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Arterial pulse wave and calcium-channel blockers in hypertension
B M Pannier1, G M London, A P Guerin
1Manhes Hospital, Fleury-Merogis, France.
Insights
Arterial pulsatility, not just mean blood pressure, impacts heart function. Central pulse pressure analysis using applanation tonometry can better evaluate hypertension treatments like calcium blockers.
Area of Science:
- Cardiovascular Physiology
- Pharmacology
Background:
- Arterial pulsatility, or pulse pressure (PP), differs between the heart and periphery.
- Brachial PP measurements do not accurately reflect central pulsatility, which is crucial for assessing left ventricular work.
- Pulse wave reflections can increase systolic pressure and left ventricular afterload, especially in older or hypertensive individuals.
Purpose of the Study:
- To investigate the utility of central pressure curve analysis for hemodynamic evaluation of antihypertensive drugs.
- To assess the effects of calcium blockers on central hemodynamics in hypertension.
Main Methods:
- Noninvasive recording of central pressure curves using applanation tonometry.
- Analysis of pulse wave reflection and its impact on central hemodynamics.
Main Results:
- Central pulsatility analysis offers a more accurate hemodynamic assessment than brachial PP.
- Calcium blockers reduce cardiac afterload through vasodilation, improved arterial compliance, and reduced central pulse wave reflection.
- These effects are observed after both single and chronic administration of calcium blockers.
Conclusions:
- Applanation tonometry provides valuable insights into central hemodynamics for evaluating antihypertensive therapies.
- Calcium channel blockers are effective in managing hypertension by improving central hemodynamic parameters.
Abstract:
In contrast to mean blood pressure, arterial pulsatility represented by pulse pressure (PP) varies from heart to periphery. It depends on the stiffness of large arteries and the degree of arteriolar vasoconstriction. The central pulsatility, directly linked to left ventricular work, cannot be accurately evaluated by measurement of brachial PP. Moreover, the pulse wave reflection, when arriving in systole, increases the late-systolic pressure and the left ventricular afterload, particularly in older and hypertensive subjects. Analysis of the central pressure curve recorded by an accurate noninvasive method (applanation tonometry) may improve the hemodynamic evaluation of antihypertensive drugs. Calcium blockers reduce cardiac afterload in hypertension by their arteriolar vasodilating properties, by improving the compliance of large arteries, and also by reducing the central influences of the reflection wave, as shown after single administration and particularly after chronic treatment with calcium blockers.