Published online before print December 27, 2005, doi: 10.1161/01.HYP.0000198539.34501.1a
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Hypertension. 2006;47:180.)
© 2006 American Heart Association, Inc.
Original Articles |
Synergistic Acceleration of Arterial Stiffening in the Presence of Raised Blood Pressure and Raised Plasma Glucose
From the Second Department of Internal Medicine (H.T., Y.H., M.Y., J.Y., Y.K., K.S., A.Y.), Tokyo Medical University; Health Management and Policy (H.H.), University of Tokyo Graduate School of Medicine; and Health Care Center (Y.Y.), Kajima Corporation, Tokyo, Japan.
Correspondence to Akira Yamashina, Second Department of Internal Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo, Japan 160-0023. E-mail akyam{at}tokyo-med.ac.jp
 |
Abstract |
|---|
 Top Abstract IntroductionMethodsResultsDiscussionReferences |
|---|
Arterial stiffness is recognized as a marker of arterial damage and an indicator of cardiovascular risk. This observational study was conducted to examine the synergistic effect of raised blood pressure (RBP;
130/85 mm Hg) and raised plasma glucose (RPG; 110 mg/dL) even at levels below those conventionally used to define hypertension and diabetes on the rate of increase of the pulse wave velocity (PWV) over a 3-year period in 2080 Japanese men (age 42±9 years). First, the subjects were classified into 4 groups based on the presence at the first examination of RBP, RPG, both abnormalities, or neither abnormality. The estimated annual rate of increase of the PWV was higher in subjects with both the abnormalities than in those with either abnormality alone or neither of the 2 abnormalities. Second, the subjects were also classified based on the evolutional status of these abnormalities during the study period; persistence of both of the abnormalities synergistically accelerated the rate of increase of the PWV (68.3±7.1 cm/s per year), as compared with the persistence of either abnormality alone (persistence of RBP alone: 18.2±1.6 cm/s per year; persistence of RPG alone: 21.2±7.4 cm/s per year) or persistence of neither abnormality (11.1±0.8 cm/s per year; P<0.01). Thus, blood pressure and fasting plasma glucose levels even below those defining hypertension and diabetes may synergistically lead to progression of arteriosclerotic arterial damage. This synergistic progression may contribute to the additive increases in the risk of cardiovascular events, at least in part.
Key Words: hypertension • diabetes mellitus • arterial stiffness
|
Introduction |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Arterial stiffness is recognized as a marker of arteriosclerotic arterial damage1,2 and has been shown to be a predictor of future cardiovascular events.3,4 Hypertension and diabetes mellitus are major atherogenic factors, they frequently coexist, and when they coexist, they additively increase the risk of life-threatening cardiovascular events.5 Some cross-sectional studies have demonstrated an increase of arterial stiffness in subjects with either hypertension or glucose intolerance,6,7 and increased arterial stiffness is associated with an increased risk of cardiovascular events, both in subjects with hypertension and in those with diabetes mellitus or glucose intolerance.3,4 Recent studies have demonstrated that values even below those defining the presence of hypertension and diabetes mellitus [raised blood pressure (RBP):
130/85 mm Hg and raised plasma glucose (RPG): 110 mg/dL] are also predictors of future cardiovascular events.8,9 However, no studies until now have evaluated the effects of RBP, RPG, and the coexistence of both disorders on the rate of progression of arterial stiffening. In this observational cohort study of Japanese men, we succeeded in recording the brachial-ankle pulse wave velocity (PWV) twice in 2 examinations conducted at an interval of 3 years. Then, we examined whether the presence of RBP alone, RPG alone, and the coexistence of both at the first examination in this study predicted an acceleration of the rate of increase of the brachial-ankle PWV and whether the persistence of either or both disorders during the study period additionally affected the rate of increase of the brachial-ankle PWV.
