RESUMO
Abstract Introduction: Central blood pressure (CBP) is considered a measure of prognostic value for cardiovascular risk. In turn, the aortic pulse wave velocity (PWVAo) and augmentation index (Aix) have been related to arterial stiffness and cardiovascular risk. Controversies exist regarding the reference values in different ethnic groups, ages, and anthropometrics. The objective of this study is to evaluate the CBP and arterial stiffness parameters in a Mexican population by age, gender, and anthropometry. Methods: Between 2015 and 2016, 1009 apparently healthy subjects were recruited in the Instituto Nacional de Cardiología Ignacio Chávez. Using the Arteriograph (TensioMed) equipment with an oscillometric technique, CBP, central pulse pressure (cPP), PWVAo, and Aix were acquired. All results were automatically obtained by computer software version 3.0.0.4. Results: Female sex was prevalent (72%), mean age was 47 ± 12 years; 26% had normal weight, 43% were overweight, and 30% had obesity. The reference values were higher than those reported in other populations. PWVAo and Aix were always found to be higher in females. A central-brachial pressure gradient was observed in < 40 years with lower CBP. Body mass index (BMI) presented a direct and positive correlation with CBP (p < 0.001); however, PWVAo and Aix were not modified. Conclusion: CBP, cPP, PWVAo, and Aix parameters should be considered based on age, gender, and BMI. In Mexican population, CBP and cPP values were higher compared with other previously reported values, especially in women, the elderly, and obese. PWVAo and Aix are higher in older women; however, they are not modified by BMI.
Resumen Introducción: La presión central aórtica (PCA) se considera una medida del valor pronóstico. A su vez, la velocidad de la onda del pulso aórtico (VOPA) y el índice de aumento (IA) se han relacionado con la rigidez arterial y riesgo cardiovascular. Existen controversias sobre los valores de referencia en diferentes grupos. El objetivo de este estudio es evaluar estos parámetros en una población mexicana por edad, género y antropometría. Métodos: Entre 2015 y 2016 se reclutaron 1,009 sujetos aparentemente sanos en el Instituto Nacional de Cardiología Ignacio Chávez. Usando el equipo de Arteriograph (TensioMed) con técnica oscilométrica, se adquirieron: PCA, presión de pulso central, VOPA e IA. Todos los resultados fueron obtenidos automáticamente. Resultados: El sexo femenino fue prevalente (72%), edad de 47 ± 12 años; 26% con peso normal, 43% con sobrepeso y 30% con obesidad. Todos los valores fueron superiores a los reportados en otras poblaciones. VOPA e IA siempre fueron más altos en mujeres. Se observó un gradiente de presión central-braquial en < 40 años, con menor PCA. El IMC presentó una correlación directa y positiva con la PCA (p < 0,001), sin embargo, VOPA e IA no se modificaron. Conclusión: Los parámetros de PCA, VOPA e IA deben considerarse en función de edad, género e IMC. En una población mexicana, los valores de PCA fueron más altos en comparación con informados previamente (Europa y Asia), especialmente en mujeres, ancianos y obesos. VOPA e IA son más altos en mujeres mayores; sin embargo, no son modificados por el IMC.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Pressão Sanguínea/fisiologia , Sobrepeso/epidemiologia , Rigidez Vascular/fisiologia , Obesidade/epidemiologia , Valores de Referência , Estudos Transversais , Fatores Etários , MéxicoRESUMO
Introduction: Central blood pressure (CBP) is considered a measure of prognostic value for cardiovascular risk. In turn, the aortic pulse wave velocity (PWVAo) and augmentation index (Aix) have been related to arterial stiffness and cardiovascular risk. Controversies exist regarding the reference values in different ethnic groups, ages, and anthropometrics. The objective of this study is to evaluate the CBP and arterial stiffness parameters in a Mexican population by age, gender, and anthropometry. Methods: Between 2015 and 2016, 1009 apparently healthy subjects were recruited in the Instituto Nacional de Cardiología Ignacio Chávez. Using the Arteriograph (TensioMed) equipment with an oscillometric technique, CBP, central pulse pressure (cPP), PWVAo, and Aix were acquired. All results were automatically obtained by computer software version 3.0.0.4. Results: Female sex was prevalent (72%), mean age was 47 ± 12 years; 26% had normal weight, 43% were overweight, and 30% had obesity. The reference values were higher than those reported in other populations. PWVAo and Aix were always found to be higher in females. A central-brachial pressure gradient was observed in < 40 years with lower CBP. Body mass index (BMI) presented a direct and positive correlation with CBP (p < 0.001); however, PWVAo and Aix were not modified. Conclusion: CBP, cPP, PWVAo, and Aix parameters should be considered based on age, gender, and BMI. In Mexican population, CBP and cPP values were higher compared with other previously reported values, especially in women, the elderly, and obese. PWVAo and Aix are higher in older women; however, they are not modified by BMI.
