(Hypertension. 1995;26:485-490.)
© 1995 American Heart Association, Inc.
Articles |
Assessment of Arterial Distensibility by Automatic Pulse Wave Velocity Measurement
Validation and Clinical Application Studies
From Hôpital Broussais, Med I, INSERM U337 (A.B., B.P., A.-M.B.); INSERM U141 (R.T., B.I.L.); and Institut de Recherche et Formation Cardiovasculaire (R.A., J.T., P.L.), Paris, France.
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Abstract |
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Abstract Pulse wave velocity is widely used as an index of arterial distensibility. The aim of this study was to evaluate the accuracy of a new automatic device to measure it and then to analyze the major determinants of pulse wave velocity by application of this device in a large population. We evaluated the accuracy of on-line and computerized measurement of pulse wave velocity using an algorithm based on the time-shifted and repeated linear correlation calculation between the initial rise in pressure waveforms compared with the reference method (manual calculation) in 56 subjects. The results, analyzed according to the recommendations of Bland and Altman, showed a mean difference of -0.20±0.45 m/s for the mean carotid-femoral pulse wave velocity values (reference method, 11.05±2.58 m/s; automatic device, 10.85±2.44 m/s). The inter-reproducibility and intrareproducibility of measurements by each method were analyzed with the use of the repeatability coefficient according to the British Standards Institution. The interobserver repeatability coefficient was 0.947 for the manual method and 0.890 for the automatic, and intraobserver repeatability coefficients were 0.938 and 0.935, respectively. We evaluated the major determinants of the carotid-femoral pulse wave velocity measured by the automatic method in a separate study performed in 418 subjects of both sexes without any cardiovascular treatment or complication (18 to 77 years of age; 98 to 222 mm Hg systolic and 62 to 130 mm Hg diastolic pressure). Multiple regression analysis between pulse wave velocity and clinical parameters (age, sex, weight, height, smoking, arterial blood pressure, heart rate) and biological plasma parameters (total cholesterol, high-density lipoprotein cholesterol, glycemia) showed that pulse wave velocity correlated positively and independently with age and systolic pressure (r2=.47; P<.001) according to the equation Pulse Wave Velocity=0.07 Systolic Pressure (mm Hg)+0.09 Age (y)-4.3 (m/s). Similar results were obtained in the normotensive and hypertensive subgroups when analyzed separately. Pulse wave velocity can be easily and automatically determined. Its measurement is accurate and highly reproducible, and its major determinants are well established. It is of great interest to evaluate in large populations the therapeutic and epidemiological applications of an arterial parameter as evaluated by aortic pulse wave velocity.
Key Words: arteries • pulse • algorithms
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Introduction |
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The mechanical properties of the large arteries are important determinants of circulatory physiology in health and disease.1 2 Elastic large arteries absorb energy during the systolic component of pulsatile flow and thereby reduce the cardiac work for a given cardiac output.3 The study of large artery dynamics is inherently difficult because of the pulsatile nature of blood flow, the complex structure of the vessel wall, and the continually changing tone of the smooth muscle component. The measurement of pulse wave velocity (PWV), which is inversely related to arterial wall distensibility, offers a simple and potentially useful approach.4 5 This concept has been formalized in a mathematical model, and the measurement of PWV as an arterial distensibility index is widely used. This PWV is calculated from measurements of pulse transit time and the distance traveled by the pulse between two recording sites. In contrast to pulse wave recording, which is simple and rapidly obtained, the manual determination of the pulse wave upstroke point reflection and the measurement of the time delay between the two waves are tedious and time consuming, thus considerably limiting the use of these procedures for a large clinical application. The aim of this study was to evaluate the accuracy of a new automatic device for measurement of PWV and then to analyze the major determinants of PWV by the application of this device to a large population.
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Methods |
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Study Design
Study I: Validation and Reproducibility of Automatic PWV Measurements
The accuracy and reproducibility of the automatic measurement of PWV were evaluated by comparison with the manual calculation (gold standard) shown on a simultaneous recording of the same waveforms on a paper recorder at high speed (150 mm/s). PWV measurements with the use of the automatic device and manual method were performed simultaneously. In each subject two sequences of measurements were performed, and their mean was considered for analysis. All procedures were repeated by two observers (observer A and observer B) for analysis of the interobserver and intraobserver reproducibilities for the two methods.
Study II: Clinical Application
After the validation study and to analyze the clinical
and biological parameters that can modify PWV, we measured
PWV using the automatic method in a large population (cross-sectional
study) in which we evaluated clinical parameters (age, sex,
weight, height, smoking, blood pressure, and heart rate) and some
plasma biological cardiovascular risk factors (total
cholesterol, high-density lipoprotein
cholesterol, and glycemia). For these investigations
a blood sample of approximately 5 mL was taken with the use of a dry
tube after subjects had fasted overnight. Determination of plasma
glucose and lipid parameters was performed with standard
techniques; serum lipids were measured by a CX7
autoanalyzer (Beckman-Gagny) with enzymatic methods;
high-density lipoprotein cholesterol was measured after
precipitation of low- and very-low-density lipoproteins by the
phosphotungstic acid MgCl2 reagent.
Subjects
Study I
Fifty-six normotensive and untreated hypertensive subjects
participated in this study (27 women and 29 men; age, 55±13 years
[±1 SD]; weight, 76±15 kg; height, 168±9 cm). In each subject
carotid-femoral PWV was measured simultaneously with the
automatic and manual methods. Two successive sequences of measurements
were performed by the same observer in each subject in the supine
position after at least 15 minutes of rest; their mean was considered
for statistical analysis. All procedures were repeated by two
different observers for analysis of interobserver and
intraobserver reproducibilities.
Study II
Four hundred and eighteen subjects of both sexes without any
cardiovascular treatment or complication participated
in this study (age, 46±12 years [±1 SD]; range, 18 to 77 years).
Their arterial blood pressure values measured by a mercury
sphygmomanometer ranged from 98 to 222 mm Hg systolic and from 62 to
130 mm Hg diastolic. A carotid-femoral PWV measurement was
performed in all subjects; the mean value of 10 consecutive
measurements in each subject was considered for analysis.
