1. Investigación

Background and Objective: Arterial Stiffness (AS) measured as pulse wave velocity has emerged in recent years as a hypertension mediated organ damage with independent prognostic value for Cardiovascular (CV) diseases that has also been discussed as a potential cause of Hypertension (HTN). The aim of this study is to (1) evaluate how measurement of AS modifies CV risk calculation by SCORE, (2) to measure the predictive value of AS for incident hypertension in normotensive patients, and (3) to analyze the association between control of HTN and presence of AS in sustained HTN. Patients and Methods: A longitudinal, prospective, observational trial under conditions of daily pharmaceutical and clinical practice will be conducted in approximately 60 community pharmacies of the Iberian Peninsula in normotensive and/or hypertensive patients entering a pharmacy spontaneously. In the first cross-sectional step, AS will be estimated with a semiautomatic, validated device (Mobil-O-Graph®, IEM), followed by a 10-item questionnaire. The patients will be referred to Primary Care for stratifying risk by SCORE tables and standard evaluation. In the second longitudinal step, patients will be asked to repeat the visit after 12 months. Discussion: This study aims to improve CV risk stratification and to investigate the potential of AS in predicting incident HTN in normotensive subjects. Besides, it will analyze the role of arterial stiffness as an associated factor to prevent control in sustained HTN in a setting of cooperation between community pharmacies and physicians in daily clinical practice.

An automated method for measuring arterial path length with devices that determine pulse wave velocity (PWV) in peripheral arteries is frequently applied. We aimed to compare arterial path length measurements based on mathematical height-based formulas with those measured manually and to assess whether the ankle-brachial difference (abD-PWV) measured with the VOPITB device is comparable to that obtained by manual measurements. In 245 patients, a metric measuring tape was used to determine the arterial path length from the suprasternal notch to the midpoint of the VOPITB cuffs wrapped around the extremities, and the results were compared with those obtained with height-based formulas. We examined the relationship between the abD-PWV measured with both methods. The arterial path length measured manually was shorter than that calculated automatically by 5 ± 2 and 30 ± 4 cm—of 13% and 21% for the arms and legs, respectively (difference of 13% and 21%). As a result, the abD-PWV calculated with the automatic method was greater (automatic abDPWV vs. manual: 462 ± 90 vs. 346 ± 79 cm/s). The Blant Altman plot showed a percentage error of: 15,2%, 7,5% and 17,3% for heart-brachial, heart-ankle length and abD-PWV respectively. In conclusion there were significant differences between manual and automated arterial length measurements and it translates into difference abD-PWV calculate from both methods. However, the Bland-Alman plot showed that abD-PWV was comparable for both techniques. The advantages of height-based formulas for the calculation of arterial path lengths suggest that they may be the recommended method for measuring the abDPWV.

Carotid-femoral pulse wave velocity ((cf)PWV) is a measure of arterial stiffness, predicting cardiovascular disease. We hypothesized that the amount of physical activity (PA) is correlated with reduced arterial stiffness in Type 2 diabetic (T2D) subjects. 570 subjects from the 1945 Oulu birth cohort were included in the analysis. (cf)PWV was determined by a non-invasive applanation tonometry. Oral glucose tolerance test was performed and LDL and HDL cholesterol analyzed. PA was registered daily with a wrist-worn acceleration meter for two weeks. (cf)PWV values in subjects with impaired glucose metabolism (IGM) and T2D were higher than in normal glycemic subjects (P < 0.001). PA, fasting and 2 h glucose and HbA1c correlated significantly with (cf)PWV, but HDL or LDL cholesterol did not. The 2 h glucose, heart rate and alcohol consumption in T2D subjects had independent effects on (cf)PWV in multiple regression analysis. T2D and IGM were significantly associated to (cf)PWV. Interestingly, lipids did not have an additional effect on (cf)PWV. Subjects walking more than 10 000 steps/day had 0.2 m/s lower (cf)PWV than those walking less than 6000 steps/day. Presence of T2D, elevated heart rate and alcohol consumption in males were associated with increased aortic stiffening in elderly subjects.