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Different relation between 24-h blood pressure and distensibility at different peripheral arteries. Data from the
Cristina Giannattasio1, Monica Failla, Michael Hennig
1Clinica Medica, University of Milan-Bicocca, San Gerardo Hospital, Monza (Milan), Italy.
Insights
Stiffening of large elastic arteries, like the carotid, is better reflected by ambulatory blood pressure (BP) than office measurements. This arterial stiffening correlates with increased wall thickness, suggesting a link between functional and structural changes.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Vascular Biology
Background:
- The European Lacidipine Study on Atherosclerosis (ELSA) investigated lacidipine vs. atenolol effects on carotid artery wall thickness in hypertensive patients.
- A sub-study examined arterial distensibility in carotid and radial arteries to link functional properties with blood pressure (BP) measurements and structural changes.
Purpose of the Study:
- To determine the relationship between arterial distensibility and both office and ambulatory BP.
- To investigate the correlation between functional arterial properties (distensibility) and structural alterations (wall thickness).
- To compare these relationships in large elastic (carotid) versus middle-size muscle (radial) arteries.
Main Methods:
- 124 patients with mild to moderate essential hypertension were recruited across four European centers.
- Blood pressure (BP) was measured using both mercury sphygmomanometry and 24-hour ambulatory monitoring.
- Carotid artery wall thickness was measured via sonography; carotid and radial artery distensibility were assessed using echotracking techniques.
Main Results:
- Carotid artery distensibility negatively correlated with systolic BP (office and 24-hour average), but not diastolic BP.
- Carotid artery distensibility showed a negative correlation with carotid wall thickness.
- Radial artery distensibility and thickness were uncorrelated with each other and with BP measures.
Conclusions:
- Arterial stiffening in large elastic arteries is more strongly associated with ambulatory systolic BP than office BP.
- Functional alterations in large elastic arteries are linked to structural changes in arterial wall thickness.
- Functional and structural properties of middle-size muscle arteries appear independent of BP in this cohort.
Introduction:
The European Lacidipine Study on Atherosclerosis (ELSA) has been planned to investigate the effect of reduction in office and ambulatory blood pressure by lacidipine versus atenolol on carotid artery wall thickness in mild to moderate essential hypertensive patients with no metabolic abnormalities. One prespecified sub-study of ELSA focused on measurements of arterial distensibility in the carotid as well as in the radial artery to determine the relationship of functional arterial properties with office versus ambulatory blood pressure (BP) values as well as the correspondence between functional and structural arterial alterations.
Methods:
The sub-study was conducted on 124 patients recruited in four centres (Monza-Milan, Paris, Grenoble and Glasgow). BP was measured both by a mercury sphygmomanometer and by 24-h ambulatory monitoring. Common carotid artery wall thickness was measured by certified sonographers as described in the main study. Common carotid and radial artery distensibility were obtained by echotracking techniques, which allowed to relate changes in arterial diameter with systo-diastolic BP changes.
Results:
Carotid artery wall distensibility showed (1) a negative correlation with office and more so 24-h average systolic BP (r = -0.45 and -0.58, P < 0.008 and 0.001) but not with office or 24-h diastolic BP) and (2) a negative correlation with the corresponding wall thickness (r = -0.47, P < 0.005). In contrast, at the radial artery level distensibility and thickness showed no correlation with each other and with BP. Carotid (but not radial) artery distensibility also correlated with ambulatory systolic BP variability but the correlation was lost after adjustment for age and mean BP values.
Conclusion:
These data suggest that stiffening of large elastic artery is reflected more by ambulatory than office BP elevations, systolic BP being much more important than diastolic. Alterations of large elastic arteries function is related to structural wall changes. Functional and structural properties of middle-size muscle arteries are independent of BP.
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