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Hypertension: HELP
Articles by James E. Sharman
Based on 63 articles published since 2010
(Why 63 articles?)
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Between 2010 and 2020, J. E. Sharman wrote the following 63 articles about Hypertension.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Editorial Arterial Loading and the Prevention of Atrial Dysfunction. 2017

Marwick, Thomas H / Sharman, James E. ·From the Baker Heart and Diabetes Institute, Melbourne, Australia (T.H.M.) · and Menzies Institute for Medical Research, Hobart, Australia (J.E.S.). ·Circ Cardiovasc Imaging · Pubmed #28592594.

ABSTRACT: -- No abstract --

2 Review Macrovasculature and Microvasculature at the Crossroads Between Type 2 Diabetes Mellitus and Hypertension. 2019

Climie, Rachel E / van Sloten, Thomas T / Bruno, Rosa-Maria / Taddei, Stefano / Empana, Jean-Philippe / Stehouwer, Coen D A / Sharman, James E / Boutouyrie, Pierre / Laurent, Stéphane. ·From the INSERM, U970, Paris Cardiovascular Research Center (PARCC), France (R.E.C., T.T.v.S., R.-M.B., J.-P.E.). · Baker Heart and Diabetes Institute, Melbourne, Australia (R.E.C.). · Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia (R.E.C., J.E.S.). · Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, the Netherlands (T.T.v.S., C.D.A.S.). · Department of Clinical and Experimental Medicine, University of Pisa, Italy (R.-M.B., S.T.). · INSERM, U970, APHP. Paris Descartes University, Paris, France (P.B., S.L.). ·Hypertension · Pubmed #31067192.

ABSTRACT: -- No abstract --

3 Review Methodological factors affecting quantification of blood pressure variability: a scoping review. 2018

Veloudi, Panagiota / Sharman, James E. ·Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia. ·J Hypertens · Pubmed #29176390.

ABSTRACT: OBJECTIVES: Blood pressure (BP) variability (BPV) may offer independent prognostic information. However, data supporting this notion are inconsistent, and this may be due to the wide variety of methodologies used for measuring BPV. A systematic analysis on the effect of BPV methodologies on BPV itself has never been undertaken and was the aim of this study. We also sought to determine the effect of participant characteristics on BPV. METHODS: A scoping review process was used to identify the effect of BPV methodologies on BPV magnitude. Key methodological factors assessed were the number of BP readings or visits used to quantify BPV and the duration of BP monitoring. In addition, the relationship between age and mean BP level on BPV was investigated. Analyses were performed across studies that measured BPV over the short-term (using 24-h BP), mid-term (using home BP in the morning, evening or day-to-day) and long-term (using visit-to-visit clinic BP). RESULTS: Data were extracted from 96 studies. The number of BP readings and visits used to quantify BPV were positively associated with mid-term and long-term BPV. Duration was weakly associated with mid-term (morning) BPV. Age was positively associated with long-term and mid-term (day-to-day), but not short-term BPV. Mean BP level was positively associated with BPV, except mid-term BPV (morning and evening). CONCLUSION: The methodology used to quantify BPV, as well as age and mean BP level, affects the magnitude of BPV itself. This highlights the need to standardize BPV protocols, particularly regarding the number of BP readings and visits.

4 Review Blood Pressure Response to Exercise and Cardiovascular Disease. 2017

Schultz, Martin G / La Gerche, Andre / Sharman, James E. ·Menzies Institute for Medical Research, University of Tasmania, Hobart, 7000, Australia. Martin.Schultz@utas.edu.au. · Baker Heart and Diabetes Institute, Melbourne, Australia. · Menzies Institute for Medical Research, University of Tasmania, Hobart, 7000, Australia. ·Curr Hypertens Rep · Pubmed #29046978.

ABSTRACT: PURPOSE OF REVIEW: This review aimed to provide a clinical update on exercise blood pressure (BP) and its relationship to cardiovascular disease (CVD), outlining key determinants of abnormal exercise BP responses. We also highlight current evidence gaps that need addressing in order to optimise the relevance of exercise BP as clinical CVD risk factor. RECENT FINDINGS: Abnormal exercise BP manifests as either exercise hypotension (low BP response) or as exaggerated exercise BP (high BP response). Exercise hypotension is an established sign of existing and likely severe CVD, but exaggerated exercise BP also carries elevated CVD risk due to its association with sub-clinical hypertension. Although exaggerated exercise BP is related to heightened CVD risk at any exercise intensity, recent data suggest that the BP response to submaximal intensity exercise holds greater prognostic and clinical significance than BP achieved at peak/maximal intensity exercise. Cardiorespiratory fitness is a strong modifier of the exercise BP response, and should be taken into consideration when assessing the association with CVD. Both exercise hypotension and exaggerated exercise BP serve as markers that should prompt evaluation for potential underlying CVD. However, the clinical utility of these markers is currently inhibited by the lack of consensus informing the definitions and thresholds for abnormalities in exercise BP.

5 Review Validation of non-invasive central blood pressure devices: ARTERY Society task force consensus statement on protocol standardization. 2017

