Arterial stiffness as a risk factor for clinical hypertension

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Michel E Safar1

  • 1Paris Descartes University, APHP, Centre de Diagnostic et de Thérapeutique, Hôpital Hôtel-Dieu, 1 place du Parvis Notre-Dame, 75181 Paris, France.

Nature Reviews. Cardiology
|October 13, 2017
PubMed

Insights

Essential hypertension involves impaired cardiovascular viscoelasticity and elevated mean circulatory pressure. Increased arterial stiffness is a key risk factor, impacting cardiovascular health, especially in patients with diabetes or kidney issues.

Area of Science:

  • Cardiovascular Physiology
  • Hypertension Pathophysiology
  • Arterial Biomechanics

Background:

  • Essential hypertension is characterized by normal cardiac output and intravascular volume, but elevated mean circulatory pressure.
  • Key pathophysiological features include augmented vascular resistance and significantly impaired cardiovascular system viscoelasticity.
  • These factors contribute to carotid-femoral arterial stiffness, a major risk factor in hypertensive individuals.

Purpose of the Study:

  • To review the mechanisms and implications of arterial stiffness in hypertension.
  • To highlight the role of arterial stiffness as a cardiovascular risk factor, particularly in patients with diabetes or renal impairment.
  • To discuss the importance of arterial stiffness in hypertension diagnosis and management, advocating for novel therapeutic strategies.

Main Methods:

  • Review of existing literature on hypertension, arterial stiffness, and cardiovascular risk.
  • Analysis of physiological parameters in uncomplicated essential hypertension, including cardiac output, intravascular volume, and mean circulatory pressure.
  • Assessment of arterial stiffness using pulse wave velocity and its correlation with hypertension and other comorbidities.

Main Results:

  • Arterial stiffness is substantially increased in hypertension, independent of blood pressure levels.
  • Structural vascular changes and endothelial dysfunction are linked to impaired vessels in hypertensive models.
  • Increased arterial stiffness significantly affects pulse pressure, wave reflections, renal function, and overall cardiovascular risk.

Conclusions:

  • Arterial stiffness is a critical factor in understanding hypertension's impact on cardiovascular health.
  • Elevated arterial stiffness poses a significant risk for cardiovascular and renal events, especially in patients with hypertension and/or type 2 diabetes mellitus.
  • New diagnostic and therapeutic approaches are needed to manage hypertension, considering arterial stiffness in patients with or without diabetes and/or renal impairment.

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