proinflammatory mechanisms.
Stella S. Daskalopoulou - One of the best experts on this subject based on the ideXlab platform.
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The association between preeclampsia and Arterial Stiffness.
Journal of hypertension, 2012Co-Authors: Anais Hausvater, Robert J. Doonan, Tania Giannone, Yessica-haydee Gomez Sandoval, Constantine N. Antonopoulos, Ioannis L. Matsoukis, Eleni Petridou, Stella S. DaskalopoulouAbstract:A systematic review and meta-analysis was conducted using MEDLINE, EMBASE, and the Cochrane Library to investigate the association between preeclampsia and Arterial Stiffness. Twenty-three relevant studies were included. A significant increase in all Arterial Stiffness indices combined was observed in women with preeclampsia vs. women with normotensive pregnancies [standardized mean difference 1.62, 95% confidence interval (CI) 0.73-2.50]; carotid-femoral pulse wave velocity (cfPWV) and augmentation index (AIx) were also significantly increased (weighted mean difference, WMDcfPWV 1.04, 95% CI 0.34-1.74; WMDAIx 15.10, 95% CI 5.08-25.11), whereas carotid-radial PWV (crPWV) increase did not reach significance (WMDcrPWV 0.99, 95% CI -0.07 to 2.05). Significant increases in Arterial Stiffness measurements were noted in women with preeclampsia compared with those with gestational hypertension. Arterial Stiffness measurements may also be useful in predicting preeclampsia and may play a role in the increased risk of future cardiovascular complications seen in women with a history of preeclampsia.
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The combined effect of hypertension and smoking on Arterial Stiffness.
Clinical and experimental hypertension (New York N.Y. : 1993), 2010Co-Authors: Ciaran Scallan, Robert J. Doonan, Stella S. DaskalopoulouAbstract:Arterial Stiffness plays a critical role in the function of the cardiovascular system as it represents the coupling of the left ventricle and Arterial tree. Increased Arterial Stiffness is associated with a number of cardiovascular complications. Increased Stiffness occurs with age and with the development of chronic conditions (e.g., hypertension) and the presence of vascular risk factors (e.g., smoking). Measuring Arterial Stiffness is increasingly gaining popularity as a method of assessing cardiovascular health and treatment efficacy. The purpose of this review was to assess the combined effect of hypertension and smoking on Arterial Stiffness. A systematic review of the literature revealed four relevant studies; hypertension and smoking were found to be independent detrimental factors for raising Arterial Stiffness, and combined they raise Arterial Stiffness more than either solitary factor. However, a need was identified for future studies to determine the extent to which smoking cessation therapy combined with the appropriate anti-hypertensive medication can lead to stabilization or even reversal of Arterial Stiffness.
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The effect of smoking on Arterial Stiffness
Hypertension research : official journal of the Japanese Society of Hypertension, 2010Co-Authors: Robert J. Doonan, Anais Hausvater, Ciaran Scallan, Dimitri P. Mikhailidis, Louise Pilote, Stella S. DaskalopoulouAbstract:A systematic literature review was conducted using PubMed, Embase and the Cochrane Library to determine the effect of acute, chronic and passive smoking on Arterial Stiffness and to determine whether these effects are reversible after smoking cessation. A total of 39 relevant studies were identified and included. Acute smoking was found to cause an acute increase in Arterial Stiffness. Similarly, passive smoking increased Arterial Stiffness acutely and chronically. The majority of studies identified chronic smoking as a risk factor for increasing Arterial Stiffness. However, some studies found no statistical difference in Arterial Stiffness between nonsmokers and long-term smokers, although chronic smoking seems to sensitize the Arterial response to acute smoking. In addition, whether Arterial Stiffness is reversed after smoking cessation and the timeline in which this may occur could not be determined from the identified literature. The effect of smoking discontinuation on Arterial Stiffness remains to be established by prospective smoking cessation trials.