PWV Measurement
Principles
The pressure pulse generated by ventricular ejection
is propagated throughout the arterial tree at a speed
determined by the elastic and geometric properties of the
arterial wall and the blood density. Since fluid is
contained in a system of elastic conduits, energy propagation occurs
predominantly along the arterial wall and not through the
incompressible blood.5 The material properties of the
arterial wall, its thickness, and the lumen diameter thus
become the major determinants of PWV. This concept has been
formalized in a mathematical model6 in which PWV is
given by the Moens-Korteweg equation, PWV=
Eh/2
R, or
by the Bramwell-Hill equation, PWV=
P · V/V · , where E is Young's modulus
of the arterial wall; h is wall thickness; R is
arterial radius; is blood density; and V and P
are changes in volume and pressure, respectively.
PWV is calculated from measurements of pulse transit time and the distance traveled by the pulse between two recording sites: PWV=Distance (meters)/Transit Time (seconds). Different signals can be used for measurement of PWV (Doppler, pressure, diameter); the most commonly used is the pressure signal recorded by a pressure-sensitive transducer.5 7 In this study we used the TY-306 pressure transducer (Fukuda Co); this transducer has a large frequency bandwidth from less than 0.1 Hz to more than 100 Hz, which largely covers the principal frequency harmonics of the pressure wave at different heart rates and thus allows its application for PWV measurement.
Manual Calculation of PWV
For the manual determination of PWV two different pressure waves
obtained at two sites (at the base of the neck for the common carotid
artery and over the right femoral artery) were recorded
simultaneously on a paper recorder at high speed (150
mm/s).
Transit time was determined from the time delay between the two corresponding foot waves: the proximal (A) and the distal (B) pulse waveforms. The foot of the wave is identified as the beginning of the initial upstroke. When this point could not be identified precisely, a tangent was drawn to the last part of the preceding wave and to the upstroke of the next wave, and the foot wave was taken as the intersection point of these two lines. The distance traveled by the pulse wave was obtained from superficial measurements of the distance between the two transducers (A and B). PWV was calculated on the mean basis of 10 consecutive pressure waveforms to cover a complete respiratory cycle.
Automatic Measurement of PWV
For automatic measurement of PWV, pressure waveforms are
digitized at different rates according to the distance between the
recording sites; the sampling acquisition frequency is 500 Hz
for carotid-femoral PWV and 800 Hz for carotid-radial PWV and all
others. The two pressure waveforms are stored in a recirculating memory
buffer, half of which is displayed at any given time. Preprocessing
analyses automatically adjust the gain of each waveform for an
equality of the two signals. A maximum of 588 data points per waveform
are displayed at any given time; ie, the display will cover a time
period from 0.735 to 1.47 seconds. This is sufficient to always capture
at least one complete cardiac pressure upstroke.
When the operator observes a pulse waveform of sufficient quality on the computer screen, digitization is suspended and calculation of the time delay between the two pressure upstrokes is initiated (Fig 1). The first operation performed is the removal of spikes that may be present in the pulse waveform because these will interfere with later processing. This is done by using a moving average digital filtering algorithm. The leading pulse waveform is then digitally differentiated, and the time at which the peak value occurs is determined. This will occur (in a normal cardiac pulse cycle) near the center of the upstroke. An interval corresponding to 90 data points is then subtracted from this time, and a second digital differentiation is performed on the distal pressure waveform, starting from that point and moving through a total of 180 data points. Two vertical lines are drawn on the computer display to indicate the positions of the maximal rate of change of the pressure waveforms.
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The delay between the two pulse waves is determined by performing a correlation between the data of the two waveforms. Hence, waveform data are transferred into the correlation array from a point 100 milliseconds before the first line position and up to 50 milliseconds after the second line. This ensures that the correlation is performed on the initial rise of the pulse until just after the true pulse peak. The correlation algorithm is then performed, the distal pressure upstroke is time-shifted by subtracting one sample period, and the correlation coefficient is again calculated. The procedure is repeated until the amount of data point shift for best fit is calculated. The correlated waveforms are then displayed in their shifted positions, and the calculated pulse delay is printed.
Statistical Analysis
Statistical analysis was performed with
STATVIEW SE 1.03 software (Abacus Concepts Inc) on a
Macintosh computer. Values are given as mean±SD. The relationship
between variables was evaluated by linear regression. The
t test was used for comparison of differences between
measurements. Two-sided P values were used.
When two series of paired measurements were compared, the results were analyzed in two steps according to the recommendations of Bland and Altman.8 First, the correlation between measurement values (equation of the linear relationship, correlation coefficient r, and P value) was investigated. This first step was used to gauge the degree of agreement between the two series of measurements. Second, the relative (positive or negative) differences within each pair of measures (Di) were plotted against the mean of the pair to make sure that no obvious relation appeared between the estimated value (mean) and Di. The lack of agreement between the two measurements was estimated by the mean difference Di and the SD of the differences.
The repeatability of the measurements by each method was investigated
through a calculation of the repeatability coefficient (RC) as defined
by the British Standards Institution,9 ie, according to
the formula RC2=
Di2/N, where N is
the sample size and Di the difference between two measurements in a
pair. This coefficient is the SD of the estimated difference between
two repeated measurements performed by the same observer for
intraobserver reproducibility and by two observers for interobserver
reproducibility. The 95% confidence interval of the expected
difference was calculated as ±1.96 RC. Repeated measurements are
expected to differ by more than the confidence interval with a
probability of only 5%.
A simple regression test was performed for analysis of the linear correlations between two parameters, and a multiple regression test was used for analysis of the multiple, simple, and partial correlations between more than two parameters. The significance level was set at a value of .05.
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Results |
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Validation of the PWV Automatic Measurement
The comparison between the mean values of PWV measured by the manual method (gold standard) and the automatic device (COMPLIOR Colson) showed a mean difference of 0.20±0.45 m/s (range, -0.65 to +1.26 m/s), with slightly lower values obtained by the automatic device (manual, 11.05±2.58; automatic, 10.85±2.44; P<.05).
