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Advances in Vascular Stiffness: Part II

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 50435

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Dr. Paolo Salvi

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Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
Interests: arteriosclerosis; arterial stiffness; cardiovascular risk
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Dr. Andrea Grillo

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Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
Interests: vascular diseases; arterial stiffness; hypertension; blood pressure measurement
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Dear Colleagues,

The area of vascular disease research is constantly evolving. New methods and devices are able to assess the dynamic properties of vessels in a way that was not possible a few years ago. The measurement of vascular stiffness is becoming increasingly important for evaluating blood pressure profiles at multiple sites of the arterial tree in vascular ageing and in patient care. Current research is addressing and debating some unresolved technical and methodological issues in evaluating the structural and functional properties of vessels. Future progress in this area of research and the implementation of new indices and methodologies related to an increasingly reliable assessment of vascular stiffness will allow for an improvement in the early diagnosis of cardiovascular damage, and therefore, in the clinical care of patients.

After the successful contribution in this field of the first Special Issue on this topic, this second part will be open to submissions regarding new methodological advances in vascular stiffness evaluation, as well as their applications in clinical or preclinical research. A privileged space will be reserved for new clinical acquisitions regarding the relationship between non-invasive hemodynamic assessment and early vascular damage in the various fields of cardiovascular research.

Dr. Paolo Salvi
Dr. Andrea Grillo
Guest Editors

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Keywords

arterial stiffness
cardiovascular risk
early vascular damage
cardiovascular prevention
myocardial ischemia
arteriosclerosis

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Related Special Issue

Frontiers in Vascular Stiffness in Journal of Clinical Medicine (14 articles)

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10 pages, 255 KiB

Open AccessArticle

Diabetes-Related Changes in Carotid Wall Properties: Role of Triglycerides

by Michaela Kozakova, Carmela Morizzo, Giuseppe Penno, Dante Chiappino and Carlo Palombo

J. Clin. Med. 2024, 13(18), 5654; https://doi.org/10.3390/jcm13185654 - 23 Sep 2024

Cited by 1 | Viewed by 1090

Abstract

Background/Objectives: This study compares the power of the radiofrequency (RF) signal reflected from the media layer (media power) of the common carotid artery (CCA) and the CCA stiffness between individuals with and without type 2 diabetes mellitus (T2DM). It also evaluates the associations of CCA media power with plasma glucose and lipid levels, as well as carotid stiffness. Methods: A total of 540 individuals, 115 with and 425 without T2DM (273 males, mean age = 64 ± 8 years) were studied using RF-based tracking of the right CCA. The following parameters were measured: CCA media thickness, luminal diameter, wall tensile stress (WTS), local pulse wave velocity (PWV), and media power. Results: Compared to the non-diabetic individuals, the T2DM patients had significantly higher CCA media thickness (652 ± 122 vs. 721 ± 138 microns, p < 0.005), luminal diameter (6.12 ± 0.78 vs. 6.86 ± 0.96 mm, p < 0.0005), media power (36.1 ± 4.8 vs. 39.3 ± 4.6, p < 0.0001), and PWV (7.65 ± 1.32 vs. 8.40 ± 1.89 m/s; p < 0.01), but comparable WTS (32.7 ± 10.4 vs. 33.1 ± 10.7 kPa; p = 0.25). In the entire population, CCA media power was independently associated with male sex, pulse pressure, current smoking, and T2DM; when T2DM was not included in the model, triglycerides emerged as an independent determinant of media power. The CCA PWV was independently associated with age, pulse pressure, media power, and T2DM. Conclusions: Our findings suggest the presence of structural changes in the arterial media of T2DM patients, leading to carotid stiffening and remodeling, aiming to preserve WTS. T2DM-related changes in arterial wall composition may be driven by high plasma triglyceride levels, which have previously been associated with both arterial stiffening and the incidence of CV events. Full article

(This article belongs to the Special Issue Advances in Vascular Stiffness: Part II)

10 pages, 879 KiB

Open AccessArticle

Deterioration of Kidney Function Is Affected by Central Arterial Stiffness in Late Life

by Lisanne Tap, Kim Borsboom, Andrea Corsonello, Fabrizia Lattanzio and Francesco Mattace-Raso