Sharman, James E / Avolio, Alberto P / Baulmann, Johannes / Benetos, Athanase / Blacher, Jacques / Blizzard, C Leigh / Boutouyrie, Pierre / Chen, Chen-Huan / Chowienczyk, Phil / Cockcroft, John R / Cruickshank, J Kennedy / Ferreira, Isabel / Ghiadoni, Lorenzo / Hughes, Alun / Jankowski, Piotr / Laurent, Stephane / McDonnell, Barry J / McEniery, Carmel / Millasseau, Sandrine C / Papaioannou, Theodoros G / Parati, Gianfranco / Park, Jeong Bae / Protogerou, Athanase D / Roman, Mary J / Schillaci, Giuseppe / Segers, Patrick / Stergiou, George S / Tomiyama, Hirofumi / Townsend, Raymond R / Van Bortel, Luc M / Wang, Jiguang / Wassertheurer, Siegfried / Weber, Thomas / Wilkinson, Ian B / Vlachopoulos, Charalambos. ·Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. · Faculty of Medicine and Health Sciences, Department of Biomedical Sciences, Macquarie University, Sydney, Australia. · Clinic of Internal Medicine II, University Hospital Schleswig-Holstein, Luebeck, Germany. · Département de Médecine Gériatrique, CHRU de Nancy and INSERM U1116, Université de Lorraine, Vandoeuvre-les-Nancy, France. · Hypertension and Cardiovascular Prevention Unit, Hôtel-Dieu University Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Descartes, Paris, France. · Departments of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France. · Faculty of Medicine, Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. · Department of Clinical Pharmacology, King's College London British Heart Foundation Centre, London, UK. · Department of Biomedical Sciences, School of Health Sciences, Cardiff Metropolitan University, Cardiff, UK. · Cardiovascular Medicine Group, Division of Diabetes and Nutritional Sciences, King's College, London, UK. · School of Public Health, The University of Queensland, Herston, Brisbane, Australia. · Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. · Institute of Cardiovascular Science, University College London, London, UK. · First Department of Cardiology and Hypertension, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland. · Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, UK. · Pulse Wave Consulting, Saint Leu la Foret, France. · Biomedical Engineering Unit, First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece. · Department of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milan, Italy. · Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. · Department of Medicine/Cardiology, Cheil General Hospital, Dankook University College of Medicine, Seoul, Korea. · Department of Pathophysiology, Cardiovascular Prevention and Research Unit, 'Laiko' Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece. · Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY, USA. · Dipartimento di Medicina, Università di Perugia, Unità di Medicina Interna, Ospedale 'S. Maria', Terni, Italy. · IBiTech-bioMMeda, Ghent University, Ghent, Belgium. · Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, Third Department of Medicine, Sotiria Hospital, Athens, Greece. · Department of Cardiology, Tokyo Medical University, Tokyo, Japan. · Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. · Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium. · The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. · Health & Environment Department, Austrian Institute of Technology, Vienna, Austria. · Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria. · First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece. ·Eur Heart J · Pubmed #28158489.

ABSTRACT: -- No abstract --

6 Review Arterial (Aortic) Stiffness in Patients with Resistant Hypertension: from Assessment to Treatment. 2017

Sharman, James E / Boutouyrie, Pierre / Laurent, Stéphane. ·Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, 7000, Australia. James.Sharman@utas.edu.au. · Departments of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Inserm UMR 970, University Paris Descartes, Paris, France. ·Curr Hypertens Rep · Pubmed #28091867.

ABSTRACT: PURPOSE OF REVIEW: The purpose of the review is to examine whether measurement of aortic stiffness could be especially value-adding for risk stratification and treatment among patients with resistant hypertension (RH). RECENT FINDINGS: Adverse arterial remodeling and increased aortic stiffness is associated with RH, and it may be of additional clinical benefit to measure aortic stiffness in these patients. However, there is insufficient evidence to determine whether aortic stiffness is excessively high relative to the level of blood pressure (BP) among people with RH. This issue needs resolution as it could help refine management decisions guided by aortic stiffness. If conventional antihypertensive therapy fails to lower BP in patients with RH, there is good rationale for effectiveness of spironolactone as add on therapy, and this should also improve aortic stiffness. Lifestyle intervention with exercise and diet should be additionally efficacious towards improving BP and aortic stiffness in patients with RH, but there is limited data in this patient population. For better characterization on the effects of BP treatment on aortic stiffness, measures of central aortic BP may help refine management decisions above and beyond conventional arm cuff BP. There is strong evidence to support the use of aortic stiffness as a tool to aid risk stratification in hypertension management. Although there is a theoretical basis for special additional benefit of measuring aortic stiffness in patients with RH (as distinct from uncomplicated hypertension), at this time, there is inadequate data available to make definitive conclusions and is an area for future investigation.

7 Review A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension. 2016

Olsen, Michael H / Angell, Sonia Y / Asma, Samira / Boutouyrie, Pierre / Burger, Dylan / Chirinos, Julio A / Damasceno, Albertino / Delles, Christian / Gimenez-Roqueplo, Anne-Paule / Hering, Dagmara / López-Jaramillo, Patricio / Martinez, Fernando / Perkovic, Vlado / Rietzschel, Ernst R / Schillaci, Giuseppe / Schutte, Aletta E / Scuteri, Angelo / Sharman, James E / Wachtell, Kristian / Wang, Ji Guang. ·Department of Internal Medicine, Holbæk Hospital and Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, University of Southern Denmark, Odense, Denmark; Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa. Electronic address: mho@dadlnet.dk. · Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene, New York, NY, USA. · Global NCD Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA. · Department of Pharmacology and INSERM U 970, Georges Pompidou Hospital, Paris Descartes University, Paris, France. · Kidney Research Centre, Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, ON, Canada. · Department of Medicine at University Hospital of Pennsylvania and Veteran's Administration, PA, USA. · Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique. · Christian Delles: Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. · INSERM, UMR970, Paris-Cardiovascular Research Center, F-75015, Paris, France; Paris Descartes University, F-75006, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Genetics, F-75015, Paris, France. · The University of Western Australia-Royal Perth Hospital, Perth, WA, Australia. · Direccion de Investigaciones, FOSCAL and Instituto de Investigaciones MASIRA, Facultad de Medicina, Universidad de Santander, Bucaramanga, Colombia. · Hypertension Clinic, Internal Medicine, Hospital Clinico, University of Valencia, Valencia, Spain. · The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia. · Department of Cardiology, Ghent University and Biobanking & Cardiovascular Epidemiology, Ghent University Hospital, Ghent, Belgium. · Department of Internal Medicine, University of Perugia, Terni University Hospital, Terni, Italy. · Medical Research Council Unit on Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa. · Hypertension Center, Hypertension and Nephrology Unit, Department of Medicien, Policlinico Tor Vergata, Rome, Italy. · Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia. · Department of Cardiology, Division of Cardiovascular and Pulmonary Diseases Oslo University Hospital, Oslo, Norway. · The Shanghai Institute of Hypertension, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. ·Lancet · Pubmed #27671667.

