Pulse Pressure, Arterial Stiffness, and Drug Treatment of Hypertension

Bortel, L.M.A.B. Van; Struijker‐Boudier, Harry A.J.; Safar, Michel E.

doi:10.1161/hy1001.095773

Cited by 217 publications

(167 citation statements)

References 88 publications

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“…This finding can be surprising because both ACEI and ARB are known to potentially reduce PWV. 25,26 However, in our study, the multiple regression analysis of the overall population showed that the population involved 50.9% diabetic subjects when ANGII blockade was present and only 18.7% diabetic subjects when ANGII blockade was absent. Clearly, the study of the overall population might suggest that, in agreement with this high incidence of diabetic subjects, the increase of PWV is more likely related to the role of HbA1c (that is, a situation related to diabetes mellitus and its treatment) than to ANGII blockade and its treatment by hypertension.…”

Section: Cardiovascular Prevention and Drug Treatmentcontrasting

confidence: 64%

Cardiovascular prevention: relationships between arterial aging and chronic drug treatment

Lieber

Millasseau²,

Mahmud

et al. 2011

J Hum Hypertens

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Drugs acting on cardiovascular (CV) prevention are, by definition, interconnected with age-induced arterial changes. However, this question has been poorly investigated along long-term treatment. This goal requires a major prerequisite: to determine statistical links associating age-induced changes in arterial stiffness and wave reflections with drug classes acting on CV prevention. We studied 347 subjects where CV prevention involved hypertension, diabetes mellitus and hypercholesterolaemia; and included six drug classes: diuretics, b-blocking agents, angiotensin II (ANGII) and calcium-channel (CCB) blockers, insulin therapy and statins. For each class, the total population was divided into two subgroups according to the presence or absence of the corresponding class. Statistical comparisons between subgroups involved brachial and central blood pressure measurements, aortic pulse wave velocity (PWV), augmentation index (AIx), used as a marker of wave reflections. Non-invasive measurements included tonometry and pulse wave analysis. Appropriate adjustments indicated among results the respective role of age, sex, mean blood pressure (MBP), standard risk factors and other confounding variables. CCB and statins did not exhibit statistical association with PWV or AIx. b-Blocking agents were significantly linked with heart rate reduction and resulting increase in AIx and central pulse pressure (PP). Increased PWV independent of age, MBP, CV risk factors were noticed under diuretics, ANGII blockers and insulin, pointing to intrinsic modifications of the arterial wall. Treatment of CV prevention involves alterations of the arterial wall depending on drug class. b-Blocking agents and insulin are associated with the higher increases of central PP.

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Section: Cardiovascular Prevention and Drug Treatmentcontrasting

confidence: 64%

Cardiovascular prevention: relationships between arterial aging and chronic drug treatment

Lieber

Millasseau²,

Mahmud

et al. 2011

J Hum Hypertens

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“…Novel therapeutic approaches available to reduce the increase in PP and arterial stiffness with age have been proposed recently and should be developed further. 50 These approaches involve converting enzyme inhibitors in association with diuretic compounds, nitrate derivatives, agents acting on collagen cross-linking, spironolactone and vasopeptidase inhibitors. Therapeutic trials using such medications will be necessary to demonstrate an improvement in morbidity and mortality on the basis of influencing vascular stiffness and increased PP.…”

Section: Discussionmentioning

confidence: 99%

Current Perspectives on Arterial Stiffness and Pulse Pressure in Hypertension and Cardiovascular Diseases

