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Current Vascular Pharmacology

Editor-in-Chief

ISSN (Print): 1570-1611
ISSN (Online): 1875-6212

Research Article

Rationale and Design of the ACS-BP Study: Prognostic Value of In-Hospital Blood Pressure and Indices of Atherosclerosis in Acute Coronary Syndromes

Author(s): Areti Koumelli , Konstantinos Konstantinou, Alexandros Kasiakogias, Kyriakos Dimitriadis, Ioannis Leontsinis , Emmanouil Mantzouranis , Elias Tolis, Christos Fragkoulis, Ioannis Ntalakouras, Costas Thomopoulos, Dimitrios Tousoulis and Costas Tsioufis*

Volume 19, Issue 4, 2021

Published on: 20 August, 2020

Page: [438 - 443] Pages: 6

DOI: 10.2174/1570161118666200820134959

Price: $65

Abstract

Background: High blood pressure (BP) is a leading risk factor for coronary artery disease and other major cardiovascular events.

Objective: Blood pressure variability (BPV), ambulatory arterial stiffness index (AASI) and ankle- brachial index (ABI) have been proposed as indices that can improve risk stratification for an adverse cardiac outcome. However, their utility in the setting of acute coronary syndromes (ACS) is unclear.

Methods: The ACS-BP study is a single-centre observational cohort study designed to investigate the prognostic role of haemodynamic load and arterial stiffness indices for cardio-renal outcomes in patients with acute myocardial infarction (AMI). All consecutive patients admitted with a diagnosis of acute AMI with or without ST segment elevation were screened for inclusion in the study. The management of AMI will follow current guidelines.

Results and Discussion: Data from baseline clinical and laboratory parameters during their hospitalization were collected. The haemodynamic load of each patient was determined by clinical BP values as well as 24-h ambulatory BP monitoring. The AASI was calculated from the raw 24-h BP data and ABI was measured after the third day of hospitalization using a certified device. Patients were followed-up for 12 months in order to collect data for hard cardiovascular and renal endpoints.

Conclusion: The study results should clarify the role of these non-invasive tools in secondary risk stratification of such patients.

Keywords: Myocardial infarction, blood pressure variability, arterial stiffness, ankle-brachial index, hypertension, cardiovascular disease.