Fig 2, top, shows the linear correlation between the mean values of PWV obtained by the two methods (r=.99, P<.001; Automatic=0.93 Manual+0.56 m/s). Fig 2, bottom, shows the plot of the individual difference observed between the PWV values calculated by the two methods according to the average of PWV calculated as (Automatic+Manual)/2.
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Repeatability of PWV Measurements
The repeatability of PWV measurements performed by each method
(manual and automatic) was evaluated through calculation of the SD of
the repeated measurements and calculation of the RC (see
"Statistical Analysis").
For intraobserver repeatability the mean values of PWV measurements performed at times 1 and 2 were, for the manual method, 11.13±2.77 and 11.03±2.54 m/s, respectively, and for the automatic method, 10.96±2.69 and 10.77±2.39 m/s. The RC values were 0.938 and 0.935 for manual and automatic, respectively. No significant difference was observed for intraobserver repeatability between the two methods.
For interobserver repeatability the mean values of two sequences of PWV measurements performed by observers A and B were, for the manual method, 11.13±2.77 and 10.98±2.54 m/s, respectively, and for the automatic method, 10.96±2.69 and 10.80±2.39 m/s. The RC values were 0.947 and 0.890 for manual and automatic, respectively. No significant difference was noted for interobserver repeatability between the two methods.
Clinical Application: PWV Determinants
The multiple regression analysis between carotid-femoral
PWV and clinical parameters and biological
cardiovascular risk factors showed that the two major
determinants of PWV are age (P<.001) and systolic pressure
(P<.001), which correlate positively with PWV. These
relations can be expressed by the formula PWV=0.07xSystolic Pressure
(mm Hg)+0.09xAge (y)-4.3 (m/s). No other major determinant of
PWV was found in this study.
To analyze the role of the other
factors10 11 12 and lower the weight of blood pressure in
this model, we studied the determinants of PWV in two separate
subgroups: normotensive subjects (n=178, blood pressure 
140/90
mm Hg) and hypertensive subjects (n=240, blood pressure >140/90
mm Hg). Similar results were observed (for normotensive
subjects: PWV=0.06xSystolic Pressure [mm Hg]+0.09xAge
[y]-2.3 [m/s]; for hypertensive subjects:
PWV=0.06xSystolic Pressure [mm Hg]+0.09xAge [y]-2.7
[m/s]).
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Discussion |
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TopAbstractIntroductionMethodsResultsDiscussionReferences |
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We designed this study to analyze the validity, accuracy, and repeatability of an automatic, noninvasive method for measurement of PWV and then to evaluate the clinical application of this method to a large population by analyzing some of the clinical parameters and biological plasma cardiovascular risk factors as PWV determinants.
We chose to measure carotid-femoral PWV to evaluate aortic distensibility for several reasons: first, because pressure waveforms can be easily recorded on these two sites; second, because the distance between these two sites is large enough to allow an accurate calculation of the time interval between the two waves (initial rise upstroke) recorded simultaneously on a paper recorder at relatively high speed (150 mm/s); and third, because carotid-femoral PWV reflects arterial wall elasticity, which is widely related to the aorta.
The validation of the automatic measurement of PWV by comparison with the manual method shows a significant linear correlation between the mean values of PWV measured by each of these methods. This highly significant correlation coefficient reflects the good agreement between the two PWV measurement methods. The analysis of the difference between the two methods showed a slightly lower value obtained by the automatic device (-0.20±0.45) that was not related to clinical parameters such as age, weight, and height. This difference is minor to consider in clinical practice because it is practically insignificant in terms of absolute values (less than 2% for a mean PWV value of approximately 11 m/s) and because the agreement between the two methods is high, with a linear correlation coefficient of r=.99. In addition, it is important to note that this difference is very low compared with the PWV modification observed after drug administration, which usually reaches 10%.
Our results indicate that the intraobserver and interobserver RC values of the automatic PWV measurement showed high reproducibility, which allows its application for longitudinal clinical studies, provided that they are done by an experienced investigator.
The clinical application of this method in a large population for analysis of PWV determinants showed that age and systolic pressure strongly correlate with PWV. In fact, the most important factor contributing to increased PWV in human populations is age because of increased arterial stiffness caused by medial calcification and loss of elasticity. Reports conflict regarding the effects of age-related development of atherosclerosis on arterial distensibility as evaluated by PWV. Some studies7 12 suggest that the increase in PWV could be an early indicator of atherosclerosis development (as diabetes); other studies show no significant difference in PWV with age in subjects predisposed to a high risk of atherosclerosis, such as familial hypercholesterolemia. However, there has been a qualitative association between the process of atherosclerosis and arterial "rigidity"; PWV studies indicate that hypertension contributes more than atherosclerosis to increased arterial stiffening with age.5 7 11
In addition to the role of age, PWV also depends on blood pressure level: the higher the pressure, the faster the speed of wave travel. In fact, since PWV is related to wall elasticity, it becomes directly related to distending pressure. However, varying correlation coefficients have been reported between PWV and systolic, diastolic, and mean blood pressures.5 These variations are probably attributable to the inherent variability in both PWV and blood pressure within and across individual subjects. In our study multiregression analysis showed that systolic pressure was correlated with PWV. This can be explained by the determinants of systolic pressure; in fact, one of the major factors influencing systolic pressure is arterial distensibility, as it can be evaluated by PWV.4
In our study sex, weight, tobacco consumption, plasma glucose, cholesterol, and high-density lipoprotein cholesterol did not significantly influence PWV. There are conflicting reports on the relationship of some of these factors with the stiffening of large arteries in humans. Reduced arterial compliance in nonoccluded arteries has been demonstrated in patients with coronary artery disease and in patients with diabetes mellitus.12 13 Other studies have shown no significant differences in PWV with age in subjects with a high risk of atherosclerosis, such as familial hypercholesterolemia, or in populations with different prevalences of atherosclerosis, such as Western and Asian populations. Furthermore, studies of large groups of Chinese and German populations have failed to demonstrate any association between PWV and total plasma cholesterol.5 7 10 However, in such investigations the different fractions of lipoproteins were not widely evaluated. More recently, in analyses of the relationship between lipid fractions and aortic PWV, Relf et al,11 London et al,14 and Asmar et al15 found a weak negative correlation between high-density lipoprotein cholesterol and aortic PWV but no significant correlation with total plasma cholesterol. In the present study we observed no significant relationship between PWV and different lipoprotein fractions. These apparently conflicting reports can be explained by the differences between the analyzed populations. In the previous studies they were healthy men,11 patients with end-stage renal failure,14 or treated hypertensive patients,15 whereas in the present study they were normotensive and untreated hypertensive subjects.
