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Arterial stiffness: pathophysiology and clinical impact
Gérard M London1, Sylvain J Marchais, Alain P Guerin
1Nephrology Department, Manhès Hospital, Ste Geneviève/des/Bois, France. glondon@club-internet.fr
Clinical and Experimental Hypertension (New York, N.Y. : 1993)
|February 11, 2005
Summary
Arterial stiffness, not just resistance, impacts blood pressure and heart function. Reducing arterial stiffness through treatments like ACE inhibitors improves survival in hypertensive patients.
Area of Science:
- Cardiovascular Physiology
- Biomedical Engineering
Background:
- Hypertension's effects are often linked to reduced arteriole caliber and increased total peripheral resistance (TPR).
- Blood pressure (BP) is a cyclic phenomenon, with systolic and diastolic pressures representing oscillation limits.
- Aortic input impedance, encompassing TPR, arterial distensibility (D), and wave reflections (WR), is a more appropriate measure of arterial factors opposing left ventricular (LV) ejection.
Purpose of the Study:
- To highlight the significance of arterial stiffness and aortic input impedance in cardiovascular health.
- To explore the relationship between arterial stiffness, pulse wave velocity (PWV), and wave reflections (WR).
- To investigate the impact of arterial stiffening on left ventricular (LV) afterload and coronary perfusion.
Main Methods:
- Evaluation of arterial distensibility (D) and stiffness, including the use of pulse wave velocity (PWV).
- Assessment of the role of wave reflections (WR) in systolic and diastolic pressures.
- Analysis of the association between arterial stiffening, collagen content, and extracellular matrix alterations (arteriosclerosis).
Main Results:
- Arterial stiffening increases LV afterload and impairs coronary perfusion.
- Increased PWV and WR during systole elevate systolic pressures and myocardial oxygen consumption while decreasing diastolic BP and coronary flow.
- Arterial stiffening, estimated by aortic PWV and WR intensity, independently predicts survival in end-stage renal disease (ESRD) and the general population.
Conclusions:
- Arterial stiffening is a critical factor in hypertension and cardiovascular outcomes.
- Antihypertensive treatments, particularly ACE inhibitors, can improve arterial stiffness and WR.
- Reversibility of aortic stiffening with ACE inhibitors offers a favorable independent effect on survival in hypertensive patients with advanced renal disease.