Hypertension, Vol 20, 10-19, Copyright © 1992 by American Heart Association
G London, A Guerin, B Pannier, S Marchais, A Benetos and M Safar
To assess the role of arterial wave reflections in the mechanism of
systolic hypertension and altered pulsatile arterial dynamics in patients
with end-stage renal disease (ESRD), 79 ESRD patients were compared with 73
age-matched control subjects with normal renal function and similar mean
blood pressure. Wave reflections were investigated from the carotid pulse
contour recorded by applanation tonometry using a Millar
micromanometer-tipped probe. Wave reflections were quantified as the ratio
(augmentation index, %) of the height of the late systolic peak to the
total height of carotid pulse wave. Travel time of the reflected wave was
timed from the foot of the pressure wave to the foot of the late systolic
peak. Systolic and pulse pressure were increased in ESRD patients (p less
than 0.001) and was not attributable to differences in left ventricular
ejection pattern. The augmentation index was increased in ESRD patients
(23.2 +/- 15.0 versus 9.8 +/- 15.6%; p less than 0.001) in association with
a shorter travel time of reflected wave (109 +/- 24 versus 131 +/- 30 msec;
p less than 0.001). Multiple regression analysis showed two principal
factors associated (p less than 0.001) with the increase in augmentation
index and shortened travel time of reflected wave: increased aortic pulse
wave velocity and smaller stature with shorter body height in ESRD
patients. The study points to the role of arterial wave reflections in the
mechanisms producing alterations in pulsatile arterial dynamics in ESRD and
is the first, through the mechanisms of early wave reflections, to show in
humans that the increase in systolic and pulse pressures is associated with
lesser body size.
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Increased systolic pressure in chronic uremia. Role of arterial wave reflections
Centre Hospitalier F.H. Manhes, Fleury-Merogis, France.
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