J. Clin. Med. 2024, 13(5), 1334; https://doi.org/10.3390/jcm13051334 - 27 Feb 2024

Viewed by 1250

Abstract

Cardiovascular diseases affect kidney function. The aim of this study was to investigate the possible associations between hemodynamic parameters and change in kidney function in individuals aged 75 years and older. Data on hemodynamics and blood and urine samples were collected at baseline and during one-year visits. Hemodynamics were split into two groups based on median values. Changes in the estimated glomerular filtration rate (eGFR) were investigated between low and high groups for each hemodynamic parameter using analysis of variance. Changes in the albumin–creatinine ratio (ACR) were examined as binary outcomes (large increase vs. stable) using logistic regression. The population consisted of 252 participants. Participants in the high central systolic blood pressure (cSBP) group had a greater decline in eGFR than participants in the low cSBP group (−6.3% vs. −2.7%, p = 0.006). Participants in the high aortic pulse wave velocity (aPWV) group had a greater decline in eGFR than those in the low aPWV group (−6.8% vs. −2.5%, p = 0.001). Other hemodynamic parameters were not associated with eGFR changes. Hemodynamics were not associated with changes in the ACR; aPWV and cSBP appear to be predictors for eGFR decline in older age; monitoring and treatment of elevated stiffness might be helpful in order to prevent kidney function decline. Full article

(This article belongs to the Special Issue Advances in Vascular Stiffness: Part II)

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11 pages, 848 KiB

Open AccessArticle

Differences between SCORE, Framingham Risk Score, and Estimated Pulse Wave Velocity-Based Vascular Age Calculation Methods Based on Data from the Three Generations Health Program in Hungary

by Helga Gyöngyösi, Gergő József Szőllősi, Orsolya Csenteri, Zoltán Jancsó, Csaba Móczár, Péter Torzsa, Péter Andréka, Péter Vajer and János Nemcsik

J. Clin. Med. 2024, 13(1), 205; https://doi.org/10.3390/jcm13010205 - 29 Dec 2023

Cited by 5 | Viewed by 1722

Abstract

Early vascular ageing contributes to cardiovascular (CV) morbidity and mortality. There are different possibilities to calculate vascular age including methods based on CV risk scores, but different methods might identify different subjects with early vascular ageing. We aimed to compare SCORE and Framingham Risk Score (FRS)-based vascular age calculation methods on subjects that were involved in a national screening program in Hungary. We also aimed to compare the distribution of subjects identified with early vascular ageing based on estimated pulse wave velocity (ePWV). The Three Generations for Health program focuses on the development of primary health care in Hungary. One of the key elements of the program is the identification of risk factors of CV diseases. Vascular ages based on the SCORE and FRS were calculated based on previous publications and were compared with chronological age and with each other in the total population and in patients with hypertension or diabetes. ePWV was calculated based on a method published previously. Supernormal, normal, and early vascular ageing were defined as <10%, 10–90%, and >90% ePWV values for the participants. In total, 99,231 subjects were involved in the study, and among them, 49,191 patients had hypertension (HT) and 15,921 patients had diabetes (DM). The chronological age of the total population was 54.0 (48.0–60.0) years, while the SCORE and FRS vascular ages were 59.0 (51.0–66.0) and 64.0 (51–80) years, respectively. In the HT patients, the chronological, SCORE, and FRS vascular ages were 57.0 (51.0–62.0), 63.0 (56.0–68.0), and 79.0 (64.0–80.0) years, respectively. In the DM patients, the chronological, SCORE, and FRS vascular ages were 58.0 (52.0–62.0), 63.0 (56.0–68.0), and 80.0 (76.0–80.0) years, respectively. Based on ePWV, the FRS identified patients with an elevated vascular age with high sensitivity (97.3%), while in the case of the SCORE, the sensitivity was much lower (13.3%). In conclusion, different vascular age calculation methods can provide different vascular age results in a population-based cohort. The importance of this finding for the implementation in CV preventive strategies requires further studies. Full article