|
Methods |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Design and Subjects
This observational study was performed on the Japanese male employees of a single large construction company. The routine annual health checkup included evaluation of the atherosclerotic risk factors (body mass index [BMI], serum levels of triglycerides [TG], high-density lipoprotein cholesterol [HDL], total cholesterol [TC], fasting plasma glucose, and blood pressure), the smoking status (current smokers versus nonsmokers), and habitual alcohol intake status (0 [nondrinker group], 1 to 14 g/day [light alcohol intake group], 15 to 29 g/day [moderate alcohol intake group], and >30 g/day [heavy alcohol intake group]) were assessed using a self-administered questionnaire. For this study, in addition to the routine tests, brachial-ankle PWV measurements were also conducted on 2 occasions, that is, at the beginning (the first examination) and at the end of the 3-year study period (the second examination). Some parts of this prospective study protocol are described elsewhere,10 and this protocol was initiated in the year 2000. Subjects with positive atherosclerotic risk factors (BMI
25, TG 150 mg/dL, HDL <40 mg/dL, fasting plasma glucose 126 mg/dL, blood pressure 140/90 mm Hg, and TC 240 mg/dL) were treated in accordance with the guidelines of the Japanese societies of atherosclerosis,11 diabetes mellitus,12 and hypertension.13 Subjects with the above-mentioned abnormalities were advised to visit the healthcare center of their construction company as a first step, and a management plan was drawn for each subject. The patients were provided guidance in regard to therapeutic lifestyle modifications by the doctor, nurse, and nutritionist team at the healthcare center. In the subjects that were judged as needing medication for the abnormalities, appropriate medication was prescribed at either the healthcare center or at other clinics; each patient was given the freedom to choose his/her own doctor for such treatment. Subjects meeting the following criteria were considered to be ineligible for the study: an ankle/brachial systolic blood pressure index (ABI) of <0.95, atrial fibrillation, and/or those undergoing regular hemodialysis. The reliability of the brachial-ankle PWV measurements in the presence of these conditions is subject to question.1,2,14,15 In addition, subjects who were receiving medication for hypertension, dyslipidemia, diabetes mellitus, heart disease, and/or stroke were also excluded from this study, because the drugs used in the treatment of these diseases have been recognized to affect the PWV.1,2 Verbal informed consent was obtained from all of the participants before their participation in this study. This verbal informed consent and the study protocol were approved by the Ethical Guidelines Committee of Tokyo Medical University.
Measurements
PWV
The brachial-ankle PWV was measured using a volume-plethysmographic apparatus (Form/ABI, Colin Co. Ltd) in accordance with a methodology described previously.9,14,15 The measurement was conducted after the subject had rested for 5 minutes in the supine position in an air-conditioned room (24 to 26°C) earmarked exclusively for this purpose. Details of measurement of the brachial-ankle PWV are described in the data supplement available online at http://www.hypertensionaha.org.
Laboratory Measurements
The TG, HDL, TC, fasting plasma glucose, and plasma creatinine levels were measured using enzymatic methods (Falco Biosystems Co Ltd). All of the blood samples were obtained in the morning after the patients had fasted overnight.
Blood Pressure and Heart Rate Measurements
Blood pressure was determined as the mean of 2 measurements obtained in an office setting by the conventional cuff method using a mercury sphygmomanometer. To adjust the brachial-ankle PWV for the blood pressure, the heart rate and mean arterial pressure simultaneously obtained during measurement of the brachial-ankle PWV were used; the blood pressure was recorded simultaneously from the right arm and the left arm using an oscillometric method, and the blood pressure variables were calculated as the means of the values measured for the right arm and the left arm. Then, the mean arterial pressure was calculated as the diastolic pressure+(pulse pressurex1/3) as a continuous variable.
Definitions of RBP and RPG
It is known that even subjects with high normal blood pressure are at an increased risk for coronary heart disease compared with those with average values8 and that a blood pressure 130/85 mm Hg is defined as RBP.8,16 The subjects of this study were classified into 4 groups based on the evolutional status of the RBP between the 2 examinations, as follows: persistence of RBP, defined as detection of RBP at both the first and the second examinations; newly detection of RBP, defined as detection of RBP only at the second examination; regression of RBP, defined as detection of RBP only at the first examination; and absence of RBP, defined as no detection of RBP at either the first or the second examination.
It is has been noted that impaired fasting glucose is usually an indicator of insulin resistance,17 and RPG has been defined as a fasting plasma glucose level 110 mg/dL.9,16,17 A similar classification as RBP was applied for the changes in their RPG status between the 2 examinations The subjects were also classified based on the evolutional status of RPG during the study period in a way similar to that of the evolutional status of RBP described above.
