|Year : 2019 | Volume
| Issue : 1 | Page : 55-57
Blood pressure deviation from the golden ratio φ and all-cause mortality: A pythagorean view of the arterial pulse
Theodore G Papaioannou1, Manolis Vavuranakis2, Elias J Gialafos3, Marianna Karamanou4, Gregory Tsoucalas5, Dimitrios A Vrachatis1, Dimitrios Soulis1, Danae Manolesou1, Christodoulos Stefanadis1, Dimitrios Tousoulis1
1 First Department of Cardiology, Biomedical Engineering Unit, Medical School, National and Kapodistrian University of Athens, Athens, Greece
2 First Department of Cardiology, Biomedical Engineering Unit; Third Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
3 Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
4 Department of History of Medicine and Medical Deontology, Medical School, University of Crete, Heraklion, Crete, Greece
5 Medical School, Democritus University of Thrace, Alexandroupolis, Greece
|Date of Submission||05-May-2018|
|Date of Acceptance||30-Oct-2018|
|Date of Web Publication||15-Feb-2019|
Assoc. Prof. Theodore G Papaioannou
First Department of Cardiology, Biomedical Engineering Unit, Medical School, National and Kapodistrian University of Athens, Vas. Sophias 114, Athens 115 28
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: There is one mathematical element with strong historical and philosophical background that exhibits remarkable properties and applications; the golden ratio (phi). Mathematically, the golden ratio equals approximately 1.61803. A rather provocative geometrical analysis of the arterial pulse according to the golden ratio was recently described, and herein, we aim to set out the hypothesis that individuals with blood pressure (BP) values that follow the golden ratio may have different prognosis than those whose BPs deviate from the divine proportions. Materials and Methods: We used published data from the National Health and Nutrition Examination Survey during 1999–2010. Results: We found that the deviation of the BP values from the golden ratio is independently associated with all-cause mortality. Conclusions: This observation stimulates further research of the potential utility of the golden ratio of BP values on the diagnosis and prediction of BP-related abnormalities and risk.
Keywords: Aorta, arterial pulse, blood pressure, brachial artery, hemodynamics, pulse wave analysis
|How to cite this article:|
Papaioannou TG, Vavuranakis M, Gialafos EJ, Karamanou M, Tsoucalas G, Vrachatis DA, Soulis D, Manolesou D, Stefanadis C, Tousoulis D. Blood pressure deviation from the golden ratio φ and all-cause mortality: A pythagorean view of the arterial pulse. Int J App Basic Med Res 2019;9:55-7
|How to cite this URL:|
Papaioannou TG, Vavuranakis M, Gialafos EJ, Karamanou M, Tsoucalas G, Vrachatis DA, Soulis D, Manolesou D, Stefanadis C, Tousoulis D. Blood pressure deviation from the golden ratio φ and all-cause mortality: A pythagorean view of the arterial pulse. Int J App Basic Med Res [serial online] 2019 [cited 2019 Nov 14];9:55-7. Available from: http://www.ijabmr.org/text.asp?2019/9/1/55/252359
| Introduction|| |
A rather provocative geometrical analysis of the arterial pulse according to the golden ratio (phi) was recently described. This ratio, otherwise known as divine proportion, extreme and mean ratio, or golden number, is defined as the ratio of two quantities (a and b) where the ratio of the larger quantity (a) to the smaller one (b) is equal to the ratio of the sum of the quantities (a + b) to the larger quantity (a). The golden ratio is symbolized by the Greek letter φ (phi), and its value is approximately 1.618. While the Egyptians seem to have employed φ in the design of the Great Pyramids (2560 BC), most evidence designates that its mathematical concept was theoretically described by the mathematician and philosopher Pythagoras of Samos (CA 580BC-500BC) and his school.
The golden ratio is observed in several places in nature, and it is believed that fulfill conditions of ultimate esthetics and harmony. Phi has been used historically in architecture and art. For example, it can be found in the famous painting the Mona Lisa, in Parthenon and other places like the pyramids of Egypt. This ratio is symbolized by the Greek letter φ (phi), the first Greek letter of the name of the Greek architect and sculptor Phidias (480BC-430BC) since he used it broadly in his sculptures including those of Parthenon.
