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Arterial properties of early hypertension
M A Weber1, D H Smith, J M Neutel
1Hypertension Center, Veterans Affairs Medical Center, Long Beach, California 90822.
Insights
Arterial compliance decreases in early hypertension, affecting both large and small arteries. This reduced elasticity, particularly in distal vessels, may serve as an early diagnostic marker for hypertension.
Area of Science:
- Cardiovascular Physiology
- Hypertension Research
- Arterial Biomechanics
Background:
- Hypertension involves metabolic and cardiovascular issues, including reduced arterial compliance.
- Arterial stiffness is a key characteristic of hypertension.
- Early detection of arterial changes is crucial for managing hypertension.
Purpose of the Study:
- To assess arterial compliance changes in early hypertension.
- To differentiate between proximal and distal arterial compliance.
- To identify potential early diagnostic markers for hypertension.
Main Methods:
- Utilized pulse wave contour analysis to quantify proximal and distal arterial compliance.
- Compared compliance in patients with borderline and established hypertension against normotensive controls.
- Analyzed age-dependency and familial history impact on arterial compliance.
Main Results:
- Proximal compliance was 24-33% lower, and distal compliance 58-61% lower in hypertensive patients versus controls.
- Age-matched comparisons confirmed significant reductions in both proximal and distal compliance in hypertensives.
- Lower compliance was observed in individuals with a family history of hypertension, independent of blood pressure or age.
- Proximal compliance inversely correlated with blood pressure variability and heart work.
Conclusions:
- Decreased distal arterial compliance is an early indicator of hypertension.
- Reduced proximal compliance is associated with established hypertension and may predict cardiovascular prognosis.
- Arterial compliance analysis offers a potential early diagnostic tool for hypertension.
Abstract:
In addition to high blood pressure, hypertension is characterised by metabolic and cardiovascular abnormalities, including decreased arterial compliance. To evaluate arterial involvement in early hypertension, we have employed a technique that analyses the arterial pulse wave contour to separately quantify proximal compliance (aorta and large arteries) and distal compliance (small arteries and arterioles). Proximal compliance was 24% lower in patients with borderline (diastolic BP 90-99 mmHg, n = 22) and 33% lower in patients with established (n = 19) hypertension than in normals (n = 15); distal compliance was 58% and 61% lower. These differences were not age-dependent, for in 27 age-matched pairs, proximal and distal compliances were 22% (P less than 0.01) and 55% (P less than 0.01) lower in hypertensives (diastolic BP greater than or equal to 95 mmHg) than in normotensives. Moreover, independent of BP or age, both proximal (P less than 0.05) and distal (P less than 0.01) compliance values were significantly lower in subjects with a family history of hypertension than in those without. Proximal compliance correlated inversely with indices of BP variability and heart work measured by automated whole-day blood pressure monitoring. Thus, changes in the elastic properties of the distal arterial circulation, reflected by decreased compliance, occur at the initiation of hypertension and may be an early diagnostic marker. Low proximal compliance appears to be associated with established hypertension, and might be a determinant of cardiovascular prognosis.