Current Hypertension Reviews - Online First

The arterial stiffness index (ASI) is a widely recognized metric used to assess arterial endothelial function and predict cardiovascular issues. This study has validated ASI as a non-invasive clinical assessment tool for atherosclerotic coronary artery disease (CAD).

We conducted a retrospective, observational study involving 396 patients undergoing coronary angiography. ASI was measured using the CardioVision MS-2000 system, and the SYNTAX scores (SXscore) were computed to evaluate CAD severity. Patients were divided into two groups according to the SXscore: low SXscore (<22) and intermediate-high SXscore (≥ 22).

In total, 257 (64.9%) patients had CAD, of whom 166 (64.6%) had low (<22), 75(29.2%) had intermediate (23−32), and 16 (6.2%) had high (≥ 33) SXscore. ASI was significantly higher in CAD patients (120.82 ± 76.26 mmHg×10) compared to non-CAD patients (56.60 ± 35.89 mmHg×10; p < 0.01). In the multivariate regression model, a significant association was observed between ASI and CAD, with an odds ratio (OR) of 1.031 [95% confidence interval (CI): 1.022−1.040; p < 0.0001]. Additionally, ASI demonstrated an independent association with both intermediate and high SXscore (adjusted OR: 1.027; 95% CI: 1.020−1.034; p < 0.0001). The levels of ASI differed significantly in groups of patients with control, low SXScore, and intermediate-high SXScore as follows: 56.60±35.89 mmHg×10, 92.67±51.79 mmHg×10, and 172.2±86.6 mmHg×10, respectively (p < 0.01). ASI exhibited 59% sensitivity and 90% specificity for recognizing CAD.

ASI serves as a non-invasive biomarker that independently predicts the risk of CAD and shows a positive correlation with coronary plaque burden and the severity of atherosclerosis. By assessing arterial elasticity and vascular endothelial function, this metric offers significant clinical value for the early detection of vascular dysfunction and subclinical atherosclerosis.

Our findings suggested ASI to accurately evaluate arterial elastic function and provide information on CAD severity.

Orthostatic hypotension (OH) is a prevalent disorder among the elderly, characterized by a marked decrease in blood pressure upon standing. It impacts 10–30% of elderly individuals and is linked to falls, cognitive deterioration, and cardiovascular issues. The primary factors include aging, autonomic dysfunction, and pharmaceutical usage.

This narrative review consolidates and examines contemporary research regarding the etiology, pharmacological effects, diagnosis, and treatment of orthostatic hypotension in elderly adults. A systematic technique was not employed; rather, expert analysis of the existing literature was utilized to distill essential ideas.

OH in the elderly is frequently complex. Frequently involved drugs encompass diuretics, β-blockers, calcium channel blockers, ACE inhibitors, antidepressants, and antiparkinsonian therapies. These medications, within the framework of age-associated physiological alterations, elevate the risk of orthostatic hypotension. The diagnosis relies on monitoring blood pressure during changes in posture. Non-pharmacological interventions, including water, sodium consumption, compression garments, and physical movements, constitute first-line therapies. In chronic instances, pharmacological treatments such as midodrine, droxidopa, and fludrocortisone may be employed, albeit with vigilant monitoring due to potential deleterious effects.

OH significantly affects the autonomy and quality of life of elderly individuals. Medication-induced orthostatic hypotension is frequently disregarded, particularly in the context of polypharmacy. Customized management, encompassing drug evaluation and integrated therapy approaches, is crucial. Clinical monitoring and regular orthostatic evaluations are essential for prompt diagnosis and management.

Effective OH management requires a personalized, multidisciplinary approach. Future research should focus on identifying reliable diagnostic biomarkers and developing individualized treatment algorithms to improve patient outcomes and support healthy aging.

True isolated systolic hypertension (ISH) in youth must be evaluated by central blood pressure to avoid false or spurious hypertension. The purpose of this study was to perform a reliable assessment to confirm true hypertension and assess target organ damage.

Fifty-eight early diagnosed, untreated systolic hypertensive patients with office BP and 24-h ABPM (25±4, 32 male) underwent central blood pressure evaluation with a non-invasive, validated Mobil-O-Graph device. In all of them, left ventricular mass (LVMi echocardiogram), pulse wave velocity (PWV), cardiac index, peripheral vascular resistance, and urinary albumin excretion were recorded at the beginning of the study.

All spurious systolic hypertensives had normal LVMi, cardiac output, peripheral vascular resistance, and urinary albumin excretion (UE), whereas true hypertensives showed a hyperkinetic behavior (high cardiac output) and early target organ damage (increased LVMi and higher urinary albumin excretion) at the time of observation.

In this study, young patients with elevated cBP had left ventricular mass index and urinary albumin excretion higher than those with normal cBP. This observation suggests that this group of subjects are true hypertensives, contrary to the claim of being spurious hypertensives. Spurious hypertension should not be underestimated because it could be a temporary condition, since other authors have found that ISH and normal cSBP in adolescents may progress to sustained hypertension and hypertensive organ damage, thus requiring close monitoring.

In this study, central blood pressure was able to define true or spurious hypertension and confirm target organ damage in this youth cohort. A multicentric study will be of interest to confirm these preliminary findings.