Arterial stiffness and 24 h ambulatory blood pressure monitoring in young healthy volunteers: The early vascular ageing Aristotle University Thessaloniki Study (EVA–ARIS Study)
Introduction
A recent report from the American Heart Association Statistics Committee demonstrated that cardiovascular (CV) disease manifestations still remain a crucial menace to public health [1]. A number of epidemiological studies have proved that ageing is a dominant risk factor for cardiovascular diseases [2]. Early vascular ageing (EVA) represents the acceleration of the vascular ageing process. EVA could provide a valuable tool for the clinical investigation and guidance of individuals at increased cardiovascular risk, especially those with marginal elevation of classic risk factors or with a strong family history of early CV disease manifestations [3], [4].
Arterial stiffness is increased when elastic properties of the arterial wall are reduced. Ageing is a procedure that causes structural and functional modifications in the vasculature, resulting in decreased arterial compliance and increased arterial stiffness [1], [5], [6]. Aortic stiffness may represent an intermediate endpoint for CV events. Carotid–femoral pulse wave velocity (PWV) has been considered as a direct measurement of arterial stiffness. Pulse wave velocity is the speed at which the pressure waveforms travel along the aorta and large arteries during each cardiac cycle. PWV has a better predictive value than classical CV risk factors possibly because it depicts the cumulative effect of both known and non-identified CV risk factors on the large arteries [7]. Therefore, it represents a useful spectrum through which the EVA process could be thoroughly yet non-invasively investigated. Factors that possibly have an influence in the EVA process may include CV risk factors such as age, gender, diabetes mellitus, dyslipidemia, smoking, alcohol consumption, obesity, hypertension, and family history of early CV disease.
Ambulatory blood pressure monitoring (ABPM) has gradually established its utility not only in the research field but also in clinical practice, as it allows the study of the blood pressure (BP), heart rate and circadian 24-h BP profile of the patients. The 24-h BP parameters are reproducible and correlate better with target organ damage than office BP [8], [9], [10], [11], [12]. There is also evidence that ambulatory values predict better CV morbidity and mortality than office values [13], [14], [15], [16]. In addition, combined office and ambulatory BP measurements have also been used to identify conditions, such as white-coat and masked hypertension [17], [18], [19].
In the present study, we hypothesized that differences in blood pressure monitoring parameters such as average 24 h BP, day to night BP ratio, and blood pressure variability could have an impact on arterial stiffness. We measured pulse wave velocity in a young healthy population and we explored possible parameters from ABPM and demographics that may associate with increased arterial stiffness. Our aim was to investigate relationships between arterial stiffness and 24-h ABPM profile and to identify determinants of premature arterial stiffness. To our knowledge, there are no previous studies of the impact of ABPM parameters on arterial stiffness in a healthy young population.
Section snippets
Study population
All subjects volunteered to participate in the study and gave their written consent to participate. The institutional review board approved the human research protocol. The study population consisted of 115 consecutive healthy volunteers with age range 18–24 years old. All participants fulfilled the following inclusion criteria: (1) no history of hypertension; (2) no history of diabetes mellitus, dyslipidemia, metabolic syndrome or other chronic inflammatory disease; (3) no pharmacological
Results
Demographic data and 24-h ABPM parameters of our population are listed in Table 1, Table 2. Characteristics of subjects with EVA are reported in Table 3. In univariate analysis, estimated carotid–femoral PWV showed a significant correlation with age, height, weight, waist circumference, clinic systolic and diastolic BP, 24-h systolic and diastolic BP, 24-h pulse pressure, standard deviation of 24-h systolic and diastolic BP, daytime systolic and diastolic BP, daytime pulse pressure, standard
Discussion
Vascular ageing is the effect of molecular mechanisms including those leading to oxidative damage of macromolecules, formation of advanced glycation end products, telomere damage, depletion of vascular progenitor cells and the accumulation of senescent endothelial and vascular smooth muscle cells. These processes are accentuated in the presence of classical cardiovascular risk factors. Even though the existence of these associations has been documented, the relationships between classical risk
Perspectives
The findings of the present study indicate that increased 24 h BP variability is significantly associated with arterial stiffness and EVA in a young healthy population. A major goal remains to design basic experiments aimed at elucidating the mechanisms involved in the age- and BP-associated alterations in the cardiovascular structure and function that occur in apparently healthy people, and finally to establish through clinical trials strategies that reduce or prevent increases in stiffness,
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