Published online before print December 10, 2007, doi: 10.1161/HYPERTENSIONAHA.107.099721
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(Hypertension. 2008;51:105.)
© 2008 American Heart Association, Inc.
Original Articles |
Aortic Diameter, Wall Stiffness, and Wave Reflection in Systolic Hypertension
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 Antihypertensive medications were withdrawn for at least 1 week before study.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
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Hypertension 2008 51: 33-36.
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