ABSTRACT: -- No abstract --

8 Review Exercise and cardiovascular risk in patients with hypertension. 2015

Sharman, James E / La Gerche, Andre / Coombes, Jeff S. ·Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia; james.sharman@menzies.utas.edu.au. · St Vincent's Hospital Department of Medicine, University of Melbourne, Fitzroy, Australia; · The University of Queensland, Brisbane, Queensland, Australia. ·Am J Hypertens · Pubmed #25305061.

ABSTRACT: Evidence for the benefits of regular exercise is irrefutable and increasing physical activity levels should be a major goal at all levels of health care. People with hypertension are less physically active than those without hypertension and there is strong evidence supporting the blood pressure-lowering ability of regular exercise, especially in hypertensive individuals. This narrative review discusses evidence relating to exercise and cardiovascular (CV) risk in people with hypertension. Comparisons between aerobic, dynamic resistance, and static resistance exercise have been made along with the merit of different exercise volumes. High-intensity interval training and isometric resistance training appear to have strong CV protective effects, but with limited data in hypertensive people, more work is needed in this area. Screening recommendations, exercise prescriptions, and special considerations are provided as a guide to decrease CV risk among hypertensive people who exercise or wish to begin. It is recommended that hypertensive individuals should aim to perform moderate intensity aerobic exercise activity for at least 30 minutes on most (preferably all) days of the week in addition to resistance exercises on 2-3 days/week. Professionals with expertise in exercise prescription may provide additional benefit to patients with high CV risk or in whom more intense exercise training is planned. Despite lay and media perceptions, CV events associated with exercise are rare and the benefits of regular exercise far outweigh the risks. In summary, current evidence supports the assertion of exercise being a cornerstone therapy in reducing CV risk and in the prevention, treatment, and control of hypertension.

9 Review Exercise Hypertension. 2014

Schultz, Martin G / Sharman, James E. ·Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tas., Australia. ·Pulse (Basel) · Pubmed #26587435.

ABSTRACT: Irrespective of apparent 'normal' resting blood pressure (BP), some individuals may experience an excessive elevation in BP with exercise (i.e. systolic BP ≥210 mm Hg in men or ≥190 mm Hg in women or diastolic BP ≥110 mm Hg in men or women), a condition termed exercise hypertension or a 'hypertensive response to exercise' (HRE). An HRE is a relatively common condition that is identified during standard exercise stress testing; however, due to a lack of information with respect to the clinical ramifications of an HRE, little value is usually placed on such a finding. In this review, we discuss both the clinical importance and underlying physiological contributors of exercise hypertension. Indeed, an HRE is associated with an increased propensity for target organ damage and also predicts the future development of hypertension, cardiovascular events and mortality, independent of resting BP. Moreover, recent work has highlighted that some of the elevated cardiovascular risks associated with an HRE may be related to high-normal resting BP (pre-hypertension) or ambulatory 'masked' hypertension and that an HRE may be an early warning signal of abnormal BP control that is otherwise undetected with clinic BP. Whilst an HRE may be amenable to treatment via pharmacological and lifestyle interventions, the exact physiological mechanism of an HRE remains elusive, but it is likely a manifestation of multiple factors including large artery stiffness, increased peripheral resistance, neural circulatory control and metabolic irregularity. Future research focus may be directed towards determining threshold values to denote the increased risk associated with an HRE and further resolution of the underlying physiological factors involved in the pathogenesis of an HRE.

10 Review Metabolomics in hypertension. 2014

Nikolic, Sonja B / Sharman, James E / Adams, Murray J / Edwards, Lindsay M. ·aMenzies Research Institute Tasmania, University of Tasmania, Hobart bSchool of Human Life Sciences, University of Tasmania, Launceston, Australia cCentre of Human & Aerospace Physiological Sciences, King's College London, London, UK. ·J Hypertens · Pubmed #24675680.

ABSTRACT: Hypertension is the most prevalent chronic medical condition and a major risk factor for cardiovascular morbidity and mortality. In the majority of hypertensive cases, the underlying cause of hypertension cannot be easily identified because of the heterogeneous, polygenic and multi-factorial nature of hypertension. Metabolomics is a relatively new field of research that has been used to evaluate metabolic perturbations associated with disease, identify disease biomarkers and to both assess and predict drug safety and efficacy. Metabolomics has been increasingly used to characterize risk factors for cardiovascular disease, including hypertension, and it appears to have significant potential for uncovering mechanisms of this complex disease. This review details the analytical techniques, pre-analytical steps and study designs used in metabolomics studies, as well as the emerging role for metabolomics in gaining mechanistic insights into the development of hypertension. Suggestions as to the future direction for metabolomics research in the field of hypertension are also proposed.

11 Review Central blood pressure in the management of hypertension: soon reaching the goal? 2013

Sharman, J E / Laurent, S. ·Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia. James.Sharman@menzies.utas.edu.au ·J Hum Hypertens · Pubmed #23535990.

