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Influence of arterial pulse and reflected waves on blood pressure and cardiac function
1Manhes Hospital, Paris, France.
Insights
Arterial stiffening reduces artery cushioning, increasing systolic pressure and cardiovascular risk. Early identification of these changes is crucial for timely therapeutic interventions.
Area of Science:
- Cardiovascular Physiology
- Biomedical Engineering
Background:
- Arterial blood pressure has steady (mean) and pulsatile (systolic, diastolic, pulse) components.
- Arteries function as conduits and also cushion pulsatile flow into steady peripheral flow.
- Arterial compliance, influenced by pressure and biomechanics, is key to blood pressure regulation.
Purpose of the Study:
- To review factors influencing arterial blood pressure components.
- To emphasize the impact of arterial stiffening on blood pressure and cardiovascular health.
- To highlight the clinical significance of identifying arterial stiffening.
Main Methods:
- Literature review of factors affecting arterial blood pressure.
- Analysis of the consequences of arterial stiffening.
- Discussion of age and hypertension as contributors to reduced arterial compliance.
Main Results:
- Arterial stiffening increases pulse wave velocity and wave reflections.
- This leads to elevated systolic and aortic/left ventricular pressures, with reduced diastolic pressure.
- Increased systolic and pulse pressures are significant cardiovascular risk factors.
Conclusions:
- Arterial stiffening significantly impacts cardiovascular physiology and risk.
- Early detection of arterial stiffening is vital for patient management.
- Therapeutic interventions are necessary for patients with increased cardiovascular risk due to arterial changes.
Abstract:
An integrated view of the role of arterial blood pressure in cardiovascular physiology should consider both the steady (mean blood pressure) and pulsatile (systolic, diastolic, and pulse pressures) components. This brief overview describes the important factors influencing these components, with emphasis on the consequences of arterial stiffening. In addition to their conduit function, arteries also perform a cushioning function that transforms the pulsatile flow generated by contraction of the left ventricle into steady flow at the periphery. Arterial compliance is a principal determinant of arterial blood pressure and is both pressure dependent and affected by vascular biomechanics. Other important factors that affect the steady and pulsatile components of blood pressure include ventricle performance, peripheral resistance, pulse wave velocity, and the timing of pulse wave reflections. Ageing and hypertension are important factors that contribute to reductions in arterial compliance. Important functional effects of this are that both the amplitude of the arterial pulse wave and pulse wave velocity increase, causing an early return of reflected waves from the periphery to the aorta. This may boost aortic and left ventricular pressures during systole at the expense of diastolic pressure, which is reduced. Studies have shown that stiffening of arteries and the associated increase in systolic and pulse pressures are important cardiovascular risk factors. Patients with an increased risk of cardiovascular events associated with such changes should be identified and receive appropriate therapeutic interventions.