At the healthcare center of this construction company, blood pressure 140/90 mm Hg and/or fasting plasma glucose >125 mg/dL were defined as criteria to advise the patient to seek treatment for hypertension and/or diabetes mellitus. Thus, the definitions of RBP and RPG for this study were set at lower levels.
Statistical Analysis
Data were expressed as mean±SD. Error bars are depicted in the figures. The significance of differences in the values of the variables between the first and the second examinations in each group was assessed by the paired t test. For assessment of the significance of differences in the status of each variable among the groups, a 1-way analysis of variance with Scheffe’s adjustment was applied for continuous variables, and the 
2 test was applied for categorical variables.
Then, the differences in the estimated annual rate of increase of the brachial-ankle PWV ([value at the second examination–value at the first examination]/3 [years]) were compared among the 4 groups of patients classified on the basis of the presence of RBP alone, RPG alone, both abnormalities, or neither abnormality at the first examination, as well as among the 4 groups classified based on the evolutional status of the RBP and RPG during the study period (persistence of RBP, regression of RBP, new detection of RBP, absence of RBP at either examination/persistence of RPG, regression of RPG, new detection of RPG, and absence of RPG at either examination), and across 4 groups of patients classified based on the presence/absence of persistence of RBP and that of RPG during the study period (coexistence of persistence of RBP and that of RPG, persistence of RBP alone, persistence of RPG alone, and persistence of neither abnormality) by analysis of covariance.
This analysis was performed with adjustments for the control of covariates that have been reported to affect the PWV in previous reports1,2,14,15,18,19 {continuous variables (values at the first examination [age, BMI, brachial-ankle PWV, mean arterial pressure and heart rate recorded during measurement of the brachial-ankle PWV, TC, TG, HDL, fasting plasma glucose, and serum creatinine] and changes in the BMI, mean arterial pressure and heart rate recorded during measurement of the brachial-ankle PWV, TC, TG, HDL, fasting plasma glucose, and serum creatinine during the study period) and categorical variables [smoking status and alcohol intake at the first examination and the change in the smoking status and alcohol intake during the study period]}. In addition, to evaluate whether higher levels of blood pressure and/or fasting plasma glucose than the levels defined initially as RBP and/or RPG for this study might additionally increase the rate of progression of arterial stiffening, the estimated annual rate of increase of the brachial-ankle PWV was compared among the following groups: subjects with blood pressure levels between 135/85 and 140/90 mm Hg versus those with blood pressure levels 140/90 mm Hg; subjects with fasting plasma glucose levels between 110 and 126 mg/dL versus those with fasting plasma glucose 126 mg/dL; and subjects with coexistence of blood pressure levels between 135/85 and 140/90 mm Hg and fasting plasma glucose levels between 110 and 126 mg/dL versus those with the coexistence of blood pressure levels 140/90 mm Hg and fasting plasma glucose levels 126 mg/dL.
For the presence of RBP and that of RPG at the first examination, a general linear model (GLM) multivariate analysis, controlling for the above-mentioned covariates potentially affecting the PWV, was conducted to identify the independence/interaction of the 2 factors on the estimated annual rate of increase of the brachial-ankle PWV. The same analysis was also applied to identify the effect of persistence of RBP and that of RPG during the study period on the estimated annual rate of increase of the brachial-ankle PWV.
All of the analyses were conducted using the SPSS software for Windows, version 11.0J (SPSS). A P value of <0.05 was considered to denote statistical significance.
|
Results |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
During the 3-year period from May 2000 to December 2004, brachial-ankle PWV measurements and other demographic and laboratory examinations were successfully conducted on 2 occasions in a total of 2389 Japanese male subjects. The subjects ranged in age from 29 to 76 years. At the first examination, 4 subjects had an ABI of <0.95; 5 subjects had atrial fibrillation; 4 subjects were undergoing regular hemodialysis; and 194 were under medication for hypertension, dyslipidemia, diabetes mellitus, heart disease, or stroke and were excluded from the analysis. During the study period (spanning the first and second examinations), 3 subjects were newly diagnosed to have atrial fibrillation, and 99 subjects were started on medication for
1 of the above-mentioned diseases. Finally, 2080 subjects could be successfully included for the present analysis.