ABSTRACT: Blood pressure (BP) is conventionally measured by cuff at the brachial artery as an indication of pressure experienced by the organs. However, individual variation in pulse pressure amplification means that brachial cuff BP may be a poor representation of true central BP. Estimation of central BP is now possible using non-invasive methods that are amenable for widespread use. This paper reviews the evidence regarding the potential value of central BP in hypertension management. The major lines of evidence that support the use of central BP as a clinical tool include the: (1) major discrepancies in central BP among people with similar brachial BP; (2) independent relationship of central BP with end-organ damage; (3) independent relationship of central BP with cardiovascular (CV) events and mortality; (4) differential central and brachial BP responses to antihypertensive medications and; (5) improvements in end-organ damage after therapy more strongly relate to central than brachial BP. Despite all this, important evidence gaps relating to clinical use of central BP need fulfilling. These include the lack of central BP reference values and randomized, controlled studies to determine if: (1) central BP can help with diagnostic/therapeutic decisions and; (2) CV outcome is improved by targeting therapy towards lowering central BP levels. Additional challenges such as standardization of central BP methods, and understanding which patients are most likely to benefit from central BP monitoring also need to be determined. Overall, the future for central BP as a worthwhile clinical instrument appears positive, but there is much to be done.

12 Review Exercise-induced hypertension, cardiovascular events, and mortality in patients undergoing exercise stress testing: a systematic review and meta-analysis. 2013

Schultz, Martin G / Otahal, Petr / Cleland, Verity J / Blizzard, Leigh / Marwick, Thomas H / Sharman, James E. ·Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia. ·Am J Hypertens · Pubmed #23382486.

ABSTRACT: BACKGROUND: The prognostic relevance of a hypertensive response to exercise (HRE) is ill-defined in individuals undergoing exercise stress testing. The study described here was intended to provide a systematic review and meta-analysis of published literature to determine the value of exercise-related blood pressure (BP) (independent of office BP) for predicting cardiovascular (CV) events and mortality. METHODS: Online databases were searched for published longitudinal studies reporting exercise-related BP and CV events and mortality rates. RESULTS: We identified for review 12 longitudinal studies with a total of 46,314 individuals without significant coronary artery disease, with total CV event and mortality rates recorded over a mean follow-up of 15.2±4.0 years. After adjustment for age, office BP, and CV risk factors, an HRE at moderate exercise intensity carried a 36% greater rate of CV events and mortality (95% CI, 1.02-1.83, P = 0.039) than that of subjects without an HRE. Additionally, each 10mm Hg increase in systolic BP during exercise at moderate intensity was accompanied by a 4% increase in CV events and mortality, independent of office BP, age, or CV risk factors (95% CI, 1.01-1.07, P = 0.02). Systolic BP at maximal workload was not significantly associated with the outcome of an increased rate of CV, whether analyzed as a categorical (HR=1.49, 95% CI, 0.90-2.46, P = 0.12) or a continuous (HR=1.01, 95% CI, 0.98-1.04, P = 0.53) variable. CONCLUSIONS: An HRE at moderate exercise intensity during exercise stress testing is an independent risk factor for CV events and mortality. This highlights the need to determine underlying pathophysiological mechanisms of exercise-induced hypertension.

13 Review Arterial stiffness: measurement and significance in management of hypertension. 2010

Sharman, James E / Marwick, Thomas H. ·Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia. James.Sharman@utas.edu.au ·Indian Heart J · Pubmed #23189876.

ABSTRACT: Hypertension is accompanied by generalized adverse vascular functional and structural changes including increased large central artery stiffness. Aortic pulse wave velocity (PWV) is a measure of regional large artery stiffness regarded as the gold standard by expert consensus. Elevated aortic PWV imposes additional left ventricular (LV) workload through increased impedance to flow, and independently correlates with LV systolic and diastolic function, as well as cardiovascular mortality. Traditional antihypertensive drugs do not specifically target wall stiffness of the central arteries, but nonetheless may achieve a decline in aortic PWV by reducing mean arterial pressure and unloading the vessel wall. Beyond medication, regular aerobic exercise combined with sodium restricted diet (such as that advocated by the Dietary Approach to Stop Hypertension [DASH] diet) is probably the most effective way to counteract increased large central artery stiffness. This paper reviews the assessment and clinical implications of arterial stiffness in managing patients with hypertension.

14 Clinical Trial Comparison of Central Blood Pressure Estimated by a Cuff-Based Device With Radial Tonometry. 2016

Peng, Xiaoqing / Schultz, Martin G / Abhayaratna, Walter P / Stowasser, Michael / Sharman, James E. ·Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; · College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia; · Princess Alexandra Hospital, School of Medicine, The University of Queensland, Brisbane, Australia. · Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; james.sharman@utas.edu.au. ·Am J Hypertens · Pubmed #27317573.

ABSTRACT: BACKGROUND: New techniques that measure central blood pressure (BP) using an upper arm cuff-based approach require performance assessment. The aim of this study was to compare a cuff-based device (CuffCBP) to estimate central BP indices (systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), augmentation pressure (AP), augmentation index (AIx)) with noninvasive radial tonometry (TonCBP). METHODS: Consecutive CuffCBP (SphygmoCor Xcel) and TonCBP (SphygmoCor 8.1) duplicate recordings were measured in 182 people with treated hypertension (aged 61±7 years, 48% male). Agreement between methods was assessed using standard calibration with brachial SBP and DBP (measured with the Xcel device), as well as with brachial mean arterial pressure (MAP; 40% form factor method) and DBP. RESULTS: The mean difference ± SD for central SBP (cSBP), central DBP (cDBP), and central PP (cPP) between methods were -0.89±3.48mm Hg (intra-class correlation (ICC) 0.977; 95% confidence interval (CI) 0.973-0.982), -0.50±1.54mm Hg (ICC 0.992, 95% CI 0.987-0.993), and -0.42±3.57mm Hg (ICC 0.966, 95% CI 0.958-0.972), indicating good agreement. Wider limits of agreement were observed for central AP (cAP) and central AIx (cAIx) (-0.91±5.31mm Hg; ICC 0.802; 95% CI 0.756-0.839, -0.99±10.91%; ICC 0.749; 95% CI 0.691-0.796). Re-calibration with brachial MAP and DBP resulted in an overestimation of cSBP with CuffCBP compared with TonCBP (8.58±19.06mm Hg, ICC 0.164, 95% CI -0.029 to 0.321). CONCLUSION: cSBP, cDBP, and cPP derived from CuffCBP are substantially equivalent to TonCBP, although the level of agreement is dependent on calibration method. Further validity testing of CuffCBP by comparison with invasively measured central BP will be required.

