Central Pulse Pressure and Aortic Stiffness Determine Renal Hemodynamics

Hashimoto, Junichiro; Ito, Sadayoshi

doi:10.1161/hypertensionaha.111.177469

Cited by 234 publications

(120 citation statements)

References 47 publications

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“…6 Such increase in central pulse pressure would be transmitted into the high flow, low resistance organs such as the brain and the kidney. [28][29][30] In support of this, our data showed that age-related increase in CBF pulsatility was accompanied by the concurrent elevations in carotid pulse pressure. Moreover, carotid pulse pressure was an independent predictor of CBF pulsatility.…”

Section: Cerebral Hemodynamics and Central Arterial Aging T Tarumi Et Alsupporting

confidence: 80%

Cerebral Hemodynamics in Normal Aging: Central Artery Stiffness, Wave Reflection, and Pressure Pulsatility

Tarumi

Khan

Liu

et al. 2014

J Cereb Blood Flow Metab

178

143

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Blood ejected from the left ventricle perfuses the brain via central elastic arteries, which stiffen with advancing age and may elevate the risk of end-organ damage. The purpose of this study was to determine the impact of central arterial aging on cerebral hemodynamics. Eighty-three healthy participants aged 22 to 80 years underwent the measurements of cerebral blood flow (CBF) and CBF velocity (CBFV) using magnetic resonance imaging (MRI) and transcranial Doppler, respectively. The CBF pulsatility was determined by the relative amplitude of CBFV to the mean value (CBFV%). Central arterial stiffness (carotid-femoral pulse wave velocity), wave reflection (carotid augmentation index), and pressure were measured using applanation tonometry. Total volume of white-matter hyperintensity (WMH) was quantified from MR images. Total CBF decreased with age while systolic and pulsatile CBFV% increased and diastolic CBFV% decreased. Women showed greater total CBF and lower cerebrovascular resistance than men. Diastolic CBFV% was lower in women than in men. Age-and sex-related differences in CBF pulsatility were independently associated with carotid pulse pressure and arterial wave reflection. In older participants, higher pulsatility of CBF was associated with the greater total volume of WMH. These findings indicate that central arterial aging has an important role in age-related differences in cerebral hemodynamics.

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Section: Cerebral Hemodynamics and Central Arterial Aging T Tarumi Et Alsupporting

confidence: 80%

Cerebral Hemodynamics in Normal Aging: Central Artery Stiffness, Wave Reflection, and Pressure Pulsatility

Tarumi

Khan

Liu

et al. 2014

J Cereb Blood Flow Metab

178

143

View full text Add to dashboard Cite

show abstract

“…2). In fact, a recent study has demonstrated that a higher aortic pulse pressure is independently associated with the presence of albuminuria in patients with hypertension (Hashimoto and Ito 2011). This study agrees well with previous studies showing significant associations of the aortic PWV and augmentation index with the urinary albumin excretion (Tsioufis et al 2003;Smith et al 2005).…”

Section: Central Hemodynamics and Kidneysupporting

confidence: 92%

“…2). In studies examining the intrarenal flow velocity waveform with duplex ultrasound (Pontremoli et al 1999;Hashimoto and Ito 2011), it has been demonstrated that (micro)albuminuria is predictable by the renal resistive index (RI). This means that intrarenal flow pulsation is related to glomerular injury, because RI is usually calculated from the equation of [RI = 1 -(minimum velocity) ÷ (maximum velocity)] and therefore it originally quantifies the flow pulsation.…”

Section: Elastic Aorta Stiff Aortamentioning

confidence: 99%

Central Hemodynamics and Target Organ Damage in Hypertension

Hashimoto

2014

Tohoku J. Exp. Med.

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Recent advances in technology have enabled the noninvasive evaluation of pulsatile hemodynamics in the central aorta; namely, central pressure and flow measurements. The central blood pressure represents the true load imposed on the heart, kidney and brain, and the central blood flow influences the local flow into these vital organs. An elevation of the central blood pressure has a direct, adverse impact on the target organ and, thus, the cardiovascular prognosis in patients with hypertension. A decrease in the central blood flow can cause organ dysfunction and failure. The central pressure and flow dynamics were conventionally regarded as unidirectional from the heart to the periphery. However, current evidence suggests that it should be recognized as a bidirectional interplay between the central and peripheral arteries. Specifically, the pressure pulse wave is not only transmitted forward to the periphery but also reflected backward to the central aorta. The flow pulse wave is also composed of the forward and reverse components. Aortic stiffening and arteriolar remodeling due to hypertension not only augment the central pressure by increasing the wave reflection but also may alter the central bidirectional flow, inducing hemodynamic damage/dysfunction in susceptible organs. Therefore, central hemodynamic monitoring has the potential to provide a diagnostic and therapeutic basis for preventing systemic target organ damage and for offering personalized therapy suitable for the arterial properties in each patient with hypertension. This brief review will summarize hypothetical mechanisms for the association between the central hemodynamics and hypertensive organ damage in the heart, kidney and brain.