Table 1 and Figure 1 show the clinical characteristics and the estimated mean annual rate of increase of the brachial-ankle PWV in the 4 groups of patients classified based on the presence/absence of RBP and/or RPG at the first examination. A significant elevation of the annual rate of increase of the brachial-ankle PWV was observed in the group with the concomitant presence of both RBP and RPG as compared with that in the other 3 groups (Figure 1). However, higher levels of blood pressure and/or fasting plasma glucose than the levels defined initially as RBP and/or RPG for the study did not additionally increase the rate of arterial stiffening. 
The estimated annual rates of increase of the brachial-ankle PWV in the groups were as follows: subjects with blood pressure levels between 135/85 and 140/90 mm Hg, 12.0±2.8 cm/s per year (n=464) versus subjects with blood pressure levels 140/90 mm Hg, 11.8±2.3 cm/s per year (n=333; P value not significant); subjects with fasting plasma glucose levels between 110 and 126 mg/dL, 24.7±7.5 cm/s per year (n=56) versus subjects with fasting plasma glucose levels 126 mg/dL, 20.2±6.1 cm/s per year (n=41; P value not significant); and subjects with coexistence of blood pressure levels between 135/85 and 140/90 mm Hg and fasting plasma glucose levels between 110 and <126 mg/dL: 27.3±7.0 cm/s per year (n=38) versus subjects with the coexistence of blood pressure levels 140/90 mm Hg and fasting plasma glucose levels 126 mg/dL, 27.4±11.6 cm/s per year (n=18; P value not significant)].
|
|
P<0.01 vs that in the group with RBP alone; 
P<0.01 vs that in the group with RPG alone (assessed by analysis of covariance with adjustments).The results of the GLM multivariate analysis with and without the term of the interaction between the presence of RBP at first examination and the presence of RPG at first examination in relation to the annual rate of increase of the brachial-ankle PWV adjusted for the covariates affecting the PWV are depicted in Table 2. The presence RPG at the first examination was a significant and independent risk factor predictive of an accelerated increase of the brachial-ankle PWV, and the presence of RBP at the first examination was marginally significant. To test the synergistic effect of the presence of RBP and that of RPG, the interaction between the presence of RBP and that of RPG at the first examination was introduced to the same model, which turned out to be significant.
|
Table 3 shows the clinical characteristics of the 4 groups of patients classified based on the evolutional status of the RBP and the RPG during the study period. The estimated annual rate of increase of the brachial-ankle PWV was higher in the group with persistence of RBP than in the groups with absence of RBP or regression of RBP (Figure 2A). This value was higher in the group with persistence of RPG than in the other 3 groups (Figure 2B).
|
|
Table 4 shows the clinical characteristics of the 4 groups of patients classified based on the persistence of RBP and/or RPG during the study period. The estimated mean annual rate of increase of the brachial-ankle PWV in these 4 groups is illustrated in Figure 3. The persistence of both RBP and RPG was associated with a marked increase in the estimated annual rate of increase of the brachial-ankle PWV as compared with the independent effects of the persistence of either persistence of RBP or that of RPG abnormality alone. These results suggest synergistic effects of persistence of both RBP and RPG during the study period on the rate of progression of arterial stiffening.
|
|
The results of the GLM multivariate analysis with and without the term of the interaction between the persistence of RBP during the study period and the persistence of RPG during the study period in relation to the annual rate of increase of the brachial-ankle PWV adjusted for the covariates affecting the PWV are depicted in Table 5. The persistence of RBP and that of RPG during the study period were found to be significant and independent variables predictive of acceleration of the annual rate of increase of the brachial-ankle PWV. To test the synergistic effect of persistence of RBP and that of RPG, the interaction between persistence of RBP and that of RPG at the first examination was introduced to the same model, which turned out to be significant.
|
|
Discussion |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
The results of the present study demonstrated that the coexistence of RBP and RPG at the first examination was a predictor of the progression of arterial stiffening in a middle-aged Japanese male cohort. In addition, it also demonstrated that the estimated rate of progression of arterial stiffening was accelerated in the event of persistence of RBP alone or RPG alone during the study period and even further synergistically accelerated when both the disorders persisted during the study period. These observed phenomena were independent of the mean blood pressure. Although increased distension of the arterial wall caused by increased blood pressure (functional stiffening) is considered one of the major determinants of increased arterial stiffness,1,2,15,20,21 pressure-independent mechanisms (arteriosclerotic changes) have also been shown to contribute to arterial stiffening.1,2,20,21 The present results suggest that the persistence of both RBP and RPG synergistically lead to the progression of arteriosclerotic arterial damage.
