Document Detail

Arterial aging: pathophysiological principles.
MedLine Citation:
PMID:  18048471     Owner:  NLM     Status:  MEDLINE    
In the nineteenth century, prior to the introduction of the cuff sphygmomanometer, arteriosclerosis (stiffening of arteries) was recognized by clinicians and by life insurance companies as an indicator of vascular aging and cardiovascular risk, even in asymptomatic individuals. Through the twentieth century, views on aging came to focus on values of systolic and diastolic pressure and on obstructive atherosclerotic disease. Such focus deflected attention from the primary aging change which occurs in all societies, and is represented by stiffening and dilation of the proximal aorta. This review emphasizes the cushioning function of elastic arteries - principally the aorta - and how in youth this results in optimal interaction with the heart, and optimal steady flow through peripheral resistance vessels. Aortic stiffening with age is principally due to fatigue and fracture of elastin lamellae, with transfer of stress to stiffer collagenous components. Stiffening increases left ventricular load and myocardial blood requirement, but limits the capacity for blood supply during diastole. Consequences are cardiac failure and predisposition to ischaemia. The second, under-appreciated effect of aortic stiffening is transmission of flow pulsations downstream into vasodilated organs, principally brain and kidney, where pulsatile energy is dissipated and fragile microvessels are damaged. This accounts for micro infarcts and microhaemorrhages, with specialized cell damage, cognitive decline and renal failure. The aging process can be best monitored by change in the arterial pressure wave rather than by reliance on the cuff sphygmomanometer. This reintroduces the approaches by clinicians and life insurance examiners of the nineteenth century, endorses modern treatments for established disease, and holds the promise of detecting premature arterial degeneration, and better applying lifestyle measures and vasoactive medications to modify the aging process.
Michael F O'Rourke
Publication Detail:
Type:  Historical Article; Journal Article; Review    
Journal Detail:
Title:  Vascular medicine (London, England)     Volume:  12     ISSN:  1358-863X     ISO Abbreviation:  Vasc Med     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-11-30     Completed Date:  2008-03-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9610930     Medline TA:  Vasc Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  329-41     Citation Subset:  IM    
St Vincent's Clinic, University of New South Wales, Sydney, Australia.
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MeSH Terms
Age Factors
Aorta / physiopathology
Arteries / drug effects,  physiopathology*
Arteriosclerosis / drug therapy,  physiopathology*
Blood Pressure
Cardiovascular Agents / pharmacology,  therapeutic use
Cerebrovascular Circulation
Heart / physiopathology
History, 20th Century
History, 21st Century
Microcirculation / physiopathology
Pulsatile Flow
Renal Circulation
Sphygmomanometers / history
Reg. No./Substance:
0/Cardiovascular Agents

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

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