15 Article Associations of reservoir-excess pressure parameters derived from central and peripheral arteries with kidney function. 2020

Armstrong, Matthew K / Schultz, Martin G / Picone, Dean S / Black, J Andrew / Dwyer, Nathan / Roberts-Thomson, Philip / Sharman, James E. ·Menzies Institute for Medical Research, University of Tasmania, Australia. · Department of Cardiology, Royal Hobart Hospital, Australia. ·Am J Hypertens · Pubmed #32006010.

ABSTRACT: BACKGROUND: Central artery reservoir-excess pressure parameters are clinically important but impractical to record directly. However, diastolic waveform morphology is consistent across central and peripheral arteries. Therefore, peripheral artery reservoir-excess pressure parameters related to diastolic waveform morphology may be representative of central parameters and share clinically important associations with end-organ damage. This has never been determined and was the aim of this study. METHODS: Intra-arterial blood pressure waveforms were measured sequentially at the aorta, brachial and radial arteries among 220 individuals (aged 61±10 years, 68% male). Customised software was used to derive reservoir-excess pressure parameters at each arterial site (reservoir and excess pressure, systolic and diastolic rate constants) and clinical relevance was determined by association with estimated glomerular filtration rate (eGFR). RESULTS: Between the aorta and brachial artery, the mean difference in the diastolic rate constant and reservoir pressure integral was -0.162S-1 (P=0.08) and -0.772 mmHg.s (P=0.23) respectively. The diastolic rate constant had the strongest and most consistent associations with eGFR across aortic and brachial sites (β=-0.20, P=0.02; β=-0.20, P=0.03 respectively; adjusted for traditional cardiovascular risk factors). Aortic, but not brachial peak reservoir pressure was associated with eGFR in adjusted models (aortic β=-0.48, P=0.02). CONCLUSIONS: The diastolic rate constant is the most consistent reservoir-excess pressure parameter, in both its absolute values and associations with kidney dysfunction, when derived from the aorta and brachial artery. Thus, the diastolic rate constant could be utilized in the clinical setting to improve BP risk stratification.

16 Article Determinants of Increased Central Excess Pressure in Dialysis: Role of Dialysis Modality and Arteriovenous Fistula. 2020

Paré, Mathilde / Goupil, Rémi / Fortier, Catherine / Mac-Way, Fabrice / Madore, François / Marquis, Karine / Hametner, Bernhard / Wassertheurer, Siegfried / Schultz, Martin G / Sharman, James E / Agharazii, Mohsen. ·CHU de Québec Research Center, L'Hôtel-Dieu de Québec Hospital, Québec, Quebec, Canada. · Division of Nephrology, Faculty of Medicine, Université Laval, Québec, Quebec, Canada. · Hôpital du Sacré-Cœur de Montréal, Montréal, Quebec, Canada. · Center for Health and Bioresources, AIT Austrian Institute of Technology, Vienna, Austria. · Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia. ·Am J Hypertens · Pubmed #31419806.

ABSTRACT: BACKGROUND: Arterial reservoir-wave analysis (RWA)-a new model of arterial hemodynamics-separates arterial wave into reservoir pressure (RP) and excess pressure (XSP). The XSP integral (XSPI) has been associated with increased risk of clinical outcomes. The objectives of the present study were to examine the determinants of XSPI in a mixed cohort of hemodialysis (HD) and peritoneal dialysis (PD) patients, to examine whether dialysis modality and the presence of an arteriovenous fistula (AVF) are associated with increased XSPI. METHOD: In a cross-sectional study, 290 subjects (232 HD and 130 with AVF) underwent carotid artery tonometry (calibrated with brachial diastolic and mean blood pressure). The XSPI was calculated through RWA using pressure-only algorithms. Logistic regression was used for determinants of XSPI above median. Through forward conditional linear regression, we examined whether treatment by HD or the presence of AVF is associated with higher XSPI. RESULTS: Patients with XSPI above median were older, had a higher prevalence of diabetes and cardiovascular disease, had a higher body mass index, and were more likely to be on HD. After adjustment for confounders, HD was associated with a higher risk of higher XSPI (odds ratio = 2.39, 95% confidence interval: 1.16-4.98). In a forward conditional linear regression analysis, HD was associated with higher XSPI (standardized coefficient: 0.126, P = 0.012), but on incorporation of AVF into the model, AVF was associated with higher XSPI (standardized coefficient: 0.130, P = 0.008) and HD was excluded as a predictor. CONCLUSION: This study suggests that higher XSPI in HD patients is related to the presence of AVF.

17 Article Masked hypertension and submaximal exercise blood pressure among adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC). 2020

Huang, Zhengzheng / Sharman, James E / Fonseca, Ricardo / Park, Chloe / Chaturvedi, Nish / Davey Smith, George / Howe, Laura D / Lawlor, Deborah A / Hughes, Alun D / Schultz, Martin G. ·Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia. · Department of Population Science & Experimental Medicine, Institute of Cardiovascular Science, University College London, London, UK. · MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK. · MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK. ·Scand J Med Sci Sports · Pubmed #31353626.