Conclusion
Large artery damage is a major contributing factor to the elevated
cardiovascular morbidity and mortality observed in
cardiovascular risk factors such as hypertension.
Reduced arterial distensibility contributes to a
disproportionate increase in systolic pressure and an increase in
arterial pulsatility, which has been shown to be associated
with an increase in cardiovascular morbidity and
mortality. Quantitative information on the large arteries may be easily
obtained by determination of PWV. This method enables one to evaluate
indirectly arterial distensibility and
stiffness.5 7
Recent progress in noninvasive techniques enables a simple automatic measurement of PWV that provides a real on-line measurement of this parameter. The validation study of this technique compared with manual calculation (the gold standard) shows that the two methods are highly correlated and have high interobserver and intraobserver reproducibilities. The analysis of the determinants of aortic PWV in a large population showed that the two major determinants of PWV are age and systolic pressure, as expressed in the formula PWV=0.07xSystolic Pressure (mm Hg)+0.09xAge (y)-4.3 (m/s). Whether these correlations will remain unchanged or will be modified by antihypertensive treatment still needs to be clarified by large therapeutic and epidemiological studies.
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Acknowledgments |
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This study was performed with a grant from the Institut National de la Santé et de la Recherche Médicale (INSERM U337), Paris, and with the help of a Biomed program of the European Community. We thank Christiane Kaikati for her excellent assistance and Zoha Khalil Issa for her statistical advice.
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Footnotes |
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Reprint requests to Dr R. Asmar, Institut de Recherche et Formation Cardiovasculaire, 21, Boulevard Delessert 75016, Paris, France.
Received January 31, 1995; first decision February 21, 1995; accepted March 30, 1995.
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References |
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 A. Kearney-Schwartz, P. Rossignol, S. Bracard, J. Felblinger, R. Fay, J.-M. Boivin, T. Lecompte, P. Lacolley, A. Benetos, and F. Zannad Vascular Structure and Function Is Correlated to Cognitive Performance and White Matter Hyperintensities in Older Hypertensive Patients With Subjective Memory Complaints Stroke, April 1, 2009; 40(4): 1229 - 1236. [Abstract] [Full Text] [PDF]
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S. Sakuragi, K. Abhayaratna, K. J. Gravenmaker, C. O'Reilly, W. Srikusalanukul, M. M. Budge, R. D. Telford, and W. P. Abhayaratna Influence of Adiposity and Physical Activity on Arterial Stiffness in Healthy Children: The Lifestyle of Our Kids Study Hypertension, April 1, 2009; 53(4): 611 - 616. [Abstract] [Full Text] [PDF]
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 O. Olafiranye, G. Qureshi, L. Salciccioli, K. Vernon-Jones, C. Philip, J. Kassotis, and J. M. Lazar The Relationship Between Effective Arterial Capacitance and Pulse Wave Velocity Is Dependent on Left Ventricular Stroke Volume Angiology, February 1, 2009; 60(1): 82 - 86. [Abstract] [PDF]
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L. F. Drager, L. A. Bortolotto, E. M. Krieger, and G. Lorenzi-Filho Additive Effects of Obstructive Sleep Apnea and Hypertension on Early Markers of Carotid Atherosclerosis Hypertension, January 1, 2009; 53(1): 64 - 69. [Abstract] [Full Text] [PDF]
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L. H.G. Henskens, A. A. Kroon, R. J. van Oostenbrugge, E. H.B.M. Gronenschild, M. M.J.J. Fuss-Lejeune, P. A.M. Hofman, J. Lodder, and P. W. de Leeuw Increased Aortic Pulse Wave Velocity Is Associated With Silent Cerebral Small-Vessel Disease in Hypertensive Patients Hypertension, December 1, 2008; 52(6): 1120 - 1126. [Abstract] [Full Text] [PDF]
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 S. Dhoat, K. Ali, C. J. Bulpitt, and C. Rajkumar Vascular compliance is reduced in vascular dementia and not in Alzheimer's disease Age Ageing, November 1, 2008; 37(6): 653 - 659. [Abstract] [Full Text] [PDF]
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 A. M. Abbatecola, M. Barbieri, M. R. Rizzo, R. Grella, M. T. Laieta, E. Quaranta, A. M. Molinari, M. Cioffi, P. Fioretto, and G. Paolisso Arterial Stiffness and Cognition in Elderly Persons With Impaired Glucose Tolerance and Microalbuminuria J. Gerontol. A Biol. Sci. Med. Sci., September 1, 2008; 63(9): 991 - 996. [Abstract] [Full Text] [PDF]
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E. Anastasakis, K. I. Paraskevas, N. Papantoniou, G. Daskalakis, S. Mesogitis, D. P. Mikhailidis, and A. Antsaklis Association Between Abnormal Uterine Artery Doppler Flow Velocimetry, Risk of Preeclampsia, and Indices of Arterial Structure and Function: A Pilot Study Angiology, August 1, 2008; 59(4): 493 - 499. [Abstract] [PDF]
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 Y. Kawagoe, H. Sameshima, and T. Ikenoue Clinical Application of Pulse Transit Time and Correlation With Intrapartum Fetal Heart Rate Monitoring: A Preliminary Study of 18 Full-Term Infants Reproductive Sciences, July 1, 2008; 15(6): 567 - 571. [Abstract] [PDF]