(This article belongs to the Special Issue Advances in Vascular Stiffness: Part II)

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14 pages, 2105 KiB

Open AccessArticle

Wall Properties of Elastic and Muscular Arteries in Children and Adolescents at Increased Cardiovascular Risk

by Simonetta Genovesi, Elena Tassistro, Giulia Lieti, Ilenia Patti, Marco Giussani, Laura Antolini, Antonina Orlando, Paolo Salvi and Gianfranco Parati

J. Clin. Med. 2023, 12(21), 6919; https://doi.org/10.3390/jcm12216919 - 3 Nov 2023

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Abstract

Background: Pulse wave velocity (PWV) assessment represents a simple method to estimate arterial distensibility. At present, carotid-femoral PWV (cf-PWV) is considered the gold standard method in the non-invasive evaluation of the elastic properties of the aorta. On the other hand, the mechanical properties of muscular arteries can be evaluated on the axillo-brachial-radia axis by estimating the carotid-radial PWV (cr-PWV). While a number of studies have addressed these issues in adults, limited information is available on the respective features of cf-PWV and cr-PWV and on their modulating factors in children and adolescents at increased cardiovascular risk. Methods: The mechanical properties of the predominantly elastic (aorta) and muscular (axillo−brachial−radial axis) arteries were evaluated in a pediatric population characterized by either elevated blood pressure (BP) or excess body weight, and the main factors affecting cf-PWV and cr-PWV values in these individuals were investigated. Results: 443 children and adolescents (median age 11.5 years, 43.3% females) were enrolled; 25% had BP values >90th percentile and 81% were excess weight. The cf-PWV values were significantly lower than the cr-PWV values: median (Q1–Q3) = 4.8 m/s (4.3–5.5) and 5.8 m/s (5.0–6.5), respectively (p < 0.001). The pubertal development (p < 0.03), systolic BP and diastolic BP z-scores (p = 0.002), heart rate (p < 0.001), and waist-to-height ratio (p < 0.005) were significantly associated with cf-PWV values. No significant association was found between BMI z-score and cf-PWV. Predictors of high cf-PWV (>95th percentile) were the heart rate (OR 1.07, 95%CI 1.04–1.10, p < 0.001) and waist-to-height ratio (OR 1.06, 95%CI 1.0–1.13, p = 0.04). The variables significantly related with cr-PWV values were diastolic BP z-score (p = 0.001), heart rate (p < 0.01), and HOMA index (p < 0.02). No significant association was found between the cr-PWV and BMI z-score or waist-to-height ratio. Conclusions: Systolic and diastolic BP values and central obesity are associated with aortic stiffness in a population of children and adolescents at increased cardiovascular risk. In contrast, diastolic BP, heart rate, and levels of insulin resistance appear to be related to distensibility of the upper limb vascular district. Full article

(This article belongs to the Special Issue Advances in Vascular Stiffness: Part II)

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11 pages, 1190 KiB

Open AccessArticle

Cardio-Ankle Vascular Index and Aging: Differences between CAVI and CAVI0

by Anna Giani, Rocco Micciolo, Elena Zoico, Gloria Mazzali, Mauro Zamboni and Francesco Fantin

