This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 51/4/1129    most recent HYPERTENSIONAHA.107.106310v1 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 Dart, A. M. Articles by Cameron, J. D. Search for Related Content PubMed PubMed Citation Articles by Dart, A. M. Articles by Cameron, J. D. Pubmed/NCBI databases Medline Plus Health Information High Blood Pressure Related Collections Clinical Studies Other Vascular biology

(Hypertension. 2008;51:1129.)
© 2008 American Heart Association, Inc.

Go Red Original Articles

Smaller Aortic Dimensions Do Not Fully Account for the Greater Pulse Pressure in Elderly Female Hypertensives

Anthony M. Dart; Bronwyn A. Kingwell; Christoph D. Gatzka; Kristyn Willson; Yu-Lu Liang; Karen L. Berry; Lindon M.H. Wing; Christopher M. Reid; Philip Ryan; Lawrence J. Beilin; Garry L.R. Jennings; Colin I. Johnston; John J. McNeil; Graham J. MacDonald; Trefor O. Morgan; Malcolm J. West; James D. Cameron

From the Baker Heart Research Institute and Alfred Hospital (A.M.D., B.A.K.); University of Melbourne (C.D.G.), Second Australian National Blood Pressure Study Group (K.W., Y.-L.L., K.L.B., L.M.H.W., C.M.R., P.R., L.J.B., G.L.R.J., C.I.J., J.J.M., G.J.M., T.O.M., M.J.W.) and La Trobe University (J.D.C.), Melbourne, Victoria, Australia.

Correspondence to Anthony M. Dart, Baker Medical Research Institute, PO Box 6492, St Kilda Rd Central, Melbourne, Victoria, 8008 Australia. E-mail a.dart{at}alfred.org.au

This study examined the importance of aortic dimensions in determining pulse pressure in elderly hypertensives participating in the 2nd Australian National Blood Pressure Study, including a substantial number not previously receiving blood pressure lowering medication. Aortic dimensions were determined by ultrasound at the transverse arch and at the insertion of the aortic valve. Unadjusted data showed negative (P<0.001) correlations between central (carotid) and (brachial) peripheral pulse pressure and both arch (–0.200, –0.181) and outflow tract (–0.238, –0.238) diameters. Correlations were similar in those previously treated with blood pressure lowering medication and in the treatment naïve. Central pulse pressure (84±26 versus 75±28 mm Hg, P<0.001) was higher and aortic dimensions (transverse arch 2.56±0.31 versus 2.88±0.35 mm, P<0.001) smaller in women than men. Women had greater aortic stiffness (beta index 29.4±36.1 versus 22.1±21.3, P<0.03). Other bivariate correlates of central pulse pressure were age, mean arterial pressure, height, heart rate, augmentation index, aortic stiffness (all P<0.001), and weight (P=0.027). In multivariate analyses gender remained a predictor of central pulse pressure (P<0.001) even with inclusion of aortic dimensions (P=0.013) height and weight. Other significant terms were age, heart rate, mean blood pressure, and aortic stiffness (all P<0.001). These findings demonstrate an independent inverse relation between aortic size and pulse pressure in older hypertensive subjects. Differences in aortic dimensions and stiffness between genders do not fully account for the observed blood pressure differences, suggesting that a contributory factor to gender differences in pulse pressure is an increased age-related mismatch in ventricular function and aortic stiffness in women compared with men.

Key Words: blood pressure • elderly • risk factors • aortic stiffness • gender

This article has been cited by other articles:

				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]

				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]

				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]