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Large artery stiffness in hypertension
Insights
Hypertension stiffens large arteries, increasing cardiovascular risk. Certain antihypertensive drugs improve artery flexibility, and genetic factors may guide future treatment choices for arterial stiffness.
Area of Science:
- Cardiovascular Physiology
- Vascular Biology
- Pharmacology
Background:
- Large arteries are crucial for cardiovascular hemodynamics, buffering stroke volume and propagating pressure pulses.
- Sustained hypertension, especially with other risk factors, leads to arterial stiffness, worsening hypertension and increasing cardiovascular morbidity and mortality.
- Environmental and genetic factors influence arterial wall composition, contributing to arterial stiffness.
Purpose of the Study:
- To investigate the effects of hypertension on large artery properties.
- To explore the role of environmental and genetic factors in arterial stiffness.
- To evaluate the efficacy of antihypertensive drugs in improving large artery compliance.
Main Methods:
- Utilized non-invasive methods to detect alterations in large arteries.
- Reviewed epidemiological and clinical studies on arterial stiffness.
- Analyzed the effects of specific antihypertensive drug classes on arterial compliance and metabolic factors.
Main Results:
- Arterial stiffness aggravates hypertension, potentially causing cardiac hypertrophy and arterial lesions.
- Stiffer arteries are associated with higher pulse pressure, morbidity, and mortality, independent of other risk factors.
- Angiotensin converting enzyme inhibitors and calcium channel blockers effectively improve large artery compliance without adverse metabolic effects.
Conclusions:
- Increased arterial stiffness is a significant cardiovascular risk factor.
- Angiotensin converting enzyme inhibitors and calcium channel blockers are suitable for treating patients with arterial stiffness.
- Genotyping may personalize future antihypertensive therapy selection for arterial stiffness.
Abstract:
EFFECTS OF HYPERTENSION ON LARGE ARTERIES: The mechanical properties of large arteries make a major contribution to cardiovascular haemodynamics through the buffering of stroke volume and by propagation of the pressure pulse. A sustained increase in blood pressure often leads to stiffness of the large arteries, especially when other risk factors are present. The increased stiffness, in turn, aggravates hypertension by increasing systolic blood pressure and can induce cardiac hypertrophy and arterial lesions. Epidemiological studies strongly suggest that subjects with stiffer arteries have a high pulse pressure, and that stiffening of large arteries is associated with excess morbidity and mortality independently of other cardiovascular risk factors. ENVIRONMENTAL AND GENETIC FACTORS: Apart from high blood pressure and ageing, various environmental and genetic factors that influence the composition of the extracellular matrix of the arterial wall can increase arterial stiffness. Clinical studies suggest that the presence of some genotypes may be a particularly important risk marker for arterial stiffness, and may modulate the effects of hypertension, ageing and lipids on large arteries. EFFECTS OF ANTIHYPERTENSIVE DRUGS: The development of accurate, non-invasive methods has now made it possible to detect alterations of the large arteries. Among antihypertensive drugs, angiotensin converting enzyme inhibitors and calcium channel blockers have proved to be highly effective in improving large artery compliance, and have shown no adverse effects on metabolic factors that can alter arterial structure and function such as lipids, plasma glucose and insulin tolerance. Therefore these drugs may be particularly suitable for treating patients with increased arterial stiffness. Finally, a determination of genotypes may be helpful in the future in choosing antihypertensive therapy.