J. Clin. Med. 2023, 12(21), 6726; https://doi.org/10.3390/jcm12216726 - 24 Oct 2023

Cited by 2 | Viewed by 1563

Abstract

Background: Cardio-ankle vascular index (CAVI) and CAVI0 (a mathematical expression derived from CAVI, supposed to be less dependent on blood pressure), can describe arterial stiffness, considering a wide proportion of the arterial tree. The aim of this study was to examine the relationship between CAVI, CAVI0 and aging, looking at the differences between the two arterial stiffness indexes. Methods: A total of 191 patients (68 male, mean age 68.3 ± 14.4 years) referred to the Geriatric Ward and Outpatient Clinic at Verona University Hospital were included and underwent a comprehensive clinical evaluation. CAVI and CAVI0 were obtained for each. Results: CAVI0 steeply rises in the elderly age strata, widening the gap between CAVI and CAVI0. An inverse relationship is evident between CAVI0 and DBP in older patients, and CAVI0 is shown to be dependent on age, DBP and age-DBP interaction (R² = 0.508). Age modifies the effect of DBP on CAVI0, but not on CAVI. Conclusions: The real new findings of our study are that the association between CAVI0 and diastolic blood pressure (DBP) is modified by age, whereas the association between CAVI and DBP is not modified by age. From a clinical point of view, these are very important findings, as DBP decreases with aging, affecting in elderly populations the reliability of CAVI0, which strictly depends on DBP in the formula to calculate it. To monitor the effect of CV therapies, progression of CV diseases and to evaluate clinical outcomes in elderly populations, we suggest using CAVI and not CAVI0. Full article

(This article belongs to the Special Issue Advances in Vascular Stiffness: Part II)

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10 pages, 268 KiB

Open AccessArticle

Comparison of Parameters for Assessment of Carotid Stiffness and Their Association with Carotid Atherosclerosis in Rural Australian Adults: A Pilot Study

by Marjana Petrova, Alex Gavino, Yujie Li and Craig S. McLachlan

J. Clin. Med. 2023, 12(8), 2935; https://doi.org/10.3390/jcm12082935 - 18 Apr 2023

Cited by 2 | Viewed by 1735

Abstract

Carotid stiffness has been associated with the development and progression of carotid artery disease and is an independent factor for stroke and dementia. There has also been a lack of comparison of different ultrasound-derived carotid stiffness parameters and their association with carotid atherosclerosis. This pilot study aimed to investigate the associations between carotid stiffness parameters (derived via ultrasound echo tracking) and the presence of carotid plaques in Australian rural adults. In cross-sectional analyses, we assessed forty-six subjects (68 ± 9 years; mean ± SD) who underwent carotid ultrasound examinations. Carotid stiffness was assessed by a noninvasive echo-tracking method, measuring and comparing multiple carotid stiffness parameters, including stroke change in diameter (ΔD), stroke change in lumen area (ΔA), β- stiffness index, pulse wave velocity beta (PWV-β), compliance coefficient (CC), distensibility coefficient (DC), Young’s elastic modulus (YEM), Peterson elastic modulus (Ep), and strain. Carotid atherosclerosis was assessed bilaterally by the presence of plaques in the common and internal carotid arteries, while carotid stiffness was assessed at the right common carotid artery. β-stiffness index, PWV-β, and Ep were significantly higher (p = 0.006, p = 0.004, p = 0.02, respectively), whilst ΔD, CC, DC, and strain were lower among subjects with carotid plaques (p = 0.036, p = 0.032, p = 0.01, p = 0.02, respectively) comparing to subjects without carotid plaques. YEM and ΔA did not significantly differ among the groups. Carotid plaques were associated with age, history of stroke, coronary artery disease, and previous coronary interventions. These results suggest that unilateral carotid stiffness is associated with the presence of carotid plaques. Full article

(This article belongs to the Special Issue Advances in Vascular Stiffness: Part II)

15 pages, 4768 KiB

Open AccessArticle

Role of Chemerin and Perivascular Adipose Tissue Characteristics on Cardiovascular Risk Assessment by Arterial Stiffness Markers in Patients with Morbid Obesity

by Viviana Aursulesei Onofrei, Ecaterina Anisie, Carmen Lacramioara Zamfir, Alexandr Ceasovschih, Mihai Constantin, Florin Mitu, Elena-Daniela Grigorescu, Antoneta Dacia Petroaie and Daniel Vasile Timofte

