This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 51/4/1123    most recent HYPERTENSIONAHA.107.108175v1 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 Google Scholar Articles by Mitchell, G. F. Articles by Harris, T. B. PubMed PubMed Citation Articles by Mitchell, G. F. Articles by Harris, T. B. Pubmed/NCBI databases Medline Plus Health Information High Blood Pressure Seniors' Health Related Collections Clinical Studies Epidemiology Echocardiography Other diagnostic testing

(Hypertension. 2008;51:1123.)
© 2008 American Heart Association, Inc.

Go Red Original Articles

Hemodynamics of Increased Pulse Pressure in Older Women in the Community-Based Age, Gene/Environment Susceptibility–Reykjavik Study

From Cardiovascular Engineering Inc (G.F.M.), Waltham, Mass; Icelandic Heart Association (V.G., T.A.), Kopavogur, Iceland; and the National Institute on Aging, National Institutes of Health (L.J.L., T.B.H.), Bethesda, Md.

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

Pulse pressure increases with advancing age particularly in women. As a result, women have a higher pulse pressure than men from midlife onward. Higher pulse pressure in older women as compared to men is often attributed to increased aortic wall stiffness and premature wave reflection. To evaluate this hypothesis, we measured central aortic input impedance, pulse wave velocity, and wave reflection in 408 older men and women (age range, 69 to 94 yr, mean 75 yr) participating in the community-based Age, Gene/Environment Susceptibility–Reykjavik Study (AGES-Reykjavik). Women as compared to men had higher pulse pressure (75.8±18.7 versus 69.5±16.8 mm Hg, P<0.001) and smaller aortic diameters (2.74±0.24 versus 2.97±0.28 cm, P<0.001). Augmentation index (AI) was higher (11.0±15.9 versus 7.9±12.9%, P=0.032) in women whereas proximal aortic elastance-wall thickness product (Eh) did not differ (P=0.61). In a stepwise model for pulse pressure that included age and sex and offered aortic diameter, Eh, mean pressure, AI, pulse wave velocity, height, weight, and body surface area as additional covariates, higher pulse pressure was associated with increased wall stiffness, smaller aortic diameter, higher mean pressure, and increased AI (Model R²=0.59, P<0.001). The sex difference in pulse pressure (6.6±1.7 mm Hg, P<0.001) persisted after Eh entered the model (6.9±1.5 mm Hg, P<0.001) but not after aortic diameter entered the model (–0.4±1.4 mm Hg, P=0.75). Thus, reduced aortic diameter and impaired matching between diameter and flow accounts for the sex difference in pulse pressure in an unselected community-based cohort of older people.

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

This article has been cited by other articles:

				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]