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The pulsatile component of blood pressure: its role in the pathogenesis of atherosclerosis
Piotr Jankowski1, Grzegorz Bilo, Kalina Kawecka-Jaszcz
1I Department of Cardiology and Hypertension, Collegium Medicum Jagiellonian University, Kraków, Poland. piotrjankowski@interia.pl
Insights
High pulse pressure (PP) may directly contribute to atherosclerosis development and progression. This creates a dangerous cycle where increased PP worsens atherosclerosis, which in turn further elevates PP.
Area of Science:
- Cardiovascular Medicine
- Atherosclerosis Research
- Hypertension Studies
Background:
- Pulse pressure (PP) is traditionally linked to cardiovascular risk via increased afterload and left ventricular hypertrophy.
- Low diastolic blood pressure, contributing to high PP, can impair myocardial perfusion.
- Emerging evidence suggests pulsatile blood pressure changes play a direct role in atherosclerosis pathogenesis.
Purpose of the Study:
- To explore the direct role of pulsatile blood pressure changes in atherosclerosis.
- To investigate the bidirectional relationship between atherosclerosis and pulse pressure.
- To highlight potential therapeutic targets for reducing pulsatile hemodynamics.
Main Methods:
- Review of experimental studies investigating the cause-and-effect relationship between pulsatile blood pressure and atherosclerosis.
- Analysis of studies demonstrating the link between pulsatile blood pressure parameters and coronary atherosclerosis extent.
- Discussion of the postulated bidirectional link between atherosclerosis and PP.
Main Results:
- Experimental data support a causal link between pulsatile blood pressure and the atherosclerotic process.
- A significant correlation exists between pulsatile blood pressure components and the severity of coronary atherosclerosis.
- A bidirectional relationship is proposed: increased PP promotes atherosclerosis, and atherosclerosis exacerbates PP.
Conclusions:
- Pulsatile blood pressure is increasingly recognized as a direct contributor to atherosclerosis.
- A vicious cycle may exist where pulsatile hemodynamics and atherosclerosis mutually reinforce each other.
- Novel drug classes targeting pulsatile pressure components are under investigation for clinical utility.
Abstract:
Pulse pressure (PP) is traditionally believed to increase cardiovascular risk because of an increase in afterload leading to left ventricular hypertrophy. It has also been emphasized that low diastolic blood pressure, being in part responsible for high PP, leads to an impairment of myocardial perfusion with all its adverse consequences. More recently, however, a direct role of pulsatile blood pressure changes in the pathogenesis of atherosclerosis and its complications has become better known. Experimental studies indicate that there is a cause-and-effect type of relationship between the pulsatile component of blood pressure and atherosclerotic process. A significant relationship between the parameters of the pulsatile blood pressure component and the extent of coronary atherosclerosis was also demonstrated. Currently the presence of a bidirectional link between atherosclerosis and PP is commonly postulated, meaning that an increased PP may be both a cause and an effect of atherosclerosis. This may result in a vicious circle wherein the pulsatile blood pressure component induces/enhances the development of atherosclerosis, which in its turn reduces the arterial compliance and enhances pulse wave reflection, thereby leading to an increase in PP. Currently new drug classes are being investigated, which might reduce the pulsatile blood pressure component without changing mean blood pressure level. Their clinical usefulness should become known over the next few years.
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