J. Clin. Med. 2023, 12(8), 2885; https://doi.org/10.3390/jcm12082885 - 14 Apr 2023

Viewed by 1890

Abstract

Background and objective: The development of arterial stiffness (AS) in obesity is a multifactorial and complex process. The pleomorphic actions of adipokines and their local activity in perivascular adipose tissue (PVAT) are potential modulators of AS appearance and progression. We aimed to assess the correlations between two adipokines (chemerin, adiponectin), PVAT morphological changes (adipocyte size, blood vessel wall thickness) and AS parameters in the special subgroup of patients with morbid obesity. Material and methods: We enrolled 25 patients with morbid obesity and 25 non-obese patients, who were age- and gender-matched, untreated for cardiovascular risk factors, and admitted to hospital for laparoscopic surgical procedures (bariatric surgery for morbid obesity and non-inflammatory benign pathology surgery for non-obese patients). Before the surgical procedures, we evaluated demographic and anthropometric data and biochemical parameters including the studied adipokines. Arterial stiffness was evaluated using a Medexpert ArteriographTM TL2 device. In both groups, adipocyte size and vascular wall thickness as well as local adiponectin activity were analyzed in PVAT from intraoperative biopsies. Results: In our study, adiponectin (p = 0.0003), chemerin (p = 0.0001) and their ratio (p = 0.005) had statistically significant higher mean values in patients with morbid obesity compared to normal-weight patients. In patients with morbid obesity there were significant correlations between chemerin and AS parameters such as aortic pulse wave velocity (p = 0.006) and subendocardial viability index (p = 0.009). In the same group adipocyte size was significantly correlated with another AS parameter, namely, aortic systolic blood pressure (p = 0.030). In normal-weight patients, blood vessel wall thickness positively correlated with AS parameters such as brachial (p = 0.023) and aortic augmentation index (p = 0.023). An important finding was the negative adipoR1 and adipoR2 immunoexpression in PVAT adipocytes of patients with morbid obesity. Additionally, we found significant correlations between blood vessel wall thickness and blood fasting glucose (p < 0.05) in both groups. Conclusions: Chemerin and adipocyte size could be predictive biomarkers for AS in patients with morbid obesity. Given the small number of patients included, our results need further validation. Full article

(This article belongs to the Special Issue Advances in Vascular Stiffness: Part II)

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14 pages, 921 KiB

Open AccessArticle

Long-Term Adverse Effects of Mild COVID-19 Disease on Arterial Stiffness, and Systemic and Central Hemodynamics: A Pre-Post Study

by Mario Podrug, Pjero Koren, Edita Dražić Maras, Josip Podrug, Viktor Čulić, Maria Perissiou, Rosa Maria Bruno, Ivana Mudnić, Mladen Boban and Ana Jerončić

J. Clin. Med. 2023, 12(6), 2123; https://doi.org/10.3390/jcm12062123 - 8 Mar 2023

Cited by 13 | Viewed by 33671

Abstract

COVID-19-associated vascular disease complications are primarily associated with endothelial dysfunction; however, the consequences of disease on vascular structure and function, particularly in the long term (>7 weeks post-infection), remain unexplored. Individual pre- and post-infection changes in arterial stiffness as well as central and systemic hemodynamic parameters were measured in patients diagnosed with mild COVID-19. As part of in-laboratory observational studies, baseline measurements were taken up to two years before, whereas the post-infection measurements were made 2–3 months after the onset of COVID-19. We used the same measurement protocol throughout the study as well as linear and mixed-effects regression models to analyze the data. Patients (N = 32) were predominantly healthy and young (mean age ± SD: 36.6 ± 12.6). We found that various parameters of arterial stiffness and central hemodynamics—cfPWV, AIx@HR75, and cDBP as well as DBP and MAP—responded to a mild COVID-19 disease. The magnitude of these responses was dependent on the time since the onset of COVID-19 as well as age (p_{regression_models} ≤ 0.013). In fact, mixed-effects models predicted a clinically significant progression of vascular impairment within the period of 2–3 months following infection (change in cfPWV by +1.4 m/s, +15% in AIx@HR75, approximately +8 mmHg in DBP, cDBP, and MAP). The results point toward the existence of a widespread and long-lasting pathological process in the vasculature following mild COVID-19 disease, with heterogeneous individual responses, some of which may be triggered by an autoimmune response to COVID-19. Full article

(This article belongs to the Special Issue Advances in Vascular Stiffness: Part II)

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Open AccessFeature PaperReview

