‘Screening for ‘causes’ of hypertension – needles, haystacks & mass spec(ulation)?’ Hypertension in the blood - & urine..? Prof Kennedy Cruickshank Cardiovascular Medicine & Diabetes Nutritional Sciences Division King’s College & King’s Health Partners (St Thomas’/Guy’s Hosps), UK London (with Univ. West Indies, Jamaica & Barbados, Cameroon, Nigeria, Ghana & New Orleans, USA).
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hypertension needles, haystacks - Viapath7) Professor...Journal of Computational Physics. DOI: 10.1016/j.jcp.2012.09.016 Variation in Flow and Pressure across the ... Velocity (PWV)
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‘Screening for ‘causes’ of
hypertension – needles, haystacks
& mass spec(ulation)?’
Hypertension in the blood - & urine..?
Prof Kennedy Cruickshank
Cardiovascular Medicine & Diabetes
Nutritional Sciences Division
King’s College &
King’s Health Partners (St Thomas’/Guy’s Hosps), UK
London (with Univ. West Indies, Jamaica & Barbados,
Cameroon, Nigeria, Ghana & New Orleans, USA).
N. Xiao, J.D. Humphrey, C.A. Figueroa. "Multi-Scale Computational Model of Three-
Dimensional Hemodynamics within a Deformable Full-Body Arterial Network."
Journal of Computational Physics. DOI: 10.1016/j.jcp.2012.09.016
Variation in
Flow and Pressure
across the
Arterial tree..
(modelled) Note resulting
Pulse Wave
Velocity
changes
(estimated) Courtesy of
Dr A Figueroa,
King’s College
Alteration in arterial parameter
Number of CV events
Arterial biomarker of CV events :
Intermediate end-point
Longitudinal study
Eg:
Pulse wave velocity (PWV)
Central (aortic) BP
Augmentation ?
CVD death rates by Systolic Blood
Pressure
0
50
100
150
200
250
300
<120 120-
139
140-
159
160-
179
180-
199
>200
Systolic BP level (mmHg)
Dea
th r
ate
s p
er 1
0,0
00
perso
n-y
rs
without diabetes
with diabetes
Age adjusted cardiovascular death rates
with and without diabetes at screening
for MRFIT
Alive Died
80 220 4
25
130 160 190
Pu
lse
Wa
ve
Vel
oci
ty (
m/s
)
Arterial Stiffness as Pulse Wave
Velocity (PWV) vs SBP for all
T2 Diabetes & GTTd Controls
Vacarro et al 2003 Cruickshank et al Circulation 2002
Systolic BP mmHg
NB: Accord Trial data 2010
Individual Patient Meta-analysis of Arterial
Stiffness and Mortality – an intermediary
outcome not a risk factor..
Ben-Shlomo et al, JACC 2014
0
10
20
30
40 %
< 50 60 70 80 90 100 110 120 130 140
Diastolic Blood Pressure mmHg
Manchester 23 Jamaica 15 Cameroon – urban 4.4
% BP (treated)
Cameroon – rural 0.5
Age-adjusted blood pressure distributions of
west African-origin populations
Cruickshank et al, J Hypert 2001; 19: 41-46
Barker hypothesis
• Fetal origins of Adult CVS Disease*
• Consistent, global association of poor fetal growth
Low Birth weight Disproportional
thin baby poor placenta
• ? Nutritional inadequacy
* Barker DJP. Mothers, babies & Disease in later
life. BMJ books, London 1998.
Weight Gain from Birth to 3 months
& Rise in Systolic BP
Bansal et al, J Hypert 2008; 26 (3): 412-18
‘Tracking’ coefficients of children blood pressure: the Brompton study, UK