on May 23, 2005
Hypertension. 2005
Published online before print May 23, 2005, doi: 10.1161/01.HYP.0000168053.34306.d4
Published online before print May 23, 2005, doi: 10.1161/01.HYP.0000168053.34306.d4
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Submitted on February 15, 2005
From the Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Md. * To whom correspondence should be addressed. E-mail: dkass{at}jhmi.edu.
Abstract--Vascular stiffening of the large arteries is a common feature of aging and is exacerbated by many common disorders such as hypertension, diabetes, and renal disease. This change influences the phasic mechanical stresses imposed on the blood vessels that in turn is important to regulating smooth muscle tone, endothelial function, and vascular health. In addition, the heart typically adapts to confront higher and later systolic loads by both hypertrophy and ventricular systolic stiffening. This creates altered coupling between heart and vessel that importantly affects cardiovascular reserve function. In this overview, I discuss the notion of a coupling disease in which stiffness of both heart and arteries interact to limit performance and generate clinical symptoms. This involves changes in the mechanical interaction of both systems, changes in signaling within the arteries themselves, and alterations in coronary flow regulation. Lastly, I briefly review recent development in de-stiffening strategies that may pave the way to treat this syndrome and its clinical manifestations.
Revised on February 23, 2005
Ventricular Arterial Stiffening. Integrating the Pathophysiology
David A. Kass*
Key words: arteries • compliance • ventricular function
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