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Non-invasive evaluation of arterial abnormalities in hypertensive patients
R G Asmar1, J A Topouchian, A Benetos
1Institut de Recherche et Formation Cardiovasculaire, Hôpital Broussais, Paris, France.
Insights
Hypertension causes arterial abnormalities in large and small arteries, increasing cardiovascular risk. Non-invasive methods assess these arterial changes, crucial for risk stratification and improved patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Hypertension Research
Background:
- Hypertension significantly contributes to morbidity and mortality through arterial lesions in vital organs.
- Structural and functional arterial abnormalities manifest early in hypertension, affecting both large and small vessels.
- These alterations impact arterial mechanics, increasing pulsatility and pulse pressure, and promoting atherosclerosis and arteriosclerosis.
Purpose of the Study:
- To investigate the arterial abnormalities associated with hypertension.
- To explore non-invasive methods for assessing arterial properties in hypertensive patients.
- To determine the clinical relevance of evaluating arterial abnormalities for cardiovascular risk management.
Main Methods:
- Utilized casual and ambulatory blood pressure measurements to assess pulse pressure.
- Employed tonometry for direct pulse pressure measurement and ultrasound techniques (Doppler, echo-tracking) for arterial structure and distensibility analysis.
- Applied pulse wave velocity (using Complior) as a key index of arterial distensibility.
Main Results:
- Hypertensive patients exhibit reduced arterial distensibility, as indicated by pulse wave velocity.
- Antihypertensive treatments do not consistently reverse these arterial abnormalities.
- Non-invasive techniques provide valuable insights into arterial hemodynamics and structure.
Conclusions:
- Arterial abnormalities are a hallmark of hypertension with significant clinical implications.
- Non-invasive assessment of arterial properties is vital for cardiovascular risk evaluation.
- Further therapeutic trials are needed to confirm the role of arterial assessment in guiding treatment and improving prognosis.
Abstract:
ARTERIAL ABNORMALITIES IN HYPERTENSION: Morbidity and mortality in hypertension are mainly determined by arterial lesions which may occur in different regional circulations (e.g. kidney, cerebral, coronary circulations, causing nephro-angiosclerosis, stroke or myocardial infarction, respectively). Despite arterial heterogeneity, structural and functional abnormalities are usually observed at an early stage of hypertension in both large and small arteries. These alterations modify physiological and mechanical properties of the arterial wall, which may become clinically evident by increasing arterial pulsatility or pulse pressure; the alterations facilitate the establishment and progression of atherosclerosis and arteriosclerosis.
Methods Of Assessing Arterial Abnormalities:
Several non-invasive techniques can be used to assess haemodynamic properties of arteries: (1) casual and ambulatory blood pressure measurements can be used to evaluate pulse pressure; (2) pulse pressure can be measured directly in different sites of the arterial tree using the Tonometer device; (3) ultrasound techniques can be applied, including Doppler signals to assess the arterial flow, video-echo signals to analyse the arterial structure such as the intimal-medial thickness and echo-tracking systems for direct measurements of arterial wall distension and thickness; (4) pulse wave velocity is widely used as index of arterial distensibility; this parameter, assessed by the Complior device, has shown that hypertensive patients have decreased arterial distensibility and that antihypertensive treatment does not always reverse this abnormality.
Treatment:
It is important to evaluate the effect of cardiovascular risk-reduction measures on the arterial wall. Large therapeutic trials are necessary to show whether an evaluation of arterial abnormalities can identify patients with a high cardiovascular risk and contribute to their treatment and prognostic improvement.