Introducción: La presión central aórtica (PCA) se considera una medida del valor pronóstico. A su vez, la velocidad de la onda del pulso aórtico (VOPA) y el índice de aumento (IA) se han relacionado con la rigidez arterial y riesgo cardiovascular. Existen controversias sobre los valores de referencia en diferentes grupos. El objetivo de este estudio es evaluar estos parámetros en una población mexicana por edad, género y antropometría. Métodos: Entre 2015 y 2016 se reclutaron 1,009 sujetos aparentemente sanos en el Instituto Nacional de Cardiología Ignacio Chávez. Usando el equipo de Arteriograph (TensioMed) con técnica oscilométrica, se adquirieron: PCA, presión de pulso central, VOPA e IA. Todos los resultados fueron obtenidos automáticamente. Resultados: El sexo femenino fue prevalente (72%), edad de 47 ± 12 años; 26% con peso normal, 43% con sobrepeso y 30% con obesidad. Todos los valores fueron superiores a los reportados en otras poblaciones. VOPA e IA siempre fueron más altos en mujeres. Se observó un gradiente de presión central-braquial en < 40 años, con menor PCA. El IMC presentó una correlación directa y positiva con la PCA (p < 0,001), sin embargo, VOPA e IA no se modificaron. Conclusión: Los parámetros de PCA, VOPA e IA deben considerarse en función de edad, género e IMC. En una población mexicana, los valores de PCA fueron más altos en comparación con informados previamente (Europa y Asia), especialmente en mujeres, ancianos y obesos. VOPA e IA son más altos en mujeres mayores; sin embargo, no son modificados por el IMC.
Assuntos
Pressão Sanguínea/fisiologia , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Rigidez Vascular/fisiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Valores de Referência , Adulto JovemRESUMO
STUDY OBJECTIVES: Evidence of an association between atherosclerosis and sleep quality is limited and has not been studied in remote rural settings, where living conditions are different than in urban centers. We aimed to assess the relationship between the aortic pulse wave velocity (PWV) and sleep quality in older adults living in rural Ecuador. METHODS: Atahualpa residents aged 60 years or older identified during door-to-door surveys, who consented to participate, underwent face-to-face interviews with the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. Aortic PWV determinations were performed for arterial stiffness estimation (as a surrogate of atherosclerosis). RESULTS: A total of 303 individuals were included (mean age: 70.3 ± 7.8 years; 59% women). Univariate logistic regression showed a significant association between the aortic PWV and poor sleep quality (odds ratio [OR] 1.22; 95% confidence interval [CI] 1.07-1.39; P = .003). A multivariate logistic regression model, adjusted for demographics, cardiovascular risk factors, oily fish intake and psychological distress showed a significant association between increased PWV and poor sleep quality (OR 1.59; 95% CI 1.12-2.25; P = .009). Similar significance was noted when the model was adjusted for neuroimaging signatures of cerebral small-vessel disease and stroke (OR 1.47; 95% CI 1.07-2.03; P = .019). CONCLUSIONS: This study shows a significant independent association between the aortic PWV and poor sleep quality in older adults living in rural Ecuador. Results provide more insights into the relevance of the impact of sleep disorders on cardiovascular diseases. CLINICAL TRIAL REGISTRATION: The Atahualpa Project has been registered at ClinicalTrials.gov. The identifier number is NCT01627600, and the date was: 10/02/2012. CITATION: Del Brutto OH, Mera RM, Peñaherrera E, Costa AF, Peñaherrera R, Castillo PR. On the association between sleep quality and arterial stiffness: a population study in community-dwelling older adults living in rural ecuador (the atahualpa project). J Clin Sleep Med. 2019;15(8):1101-1106.
Assuntos
Sono/fisiologia , Rigidez Vascular , Idoso , Aterosclerose/epidemiologia , Aterosclerose/etiologia , Equador/epidemiologia , Feminino , Humanos , Vida Independente/estatística & dados numéricos , Modelos Logísticos , Masculino , Fatores de Risco , População Rural/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
ABSTRACT Objectives: We aimed to assess the association between arterial stiffness and nighttime sleep duration in community-dwelling older adults living in rural Ecuador. Methods: Aortic pulse wave velocity (PWV) determinations were used to assess arterial stiffness. Nighttime sleep duration was assessed by a single question. A generalized linear model - adjusted for demographics, cardiovascular risk factors and psychological distress - was fitted to assess the independent association between the aortic PWV and nighttime sleep duration (dependent variable). Results: A total of 303 individuals were enrolled. Univariate analysis showed a significant association between the aortic PWV and long sleep duration (p=0.034), which vanished in a multivariate linear model (p=0.524). The single covariable remaining significant was anxiety (p=0.013). Conclusion: Lack of independent association between arterial stiffness and nighttime sleep duration might be more likely related to lack of reliability of evaluation of sleep duration by means of a single question.