2003

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Blood pressure (BP) is a powerful cardiovascular (CV) risk factor that acts on the arterial wall and is responsible in part for various CV events, such as cerebrovascular accidents and ischemic heart disease. In clinical practice, 2 specific and arbitrary points of the BP curve, peak systolic BP (SBP) and end-diastolic BP (DBP), are used to define the CV risk factor. Because the goal of drug treatment of hypertension is to prevent CV complications, it appears likely that the totality of the BP curve, not simply 2 specific and arbitrary points, should be considered to act mechanically on the arterial wall and therefore should be used to propose an adequate definition of high BP.A current approach consists of considering the BP curve as the summation of a steady component, mean blood pressure (MBP), and a pulsatile component, pulse pressure (PP). 1 MBP, the product of cardiac output multiplied by total peripheral resistance, is the pressure for the steady flow of blood and oxygen to peripheral tissues and organs. The pulsatile component, PP, is the consequence of intermittent ventricular ejection from the heart. PP is influenced by several cardiac and vascular factors, but it is the role of large conduit arteries, mainly the aorta, to minimize pulsatility. In addition to the pattern of left ventricular ejection, the determinants of PP (and SBP) are the cushioning capacity of arteries and the timing and intensity of wave reflections. 1 The former is influenced by arterial stiffness, usually expressed in the quantitative terms of compliance and distensibility. 1 The latter result from the summation of a forward wave coming from the heart and propagating at a given speed (pulse wave velocity, or PWV) toward the origin of resistance vessels and a backward wave returning toward the heart from particular sites characterized by specific reflection coefficients. 1 Over the past few years, arterial stiffness and wave reflections have been widely investigated in old and/or hypertensive subjects for several reasons. First, whereas DBP was considered in the past as the better guide to determine disease severity, epidemiological studies have directed attention to SBP as a more informative CV risk factor, particularly in patients older than 50 years of age, and it has been shown that PP is an independent marker of CV risk, mainly for myocardial infarction. 2 Second, in subjects Ͼ50 years of age, ventricular ejection tends to be reduced, so that arterial stiffness and amplitude and timing of wave reflections become the main determinants of increased SBP and PP. Third, whereas drug control of DBP is consistently obtained in large populations of hypertensive patients, the ability to control SBP is observed much less frequently. 3 Finally, increased PP is also a predictor of CV risk in subjects with recurrent myocardial infarction and congestive heart failure. 2,4,5 From the hemodynamic factors that influence PP, 2 have been shown to independently predict CV risk: aortic stiffness, measured from aortic PWV, 6,7 and early return of...

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“…27 Pulse pressure was the difference between 24 h systolic and diastolic blood pressure and was used as an indirect measure of aortic stiffness. 28 In addition to ambulatory blood pressure, and after at least 5 min rest, duplicate blood pressure readings were taken 5 min apart by making use of a single-headed stethoscope and a table model mercury sphygmomanometer.…”

Section: Cardiovascular Measurementsmentioning

confidence: 99%

Arterial stiffness, ambulatory blood pressure and low-grade albuminuria in non-diabetic African and Caucasian men: the SABPA study

Schutte

Huisman

et al. 2011

Hypertens Res

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Recent evidence suggests that low-grade urinary albumin excretion is a marker of early general attenuation of vascular function, but studies are limited to Caucasian population groups. We compared low-grade urinary albumin excretion (o3.5 mg mmol À1 or 30 lg mg À1 ) between non-diabetic African (aged, 41.7 years; n¼70) and Caucasian (aged, 44.6 years; n¼91) men and ethnic-specific associations thereof with arterial stiffness and ambulatory blood pressure. The albumin-to-creatinine ratio (ACR) was determined from an 8 h overnight urine collection. We recorded ambulatory blood pressure over 24 h during a typical workday and the carotid-dorsalis pedis pulse wave velocity measured the next morning after a controlled overnight stay. ACR was higher in Africans compared with Caucasians (Po0.001), also after adjusting for 24 h systolic blood pressure, diastolic blood pressure and hypertension prevalence (Po0.001) or when grouped by similar 24 h mean arterial pressures (Po0.01 for all categories). Daytime (P¼0.002) and night time (Po 0.001) systolic and daytime (Po0.001) and night time (Po0.001) diastolic blood pressures were higher in Africans compared with Caucasians, but no differences existed for daytime and night time pulse pressure and pulse wave velocity. In African men only, after adjustment for covariates, night time systolic blood pressure (b¼0.347; P¼0.003), diastolic blood pressure (b¼0.298; P¼0.010) and mean arterial pressure (b¼0.331; P¼0.004) correlated positively with ACR. In addition, daytime (b¼0.265; P¼0.032) and night time (b¼0.258; P¼0.038) pulse pressure as well as pulse wave velocity (b¼0.271; P¼0.032) correlated positively with ACR. In conclusion, arterial stiffness and ambulatory blood pressure are already associated with low-grade albuminuria in non-diabetic African men with normal kidney function.

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Pulse Pressure, Arterial Stiffness, and Drug Treatment of Hypertension

Cited by 217 publications

References 88 publications

Cardiovascular prevention: relationships between arterial aging and chronic drug treatment

Cardiovascular prevention: relationships between arterial aging and chronic drug treatment

Current Perspectives on Arterial Stiffness and Pulse Pressure in Hypertension and Cardiovascular Diseases

Arterial stiffness, ambulatory blood pressure and low-grade albuminuria in non-diabetic African and Caucasian men: the SABPA study

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