Pulse wave velocity reference values in 3,160 adults referred to a hypertension clinic for 24-hour ambulatory blood pressure monitoring

Background: Carotid-femoral pulse wave velocity (PWV) is a direct measure of aortic stiffness used in the stratification of cardiovascular risk. Its clinical application in Latin America has been limited by the absence of reference values. The objective of this study was to establish PWV reference values among adults referred to a specialized cardiology center for 24-hour ambulatory blood pressure monitoring (ABPM) in Medellín, Colombia. Methods: A descriptive study of 3,160 records of adult (older than 18 years) patients without pharmacological treatment assessed for PWV using a Mobil-O-Graph® 24-hour PWA device (IEM, Stolberg, Germany) and 24-hour ABPM with hemodynamic parameters based on suspected hypertension or hypotension was conducted. Patient records were categorized by decade of age and sub-divided based on the following 24-hour ABPM categories: normal ( 150/90 mmHg). Results: PWV increased with age (r = 0,894; p < 0,001) and blood pressure category (ρ = 0,081; p < 0,001); the age-related increase was more pronounced among the patients in the higher blood pressure categories. Measures of central tendency and dispersion regarding PWV are presented, and reference values are proposed from the 90th percentile based on the age and 24-hour ABPM categories. Conclusions: PWV is directly related to age and blood pressure and can be predicted using a simple equation that includes these two variables. To stratify the cardiovascular risk of patients and make clinical decisions, the 90th percentile based on the age and 24-hour ABPM categories is recommended as a cut-off

Hypertensive Response Associated with a Submaximal step Exercise Test as a Diagnostic Method for hypertension

RESUMEN: Introducción y objetivos: la respuesta hipertensiva al ejercicio (RHE) se asocia con alteraciones en los mecanismos que controlan la presión arterial (PA); aunque se sabe de su valor pronóstico, la evidencia de su validez diagnóstica es limitada. El objetivo de este estudio fue evaluar las características operativas de la RHE para detectar la presencia de hipertensión arterial (HTA). Métodos: estudio transversal de validez de una prueba diagnóstica que incluyó personas de ambos sexos, con edades entre 40-60 años, con sospecha de alteraciones de la PA. Se definió una RHE por cifras de PA sistólica mayores de 150 mmHg luego de la prueba del escalón de Dundee. La presencia de HTA se definió con monitoreo ambulatorio de la presión arterial de 24-horas, actual patrón de referencia. Resultados: se incluyeron 124 pacientes con edad promedio de 50,5 ± 5,9 años; 54,0% fueron mujeres. La frecuencia de RHE fue 57,3% mientras que de HTA fue 78,2%. La RHE tuvo una sensibilidad del 59,8% (IC 95% 49,5 a 70,1), especificidad del 51,9% (IC 95% 31,2 a 72,6), valor predictivo positivo del 81,7% (IC 95% 72,0 a 91,4), valor predictivo negativo del 26,4% (IC 95% 13,6 a 39,2), LR+ de 1,2 (IC 95% 0,8 a 1,9) y LR- de 0,8 (IC 95% 0,5 a 1,2), para detectar la presencia de HTA. Conclusiones: la RHE durante un esfuerzo sub-máximo en escalón, no presenta buenas características operativas para detectar HTA en pacientes de edad media con sospecha de alteraciones de la PA; por tal razón, no se recomienda como método de diagnósticoABSTRACT: Introduction and objectives: hypertensive response to exercise (HRE) is associated with changes in mechanisms that control blood pressure (BP); although its prognostic value is well known, the evidence of its diagnostic validity is limited. The objective of this study was to evaluate the operational characteristics of HRE to detect the presence of hypertension. Methods: A cross-sectional study to assess the validity of a diagnostic test, which included middle-aged (40-60) subjects of both sexes, with suspected BP alterations. HRE was defined as systolic BP levels greater than 150 mmHg after the Dundee step test. The presence of hypertension was defined with 24-hour ambulatory blood pressure monitoring , current gold standard. Results: we include 124 patients with an average age of 50.5 ± 5.9 years; 54.0% were women. The frequency of HRE was 57.3% while that of hypertension was 78.2%. HRE had a sensitivity of 59.8% (95% CI 49.5 to 70.1); specificity of 51.9% (95% CI 31.2 to 72.6); positive predictive value of 81.7% (95% CI 72.0 to 91.4); negative predictive value of 26.4% (95% CI 13.6 to 39.2): LR + of 1.2 (95% CI 0.8 to 1.9) and LR- of 0.8 (95% CI 0.5 to 1.2) to detect the presence of hypertension. Conclusions: HRE during a submaximal step test, does not have appropriate operating characteristics to detect hypertension in middle-aged patients with suspected BP alterations; therefore, it is not recommended as a diagnostic metho

Effect of dancing and nutrition education on hemodynamic and autonomic status in adults with metabolic syndrome: a randomized controlled clinical trial

Background: Although the benefits of exercise and changes in lifestyle on components of the metabolic syndrome (MS) have been described, little is known about the effect of dancing and nutritional changes on the cardiovascular system. Objective: Evaluate the effect of an intervention based on dancing and nutrition education on hemodynamic and autonomic status in adults with MS. Methods: A randomized controlled clinical trial was conducted involving 59 adults with MS. The intervention lasted 12 weeks and consisted of an aerobic exercise program (dancing) at an intensity of 60-75% of heart rate reserve, 60 minutes 3 times a week, and muscle strength training at an intensity of 50% of a maximum repetition, 30 minutes twice a week. The nutrition education program consisted of 2-hour workshops each week. Assessment of impedance cardiography and function of nervous system with analysis of heart rate variability (HRV) were made before and after the intervention. Results: In the intervention group, a decrease in mean arterial pressure of -7.8 mmHg (95% CI, -12.84 to -2.75; P = 0.004) was found as well as in the systemic vascular resistance (SVR) index of -864.29 dyn·s·m2/cm5 (95% CI, -1506.31 to -222.26; P = 0.010). Increase was observed in the cardiac output index of 0.48 L/min/m2 (95% CI, 0.14 to 0.83; P = 0.007). In the spectral analysis of HRV a reduction in LF/HF ratio of -0.52 (95% CI, -1.02 to -0.02; P = 0.040) was also found. Conclusions: An intervention with dancing and nutrition education lowers arterial blood pressure and SVR and has favorable effects on the sympathovagal balance in patients with MS