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J. Karalliedde, A. Smith, L. DeAngelis, V. Mirenda, A. Kandra, J. Botha, P. Ferber, and G. Viberti Valsartan Improves Arterial Stiffness in Type 2 Diabetes Independently of Blood Pressure Lowering Hypertension, June 1, 2008; 51(6): 1617 - 1623. [Abstract] [Full Text] [PDF]
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 T. Knipfer and E. Steudle Root hydraulic conductivity measured by pressure clamp is substantially affected by internal unstirred layers J. Exp. Bot., May 1, 2008; 59(8): 2071 - 2084. [Abstract] [Full Text] [PDF]
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 M. Delahousse, M. Chaignon, L. Mesnard, P. Boutouyrie, M. E. Safar, T. Lebret, M. Pastural-Thaunat, L. Tricot, A. Kolko-Labadens, A. Karras, et al. Aortic Stiffness of Kidney Transplant Recipients Correlates with Donor Age J. Am. Soc. Nephrol., April 1, 2008; 19(4): 798 - 805. [Abstract] [Full Text] [PDF]
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A. Qasem and A. Avolio Determination of Aortic Pulse Wave Velocity From Waveform Decomposition of the Central Aortic Pressure Pulse Hypertension, February 1, 2008; 51(2): 188 - 195. [Abstract] [Full Text] [PDF]
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M. M. Lemos, A. D. B. Jancikic, F. M. R. Sanches, D. M. Christofalo, S. A. Ajzen, M. H. Miname, R. D. Santos, F. C. Fachini, A. B. Carvalho, S. A. Draibe, et al. Pulse wave velocity a useful tool for cardiovascular surveillance in pre-dialysis patients Nephrol. Dial. Transplant., December 1, 2007; 22(12): 3527 - 3532. [Abstract] [Full Text] [PDF]
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 L. F. Drager, L. A. Bortolotto, A. C. Figueiredo, E. M. Krieger, and G. Lorenzi-Filho Effects of Continuous Positive Airway Pressure on Early Signs of Atherosclerosis in Obstructive Sleep Apnea Am. J. Respir. Crit. Care Med., October 1, 2007; 176(7): 706 - 712. [Abstract] [Full Text] [PDF]
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V. K. Yeragani, R. Kumar, K. J. Bar, P. Chokka, and M. Tancer Exaggerated Differences in Pulse Wave Velocity Between Left and Right Sides Among Patients With Anxiety Disorders and Cardiovascular Disease Psychosom Med, October 1, 2007; 69(8): 717 - 722. [Abstract] [Full Text] [PDF]
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M. Yildiz, A. Altun, and G. Ozbay Assessment of Arterial Distensibility in Patients With Cardiac Syndrome X Angiology, September 1, 2007; 58(4): 458 - 462. [Abstract] [PDF]
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A. D. Protogerou, M. E. Safar, P. Iaria, H. Safar, K. Le Dudal, J. Filipovsky, O. Henry, P. Ducimetiere, and J. Blacher Diastolic Blood Pressure and Mortality in the Elderly With Cardiovascular Disease Hypertension, July 1, 2007; 50(1): 172 - 180. [Abstract] [Full Text] [PDF]
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L. F. Drager, L. A. Bortolotto, A. C. Figueiredo, B. C. Silva, E. M. Krieger, and G. Lorenzi-Filho Obstructive Sleep Apnea, Hypertension, and Their Interaction on Arterial Stiffness and Heart Remodeling Chest, May 1, 2007; 131(5): 1379 - 1386. [Abstract] [Full Text] [PDF]
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 C. Tsioufis, K. Dimitriadis, M. Selima, C. Thomopoulos, C. Mihas, I. Skiadas, D. Tousoulis, C. Stefanadis, and I. Kallikazaros Low-grade inflammation and hypoadiponectinaemia have an additive detrimental effect on aortic stiffness in essential hypertensive patients Eur. Heart J., May 1, 2007; 28(9): 1162 - 1169. [Abstract] [Full Text] [PDF]
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M. M.F. Poels, M. van Oijen, F. U.S. Mattace-Raso, A. Hofman, P. J. Koudstaal, J. C.M. Witteman, and M. M.B. Breteler Arterial Stiffness, Cognitive Decline, and Risk of Dementia: The Rotterdam Study Stroke, March 1, 2007; 38(3): 888 - 892. [Abstract] [Full Text] [PDF]
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A. D. Achimastos, S. P. Efstathiou, T. Christoforatos, T. N. Panagiotou, G. S. Stergiou, and T. D. Mountokalakis Arterial Stiffness: Determinants and Relationship to the Metabolic Syndrome Angiology, February 1, 2007; 58(1): 11 - 20. [Abstract] [PDF]
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G. M. London, A. P. Guerin, F. H. Verbeke, B. Pannier, P. Boutouyrie, S. J. Marchais, and F. Metivier Mineral Metabolism and Arterial Functions in End-Stage Renal Disease: Potential Role of 25-Hydroxyvitamin D Deficiency J. Am. Soc. Nephrol., February 1, 2007; 18(2): 613 - 620. [Abstract] [Full Text] [PDF]
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S. Laurent, J. Cockcroft, L. Van Bortel, P. Boutouyrie, C. Giannattasio, D. Hayoz, B. Pannier, C. Vlachopoulos, I. Wilkinson, H. Struijker-Boudier, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications Eur. Heart J., November 1, 2006; 27(21): 2588 - 2605. [Abstract] [Full Text] [PDF]
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 S R Hart, A A Mangoni, C G Swift, and S H D Jackson Effect of methionine loading on pulse wave analysis in elderly volunteers. Postgrad. Med. J., August 1, 2006; 82(970): 524 - 527. [Abstract] [Full Text] [PDF]
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 C. Vlachopoulos, N. Alexopoulos, I. Dima, K. Aznaouridis, I. Andreadou, and C. Stefanadis Acute Effect of Black and Green Tea on Aortic Stiffness and Wave Reflections J. Am. Coll. Nutr., June 1, 2006; 25(3): 216 - 223. [Abstract] [Full Text] [PDF]