ABSTRACT: PURPOSE: Masked hypertension is associated with increased cardiovascular risk but is undetectable by clinic blood pressure (BP). Elevated systolic BP responses to submaximal exercise reveal the presence of masked hypertension in adults, but it is unknown whether this is the case during adolescence. We aimed to determine if exercise BP was raised in adolescents with masked hypertension, and its association with cardiovascular risk markers. METHODS: A total of 657 adolescents (aged 17.7 ± 0.3 years; 41.9% male) from the Avon longitudinal study of parents and children (ALSPAC) completed a step-exercise test with pre-, post-, and recovery-exercise BP, clinic BP and 24-hour ambulatory BP. Masked hypertension was defined as clinic BP <140/90 mm Hg and 24-hour ambulatory BP ≥130/80 mm Hg. Assessment of left-ventricular (LV) mass index and carotid-femoral pulse wave velocity (aortic PWV) was also undertaken. Thresholds of clinic, pre-, post-, and recovery-exercise systolic BP were explored from ROC analysis to identify masked hypertension. RESULTS: Fifty participants (7.8%) were classified with masked hypertension. Clinic, pre-, post-, and recovery-exercise systolic BP were associated with masked hypertension (AUC ≥ 0.69 for all, respectively), with the clinic systolic BP threshold of 115 mm Hg having high sensitivity and specificity and exercise BP thresholds of 126, 150, and 130 mm Hg, respectively, having high specificity and negative predictive value (individually or when combined) for ruling out the presence of masked hypertension. Additionally, this exercise systolic BP above the thresholds was associated with greater left-ventricular mass index and aortic PWV. CONCLUSIONS: Submaximal exercise systolic BP is associated with masked hypertension and adverse cardiovascular structure in adolescents. Exercise BP may be useful in addition to clinic BP for screening of high BP and cardiovascular risk in adolescents.

18 Article Association Between Occupational, Sport, and Leisure Related Physical Activity and Baroreflex Sensitivity: The Paris Prospective Study III. 2019

Climie, Rachel E / Boutouyrie, Pierre / Perier, Marie-Cecile / Chaussade, Edouard / Plichart, Mattieu / Offredo, Lucile / Guibout, Catherine / van Sloten, Thomas T / Thomas, Frederique / Pannier, Bruno / Sharman, James E / Laurent, Stephane / Jouven, Xavier / Empana, Jean-Philippe. ·From the University de Paris, INSERM, U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, France (R.E.C., M.-C.P., L.O., C.G., T.T.v.S., X.J., J.-P.E.). · Baker Heart and Diabetes Institute, Melbourne, Australia (R.E.C.). · Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia (R.E.C., J.E.S.). · INSERM U970, Department of Pharmacology, APHP, Paris Descartes University, France (P.B., S.L.). · APHP, University de Paris, France (E.C., M.P.). · Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, the Netherlands (T.T.v.S.). · Investigations Préventives et cliniques (IPC), Paris, France (F.T., B.P.). ·Hypertension · Pubmed #31679418.

ABSTRACT: Physical activity (PA) is a preventative behavior for noncommunicable disease. However, little consideration is given as to whether different domains of PA have differing associations with health outcomes. We sought to determine the association between occupational, sport, leisure, and total PA with baroreflex sensitivity (BRS), distinguishing between neural (nBRS) and mechanical (mBRS) BRS. In a cross-sectional analysis of 8649 adults aged 50 to 75 years, resting nBRS (estimated by low-frequency gain, from carotid distension rate and heart rate) and mBRS (carotid stiffness) were measured by high-precision carotid echo-tracking. PA was self-reported using the validated Baecke questionnaire. The associations between PA and nBRS and mBRS were quantified using multivariate linear regression analysis, separately in the working and nonworking population. In working adults (n=5039), occupational PA was associated with worse nBRS (unstandardized β=-0.02; [95% CI, -0.04 to -0.003];

19 Article Association of central blood pressure with left atrial structural and functional abnormalities in hypertensive patients: Implications for atrial fibrillation prevention. 2019

Przewłocka-Kosmala, Monika / Jasic-Szpak, Ewelina / Rojek, Aleksandra / Kabaj, Maciej / Sharman, James E / Kosmala, Wojciech. ·1 Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. · 2 Cardiology Department, Wroclaw Medical University, Poland. ·Eur J Prev Cardiol · Pubmed #30913902.

ABSTRACT: AIMS: Functional and structural abnormalities of the left atrium have been demonstrated to be clinically and prognostically significant in a range of cardiovascular disorders, increasing the risk of atrial fibrillation. Among the potential contributors to these aberrations, central arterial factors remain insufficiently defined. Accordingly, we sought to investigate the determinants of left atrium abnormalities in hypertension, with special focus on central haemodynamics. METHODS: In this retrospective, cross-sectional study, 263 patients (age 63.8 ± 8.0 years) with uncomplicated hypertension underwent echocardiography including left atrium strain (LAS) and volume analysis, and central haemodynamics assessment using radial tonometry. RESULTS: Patients were grouped depending on LAS and left atrium volume index (LAVI), using externally validated cutpoints (34.1% for LAS and 34 ml/m CONCLUSION: Higher cPP is detrimentally associated with left atrium structural and functional characteristics, thus providing a possible pathophysiological link with the development of substrate for atrial fibrillation. Prophylaxis of atrial fibrillation might be another argument for consideration in the treatment strategy in hypertension targeted measures addressing central blood pressure.

20 Article Brachial and Radial Systolic Blood Pressure Are Not the Same. 2019

Armstrong, Matthew K / Schultz, Martin G / Picone, Dean S / Black, J Andrew / Dwyer, Nathan / Roberts-Thomson, Philip / Sharman, James E. ·From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (M.K.A., M.G.S., D.S.P., J.E.S.). · Department of Cardiology, Royal Hobart Hospital, Hobart, Australia (J.A.B., N.D., P.R.-T.). ·Hypertension · Pubmed #30905194.