Hypertrophy of the tunica media of the arteries, the renin–angiotensin system, and endothelial dysfunction are all thought to contribute significantly to the arterial stiffening in cases of hypertension.1,2,21 Hyperglycemia and hyperinsulinemia have been shown to directly or indirectly (ie, via accumulation of advanced glycation end products, endothelial dysfunction, and alterations of the activities of vasoactive substances) cause stiffening of the arteries.1,2,20,21 In addition, in both the presence of RBP and that of RPG, increased oxidative stress and/or activation of vascular inflammation may directly cause stiffening of the arteries.2,20,21 All of these aforementioned mechanisms represent pressure-independent mechanisms of arterial stiffening. In the present study, the results of the GLM analysis suggested that the coexistence of RBP and RPG, rather than the presence of either abnormality alone, caused acceleration of arterial stiffening. Worsening of endothelial dysfunction has been demonstrated in the concomitant presence of hypertension and abnormal glucose tolerance.22 The results of a recent study suggested that the coexistence of diabetes mellitus and hypertension augmented the production of advanced glycation end products.23 Additional studies are proposed to clarify the underlying mechanisms of the synergistic effects of the 2 abnormalities, even in their early stage, on the accelerated progression of structural arterial stiffening.
The mechanisms underlying the association of increased PWV with elevated cardiovascular risk, in which increased central aortic stiffness has been shown to play a key role, are described elsewhere.1,2,20,21 It is believed that the brachial-ankle PWV reflects the stiffness of not only the central, but also the peripheral, arterial components,10,15 because it has been shown to bear a close correlation with the aortic PWV,15 which is a known marker of cardiovascular risk.1–4,20,21 On the other hand, increased peripheral arterial stiffness has also been shown to be associated with an increased cardiovascular risk.24 Furthermore, a recent study conducted by us demonstrated that the brachial-ankle PWV may be a predictor of future cardiovascular events in subjects with acute coronary syndromes.25 Therefore, it is possible that the concomitant presence of the abnormalities, even at levels below those conventionally used to define hypertension and diabetes mellitus, respectively, may additionally increase the cardiovascular risk, at least in part, by causing synergistic acceleration of arterial stiffening.
It must be pointed out, however, that the study has some limitations, as described below. First, attention has been paid recently to the metabolic syndrome as a potent atherogenic state, and the presence of this syndrome has been reported to be associated with poor cardiovascular outcomes.16 Although several studies have suggested that central obesity has a key role in the elevated cardiovascular risk associated with the metabolic syndrome,16,26 the waist circumference, which is a robust marker of central obesity,16 was not measured in this study. A cross-sectional study demonstrated the association between central obesity and arterial stiffness.27 Therefore, the significance of central obesity as the determinant of the rate of progression of arterial stiffening should be evaluated in future studies. Second, as mentioned above, central, rather than peripheral arterial stiffness is thought to play a major role in the increased cardiovascular risk related to increased arterial stiffness.1,2,20,21 Therefore, additional studies are proposed to confirm the present results using a more robust marker of central arterial stiffness than the brachial-ankle PWV, such as the carotid-femoral PWV or augmentation index.1,2,20,21 Third, the subjects of the study were restricted to Japanese men, and additional studies including female subjects and subjects of other ethnicities are needed to confirm the findings. Fourth, in this study protocol, therapeutic lifestyle modifications and medication were advised only for subjects with hypertension (blood pressure >140/90 mm Hg) and diabetes mellitus (fasting blood glucose >126 mg/dL) and not for those with RBP (blood pressure >130/85 mm Hg) or RPG (fasting blood glucose >110 mg/dL). Thus, the effects of therapeutic approaches, including medication, for RBP and RPG on the progression of arterial stiffening must also be examined in future studies.