Among other biological phenotypes, the arterial pulse may also exhibit characteristics following the divine proportion.,, In terms of rhythm (in time domain), the cardiac pulse has been thought to follow a harmonic and perhaps “divine” pattern as recently speculated and described. Furthermore, the ratio of systolic blood pressure (SBP) to diastolic blood pressure (DBP) may equal to 1.618 according to the equation: DBP/PP = SBP/DBP φ, where PP the pulse pressure. Although this geometrical approach has no proven physical-hemodynamic rationale yet, it is intriguing to examine whether participants with SBP/DBP (or DBP/pulse pressure [PP]) ratio close to 1.618 [Figure 1] have different prognosis compared to those whose ratio deviates from φ. To test this hypothesis, we analyzed the data from the National Health and Nutrition Examination Survey (NHANES) during 1999–2010.
|Figure 1: Illustration of blood pressure ratios according to the golden ratio φ (phi)|
Click here to view
| Materials and Methods|| |
NHANES is a multistage, stratified probability sample of noninstitutionalized individuals at the US, conducted by the National Center for Health Statistics (NCHS). Methodological and research details concerning the NHANES study have been described elsewhere.,, The following data were extracted and used in our analysis: age, gender, smoking status, history of diabetes, hypercholesterolemia, hypertension, heart attack, angina, congestive heart failure, coronary heart disease, and stroke. Mortality status was extracted from the Public-use Linked Mortality Files of the NCHS which includes a limited set of mortality variables for adult participants only that correspond to the period from the date of survey participation through December 31, 2011.
At each participant, after resting quietly in a sitting position for 5 min, three consecutive BP readings were obtained by certified examiners. The deviation of the arterial pulse from the golden ratio was quantified using the absolute difference between the two BP ratios; absolute Δ-BPratios = abs ([DBP/PP]−[SBP/DBP]). Values close to zero indicate that BP ratios are close to the golden number 1.618, whereas larger values imply that the ratios deviate from φ.
Distribution normality of continuous variables was evaluated graphically by histograms and statistically using Kolmogorov–Smirnov test. Multiple logistic regression analysis was performed to assess the independent predictors of all-cause mortality. Collinearity between continuous variables was assessed by bivariate correlation coefficients and by the variance inflation factor (VIF) determined by multiple regression models. Statistical significance was accepted for P values lower than 0.05. Statistical analysis was performed by IBM SPSS for windows (IBM Corp., Armonk, NY, USA) and STATA (StataCorp LP, College Station, Texas, USA).
| Results|| |
We analyzed the data from 31,622 individuals (above 17 years old) with valid BP measurements and known mortality status. A total of 2820 individuals were deceased (8.9%). In the analyzed dataset, the estimated date of death was not available.
[Table 1] reports the strongest, independent predictors of all-cause mortality, using multiple logistic regression analysis. SBP, DBP, and absolute Δ-BPratios did not exhibit collinearity (r<0.5 and VIF <1.3). By this preliminary analysis, it was found that participants with SBP/DBP values that deviate from the golden ratio have a significantly higher risk of death, regardless from other established risk factors in comparison to individuals whose BP values fulfill the golden proportion.
|Table 1: Multivariate logistic regression analysis for the identification of independent parameters associated with all-cause mortality|
Click here to view
| Discussion|| |
Current evidence supports that traditional assessment of BP at the brachial artery (and its corresponding systolic and diastolic values), which is still based on the same main methodological-measurement principles during the last decades, does not always predict accurately cardiovascular (CV) risk and target organs' damage. For example, there is plenty of evidence indicating that in older persons, SBP is no longer associated with mortality under specific circumstances.,,, Moreover, a debate exists concerning the comparative relevance of SBP and DBP on CV risk prediction of specific populations and which value can provide optimal management of the hypertension burden. Despite the huge number of currently available epidemiological data, recommendations for optimal BP values (SBP and DBP) are continuously being modified and recently reconsidered. These limitations in the prognostic value of SBP and DBP seem to be overcome in some cases if a combined index such as the PP is used., A step forward might be made by considering an alternative BP-related index such as the ratio of SBP/DBP or DBP/PP. In our current hypothesis, a challenging geometrical concept of the “golden arterial pulse” based on historical and philosophical theories on harmony and balance (expressed by the golden ratio) was applied on existing epidemiological data. The deviation of the arterial pulse from the divine proportion between SBP and DBP (~1.618) was quantified and found to be a strong and independent predictor of all-cause mortality in the NHANES population.