Graphical Abstract
[1]
Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet 2008; 371(9623): 1513-8.
[http://dx.doi.org/10.1016/S0140-6736(08)60655-8] [PMID: 18456100]
[2]
García-García Á, García-Ortiz L, Recio-Rodríguez JI, et al. Relationship of 24-h blood pressure variability with vascular structure and function in hypertensive patients. Blood Press Monit 2013; 18(2): 101-6.
[http://dx.doi.org/10.1097/MBP.0b013e32835ebc58] [PMID: 23388405]
[3]
Mena LJ, Felix VG, Melgarejo JD, Maestre GE. 24-Hour blood pressure variability assessed by average real variability: A systematic review and meta-analysis. J Am Heart Assoc 2017; 6(10): e006895.
[http://dx.doi.org/10.1161/JAHA.117.006895] [PMID: 29051214]
[4]
Hoshide S, Yano Y, Mizuno H, Kanegae H, Kario K. Day-by-Day Variability of Home Blood Pressure and Incident Cardiovascular Disease in Clinical Practice: The J-HOP Study (Japan Morning Surge-Home Blood Pressure). Hypertension 2018; 71(1): 177-84.
[http://dx.doi.org/10.1161/HYPERTENSIONAHA.117.10385] [PMID: 29133364]
[5]
Parati G, Pomidossi G, Albini F, Malaspina D, Mancia G. Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension. J Hypertens 1987; 5(1): 93-8.
[http://dx.doi.org/10.1097/00004872-198702000-00013] [PMID: 3584967]
[6]
Sumida K, Molnar MZ, Potukuchi PK, et al. Pre-end-stage renal disease visit-to-visit systolic blood pressure variability and post-end-stage renal disease mortality in incident dialysis patients. J Hypertens 2017; 35(9): 1816-24.
[http://dx.doi.org/10.1097/HJH.0000000000001376] [PMID: 28399042]
[7]
Hisamatsu T, Miura K, Ohkubo T, et al. Home blood pressure variability and subclinical atherosclerosis in multiple vascular beds: a population-based study. J Hypertens 2018; 36(11): 2193-203.
[http://dx.doi.org/10.1097/HJH.0000000000001810] [PMID: 29939942]
[8]
Mehlum MH, Liestøl K, Kjeldsen SE, et al. Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline risks. Eur Heart J 2018; 39(24): 2243-51.
[http://dx.doi.org/10.1093/eurheartj/ehx760] [PMID: 29365085]
[9]
Stevens SL, Wood S, Koshiaris C, et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ 2016; 354: i4098.
[http://dx.doi.org/10.1136/bmj.i4098] [PMID: 27511067]
[10]
Gosmanova EO, Mikkelsen MK, Molnar MZ, et al. Association of systolic blood pressure variability with mortality, coronary heart disease, stroke, and renal Disease. J Am Coll Cardiol 2016; 68(13): 1375-86.
[http://dx.doi.org/10.1016/j.jacc.2016.06.054] [PMID: 27659458]
[11]
Levi-Marpillat N, Macquin-Mavier I, Tropeano AI, Parati G, Maison P. Antihypertensive drug classes have different effects on short-term blood pressure variability in essential hypertension. Hypertens Res 2014; 37(6): 585-90.
[http://dx.doi.org/10.1038/hr.2014.33] [PMID: 24671016]
[12]
Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2018; 39(9): 763-816.
[http://dx.doi.org/10.1093/eurheartj/ehx095] [PMID: 28886620]
[13]
Aboyans V, Criqui MH, Abraham P, et al. Measurement and interpretation of the ankle-brachial index: a scientific statement from the American Heart Association. Circulation 2012; 126(24): 2890-909.
[http://dx.doi.org/10.1161/CIR.0b013e318276fbcb] [PMID: 23159553]
[14]
Fowkes FGR, Murray GD, Butcher I, et al. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA 2008; 300(2): 197-208.
[http://dx.doi.org/10.1001/jama.300.2.197] [PMID: 18612117]
[15]
Leoncini G, Ratto E, Viazzi F, et al. Increased ambulatory arterial stiffness index is associated with target organ damage in primary hypertension. Hypertension 2006; 48(3): 397-403.
[http://dx.doi.org/10.1161/01.HYP.0000236599.91051.1e] [PMID: 16880345]
[16]
Kollias A, Stergiou GS, Dolan E, O’Brien E. Ambulatory arterial stiffness index: a systematic review and meta-analysis. Atherosclerosis 2012; 224(2): 291-301.
[http://dx.doi.org/10.1016/j.atherosclerosis.2012.03.039] [PMID: 22632918]
[17]
Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39(2): 119-77.
[http://dx.doi.org/10.1093/eurheartj/ehx393] [PMID: 28886621]
[18]
Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2016; 37(29): 2315-81.
[http://dx.doi.org/10.1093/eurheartj/ehw106] [PMID: 27222591]
[19]
Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J 2019; 40(3): 226.
[http://dx.doi.org/10.1093/eurheartj/ehy856] [PMID: 30649367]
[20]
Li Y, Wang JG, Dolan E, et al. Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring. Hypertension 2006; 47(3): 359-64.
[http://dx.doi.org/10.1161/01.HYP.0000200695.34024.4c] [PMID: 16432048]
[21]
Eagle KA, Lim MJ, Dabbous OH, et al. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA 2004; 291(22): 2727-33.
[http://dx.doi.org/10.1001/jama.291.22.2727] [PMID: 15187054]
[22]
Aoyama R, Takano H, Suzuki K, et al. The impact of blood pressure variability on coronary plaque vulnerability in stable angina: an analysis using optical coherence tomography. Coron Artery Dis 2017; 28(3): 225-31.
[http://dx.doi.org/10.1097/MCA.0000000000000462] [PMID: 28005559]
[23]
Hassan AKM, Abd-El Rahman H, Mohsen K, Dimitry SR. Impact of in-hospital blood pressure variability on cardiovascular outcomes in patients with acute coronary syndrome. J Clin Hypertens (Greenwich) 2017; 19(12): 1252-9.
[http://dx.doi.org/10.1111/jch.13107] [PMID: 29105946]
[24]
Manning LS, Rothwell PM, Potter JF, Robinson TG. Prognostic significance of short-term blood pressure variability in acute stroke: systematic review. Stroke 2015; 46(9): 2482-90.
[http://dx.doi.org/10.1161/STROKEAHA.115.010075] [PMID: 26243226]
[25]
Konstantinou K, Tsioufis C, Koumelli A, et al. Hypertension and patients with acute coronary syndrome: Putting blood pressure levels into perspective. J Clin Hypertens (Greenwich) 2019; 21(8): 1135-43.
[http://dx.doi.org/10.1111/jch.13622] [PMID: 31301119]
[26]
Bahrainwala J, Patel A, Diaz KM, et al. Ambulatory Arterial Stiffness Index and circadian blood pressure variability. J Am Soc Hypertens 2015; 9(9): 705-10.
[http://dx.doi.org/10.1016/j.jash.2015.07.001] [PMID: 26260424]
[27]
Cieślik-Guerra UI, Kamiński M, Kurpesa M. Correlations of pulse wave velocity with augmentation index and ambulatory arterial stiffness index in the population of patients after acute coronary syndrome. Preliminary results of the FOREVER study. Pol Arch Med Wewn 2013; 123(6): 327-9.
[http://dx.doi.org/10.20452/pamw.1790] [PMID: 23828154]

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