Perspectives
The present observational study demonstrated that the coexistence of both RBP and RPG at the first examination was a predictor of the progression of arterial stiffening. Furthermore, in relation to the evolutional changes of the 2 disorders during the study period, the persistence of both RBP alone and RPG alone significantly accelerated the progression of arterial stiffening, and the persistence of both synergistically increased the rate of progression of arterial stiffening even more. Pressure-independent mechanisms were also surmised to contribute, at least in part, to these results. Thus, blood pressure and fasting plasma glucose levels even below those defining hypertension and diabetes mellitus, respectively, may synergistically lead to progression of arteriosclerotic arterial damage. This synergistic progression may contribute to the additive increases in the risk of cardiovascular events, at least in part. Therefore, the present study strengthens the necessity of advising therapeutic lifestyle modifications for subjects with the coexistence of above disorders.
|
Acknowledgments |
|---|
This study was supported in part by a grant-in-aid from the Japanese Atherosclerosis Prevention Fund (A.Y.). We thank Yuko Kanda, Ryoko Asanuma, and Chikako Wakabayashi for their technical assistance.
Received September 11, 2005; first decision September 29, 2005; accepted November 21, 2005.
|
References |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
- Safar ME, Levy BI, Struijker-Boudier H. Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation. 2003; 107: 2864–2869.
[Free Full Text] - Zieman SJ, Melenovsky V, Kass DA. Mechanisms, pathophysiology, and therapy of arterial stiffness. Arterioscler Thromb Vasc Biol. 2005; 25: 1–12.
[Free Full Text] - Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, Ducimetiere P, Benetos A. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001; 37: 1236–1241.
[Abstract/Free Full Text] - Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation. 2002; 106: 2085–2090.
[Abstract/Free Full Text] - Mooradian AD. Cardiovascular disease in type 2 diabetes mellitus: current management guidelines. Arch Intern Med. 2003; 163: 33–40.
[Abstract/Free Full Text] - Tomiyama H, Arai T, Koji Y, Yambe M, Motobe K, Zaydun G, Yamamoto Y, Hori S, Yamashina A. The age-related increase in arterial stiffness is augmented in phases according to the severity of hypertension. Hypertens Res. 2004; 27: 465–470.[Medline] [Order article via Infotrieve]
- Henry RM, Kostense PJ, Spijkerman AM, Dekker JM, Nijpels G, Heine RJ, Kamp O, Westerhof N, Bouter LM, Stehouwer CD. Arterial stiffness increases with deteriorating glucose tolerance status: the Hoorn Study. Circulation. 2003; 107: 2089–2095.
[Abstract/Free Full Text] - Vasan RS, Larson MG, Leip EP, Evans JC, O’Donnell CJ, Kannel WB, Levy D. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med. 2001; 345: 1291–1297.
[Abstract/Free Full Text] - Coutinho M, Gerstein HC, Wang Y, Yusuf S. The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes Care. 1999; 22: 233–240.
[Abstract/Free Full Text] - Tomiyama H, Koji Y, Yambe M, Motobe K, Shiina K, Gulnisa Z, Yamamoto Y, Yamashina A. Elevated C-reactive protein augments increased arterial stiffness in subjects with metabolic syndrome. Hypertension. 2005; 45: 997–1003.
[Abstract/Free Full Text] - Japan Atherosclerosis Society. Guidelines for diagnosis and treatment of atherosclerotic cardiovascular diseases. 2000; 4–21(In Japanese).
- Japan Diabetes Society. Guidelines for diagnosis of diabetes mellitus. J Jpn Diabetes Soc. 1999; 42: 385–404(In Japanese).
- Japanese Society of Hypertension. Guidelines for the management of hypertension. 2000: 14–21(In Japanese).
- Motobe K, Tomiyama H, Koji Y, Yambe M, Gulinisa Z, Arai T, Ichihashi H, Nagae T, Ishimaru S, Yamashina A. Cut-off value of the ankle-brachial pressure index at which the accuracy of brachial-ankle pulse wave velocity measurement is diminished. Circ J. 2005; 69: 55–60.[Medline] [Order article via Infotrieve]
- Yamashina A, Tomiyama H, Takeda K, Tsuda H, Arai T, Hirose K, Koji Y, Hori S, Yamamoto Y. Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. Hypertens Res. 2002; 25: 359–364.[CrossRef][Medline] [Order article via Infotrieve]
- Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C. American Heart Association; National Heart, Lung, and Blood Institute. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation. 2004; 109: 433–438.
