This Article Full Text Full Text (PDF) All Versions of this Article: 51/1/105    most recent HYPERTENSIONAHA.107.099721v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mitchell, G. F. Articles by Pfeffer, M. A. Search for Related Content PubMed PubMed Citation Articles by Mitchell, G. F. Articles by Pfeffer, M. A. Pubmed/NCBI databases Medline Plus Health Information High Blood Pressure Related Collections Clinical Studies Other etiology Other diagnostic testing

(Hypertension. 2008;51:105.)
© 2008 American Heart Association, Inc.

Original Articles

Aortic Diameter, Wall Stiffness, and Wave Reflection in Systolic Hypertension

Gary F. Mitchell; Paul R. Conlin; Mark E. Dunlap; Yves Lacourcière; J. Malcolm O. Arnold; Richard I. Ogilvie; Joel Neutel; Joseph L. Izzo, Jr; Marc A. Pfeffer

From Cardiovascular Engineering Inc (G.F.M.), Waltham, Mass; Brigham and Women’s Hospital (P.R.C., M.A.P.), Boston, Mass; MetroHealth Medical Center (M.E.D.), Cleveland, Ohio; the Centre hospitalier de l’Universite Laval (Y.L.), Ste. Foy, QB; London Health Sciences Centre (J.M.O.A.), London, ON; Toronto Western Hospital (R.I.O.), Toronto, ON; Orange County Research Center (J.N.), Tustin, Calif; and SUNY at Buffalo (J.L.I.), NY.

Correspondence to Gary F. Mitchell, MD, Cardiovascular Engineering Inc, University Office Park, Bldg. 2, Suite 100, 51 Sawyer Road, Waltham, MA 02453. E-mail GaryFMitchell{at}mindspring.com

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.

Key Words: hypertension • hemodynamics • pulse pressure • aorta • vascular stiffness • pulse wave velocity

This article has been cited by other articles:

				A. N. Gurovich, D. T. Beck, and R. W. Braith Aortic Pulse Wave Analysis Is Not a Surrogate for Central Arterial Pulse Wave Velocity Experimental Biology and Medicine, November 1, 2009; 234(11): 1339 - 1344. [Abstract] [Full Text] [PDF]

				J. Hashimoto and S. Ito Some mechanical aspects of arterial aging: physiological overview based on pulse wave analysis Therapeutic Advances in Cardiovascular Disease, October 1, 2009; 3(5): 367 - 378. [Abstract] [PDF]

				M. Cecelja, B. Jiang, K. McNeill, B. Kato, J. Ritter, T. Spector, and P. Chowienczyk Increased wave reflection rather than central arterial stiffness is the main determinant of raised pulse pressure in women and relates to mismatch in arterial dimensions: a twin study. J. Am. Coll. Cardiol., August 18, 2009; 54(8): 695 - 703. [Abstract] [Full Text] [PDF]

				A. P. Avolio, L. M. Van Bortel, P. Boutouyrie, J. R. Cockcroft, C. M. McEniery, A. D. Protogerou, M. J. Roman, M. E. Safar, P. Segers, and H. Smulyan Role of Pulse Pressure Amplification in Arterial Hypertension: Experts' Opinion and Review of the Data Hypertension, August 1, 2009; 54(2): 375 - 383. [Full Text] [PDF]

				M. Namasivayam, B. J. McDonnell, C. M. McEniery, M. F. O'Rourke, and on behalf of the Anglo-Cardiff Collaborative Trial Does Wave Reflection Dominate Age-Related Change in Aortic Blood Pressure Across the Human Life Span? Hypertension, June 1, 2009; 53(6): 979 - 985. [Abstract] [Full Text] [PDF]

				F. Antonini-Canterin, S. Carerj, V. Di Bello, G. Di Salvo, S. La Carrubba, O. Vriz, D. Pavan, A. Balbarini, G. L. Nicolosi, and On behalf of the Research Group of the Italian Soc Arterial stiffness and ventricular stiffness: a couple of diseases or a coupling disease? A review from the cardiologist's point of view Eur J Echocardiogr, January 1, 2009; 10(1): 36 - 43. [Abstract] [Full Text] [PDF]

				G. F. Mitchell Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage J Appl Physiol, November 1, 2008; 105(5): 1652 - 1660. [Abstract] [Full Text] [PDF]

				J. Andrade, L. Er, A. Ignaszewski, and A. Levin Exploration of Association of 1,25-OH2D3 with Augmentation Index, a Composite Measure of Arterial Stiffness Clin. J. Am. Soc. Nephrol., November 1, 2008; 3(6): 1800 - 1806. [Abstract] [Full Text] [PDF]

				B. P. Shapiro, T. E. Owan, S. F. Mohammed, D. M. Meyer, L. D. Mills, C. G. Schalkwijk, and M. M. Redfield Advanced Glycation End Products Accumulate in Vascular Smooth Muscle and Modify Vascular but Not Ventricular Properties in Elderly Hypertensive Canines Circulation, September 2, 2008; 118(10): 1002 - 1010. [Abstract] [Full Text] [PDF]

				E. Ingelsson, M. J. Pencina, D. Levy, J. Aragam, G. F. Mitchell, E. J. Benjamin, and R. S. Vasan Aortic Root Diameter and Longitudinal Blood Pressure Tracking Hypertension, September 1, 2008; 52(3): 473 - 477. [Abstract] [Full Text] [PDF]

				B. E. Westerhof, J. P. van den Wijngaard, J. P. Murgo, and N. Westerhof Location of a Reflection Site Is Elusive: Consequences for the Calculation of Aortic Pulse Wave Velocity Hypertension, September 1, 2008; 52(3): 478 - 483. [Abstract] [Full Text] [PDF]

				T. Richart, T. Kouznetsova, H. Struijker-Boudier, and J. A. Staessen Wave Reflection in Systolic Hypertension: Smaller Stature, Shorter Aorta: Higher Pulse Pressure? Hypertension, May 1, 2008; 51(5): e37 - e37. [Full Text] [PDF]

				G. F. Mitchell, P. R. Conlin, M. E. Dunlap, Y. Lacourciere, J. M. O. Arnold, R. I. Ogilvie, J. Neutel, J. L. Izzo Jr, and M. A. Pfeffer Response to Wave Reflection in Systolic Hypertension: Smaller Stature, Shorter Aorta: Higher Pulse Pressure? and Questions Regarding the Aortic Measurements of Mitchell et al Hypertension, May 1, 2008; 51(5): e39 - e40. [Full Text] [PDF]

				M. J. Roman and R. B. Devereux Questions Regarding the Aortic Measurements of Mitchell et al Hypertension, May 1, 2008; 51(5): e38 - e38. [Full Text] [PDF]

				G. F. Mitchell, V. Gudnason, L. J. Launer, T. Aspelund, and T. B. Harris Hemodynamics of Increased Pulse Pressure in Older Women in the Community-Based Age, Gene/Environment Susceptibility-Reykjavik Study Hypertension, April 1, 2008; 51(4): 1123 - 1128. [Abstract] [Full Text] [PDF]

				R. S. Vasan Pathogenesis of Elevated Peripheral Pulse Pressure: Some Reflections and Thinking Forward Hypertension, January 1, 2008; 51(1): 33 - 36. [Full Text] [PDF]