Table 2 Factors influencing prognosis Risk factors Subclinical Organ Damage Systolic and diastolic BP levels Electrocardiographic LVH (Sokolow-Lyon > 38 mm; Cornell > 2440 mm M ms) or: Levels of pulse pressure (in the elderly) Echocardiographic LVH8 (LVMI M ! 125 g/m 2 , W ! 110 g/m 2 ) Age (M > 55 years; W > 65 years) Carotid wall thickening (IMT > 0.9 mm) or plaque Smoking Carotid-femoral pulse wave velocity >12 m/s Dyslipidaemia Ankle/brachial BP index < 0.9 -TC > 5.0 mmol/l (190 mg/dl) or:Slight increase in plasma creatinine:-LDL-C > 3.0 mmol/l (115 mg/dl) or: M: 115-133 mmol/l (1.3-1.5 mg/dl); -HDL-C: M < 1.0 mmol/l (40 mg/dl), W < 1.2 mmol/l (46 mg/dl) or:Low estimated glomerular filtration rate y (< 60 ml/min/1.73 m 2 ) or creatinine clearance^(< 60 ml/min) -TG > 1.7 mmol/l (150 mg/dl) Fasting plasma glucose 5.6-6.9 mmol/L (102-125 mg/dl) Microalbuminuria 30-300 mg/24 h or albumin-creatinine ratio: ! 22 (M); or ! 31(W) mg/g creatinine Abnormal glucose tolerance test Abdominal obesity (Waist circumference > 102 cm (M), > 88 cm (W)) Family history of premature CV disease (M at age < 55 years; W at age < 65 years) Diabetes Mellitus Established CV or renal disease Fasting plasma glucose ! 7.0 mmol/l (126 mg/dl) on repeated measurements, or Cerebrovascular disease: ischaemic stroke; cerebral haemorrhage; transient ischaemic attack Postload plasma glucose > 11.0 mmol/l (198 mg/dl) Heart disease: myocardial infarction; angina; coronary revascularization; heart failure Renal disease: diabetic nephropathy; renal impairment (serum creatinine M > 133, W > 124 mmol/l); proteinuria (> 300 mg/24 h) Peripheral artery disease Advanced retinopathy: haemorrhages or exudates, papilloedema Note: the cluster of three out of 5 risk factors among abdominal obesity, altered fasting plasma glucose, BP > --130/85 mmHg, low HDL-cholesterol and high TG (as defined above) indicates the presence of metabolic syndrome M: men; W: women; CV: cardiovascular disease; IMT: intima-media thickness; BP: blood pressure; TG: triglycerides; C: cholesterol;^Cockroft Gault formula; y MDRD formula; 8Risk maximal for concentric LVH (left ventricular hypertrophy): increased LVMI (left ventricular mass index) with a wall thickness/radius ratio ! 0.42.

Pulse pressure obtained from alternatively calibrated tonometer-derived pressure waves and echo-tracking-derived distension waves demonstrates good accuracy. Accuracy of pulse pressure from internally calibrated applanation tonometer readings at the carotid artery is poor.

Abstract-Compliance and distensibility are wall properties of large arteries, which may play a role in cardiovascular disease. The purpose of this study was to investigate whether the influence of age on these vessel wall properties differs between vascular territories and is gender-dependent. In a population sample of 498 men and women 20 to 79 years of age, diameter, distensibility, and compliance coefficient of the muscular brachial artery were measured with an echo-tracking device. Distensibility of the aorta was measured with the use of pulse-wave velocity. The effects of age and gender were assessed and adjusted for confounding factors such as mean blood pressure, pulse rate, body mass index, smoking, alcohol intake, and antihypertensive treatment. Covariance analysis showed no relation between gender and distensibility of the elastic aorta. Distensibility of the muscular brachial artery was lower in men, whereas men had a larger diameter and larger compliance of the brachial artery. With age, distensibility of the aorta decreased in both sexes to the same extent, whereas distensibility of the brachial artery did not change significantly. With age, brachial artery diameter increased; this increase was more pronounced in women. In men brachial artery compliance did not change with age, whereas in women compliance of the brachial artery increased with age. This study (1) confirms that distensibility of the aorta, an elastic artery, decreases with age. (2) In contrast to the aorta, after adjustment for confounding factors, in both men and women, no relation exists between age and distensibility of the muscular brachial artery. (3) Brachial artery diameter increase with age is more pronounced in women than in men. (4) In contrast to the well-known decrease in arterial compliance of elastic arteries with age, brachial artery compliance is not decreased with age and is increased in women. In conclusion, the effect of age on large-artery wall properties is not uniform but depends on gender and vascular territory. (Hypertension. 2000;35:637-642.)

The accumulation of advanced glycosylation endproducts (AGEs) on collagen and the subsequent stiffening of this matrix protein in diabetes has been described many years ago. Structural modification of collagen in the arterial wall might have important effects on arterial elasticity. Aminoguanidine is known to decrease the formation of AGEs. In this study we evaluated the effects of aminoguanidine treatment on different parameters reflecting arterial wall elasticity in diabetic rats. We demonstrated that treatment of diabetic rats with aminoguanidine resulted in a significant increase in carotid static compliance (+39%, P < 0.01 under control conditions, and +27%, P < 0.01 after abolition of vascular tone by KCN), and a decrease in characteristic aortic input impedance (-40%, P < 0.01 ). The arterial pulse pressure in aminoguanidine-treated rats was decreased (-15%, P < 0.05) and the pulsatile component of left ventricular power output was relatively diminished (-35%, P < 0.05). In addition, we observed a lower fluid filtration across the carotid wall. These results indicate an increased vascular elasticity, an improved left ventricular-arterial coupling, and a decreased vascular permeability in diabetic rats after aminoguanidine treatment, suggesting that AGE-accumulation on collagen negatively affects arterial wall properties in experimental diabetes. (J. Clin. Invest. 1993. 92:1407-1411

Рабочая группа по лечению артериальной гипертонии европейского Общества Гипертонии (European society of hypertension, Esh) и европейского Общества кардиологов (European society of Cardiology, EsC).