RESUMEN Objetivos: En el presente estudio se evaluó la asociación entre rigidez arterial y duración del sueño nocturno en adultos mayores que viven en la comunidad en una zona rural de la costa Ecuatoriana. Métodos: Se utilizaron determinaciones de velocidad de onda de pulso aórtico (PWV) para evaluar la rigidez arterial. La duración del sueño nocturno se evaluó mediante una sola pregunta. Un modelo lineal generalizado, ajustado por variables demográficas, factores de riesgo cardiovascular y distress psicológico, evaluó la asociación independiente entre el PWV aórtico y la duración del sueño nocturno (variable dependiente). Resultados: Se registraron un total de 303 individuos. El análisis univariado mostró una asociación significativa entre el PWV aórtico y larga duración del sueño (p=0.034), que desapareció en un modelo lineal multivariado (p=0.524). La única covariable que permaneció significativa fue la ansiedad (p=0.013). Conclusión: La falta de asociación independiente entre rigidez arterial y duración del sueño nocturno podría estar relacionada con la falta de confiabilidad de la evaluación de la duración del sueño mediante una sola pregunta.
RESUMO
Age-related reference intervals (RIs) of aortic pulse wave velocity (Ao-PWV) obtained from a large healthy population are lacking in South America. The aims of this study were to determine Ao-PWV RIs in a cohort of healthy children and adolescents from Argentina and to generate year-to-year percentile curves. Ao-PWV was measured in 1000 healthy subjects non-exposed to traditional cardiovascular risk factors (Age: 10-22 y. o., 56% males). First, we evaluated if RIs for males and females were necessaries (correlation and covariate analysis). Second, mean (M) and standard deviation (SD) age-related equations were obtained for cf-PWV, using parametric regression methods based on fractional polynomials. Third, age-specific (year to year) percentiles curves (for all, males and females children and adolescents) were generated using the standard normal distribution. They were, age-specific 1st, 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97.5th and 99th percentile curves and values. After covariate analysis (i.e., adjusting by age, jugulum-symphysis distance, body weight and height), specific RIs for males and females of children and adolescents were evidenced as necessaries. The equations were For all subjects: Ao-PWV_Mean = 4.98 + 12.86x10-5 Age3. Ao-PWV_SD = 0.47 + 21.00x10-6Age3. For girls: Ao-PWV_Mean = 5.07 + 10.23x10-5Age3. Ao-PWV_SD = 0.50 + 10.00x10-6Age3. For boys: Ao-PWV_Mean = 4.87 + 15.81x10-5Age3. Ao-PWV_SD = 0.46 + 22.34x10-6Age3. Our study provides the largest database to-date concerning Ao-PWV in healthy children and adolescents in Argentina. Age-related equations (M and SD values) for Ao-PWV are reported by the first time. Specific RIs and percentiles of Ao-PWV are now available according to age and sex for an Argentinian population.
Assuntos
Aorta/fisiologia , Análise de Onda de Pulso , Adolescente , Algoritmos , Argentina , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Oscilometria , Valores de Referência , Adulto JovemRESUMO
BACKGROUND: No previous population study assessed the diurnal profile of central arterial properties. METHODS: In 167 participants (mean age, 56.1 years; 63.5% women), randomly recruited in Montevideo, Uruguay, we used the oscillometric Mobil-O-Graph 24-h PWA monitor to measure peripheral and central systolic (SBP), diastolic (DBP), and pulse (PP) pressures and central hemodynamics standardized to a heart rate of 75 bpm, including aortic pulse wave velocity, systolic augmentation (first/second peak × 100), and pressure amplification (peripheral PP/central PP). RESULTS: Over 24 hours, day and night, peripheral minus central differences in SBP/DBP and in PP averaged 12.2/-1.1, 14.0/-0.7, and 9.7/0.2mm Hg and 12.6, 14.7, and 9.5mm Hg, respectively (P < 0.001 except for nighttime DBP (P = 0.38)). The central-to-peripheral ratios of SBP, DBP, and PP were 0.89, 1.00, and 0.70 unadjusted, but after accounting for anthropometric characteristics decreased to 0.74, 0.97, and 0.63, respectively, with strong influence of height for SBP and DBP and of sex for PP. From day (10-20h) to nighttime (0-6h), peripheral (-10.4/-10.5 mm Hg) and central (-6.0/-11.3mm Hg) SBP/DBP, pulse wave velocity (-0.7 m/s) and pressure amplification (-0.05) decreased (P < 0.001), whereas central PP (+5.3mm Hg) and systolic augmentation (+2.3%) increased (P < 0.001). CONCLUSIONS: The diurnal rhythm of central pressure runs in parallel with that of peripheral pressure, but the nocturnal fall in SBP is smaller centrally than peripherally. pulse wave velocity, systolic augmentation, and pressure amplification loop through the day with high pulse wave velocity and pressure amplification but low systolic augmentation in the evening and opposite trends in the morning.