ABSTRACT: Radial intra-arterial blood pressure (BP) is sometimes used as the reference standard for validation of brachial cuff BP devices. Moreover, there is an emerging wearables market seeking to measure BP at the wrist. However, radial systolic BP may differ when compared with brachial; yet some authors have labeled these differences as a fictional Popeye phenomenon. Indeed, differences between brachial and radial systolic BP have never been accurately quantified, and this was the aim of this study. Intra-arterial BP was measured consecutively at the brachial and radial artery in 180 participants undergoing coronary angiography (aged 61±10 years; 69% men). On average, radial systolic BP was 5.5 mm Hg higher than brachial systolic BP. Only 43% of participants had radial systolic BP within ±5 mm Hg of brachial. Additionally, 46%, 19%, and 13% of participants had radial systolic BP >5, between 5 and 10, and between 10 and 15 mm Hg higher than brachial respectively. A further 14% of participants had radial systolic BP >15 mm Hg higher than brachial, representing the so-called Popeye phenomenon. Finally, 11% of participants had radial systolic BP >5 mm Hg lower than brachial. In conclusion, radial systolic BP is not representative of brachial systolic BP, with most participants having a radial systolic BP >5 mm Hg higher than brachial and many with differences >15 mm Hg. Therefore, validation testing of BP devices utilizing intra-arterial BP as the reference standard should use intra-arterial BP measured at the same site as the brachial cuff or wearable device.

21 Article Submaximal exercise blood pressure and cardiovascular structure in adolescence. 2019

Schultz, Martin G / Park, Chloe / Fraser, Abigail / Howe, Laura D / Jones, Siana / Rapala, Alicja / Davey Smith, George / Sharman, James E / Lawlor, Deborah A / Chaturvedi, Nish / Deanfield, John / Hughes, Alun D. ·Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. Electronic address: Martin.Schultz@utas.edu.au. · Institute of Cardiovascular Sciences, University College London, London, UK. · MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; School of Social and Community Medicine, University of Bristol, Bristol, UK; NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, UK. · MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; School of Social and Community Medicine, University of Bristol, Bristol, UK. · Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. ·Int J Cardiol · Pubmed #30509371.

ABSTRACT: PURPOSE: Dynamic exercise results in increased systolic blood pressure (BP). Irrespective of resting BP, some individuals may experience exaggerated rise in systolic BP with exercise, which in adulthood is associated with risk of hypertension, and cardiovascular (CV) disease. It is unknown if exercise BP is associated with markers of CV structure during adolescence. We examined this question in a large adolescent cohort taking account of the possible confounding effect of body composition and BP status. METHODS: 4036 adolescents (mean age 17.8 ± 0.4 years, 45% male), part of a UK population-based birth cohort study completed a sub-maximal step-test with BP immediately post-exercise. Sub-samples underwent comprehensive echocardiography for assessment of cardiac structure; arterial structure including aortic pulse wave velocity (PWV) and carotid intima-media thickness; and assessment of body composition by dual-energy X-ray absorptiometry (DXA). RESULTS: Each 5 mm Hg higher post-exercise systolic BP was associated with CV structure, including 0.38 g/m CONCLUSION: Submaximal exercise systolic BP is associated with markers of CV structure in adolescents. Given the clinical relevance of exercise BP in adulthood, such associations may have implications for CV disease screening in young people and risk in later life.

22 Article Body Silhouette Trajectories Across the Lifespan and Vascular Aging. 2018

van Sloten, Thomas T / Boutouyrie, Pierre / Lisan, Quentin / Tafflet, Muriel / Thomas, Frédérique / Guibout, Catherine / Climie, Rachel E / Pannier, Bruno / Sharman, James E / Laurent, Stéphane / Jouven, Xavier / Empana, Jean-Philippe. ·From the Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, France (T.T.v.S., P.B., Q.L., M.T., C.G., R.E.C., J.E.S., S.L., X.J., J.-P.E.). · Department of Epidemiology, INSERM UMR-S970, Paris Cardiovascular Research Center, France (T.T.v.S., Q.L., M.T., C.G., R.E.C., X.J., J.-P.E.). · Department of Arterial Mechanics, INSERM UMR-S970, Paris Cardiovascular Research Center, France (T.T.v.S., P.B., R.E.C., S.L.). · Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, The Netherlands (T.T.v.S.). · Preventive and Clinical Investigation Center, Paris, France (F.T., B.P.). · Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia (R.E.C., J.E.S.). · Physical Activity and Behavioural Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia (R.E.C.). · Department of Pharmacology, AP-HP, Georges Pompidou European Hospital, Paris, France (P.B., S.L.). ·Hypertension · Pubmed #30354814.

ABSTRACT: Vascular aging is a major contributor to cardiovascular disease and can be quantified by higher carotid stiffness, intima-media thickness and diameter, and hypertension. Weight gain across the lifetime may be an important, modifiable determinant of vascular aging. We therefore aimed to assess lifetime body silhouette trajectories (a marker of weight change across the lifespan) in relation to vascular aging in late adulthood. We used cross-sectional data from a community-based cohort study (n=8243; age, 59.4; 38.7% women). A linear mixed model was used to assess trajectories of recalled body silhouettes from age 8 to 45 years. We assessed carotid artery properties (ultrasonography), resting hypertension (blood pressure ≥140/90 mm Hg or use of antihypertensives), and exaggerated exercise blood pressure, a marker of masked hypertension (systolic blood pressure ≥150 mm Hg during submaximal exercise) at study recruitment when the participants were 50 to 75 years of age. We identified 5 distinct body silhouette trajectories: lean stable (32.0%), lean increase (11.1%), moderate stable (32.5%), lean-marked increase (16.3%), and heavy stable (8.1%). Compared with individuals in the lean-stable trajectory, those in the moderate-stable, lean-marked increase, and heavy-stable trajectories had higher carotid stiffness, intima-media thickness and diameter (odds ratios between 1.23 and 2.10 for highest quartile versus lowest quartile of manifestations of vascular aging; P<0.05) and were more likely to have resting hypertension and exaggerated exercise blood pressure, after adjustment for potential confounders (odds ratios between 1.31 and 1.60; P<0.05). Vascular aging was most prominent among individuals who were lean in early life but markedly gained weight during young adulthood and among those who were heavy in early life and maintained weight.

