Aortic pulse pressure and atherosclerotic structural alterations of coronary arteries

Abstract

Pulse pressure (PP) is an independent predictor of myocardial infarction, mainly above 50 years of age. In subjects with preserved ejection fraction (EF), aortic PP predicts the severity of coronary atherosclerosis. Comparable findings in subjects with reduced EF have not been evaluated. In 1337 subjects with severe coronary ischaemic disease, intra-aortic and brachial blood pressures were measured together with EF and coronary angiography to evaluate cardiac function, the presence of coronary stenosis and/or occlusions or calcifications. The presence (odds ratio±95% CI) of coronary calcification was marginally but not significantly associated (P ¼ 0.06) to increased aortic PP (1.32 (0.97-1.80)), whereas that of coronary occlusion was significantly associated (Po0.01) with decreased aortic PP (0.62 (0.42-0.91)), even after adjustment to EF and heart rate. Increased aortic PP did not correlate with stenosis number. No comparable predictive value was observed using intra-aortic or non-invasive brachial systolic blood pressure (SBP) or diastolic blood pressure (DBP). In high cardiovascular risk populations, even in the presence of reduced EF and high heart rate, intra-aortic PP, but not SBP or DBP, is a significant predictor of coronary occlusions and possibly calcifications, but not stenosis.

Association of Central and Peripheral Blood Pressures With Intermediate Cardiovascular Phenotypes

“…A more recent study compared intra-aortic and brachial BPs in 1337 patients undergoing invasive coronary angiography. 30 Coronary occlusion and low ejection fraction (≤50%) were independently associated with lower aortic but not brachial PP. This inverse relation of PP to vascular and LV disease highlights the extent to which PP depends on both intrinsic arterial stiffness and LV stroke volume.…”

Does Measurement of Central Blood Pressure have Treatment Consequences in the Clinical Praxis?

“…In addition, it is important to acknowledge that cross-sectional analyses cannot establish cause and effect. For example, stronger relations between LV mass and central pressure may be attributable to the greater ability of a hypertrophied heart to augment pressure in the presence of a comparable reflected wave [42].…”

Low admission blood pressure as a marker of poor 1-year survival in patients with revascularized critical limb ischemia

“…As the majority of deaths were from noncardiovascular documented causes (infection, limb ischemia, cancer and hemorrhage) in the present study, lower BP may be a surrogate marker of a poor health status and a number of confounding factors may interfere in the relationship between BP level and mortality. First, advanced cardiac disease with impaired cardiac function can be proposed as an underlying mechanism for BP-related mortality [29]. Previously diagnosed CHD was present in nearly 40% of the study population.…”