1. Case studies Subjects measured with Arteriograph

2. The scope of the Arteriograph: 1.Screening asymptomatic, apparently healthy subjects It makes possible to detect atherosclerosis in an early phase 2.Evaluating the efficiency of applied therapy Follow-up Comparison

3. 1. Screening asymptomatic, apparently healthy subjects

4. The data show low risk – the subject is presumed to be healthy, no intervention is needed (according to guidelines) !!! However, according to arterial stiffness evaluation with Arteriograph... Elevated Aix = risk of endothel disfunction !!!

5. Examination: – High cholesterol level (7,30 mmol/l) was determined Conclusion: – By screening a low-risk, apparently healthy subject with Arteriograph risk of endothel disfunction could be showed – Therefore the screening of asymptomatic subject with Arteriograph is needed and important !!!

6. However according to arterial stiffness evaluation with Arteriograph... Elevated PWV (>9,62) = high CV risk !!! According to ESH / ESC guidelines intervention is needed !!! Enalapril, Hydrochlorothiazide Low CV risk, according to SCORE stratification, no intervention is needed

7. Examination: – Carotid Ultrasound – positive (plaque) Conclusion: – By screening an apparently healthy subject with Arteriograph high CV risk could be showed – Further examination (CUS) confirmed the necessity of treatment

8. 2. Evaluating the efficiency of applied therapy

9. Bisoprolol, Ramipril Abnormal Aix, high central blood pressure (Increased peripheral vasoconstriction!) First example Use a β-blocker, with vasodilation effect !!! However… Treated (β-blocker) hypertensive subject

10. Quinapril, Nebivolol, Atorvastatin, Acetylsalicylic Acid First example β-blocker with vasodilation effect Normal Aix, normal central blood pressure !!! The same subject with modified therapy

11. Bisoprolol, Simvastatin Treated (β-blocker) hypertensive subject Abnormal Aix, high central blood pressure (Increased peripheral vasoconstriction!) What are we supposed to do??? Rethink the treatment!!! (Change therapy!) Second example

12. Amlodipine, Simvastatin The suggested new medicine is a CCB Normal Aix, improved central systolic blood pressure !!! Second example

13. Conclusion: – When treating a hypertensive subject, it is very important to lower - besides the peripheral BP - the central blood pressure as well !!! – The Arteriograph gives important hemodynamical parameters by which the effect of an anti-hypertensive drug can be evaluated

14. Acetylsalicylic Acid, Clopidogrel, Ramipril A study ??? Post-MI, post-PTCA subject Which one is good prognosis: high Aix, or low Aix ????????????