| Conclusions|| |
The hypothesis stated in this article expands the application of the golden ratio in respect to the morphology of the arterial pressure wave. Are these statistical findings a matter of alchemy, a statistical “illusion” or the results of real biological and physical principles? Further evidence-based research and experiments will give us the answer.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Papaioannou TG, Gialafos E, Karamanou M, Tsoucalas G, Tousoulis D. The 'Divine' or 'Golden' arterial pulse. Eur Heart J 2017;38:2925-8.
Livio M. The Golden Ratio: The Story of Phi, the World's Most Astonishing Number. New York: Broadway Books; 2003.
Yetkin E, Topbaş U, Yanik A, Yetkin G. Does systolic and diastolic blood pressure follow Golden Ratio? Int J Cardiol 2014;176:1457-9.
Ulmer H, Kelleher CC, Dünser M. George clooney, the cauliflower, the cardiologist, and phi, the golden ratio. Br Med J 2009;339:1417.
Yetkin G, Sivri N, Yalta K, Yetkin E. Golden Ratio is beating in our heart. Int J Cardiol 2013;168:4926-7.
Centers for Disease Control and Prevention. National Center for Health Statistics. National Health and Nutrition Examination Survey Data. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2018. Available from: https://www.cdc.gov/nchs/nhanes/index.htm
. [Last accessed 2018 Jan].
Wu C, Woo JG, Zhang N. Association between urinary manganese and blood pressure: Results from national health and nutrition examination survey (NHANES), 2011-2014. PLoS One 2017;12:e0188145.
Lekoubou A, Ovbiagele B, Markovic D, Sanossian N, Towfighi A. Age, sex, and race/ethnic temporal trends in metabolic syndrome prevalence among individuals with myocardial infarction or stroke in the United States. J Neurol Sci 2017;376:24-8.
Karamanou M, Papaioannou TG, Tsoucalas G, Tousoulis D, Stefanadis C, Androutsos G, et al.
Blood pressure measurement: Lessons learned from our ancestors. Curr Pharm Des 2015;21:700-4.
van Bemmel T, Gussekloo J, Westendorp RG, Blauw GJ. In a population-based prospective study, no association between high blood pressure and mortality after age 85 years. J Hypertens 2006;24:287-92.
Trenkwalder P, Hendricks P, Schöniger R, Rossberg J, Lydtin H, Hense HW, et al.
Hypertension as a risk factor for cardiovascular morbidity and mortality in an elderly German population; the prospective STEPHY II study. Starnberg study on epidemiology of Parkinsonism and hypertension in the elderly. Eur Heart J 1999;20:1752-6.
Hakala SM, Tilvis RS, Strandberg TE. Blood pressure and mortality in an older population. A 5-year follow-up of the Helsinki ageing study. Eur Heart J 1997;18:1019-23.
Blom JW, de Ruijter W, Witteman JC, Assendelft WJ, Breteler MM, Hofman A, et al.
Changing prediction of mortality by systolic blood pressure with increasing age: The rotterdam study. Age (Dordr) 2013;35:431-8.
Tin LL, Beevers DG, Lip GY. Systolic vs. diastolic blood pressure and the burden of hypertension. J Hum Hypertens 2002;16:147-50.
Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JT Jr., et al
. Potential U.S. population impact of the 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline. J Am Coll Cardiol 2018;71:109-118.
Benetos A, Rudnichi A, Safar M, Guize L. Pulse pressure and cardiovascular mortality in normotensive and hypertensive subjects. Hypertension 1998;32:560-4.
Glynn RJ, Chae CU, Guralnik JM, Taylor JO, Hennekens CH. Pulse pressure and mortality in older people. Arch Intern Med 2000;160:2765-72.