Document Detail

Aortic diameter, wall stiffness, and wave reflection in systolic hypertension.
MedLine Citation:
PMID:  18071054     Owner:  NLM     Status:  MEDLINE    
Systolic hypertension is associated with increased pulse pressure (PP) and increased risk for adverse cardiovascular outcomes. However the pathogenesis of increased PP remains controversial. One hypothesis suggests that aortic dilatation, wall stiffening and increased pulse wave velocity result from elastin fragmentation, leading to a premature reflected pressure wave that contributes to elevated PP. An alternative hypothesis suggests that increased proximal aortic stiffness and reduced aortic diameter leads to mismatch between pressure and flow, giving rise to an increased forward pressure wave and increased PP. To evaluate these two hypotheses, we measured pulsatile hemodynamics and proximal aortic diameter directly using tonometry, ultrasound imaging, and Doppler in 167 individuals with systolic hypertension. Antihypertensive medications were withdrawn for at least 1 week before study. Patients with PP above the median (75 mm Hg) had lower aortic diameter (2.94+/-0.36 versus 3.13+/-0.28 cm, P<0.001) and higher aortic wall stiffness (elastance-wall stiffness product: 16.1+/-0.7 versus 15.7+/-0.7 ln[dyne/cm], P<0.001) with no difference in augmentation index (19.9+/-10.4 versus 17.5+/-10.0%, P=0.12). Aortic diameter and wall stiffness both increased with advancing age (P<0.001). However, an inverse relation between PP and aortic diameter remained significant (P<0.001) in models that adjusted for age, sex, height, and weight and then further adjusted for aortic wall stiffness, augmentation index, and mean arterial pressure. Among individuals with systolic hypertension, increased PP is primarily attributable to increased wall stiffness and reduced aortic diameter rather than premature wave reflection.
Gary F Mitchell; Paul R Conlin; Mark E Dunlap; Yves Lacourcière; J Malcolm O Arnold; Richard I Ogilvie; Joel Neutel; Joseph L Izzo; Marc A Pfeffer
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2007-12-10
Journal Detail:
Title:  Hypertension     Volume:  51     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2007-12-20     Completed Date:  2008-01-10     Revised Date:  2008-05-07    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  105-11     Citation Subset:  IM    
Cardiovascular Engineering Inc, University Office Park, Bldg. 2, Suite 100, 51 Sawyer Road, Waltham, MA 02453, USA.
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MeSH Terms
Aging / physiology
Aorta / pathology*,  physiopathology*
Blood Pressure / physiology
Cardiovascular Diseases / etiology,  physiopathology
Carotid Arteries / pathology,  physiopathology
Cohort Studies
Femoral Artery / pathology,  physiopathology
Hypertension / complications,  pathology*,  physiopathology*
Middle Aged
Models, Statistical
Regional Blood Flow / physiology
Regression Analysis
Risk Factors
Comment In:
Hypertension. 2008 May;51(5):e38; author reply e39-40   [PMID:  18391090 ]
Hypertension. 2008 Jan;51(1):33-6   [PMID:  18071060 ]
Hypertension. 2008 May;51(5):e37; author reply e39-40   [PMID:  18391095 ]

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