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C. Vlachopoulos, F. Kosmopoulou, N. Alexopoulos, N. Ioakeimidis, G. Siasos, and C. Stefanadis Acute mental stress has a prolonged unfavorable effect on arterial stiffness and wave reflections. Psychosom Med, March 1, 2006; 68(2): 231 - 237. [Abstract] [Full Text] [PDF]
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A. Paini, P. Boutouyrie, D. Calvet, A.-I. Tropeano, B. Laloux, and S. Laurent Carotid and Aortic Stiffness: Determinants of Discrepancies Hypertension, March 1, 2006; 47(3): 371 - 376. [Abstract] [Full Text] [PDF]
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 F. U.S. Mattace-Raso, T. J.M. van der Cammen, A. Hofman, N. M. van Popele, M. L. Bos, M. A.D.H. Schalekamp, R. Asmar, R. S. Reneman, A. P.G. Hoeks, M. M.B. Breteler, et al. Arterial Stiffness and Risk of Coronary Heart Disease and Stroke: The Rotterdam Study Circulation, February 7, 2006; 113(5): 657 - 663. [Abstract] [Full Text] [PDF]
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T. Willum Hansen, J. A. Staessen, C. Torp-Pedersen, S. Rasmussen, L. Thijs, H. Ibsen, and J. Jeppesen Prognostic Value of Aortic Pulse Wave Velocity as Index of Arterial Stiffness in the General Population Circulation, February 7, 2006; 113(5): 664 - 670. [Abstract] [Full Text] [PDF]
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F. U. S. Mattace-Raso, T. J. M. van der Cammen, A. P. M. van den Elzen, M. A. D. H. Schalekamp, R. Asmar, R. S. Reneman, A. P. G. Hoeks, A. Hofman, and J. C. M. Witteman Moderate Alcohol Consumption Is Associated With Reduced Arterial Stiffness in Older Adults: The Rotterdam Study J. Gerontol. A Biol. Sci. Med. Sci., November 1, 2005; 60(11): 1479 - 1483. [Abstract] [Full Text] [PDF]
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N. Amabile, A. P. Guerin, A. Leroyer, Z. Mallat, C. Nguyen, J. Boddaert, G. M. London, A. Tedgui, and C. M. Boulanger Circulating Endothelial Microparticles Are Associated with Vascular Dysfunction in Patients with End-Stage Renal Failure J. Am. Soc. Nephrol., November 1, 2005; 16(11): 3381 - 3388. [Abstract] [Full Text] [PDF]
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C. Vlachopoulos, I. Dima, K. Aznaouridis, C. Vasiliadou, N. Ioakeimidis, C. Aggeli, M. Toutouza, and C. Stefanadis Acute Systemic Inflammation Increases Arterial Stiffness and Decreases Wave Reflections in Healthy Individuals Circulation, October 4, 2005; 112(14): 2193 - 2200. [Abstract] [Full Text] [PDF]
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O. Hanon, S. Haulon, H. Lenoir, M.-L. Seux, A.-S. Rigaud, M. Safar, X. Girerd, and F. Forette Relationship Between Arterial Stiffness and Cognitive Function in Elderly Subjects With Complaints of Memory Loss Stroke, October 1, 2005; 36(10): 2193 - 2197. [Abstract] [Full Text] [PDF]
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L. F. Drager, L. A. Bortolotto, M. C. Lorenzi, A. C. Figueiredo, E. M. Krieger, and G. Lorenzi-Filho Early Signs of Atherosclerosis in Obstructive Sleep Apnea Am. J. Respir. Crit. Care Med., September 1, 2005; 172(5): 613 - 618. [Abstract] [Full Text] [PDF]
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 C. Vlachopoulos, D. Panagiotakos, N. Ioakeimidis, I. Dima, and C. Stefanadis Chronic coffee consumption has a detrimental effect on aortic stiffness and wave reflections Am. J. Clinical Nutrition, June 1, 2005; 81(6): 1307 - 1312. [Abstract] [Full Text] [PDF]
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 W. D. Strain, N. Chaturvedi, C. J. Bulpitt, C. Rajkumar, and A. C. Shore Albumin Excretion Rate and Cardiovascular Risk: Could the Association Be Explained by Early Microvascular Dysfunction? Diabetes, June 1, 2005; 54(6): 1816 - 1822. [Abstract] [Full Text] [PDF]
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S. Laurent, P. Boutouyrie, and P. Lacolley Structural and Genetic Bases of Arterial Stiffness Hypertension, June 1, 2005; 45(6): 1050 - 1055. [Abstract] [Full Text] [PDF]
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R. S. Reneman, J. M. Meinders, and A. P.G. Hoeks Non-invasive ultrasound in arterial wall dynamics in humans: what have we learned and what remains to be solved Eur. Heart J., May 2, 2005; 26(10): 960 - 966. [Abstract] [Full Text] [PDF]
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A. Smith, J. Karalliedde, L. De Angelis, D. Goldsmith, and G. Viberti Aortic Pulse Wave Velocity and Albuminuria in Patients with Type 2 Diabetes J. Am. Soc. Nephrol., April 1, 2005; 16(4): 1069 - 1075. [Abstract] [Full Text] [PDF]
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B. Pannier, A. P. Guerin, S. J. Marchais, M. E. Safar, and G. M. London Stiffness of Capacitive and Conduit Arteries: Prognostic Significance for End-Stage Renal Disease Patients Hypertension, April 1, 2005; 45(4): 592 - 596. [Abstract] [Full Text] [PDF]
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S. C. Millasseau, A. D. Stewart, S. J. Patel, S. R. Redwood, and P. J. Chowienczyk Evaluation of Carotid-Femoral Pulse Wave Velocity: Influence of Timing Algorithm and Heart Rate Hypertension, February 1, 2005; 45(2): 222 - 226. [Abstract] [Full Text] [PDF]
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D. Lemogoum, L. Van Bortel, B. Najem, A. Dzudie, C. Teutcha, E. Madu, M. Leeman, J.-P. Degaute, and P. van de Borne Arterial Stiffness and Wave Reflections in Patients With Sickle Cell Disease Hypertension, December 1, 2004; 44(6): 924 - 929. [Abstract] [Full Text] [PDF]
