The arterial reservoir pressure increases with aging and is the major determinant of the aortic augmentation index

Davies, Justin E.; Baksi, John; Francis, Dárrel P.; Hadjiloizou, Nearchos; Whinnett, Zachary I.; Manisty, Charlotte; Aguado-Sierra, Jazmín; Foale, Rodney A.; Malik, Iqbal; Tyberg, John V.; Parker, Kim H.; Mayet, Jamil; Hughes, Alun D.

doi:10.1152/ajpheart.00875.2009

Cited by 138 publications

(153 citation statements)

References 32 publications

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“…This finding supports recent observations that forward wave propagation and aortic reservoir characteristics (aortic compliance) may play a more dominant role in determining central BP. 9,11,[18][19][20] …”

Section: Discussionmentioning

confidence: 99%

“…9,10 Moreover, recent work has proposed that such discrete reflected waves make only a minor contribution to augmentation of the central BP under resting conditions. 11 Whether the rise in central systolic BP with exercise can be attributed to increases in discrete forward or reflected waves, or the reservoir, has not been determined in humans. Given the large increase in systemic vasodilation that Abstract-Exercise hypertension independently predicts cardiovascular mortality, although little is known about exercise central hemodynamics.…”

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confidence: 99%

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Exercise Central (Aortic) Blood Pressure Is Predominantly Driven by Forward Traveling Waves, Not Wave Reflection

et al. 2013

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A hypertensive response to exercise independently predicts cardiovascular events and mortality.1 However, the physiological mechanisms contributing to elevation in blood pressure (BP) with exercise are poorly understood. Previous studies have focussed on changes to brachial BP during exercise, but little attention has been directed toward understanding central (aortic) BP (the pressure to which organs such as the heart are exposed). Because of variations in pulse pressure amplification, central systolic BP is usually lower than brachial systolic BP and may differ greatly between individuals with the same brachial systolic BP.2-5 Moreover, central to peripheral pressure amplification may be magnified during exercise, 6,7 and we have also reported that individuals with increased cardiovascular risk because of hypercholesterolemia have significantly raised central systolic BP and augmentation index, but not brachial systolic BP, during light to moderate exercise. 8 Thus, risk related to BP may be better assessed by central BP during light to moderate intensity exercise, rather than resting brachial BP. However, despite these observations, little is known of the contributing central hemodynamics.At rest, with each heart beat a pressure wave generated by the left ventricle is propagated along the arteries and is reflected back toward the heart at sites of impedance mismatch. Return of this reflected pressure wave is proposed to be the sole contributor to augmentation (increase) in central BP.3 However, more recently it has been proposed that aortic pressure can be regarded as the sum of a reservoir pressure and an excess pressure, composed of discernibly discrete forward and backward propagating waves.9,10 Moreover, recent work has proposed that such discrete reflected waves make only a minor contribution to augmentation of the central BP under resting conditions.11 Whether the rise in central systolic BP with exercise can be attributed to increases in discrete forward or reflected waves, or the reservoir, has not been determined in humans. Given the large increase in systemic vasodilation that Abstract-Exercise hypertension independently predicts cardiovascular mortality, although little is known about exercise central hemodynamics. This study aimed to determine the contribution of arterial wave travel and aortic reservoir characteristics to central blood pressure (BP) during exercise. We hypothesized that exercise central BP would be principally related to forward wave travel and aortic reservoir function. After routine diagnostic coronary angiography, invasive pressure and flow velocity were recorded in the ascending aorta via sensor-tipped intra-arterial wires in 10 participants (age, 55±10 years; 70% men) free of coronary artery disease with normal left ventricular function. Measures were recorded at baseline and during supine cycle ergometry. Using wave intensity analysis, dominant wave types throughout the cardiac cycle were identified (forward and backward, compression, and decompression), and aortic reservoi...

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Section: Discussionmentioning

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Exercise Central (Aortic) Blood Pressure Is Predominantly Driven by Forward Traveling Waves, Not Wave Reflection

et al. 2013

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“…Additionally, recent studies have emphasized the importance of the aortic reservoir function in determining the systolic pressure waveform (Sharman et al 2009;Davies et al 2010). The relative contribution of this reservoir pressure wave (in comparison with the reflected pressure wave) to late-systolic augmentation is currently a matter of debate (Mynard et al 2012;Segers et al 2012), while it has long been well-recognized that the diastolic pressure waveform is determined by the Windkessel (reservoir and recoil) function.…”

Section: Difference Between Brachial and Aortic Blood Pressuresmentioning

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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“…1,4 The intensity of global wave reflection has conventionally been estimated from the analysis of central aortic or carotid pressure waveforms and from the calculation of the augmentation index (cAI), based on the concept of augmentation of central aortic systolic pressure (SBP) by a summated reflected wave. 1,3 However, the impacts of wave reflection on central pulse pressure (PP), 5 central aortic pressure waveform, 2 target organ damages and cardiovascular events may have been underestimated when cAI or augmented pressure (Pa) is used as a surrogate of the wave reflection intensity, 6 probably because cAI is dependent of the reflected wave transit time (RWTT) and sex, 3,7,8 and is principally determined by aortic reservoir function, other elastic arteries and only to a minor extent by reflected waves, 9 and may be dissociated with arterial stiffness measured by the aortic pulse wave velocity. 10,11 The absolute amplitude (Pb) of the reflected pressure wave decomposed from a central aortic or carotid pressure waveform is independent of RWTT and may be a better measure of wave reflection intensity than cAI or Pa. 6,8 Because of the limitations of cAI and Pa, our current understanding about the determinants of wave reflection has been incomplete.…”

Section: Introductionmentioning

confidence: 99%

Determinants of pressure wave reflection: characterization by the transit time-independent reflected wave amplitude

et al. 2010

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The effects of pressure wave reflection have been incompletely described by the central augmentation index (cAI) and augmented pressure (Pa). We therefore investigated the determinants of amplitude of the reflected wave (Pb), which is independent of the reflected wave transit time (RWTT) and has been shown to predict cardiovascular mortality in the general population. A total of 180 (117 men, mean age 68 years old) patients were recruited. Carotid pressure waveforms derived by tonometry at baseline and 3 min after administration of sublingual nitroglycerin (NTG) were calibrated and then decomposed into the forward and backward waves to yield Pb. The ratio of pre-ejection period/ejection time (PEP/ET) was measured. By stepwise multivariate analysis, independent determinants of Pb included brachial mean blood pressure (b ¼ 0.56, Po0.001), heart rate (b ¼ À0.29, Po0.001), age (b ¼ 0.20, Po0.001), PEP/ET (b ¼ À0.16, P ¼ 0.004) and height (b ¼ À0.13, P ¼ 0.018). RWTT, body mass index and sex were significant independent determinants of Pa and cAI but did not contribute to Pb. Change of Pb but not Pa or cAI significantly predicted the changes of carotid systolic (r ¼ 0.550, Po0.001) and pulse pressure (r ¼ 0.618, Po0.001) after NTG. In conclusion, determinants of Pb differ from those of cAI and Pa. Pb is independent of sex and RWTT.

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The arterial reservoir pressure increases with aging and is the major determinant of the aortic augmentation index

Cited by 138 publications

References 32 publications

Exercise Central (Aortic) Blood Pressure Is Predominantly Driven by Forward Traveling Waves, Not Wave Reflection

Exercise Central (Aortic) Blood Pressure Is Predominantly Driven by Forward Traveling Waves, Not Wave Reflection

Central Hemodynamics and Target Organ Damage in Hypertension

Determinants of pressure wave reflection: characterization by the transit time-independent reflected wave amplitude

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