23 Article J-curves in hypertension: what do they tell us about treatment of high blood pressure? 2018

Auer, Johann / Sharman, James E / Weber, Thomas. ·Department of Cardiology and Intensive Care, St Josef Hospital, Braunau, Austria. · Menzies Institute for Medical Research, University of Tasmania, Australia. · Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria. ·Eur Heart J · Pubmed #29905774.

ABSTRACT: -- No abstract --

24 Article Discovery of New Blood Pressure Phenotypes and Relation to Accuracy of Cuff Devices Used in Daily Clinical Practice. 2018

Picone, Dean S / Schultz, Martin G / Peng, Xiaoqing / Black, J Andrew / Dwyer, Nathan / Roberts-Thomson, Philip / Chen, Chen-Huan / Cheng, Hao-Min / Pucci, Giacomo / Wang, Ji-Guang / Sharman, James E. ·From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., X.P., J.A.B., N.D., P.R.-T., J.E.S.). · Royal Hobart Hospital, Australia (J.A.B., N.D., P.R.-T.). · Department of Medicine, National Yang-Ming University, Taipei, Taiwan (C.-H.C., H.-M.C.). · Department of Medical Education, Taipei Veterans General Hospital, Taiwan (C.-H.C., H.-M.C.). · Unit of Internal Medicine, Terni University Hospital, Department of Medicine, University of Perugia, Italy (G.P.). · and Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, China (J.G.W.). · and Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, China (J.G.W.). · From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (D.S.P., M.G.S., X.P., J.A.B., N.D., P.R.-T., J.E.S.) james.sharman@utas.edu.au. ·Hypertension · Pubmed #29632105.

ABSTRACT: Cuff blood pressure (BP) is the reference standard for management of high BP, but the method is inaccurate and can lead to BP misclassification. The aims of this study were to determine whether distinctive BP phenotypes exist based on BP transmission (amplification) variability from central-to-peripheral arteries and whether applying one standard cuff BP measurement approach (eg, oscillometry) to all people could discriminate the BP phenotypes. Intra-arterial BP was measured at the ascending aorta and brachial and radial arteries in 126 participants (61±10 years; 69% male) after coronary angiography. Central-to-peripheral systolic BP (SBP) transmission (SBP amplification) was defined by ≥5 mm Hg SBP increase between the aorta-to-brachial or brachial-to-radial arteries. Standard cuff BP was measured 4 different times using 3 different devices. Three independent investigators also provided data (n=255 from 4 studies) using another 3 separate cuff BP devices. Four distinct BP phenotypes were discovered based on variability in SBP amplification: phenotype 1, both aortic-to-brachial and brachial-to-radial SBP amplification; phenotype 2, only aortic-to-brachial SBP amplification; phenotype 3, only brachial-to-radial SBP amplification; and phenotype 4, neither aortic-to-brachial nor brachial-to-radial SBP amplification. Aortic SBP was significantly higher among phenotypes 3 and 4 compared with phenotypes 1 and 2 (

25 Article Impaired baroreflex sensitivity, carotid stiffness, and exaggerated exercise blood pressure: a community-based analysis from the Paris Prospective Study III. 2018

Sharman, James E / Boutouyrie, Pierre / Perier, Marie-Cécile / Thomas, Frédérique / Guibout, Catherine / Khettab, Hakim / Pannier, Bruno / Laurent, Stéphane / Jouven, Xavier / Empana, Jean-Philippe. ·Department of Epidemiology, INSERM, U970, Paris Cardiovascular Research Center, 56 rue Leblanc, 75015 Paris, France. · Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, 7000 Australia. · Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, 12 rue de l'école de médecine, 75006 Paris, France. · Pharmacology Departments, APHP, Georges Pompidou European Hospital, 20 rue Leblanc, 75015 Paris, France. · Preventive and Clinical Investigation Center, 6 rue Laperouse, 75016 Paris, France. · Georges Pompidou European Hospital Cardiology Departments, APHP, 20 rue Leblanc, 75015 Paris, France. ·Eur Heart J · Pubmed #29281076.

ABSTRACT: Aims: People with exaggerated exercise blood pressure (BP) have adverse cardiovascular outcomes. Mechanisms are unknown but could be explained through impaired neural baroreflex sensitivity (BRS) and/or large artery stiffness. This study aimed to determine the associations of carotid BRS and carotid stiffness with exaggerated exercise BP. Methods and results: Blood pressure was recorded at rest and following an exercise step-test among 8976 adults aged 50 to 75 years from the Paris Prospective Study III. Resting carotid BRS (low frequency gain, from carotid distension rate, and heart rate) and stiffness were measured by high-precision echotracking. A systolic BP threshold of ≥ 150 mmHg defined exaggerated exercise BP and ≥140/90 mmHg defined resting hypertension (±antihypertensive treatment). Participants with exaggerated exercise BP had significantly lower BRS [median (Q1; Q3) 0.10 (0.06; 0.16) vs. 0.12 (0.08; 0.19) (ms2/mm) 2×108; P < 0.001] but higher stiffness [mean ± standard deviation (SD); 7.34 ± 1.37 vs. 6.76 ± 1.25 m/s; P < 0.001) compared to those with non-exaggerated exercise BP. However, only lower BRS (per 1SD decrement) was associated with exaggerated exercise BP among people without hypertension at rest {specifically among those with optimal BP; odds ratio (OR) 1.16 [95% confidence intervals (95% CI) 1.01; 1.33], P = 0.04 and high-normal BP; OR, 1.19 (95% CI 1.07; 1.32), P = 0.001} after adjustment for age, sex, body mass index, smoking, alcohol, total cholesterol, high-density lipoprotein cholesterol, resting heart rate, and antihypertensive medications. Conclusion: Impaired BRS, but not carotid stiffness, is independently associated with exaggerated exercise BP even among those with well controlled resting BP. This indicates a potential pathway from depressed neural baroreflex function to abnormal exercise BP and clinical outcomes.

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