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 C. Vlachopoulos, F. Kosmopoulou, D. Panagiotakos, N. Ioakeimidis, N. Alexopoulos, C. Pitsavos, and C. Stefanadis Smoking and caffeine have a synergistic detrimental effect on aortic stiffness and wave reflections J. Am. Coll. Cardiol., November 2, 2004; 44(9): 1911 - 1917. [Abstract] [Full Text] [PDF]
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 M. Zureik, P. Galan, S. Bertrais, L. Mennen, S. Czernichow, J. Blacher, P. Ducimetiere, and S. Hercberg Effects of Long-Term Daily Low-Dose Supplementation With Antioxidant Vitamins and Minerals on Structure and Function of Large Arteries Arterioscler Thromb Vasc Biol, August 1, 2004; 24(8): 1485 - 1491. [Abstract] [Full Text] [PDF]
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P. Boutouyrie, D. P. Germain, J.-N. Fiessinger, B. Laloux, J. Perdu, and S. Laurent Increased Carotid Wall Stress in Vascular Ehlers-Danlos Syndrome Circulation, March 30, 2004; 109(12): 1530 - 1535. [Abstract] [Full Text] [PDF]
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 M Eren, S Gorgulu, N Uslu, S Celik, B Dagdeviren, and T Tezel Relation between aortic stiffness and left ventricular diastolic function in patients with hypertension, diabetes, or both Heart, January 1, 2004; 90(1): 37 - 43. [Abstract] [Full Text] [PDF]
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 C. Vlachopoulos, K. Hirata, and M. F O'Rourke Effect of sildenafil on arterial stiffness and wave reflection Vascular Medicine, November 1, 2003; 8(4): 243 - 248. [Abstract] [PDF]
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N. Nakanishi, K. Suzuki, and K. Tatara Clustered Features of the Metabolic Syndrome and the Risk for Increased Aortic Pulse Wave Velocity in Middle-aged Japanese Men Angiology, September 1, 2003; 54(5): 551 - 559. [Abstract] [PDF]
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C. O'Sullivan, J. Duggan, S. Lyons, J. Thornton, M. Lee, and E. O'Brien Hypertensive Target-Organ Damage in the Very Elderly Hypertension, August 1, 2003; 42(2): 130 - 135. [Abstract] [Full Text] [PDF]
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A.F.C. Schut, J.A.M.J.L. Janssen, J. Deinum, J.M. Vergeer, A. Hofman, S.W.J. Lamberts, B.A. Oostra, H.A.P. Pols, J.C.M. Witteman, and C.M. van Duijn Polymorphism in the Promoter Region of the Insulin-like Growth Factor I Gene Is Related to Carotid Intima-Media Thickness and Aortic Pulse Wave Velocity in Subjects With Hypertension Stroke, July 1, 2003; 34(7): 1623 - 1627. [Abstract] [Full Text] [PDF]
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M. Karamanoglu, P. Lantelme, C. Mestre, and H. Milon Errors in Estimating Propagation Distances in Pulse Wave Velocity * Response Hypertension, June 1, 2003; e8(6): . [Full Text] [PDF]
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S. Laurent, S. Katsahian, C. Fassot, A.-I. Tropeano, I. Gautier, B. Laloux, and P. Boutouyrie Aortic Stiffness Is an Independent Predictor of Fatal Stroke in Essential Hypertension Stroke, May 1, 2003; 34(5): 1203 - 1206. [Abstract] [Full Text] [PDF]
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W. B. White, D. Duprez, R. St Hillaire, S. Krause, B. Roniker, J. Kuse-Hamilton, and M. A. Weber Effects of the Selective Aldosterone Blocker Eplerenone Versus the Calcium Antagonist Amlodipine in Systolic Hypertension Hypertension, May 1, 2003; 41(5): 1021 - 1026. [Abstract] [Full Text] [PDF]
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M Kidawa, M Krzeminska-Pakula, J Z Peruga, and J D Kasprzak Arterial dysfunction in syndrome X: results of arterial reactivity and pulse wave propagation tests Heart, April 1, 2003; 89(4): 422 - 426. [Abstract] [Full Text] [PDF]
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J. J. Oliver and D. J. Webb Noninvasive Assessment of Arterial Stiffness and Risk of Atherosclerotic Events Arterioscler Thromb Vasc Biol, April 1, 2003; 23(4): 554 - 566. [Abstract] [Full Text] [PDF]
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 K. K. Naka, A. C. Tweddel, D. Parthimos, A. Henderson, J. Goodfellow, and M. P. Frenneaux Arterial distensibility: acute changes following dynamic exercise in normal subjects Am J Physiol Heart Circ Physiol, March 1, 2003; 284(3): H970 - H978. [Abstract] [Full Text] [PDF]
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M. Zureik, J.-M. Bureau, M. Temmar, C. Adamopoulos, D. Courbon, K. Bean, P.-J. Touboul, A. Benetos, and P. Ducimetiere Echogenic Carotid Plaques Are Associated With Aortic Arterial Stiffness in Subjects With Subclinical Carotid Atherosclerosis Hypertension, March 1, 2003; 41(3): 519 - 527. [Abstract] [Full Text] [PDF]
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A. Mahmud and J. Feely Effect of Smoking on Arterial Stiffness and Pulse Pressure Amplification Hypertension, January 1, 2003; 41(1): 183 - 187. [Abstract] [Full Text] [PDF]
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C. S. Hayward, A. P. Avolio, M. F. O'Rourke, P. Lantelme, C. Mestre, M. Lievre, A. Gressard, and H. Milon Arterial Pulse Wave Velocity and Heart Rate * Response: Heart Rate and Pulse Wave Velocity Hypertension, December 1, 2002; e9(6): . [Full Text] [PDF]
