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Microvascular changes during laboratory stimuli and structural haemodynamic indices: the role of pulse pressure
P Nazzaro1, R Triggiani, L Ciancio
1Department of Clinical Methodology and Medico-Surgical Technology, Stress Research Center, Medical School of Bari, University of Bari, Italy.
Insights
Young adults with high pulse pressure show impaired vascular reactivity and reduced blood flow, suggesting early-stage vascular damage. This indicates potential structural and functional issues even without metabolic disorders.
Area of Science:
- Cardiovascular Physiology
- Hypertension Research
- Vascular Biology
Background:
- Office and ambulatory pulse pressure are established predictors of cardiovascular mortality and atherosclerosis.
- Vascular reactivity in individuals with a high pulsatile blood pressure component remains understudied.
Purpose of the Study:
- To investigate regional muscular hemodynamics and cutaneous microvascular changes in response to laboratory stimuli.
- To identify vascular differences in young adults with very mild hypertension and high pulse pressure compared to those with lower pulse pressure.
Main Methods:
- Utilized Finapres for cardiovascular monitoring, plethysmography for forearm vascular assessment, and laser-Doppler flowmetry with transcutaneous oximetry for cutaneous microvascular evaluation.
- Assessed hyperemic forearm vascular response to an ischemic test as a hemodynamic index of vascular damage.
- Compared 15 very mild hypertensives with high pulse pressure against 15 controls matched for age, hypertension history, metabolic parameters, and systolic-diastolic blood pressure.
Main Results:
- Individuals with high pulse pressure exhibited reduced hyperemic response and increased residual vascular resistance during the forearm ischemic test.
- Higher office pulse pressure correlated with significantly increased heart rate, systolic, and pulsatile blood pressure reactivity.
- Conversely, high pulse pressure was associated with reduced forearm and cutaneous blood flow, alongside decreased transcutaneous tissue oxygenation.
Conclusions:
- Increased pulsatile blood pressure component in young adults may be linked to early structural and functional vascular impairments.
- These vascular changes occur even in the early stages of hypertension and in the absence of metabolic disorders.
- Findings highlight the significance of pulse pressure as an indicator of subclinical vascular dysfunction.
Abstract:
Office and ambulatory pulse pressure have been recognized as independent predictors of cardiovascular mortality and atherosclerosis in hypertensives as well as in normotensives. On the other hand, the vascular reactivity, in subjects with high pulsatile component of blood pressure, has not been studied yet. The purpose of our study was to identify the regional muscular hemodynamics and the cutaneous microvascular changes during laboratory stimuli in young adult very mild hypertensives with high pulse pressure. The cardiovascular (Finapres), the forearm vascular (plethysmography) and the microvascular cutaneous (laser-Doppler flowmetry and transcutaneous oximetry) responses to psychophysiological stimuli were measured. In addition, the hyperemic forearm vascular response to the ischaemic test was measured as haemodynamic index of vascular damage. We studied 15 very mild hypertensives with higher office pulse pressure and 15 patients with similar age, history of hypertension, metabolic parameters and systodiastolic blood pressure but lower pulse pressure values. Patients with high pulse pressure demonstrated reduced hyperemic response and increased residual vascular resistance at the forearm ischaemic test. They did not vary for all the parameters, except pulse pressure, during the baseline period but the total stress response, as residualized area-under-the-curve, was notably different. Patients with higher office pulse pressure demonstrated a significant increased heart rate, systolic and pulsatile blood pressure reactivity. On the contrary, they showed a reduced forearm and cutaneous blood flow response combined to a reduced transcutaneous tissutal oxygenation. The findings suggest that the increased pulsatile component of blood pressure might be associated to structural and functional vascular impairments since the very early stages of hypertension in young adults without metabolic disorders.