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“…Other studies also found that, in essential hypertension, RI was associated with ambulatory arterial stiffness index 29 or central pulse pressure and aortic stiffness. 30 Therefore, renal RI should be considered as a marker of systemic atherosclerotic vessel damage rather than a specific marker of renal damage.…”

Section: Discussionmentioning

confidence: 99%

Renal Resistive Index and Cardiovascular and Renal Outcomes in Essential Hypertension

Doi

Iwashima²,

Yoshihara³

et al. 2012

Hypertension

112

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Abstract-Increased renal restive index (RI) measured using Doppler ultrasonography has been shown to correlate with the degree of renal impairment in hypertensive patients. We investigated the prognostic role of RI in cardiovascular and renal outcomes. A total of 426 essential hypertensive subjects (mean age, 63 years; 50% female) with no previous cardiovascular disease were included in this study. Renal segmental arterial RI was measured by duplex Doppler ultrasonography. During follow-up (mean, 3.1 years), 57 participants developed the primary composite end points including cardiovascular and renal outcomes. In multivariate Cox regression analysis, RI was an independent predictor of worse outcome in total subjects (hazard ratio, 1.71 for 1 SD increase), as well as in patients with estimated glomerular filtration rate (eGFR) Ͻ60 mL/min per 1.73 m 2 (hazard ratio, 2.11 for 1 SD increase; PϽ0.01, respectively). When divided into 4 groups based on the respective sex-specific median levels of RI in the eGFR Ն60 and eGFR Ͻ60 mL/min per 1.73 m 2 groups, the group with eGFR Ͻ60 and high RI (male Ն0.73, female Ն0.72) had a significantly poorer event-free survival rate ( 2 ϭ126.4; PϽ0.01), and the adjusted hazard ratio by multivariate Cox regression analysis was 9.58 (95% CI, PϽ0.01). In conclusion, impairment of renal hemodynamics evaluated by increased RI is associated with an increased risk of primary composite end points, and the combination of high RI and low eGFR is a powerful predictor of these diseases in essential hypertension. In hypertensive patients with chronic kidney disease, RI evaluation may complement predictors of cardiovascular and renal outcomes. Key Words: cardiovascular disease Ⅲ renal hemodynamics Ⅲ ultrasonography Ⅲ hypertension Ⅲ predictor I n the past few years, there has been growing attention to markers of subclinical renal damage because they provide an accurate prediction of global cardiovascular outcome.1 Renal Doppler sonography permits noninvasive assessment of intrarenal hemodynamics in addition to evaluation of anatomic information. Intrarenal arterial waveforms recorded by Doppler sonography have been widely used to evaluate renal dysfunction.2,3 Previous studies have explored the capacity of resistive index (RI) calculated from blood flow velocity in vessels to predict the progression of renal function in patients with hypertension, 4 diabetes mellitus, 5 or chronic nephropathy. 6,7 In addition, histological studies demonstrated that RI not only reflects changes in intrarenal perfusion and renovascular resistance but was increased in several pathological conditions, such as renal atherosclerosis 8 and tubulointerstitial damage. 9,10 In previous studies, the prognostic value of RI was examined only in chronic nephropathy, 6 elderly, 11 or heart failure patients 12; however, the results obtained were inconsistent. Thus, the status of RI as an independent cardiovascular risk marker remains to be elucidated. Estimated glomerular filtration rate (eGFR), which is a measure of the kidneys' ...

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Central Pulse Pressure and Aortic Stiffness Determine Renal Hemodynamics

Cited by 234 publications

References 47 publications

Cerebral Hemodynamics in Normal Aging: Central Artery Stiffness, Wave Reflection, and Pressure Pulsatility

Cerebral Hemodynamics in Normal Aging: Central Artery Stiffness, Wave Reflection, and Pressure Pulsatility

Central Hemodynamics and Target Organ Damage in Hypertension

Renal Resistive Index and Cardiovascular and Renal Outcomes in Essential Hypertension

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