Atrial Fibrillation and Early Vascular Aging: Clinical Implications, Methodology Issues and Open Questions—A Review from the VascAgeNet COST Action

by Giacomo Pucci, Andrea Grillo, Kalliopi V. Dalakleidi, Emil Fraenkel, Eugenia Gkaliagkousi, Spyretta Golemati, Andrea Guala, Bernhard Hametner, Antonios Lazaridis, Christopher C. Mayer, Ioana Mozos, Telmo Pereira, Dave Veerasingam, Dimitrios Terentes-Printzios and Davide Agnoletti

J. Clin. Med. 2024, 13(5), 1207; https://doi.org/10.3390/jcm13051207 - 20 Feb 2024

Viewed by 2356

Abstract

Atrial fibrillation (AF), the most common cardiac arrhythmia, is associated with adverse CV outcomes. Vascular aging (VA), which is defined as the progressive deterioration of arterial function and structure over a lifetime, is an independent predictor of both AF development and CV events. A timing identification and treatment of early VA has therefore the potential to reduce the risk of AF incidence and related CV events. A network of scientists and clinicians from the COST Action VascAgeNet identified five clinically and methodologically relevant questions regarding the relationship between AF and VA and conducted a narrative review of the literature to find potential answers. These are: (1) Are VA biomarkers associated with AF? (2) Does early VA predict AF occurrence better than chronological aging? (3) Is early VA a risk enhancer for the occurrence of CV events in AF patients? (4) Are devices measuring VA suitable to perform subclinical AF detection? (5) Does atrial-fibrillation-related rhythm irregularity have a negative impact on the measurement of vascular age? Results showed that VA is a powerful and independent predictor of AF incidence, however, its role as risk modifier for the occurrence of CV events in patients with AF is debatable. Limited and inconclusive data exist regarding the reliability of VA measurement in the presence of rhythm irregularities associated with AF. To date, no device is equipped with tools capable of detecting AF during VA measurements. This represents a missed opportunity to effectively perform CV prevention in people at high risk. Further advances are needed to fill knowledge gaps in this field. Full article

(This article belongs to the Special Issue Advances in Vascular Stiffness: Part II)

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16 pages, 311 KiB

Open AccessReview

Changes in Arterial Stiffness in Response to Blood Flow Restriction Resistance Training: A Narrative Review

by Ioana Mădălina Zota, Cristina Mihaela Ghiciuc, Doina Clementina Cojocaru, Corina Lucia Dima-Cozma, Maria Magdalena Leon, Radu Sebastian Gavril, Mihai Roca, Alexandru Dan Costache, Alexandra Maștaleru, Larisa Anghel, Cristian Stătescu, Radu Andy Sascău and Florin Mitu

J. Clin. Med. 2023, 12(24), 7602; https://doi.org/10.3390/jcm12247602 - 10 Dec 2023

Cited by 1 | Viewed by 2846

Abstract

Arterial stiffness naturally increases with age and is a known predictor of cardiovascular morbimortality. Blood flow restriction (BFR) training involves decreasing muscle blood flow by applying a strap or a pneumatic cuff during exercise. BFR induces muscle hypertrophy even at low intensities, making it an appealing option for older, untrained individuals. However, BFR use in patients with cardiovascular comorbidities is limited by the increased pressor and chronotropic response observed in hypertensive elderly patients. Furthermore, the impact of BFR on vascular function remains unclear. We conducted a comprehensive literature review according to PRISMA guidelines, summarizing available data on the acute and long-term consequences of BFR training on vascular function. Although evidence is still scarce, it seems that BFR has a mild or neutral long-term impact on arterial stiffness. However, current research shows that BFR can cause an abrupt, albeit transient, increase in PWV and central blood pressure. BFR and, preferably, lower-body BFR, should be prescribed with caution in older populations, especially in hypertensive patients who have an exacerbated muscle metaboreflex pressor response. Longer follow-up studies are required to assess the chronic effect of BFR training on arterial stiffness, especially in elderly patients who are usually unable to tolerate high-intensity resistance exercises. Full article

(This article belongs to the Special Issue Advances in Vascular Stiffness: Part II)

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