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P. Lantelme, C. Mestre, M. Lievre, A. Gressard, and H. Milon Heart Rate: An Important Confounder of Pulse Wave Velocity Assessment Hypertension, June 1, 2002; 39(6): 1083 - 1087. [Abstract] [Full Text] [PDF]
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M. E. Safar, J. Blacher, B. Pannier, A. P. Guerin, S. J. Marchais, P.-M. Guyonvarc'h, and G. M. London Central Pulse Pressure and Mortality in End-Stage Renal Disease Hypertension, March 1, 2002; 39(3): 735 - 738. [Abstract] [Full Text] [PDF]
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R. Tatchum-Talom, C. Martel, and A. Marette Influence of estrogen on aortic stiffness and endothelial function in female rats Am J Physiol Heart Circ Physiol, February 1, 2002; 282(2): H491 - H498. [Abstract] [Full Text] [PDF]
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P. Boutouyrie, A. I. Tropeano, R. Asmar, I. Gautier, A. Benetos, P. Lacolley, and S. Laurent Aortic Stiffness Is an Independent Predictor of Primary Coronary Events in Hypertensive Patients: A Longitudinal Study Hypertension, January 1, 2002; 39(1): 10 - 15. [Abstract] [Full Text] [PDF]
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M. ZUREIK, A. BENETOS, C. NEUKIRCH, D. COURBON, K. BEAN, F. THOMAS, and P. DUCIMETIERE Reduced Pulmonary Function Is Associated with Central Arterial Stiffness in Men Am. J. Respir. Crit. Care Med., December 15, 2001; 164(12): 2181 - 2185. [Abstract] [Full Text] [PDF]
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S. Meaume, A. Benetos, O.F. Henry, A. Rudnichi, and M.E. Safar Aortic Pulse Wave Velocity Predicts Cardiovascular Mortality in Subjects >70 Years of Age Arterioscler Thromb Vasc Biol, December 1, 2001; 21(12): 2046 - 2050. [Abstract] [Full Text] [PDF]
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 E. Suzuki, A. Kashiwagi, Y. Nishio, K. Egawa, S. Shimizu, H. Maegawa, M. Haneda, H. Yasuda, S. Morikawa, T. Inubushi, et al. Increased Arterial Wall Stiffness Limits Flow Volume in the Lower Extremities in Type 2 Diabetic Patients Diabetes Care, December 1, 2001; 24(12): 2107 - 2114. [Abstract] [Full Text] [PDF]
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R. G. Asmar, G. M. London, M. E. O'Rourke, and M. E. Safar Improvement in Blood Pressure, Arterial Stiffness and Wave Reflections With a Very-Low-Dose Perindopril/Indapamide Combination in Hypertensive Patient: A Comparison With Atenolol Hypertension, October 1, 2001; 38(4): 922 - 926. [Abstract] [Full Text] [PDF]
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P. Albaladejo, X. Copie, P. Boutouyrie, B. Laloux, A. D. Declere, H. Smulyan, and A. Benetos Heart Rate, Arterial Stiffness, and Wave Reflections in Paced Patients Hypertension, October 1, 2001; 38(4): 949 - 952. [Abstract] [Full Text] [PDF]
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M. Kosch, A. Levers, M. Barenbrock, F. Matzkies, R. M. Schaefer, K. Kisters, K.-H. Rahn, and M. Hausberg Acute effects of haemodialysis on endothelial function and large artery elasticity Nephrol. Dial. Transplant., August 1, 2001; 16(8): 1663 - 1668. [Abstract] [Full Text] [PDF]
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A. Mahmud and J. Feely Acute Effect of Caffeine on Arterial Stiffness and Aortic Pressure Waveform Hypertension, August 1, 2001; 38(2): 227 - 231. [Abstract] [Full Text] [PDF]
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S. Laurent, P. Boutouyrie, R. Asmar, I. Gautier, B. Laloux, L. Guize, P. Ducimetiere, and A. Benetos Aortic Stiffness Is an Independent Predictor of All-Cause and Cardiovascular Mortality in Hypertensive Patients Hypertension, May 1, 2001; 37(5): 1236 - 1241. [Abstract] [Full Text] [PDF]
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H. Smulyan, R. G. Asmar, A. Rudnicki, G. M. London, and M. E. Safar Comparative effects of aging in men and women on the properties of the arterial tree J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1374 - 1380. [Abstract] [Full Text] [PDF]
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F. Selzer, K. Sutton-Tyrrell, S. Fitzgerald, R. Tracy, L. Kuller, and S. Manzi Vascular Stiffness in Women With Systemic Lupus Erythematosus Hypertension, April 1, 2001; 37(4): 1075 - 1082. [Abstract] [Full Text] [PDF]
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N. M. van Popele, D. E. Grobbee, M. L. Bots, R. Asmar, J. Topouchian, R. S. Reneman, A. P. G. Hoeks, D. A. M. van der Kuip, A. Hofman, and J. C. M. Witteman Association Between Arterial Stiffness and Atherosclerosis : The Rotterdam Study Stroke, February 1, 2001; 32(2): 454 - 460. [Abstract] [Full Text] [PDF]
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A. Benetos, K. Okuda, M. Lajemi, M. Kimura, F. Thomas, J. Skurnick, C. Labat, K. Bean, and A. Aviv Telomere Length as an Indicator of Biological Aging : The Gender Effect and Relation With Pulse Pressure and Pulse Wave Velocity Hypertension, February 1, 2001; 37(2): 381 - 385. [Abstract] [Full Text] [PDF]
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N. M. van Popele, W. J. W. Bos, N. A. M. de Beer, D. A. M. van der Kuip, A. Hofman, D. E. Grobbee, and J. C. M. Witteman Arterial Stiffness as Underlying Mechanism of Disagreement Between an Oscillometric Blood Pressure Monitor and a Sphygmomanometer Hypertension, October 1, 2000; 36(4): 484 - 488. [Abstract] [Full Text] [PDF]
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