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(Hypertension. 2004;44:121.)
© 2004 American Heart Association, Inc.

Editorial Commentaries

Peripheral Pulse Pressure, Large Arteries, and Microvessels

From the Diagnosis Center, Hôtel-Dieu Hospital, Paris, France.

Correspondence to Pr Michel Safar, Diagnosis Center, Hôpital Hôtel-Dieu, 1, place du Parvis Notre-Dame, 75181 Paris Cedex 04. E-mail michel.safar@htd.ap-hop-paris.fr

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The aorta is a capacitance vessel that enables transformation of the "on-off" blood-flow characteristics of the left ventricle into a less pulsatile flow in more distal vessels. Thus, a smooth nonpulsatile blood-flow pattern is achieved at capillary level. Arterial wall stiffness determines the degree of energy absorbed by the elastic aorta and its recoil in diastole. Aortic pulse pressure (PP) in health is physiologically lower than peripheral PP. Reduction of elevated aortic systolic blood pressure (SBP) protects circulation from pressure-induced damage. Maintaining aortic diastolic blood pressure (DBP) ensures adequate coronary perfusion. A stiffer aorta, which can be observed with aging and in different pathological conditions such as hypertension, obesity, diabetes mellitus, and dyslipidemia, fails in both of these tasks. Numerous studies now show that PP, arterial stiffness, and early wave reflections are strong predictors of cardiovascular (CV) risk.¹ The CV complications are usually located above the aortic recoil and mainly affect the heart. The downward consequences of enhanced pulsatility, particularly at the peripheral and even the microvascular levels, are less documented. The study by Mitchell et al² in the June issue of Hypertension addresses this subject, with particular focus on a healthy elderly population.

Central Versus Peripheral Pulse Pressure: Role of Wave Reflections

In addition to arterial stiffness, the pulse waveform characteristics are influenced by wave reflection. Energy propagated through the circulation usually meets vessel branching points, at which some of the antegrade energy is "reflected" and becomes retrograde. At some point through the aorta and its braches, the incident and reflected waves summate. Where and when this happens . . . [Full Text of this Article]

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