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(Hypertension. 2001;38:949.)
© 2001 American Heart Association, Inc.

Fourth Workshop on Structure and Function of Large Arteries

Heart Rate, Arterial Stiffness, and Wave Reflections in Paced Patients

Pierre Albaladejo; Xavier Copie; Pierre Boutouyrie; Brigitte Laloux; André Descorps Déclère; Harry Smulyan; Athanase Bénétos

From UPRES 392, Hôpital de Bicêtre (P.A., A.D.D.), Le Kremlin Bicêtre, France; the Department of Internal Medicine and INSERM U337, Hôpital Broussais (X.C., P.B., B.L., A.B.), Paris, France; and the Cardiology Division, Department of Medicine, State University of New York, Upstate Medical University (H.S.), Syracuse.

Reprint requests to Prof Athanase Benetos, c/o Prof Michel Safar, Médecine Interne 1, Groupe Hospitalier Broussais–G. Pompidou, Hôpital Broussais, 96 rue Didot, 75674, Paris Cedex 14, France. E-mail michel.safar{at}brs.ap-hop-paris.fr

Abstract

Abstract—— Elevated heart rate (HR) and pulse pressure (PP) have a cumulative effect on cardiovascular risk, with the exception of HR 100 bpm. How an increase in HR may influence the PP level has never been investigated. In 11 patients with pacemaker monitoring, aortic (pulse-wave analysis) and digital (photoplethysmographic device) blood pressure were measured at 3 different levels of HR, together with determinations of carotid dimensions (echo tracking technique), wave reflections (pulse-wave analysis), and aortic pulse-wave velocity. Increased HR is associated with the following: (1) a significant increase of digital systolic, diastolic, and mean blood pressure; (2) a significant reduction of digital and carotid PP, with a more pronounced reduction of the carotid than of the digital PP, resulting in a significant PP amplification; and (3) a reduction in the time required for the backward pressure wave to return toward the heart, without any change of arterial stiffness. Increased HR significantly enhances PP amplification, leading to an increase of peripheral blood pressure without comparable change in central blood pressure. These results are important to consider for a better understanding of cardiovascular risk and the mechanism of white-coat hypertension.

Key Words: pacemaker • arteries, stiffness • heart rate • hypertension, white coat

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