Document Detail


Aortic diameter, wall stiffness, and wave reflection in systolic hypertension.
MedLine Citation:
PMID:  18071054     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 Antihypertensive medications were withdrawn for at least 1 week before study.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.
Authors:
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
Related Documents :
11897754 - Central pulse pressure and mortality in end-stage renal disease.
16092224 - Measurement of the frequency response of a diaphragm-based pressure sensor by use of a ...
11356764 - Midlatency respiratory-related somatosensory activity and perception of oral pressure p...
12420194 - Effects of atorvastatin on aortic pulse wave velocity in patients with hypertension and...
24457614 - The prevalence, characteristics, and clinical significance of abnormal albuminuria in p...
9264494 - Comparative effects of enalapril and verapamil on myocardial blood flow in systemic hyp...
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    
Affiliation:
Cardiovascular Engineering Inc, University Office Park, Bldg. 2, Suite 100, 51 Sawyer Road, Waltham, MA 02453, USA. GaryFMitchell@mindspring.com
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Aging / physiology
Aorta / pathology*,  physiopathology*
Blood Pressure / physiology
Cardiovascular Diseases / etiology,  physiopathology
Carotid Arteries / pathology,  physiopathology
Cohort Studies
Elasticity
Electrocardiography
Female
Femoral Artery / pathology,  physiopathology
Humans
Hypertension / complications,  pathology*,  physiopathology*
Male
Middle Aged
Models, Statistical
Regional Blood Flow / physiology
Regression Analysis
Risk Factors
Comments/Corrections
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 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Activity-adjusted 24-hour ambulatory blood pressure and cardiac remodeling in children with sleep di...
Next Document:  Physical activity and blood pressure in childhood: findings from a population-based study.