Towards optimization of wave reflection: therapeutic goal for tomorrow?

1. The conventional approach to drug therapy of hypertension and heart failure considers only effects of such drugs on peripheral resistance, cardiac output and heart rate. 2. A more complete approach needs to consider the pulsatile nature of cardiac ejection and so the influence of arterial stiffness and wave reflection properties and the effects of drugs on these. 3. Wave reflection normally aids cardiac function when full body height is achieved and arterial distensibility is high. However, with ageing or in hypertension the arteries stiffen and wave reflection returns early, augmenting systolic pressure, increasing pulse pressure and reducing the capacity for coronary perfusion. 4. In mature or older adults, delay of or reduction in wave reflection is an important therapeutic strategy for management of hypertension, angina pectoris and cardiac failure. 5. Beneficial effects of such therapy cannot always be gauged from conventional recordings of blood pressure, but can be inferred from analysis of pulse waveform.