Systemic arterial compliance in patients with arteriosclerosis obliterans of the lower limbs. Observations on the effect of intravenous propranolol.

Abstract

Hemodynamic parameters and systemic arterial compliance were measured in patients with arteriosclerosis obliterans of the lower limbs before and after acute administration of propranolol. Arterial compliance was evaluated from a simple viscoelastic model, enabling the calculation of diastoiic drainage and diastoiic blood flow as indices of the reservoir role of the large arteries in overall circulation, in comparing basal conditions with normal subjects of the same age, patients with arteriosclerosis obliterans exhibited a significant decrease in arterial compliance (p < 0.01) and heart rate (p < 0.02) with a significant increase in systolic pressure (p < 0.001). Diastoiic drainage was increased (p < 0.01) and was positively correlated with diastoiic time (r = 0.73, p < 0.001). Diastoiic blood flow remained within normal ranges (52 ± 2 vs 49 ± 3 ml/m 2 /sec). After acute propranolol intravenous administration, heart rate and stroke volume decreased (p < 0.001), while total peripheral resistance increased (p < 0.001). Systemic arterial compliance and diastoiic blood flow significantly decreased (p < 0.01). The study provided evidence that in patients with arteriosclerosis obliterans, the diastoiic blood flow was maintained in basal conditions despite the observed reduction in arterial compliance, and that intravenous propranolol administration decreased systemic arterial compliance and diastoiic blood flow. (Arteriosclerosis 2:266-271, May/June 1982)

Regional compliance of brachial artery and saline infusion in patients with arteriosclerosis obliterans.

“…Indeed, it has been shown in patients with arteriosclerosis obliterans that decreased arterial compliance is exaggerated by beta-blockade. 1 Within the limits of the present investigation, it is difficult to assess the basis for an alteration in the autonomic system of patients with arteriosclerosis obliterans. One of the more surprising findings of this study was the observation of a slight, but significant, decrease in heart rate, as already reported.…”

Hypertension and peripheral arterial disease

“…18 Increased SBP in PAD seems to be due to a combination of arterial stiffness and reflection sites being closer to the heart, resulting in an increase in the rate and amplitude of central wave reflection. 19,20 The finding of ISH in the PAD cohort in the ATTEST study may also be a reflection of the increased age associated with onset of this condition. With age, increased arterial stiffness leads to increased SBP with a decrease in DBP, resulting in a higher pulse pressure.…”

Peripheral arterial disease and isolated systolic hypertension: The ATTEST Study

“…Sodium excess and b-blocking agents may increase SBP through increase in arterial stiffness and disturbed wave reflections, whereas nitrates and angiotensin-converting enzyme inhibitors (ACEI) have an opposite effect. 12,[16][17][18] Third, stenoses of renal artery are relatively frequent in subjects with PAD and favour the presence of systolic-diastolic hypertension. 19 Finally, clinical studies have shown that increased arterial stiffness and disturbed wave reflections are not only frequent in subjects with PAD but also are significantly associated with reduced walking distance and impaired vasodilating arteriolar properties.…”

“…10,11 Increased SBP in subjects with PAD is mainly because of increased arterial stiffness and disturbed timing and amplitude of central wave reflections. [12][13][14] More specifically, reflection sites are closer from the heart than in normal subjects, because of the importance of structural alterations of the aortic bifurcations, as extensively shown from arteriography. 12 This interpretation is strengthened by the presence of an increased frequency of systolic hypertension around 50 years of age in subjects with traumatic amputation of the lower limbs.…”

“…[12][13][14] More specifically, reflection sites are closer from the heart than in normal subjects, because of the importance of structural alterations of the aortic bifurcations, as extensively shown from arteriography. 12 This interpretation is strengthened by the presence of an increased frequency of systolic hypertension around 50 years of age in subjects with traumatic amputation of the lower limbs. 15 In these patients the height of SBP is proportional to the number of lower limb amputations and therefore to the number and diffusion of reflection sites, which all together become closer from the heart.…”