[Free Full Text] - Tripathy D, Carlsson M, Almgren P, Isomaa B, Taskinen MR, Tuomi T, Groop LC. Insulin secretion and insulin sensitivity in relation to glucose tolerance: lessons from the Botnia Study. Diabetes. 2000; 49: 975–980.[Abstract]
- Benetos A, Adamopoulos C, Bureau JM, Temmar M, Labat C, Bean K, Thomas F, Pannier B, Asmar R, Zureik M, Safar M, Guize L. Determinants of accelerated progression of arterial stiffness in normotensive subjects and in treated hypertensive subjects over a 6-year period. Circulation. 2002; 105: 1202–1207.
[Abstract/Free Full Text] - Sierksma A, Lebrun CE, van der Schouw YT, Grobbee DE, Lamberts SW, Hendriks HF, Bots ML. Alcohol consumption in relation to aortic stiffness and aortic wave reflections: a cross-sectional study in healthy postmenopausal women. Arterioscler Thromb Vasc Biol. 2004; 24: 342–348.
[Abstract/Free Full Text] - Dart AM, Kingwell BA. Pulse pressure–a review of mechanisms and clinical relevance. J Am Coll Cardiol. 2001; 37: 975–984.
[Abstract/Free Full Text] - Oliver JJ, Webb DJ. Noninvasive assessment of arterial stiffness and risk of atherosclerotic events. Arterioscler Thromb Vasc Biol. 2003; 23: 554–566.
[Abstract/Free Full Text] - Tomiyama H, Kimura Y, Okazaki R, Kushiro T, Abe M, Kuwabara Y, Yoshida H, Kuwata S, Kinouchi T, Doba N. Close relationship of abnormal glucose tolerance with endothelial dysfunction in hypertension. Hypertension. 2000; 36: 245–249.
[Abstract/Free Full Text] - Wang X, Desai K, Chang T, Wu L. Vascular methylglyoxal metabolism and the development of hypertension. J Hypertens. 2005; 23: 1565–1573.[Medline] [Order article via Infotrieve]
- Newman AB, Shemanski L, Manolio TA, Cushman M, Mittelmark M, Polak JF, Powe NR, Siscovick D. Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. The Cardiovascular Health Study Group. Arterioscler Thromb Vasc Biol. 1999; 19: 538–545.
[Abstract/Free Full Text] - Tomiyama H, Koji Y, Yambe Y, Shiina K, Motobe M, Yamada J, Shido N, Tanaka N, Chikamori T, Yamashina A. Brachial-ankle pulse wave velocity is a simple and independent predictor of prognosis in patients with acute coronary syndrome. Circ J. 2005; 69: 815–822.[CrossRef][Medline] [Order article via Infotrieve]
- Kip KE, Marroquin OC, Kelley DE, Johnson BD, Kelsey SF, Shaw LJ, Rogers WJ, Reis SE. Clinical importance of obesity versus the metabolic syndrome in cardiovascular risk in women: a report from the Women’s Ischemia Syndrome Evaluation (WISE) study. Circulation. 2004; 109: 706–713.
[Abstract/Free Full Text] - Sutton-Tyrrell K, Newman A, Simonsick EM, Havlik R, Pahor M, Lakatta E, Spurgeon H, Vaitkevicius P. Aortic stiffness is associated with visceral adiposity in older adults enrolled in the study of health, aging, and body composition. Hypertension. 2001; 38: 429–433.
[Abstract/Free Full Text]
This article has been cited by other articles:
 |
|
 |
|
  R. D. Smith and P. J. Levy Review: New techniques for assessment of vascular function Therapeutic Advances in Cardiovascular Disease, October 1, 2008; 2(5): 373 - 385. [Abstract] [PDF]
|
|
|
|
 |
|
 S. Shibata, J. L. Hastings, A. Prasad, Q. Fu, K. Okazaki, M. D. Palmer, R. Zhang, and B. D. Levine 'Dynamic' Starling mechanism: effects of ageing and physical fitness on ventricular-arterial coupling J. Physiol., April 1, 2008; 586(7): 1951 - 1962. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||