Arterial stiffness, central hemodynamics, and cardiovascular risk in hypertension

Abstract

This review summarizes several scientific contributions at the recent Satellite Symposium of the European Society of Hypertension, held in Milan, Italy. Arterial stiffening and its hemodynamic consequences can be easily and reliably measured using a range of noninvasive techniques. However, like blood pressure (BP) measurements, arterial stiffness should be measured carefully under standardized patient conditions. Carotid-femoral pulse wave velocity has been proposed as the gold standard for arterial stiffness measurement and is a well recognized predictor of adverse cardiovascular outcome. Systolic BP and pulse pressure in the ascending aorta may be lower than pressures measured in the upper limb, especially in young individuals. A number of studies suggest closer correlation of end-organ damage with central BP than with peripheral BP, and central BP may provide additional prognostic information regarding cardiovascular risk. Moreover, BP-lowering drugs can have differential effects on central aortic pressures and hemodynamics compared with brachial BP. This may explain the greater beneficial effect provided by newer antihypertensive drugs beyond peripheral BP reduction. Although many methodological problems still hinder the wide clinical application of parameters of arterial stiffness, these will likely contribute to cardiovascular assessment and management in future clinical practice. Each of the abovementioned parameters reflects a different characteristic of the atherosclerotic process, involving functional and/or morphological changes in the vessel wall. Therefore, acquiring simultaneous measurements of different parameters of vascular function and structure could theoretically enhance the power to improve risk stratification. Continuous technological effort is necessary to refine our methods of investigation in order to detect early arterial abnormalities. Arterial stiffness and its consequences represent the great challenge of the twenty-first century for affluent countries, and "de-stiffening" will be the goal of the next decades.

Keywords: arterial elasticity; central blood pressure; compliance; pulse wave velocity; stiffness.

Figure 1

Radial (left) and aortic (right) waveforms in a young and an old subject. Abbreviations: cSBP, central systolic blood pressure; cDBP, central diastolic blood pressure; cPP, central pulse pressure; AP, augmented pressure; PW, pulse wave.

Figure 2

Odds ratios and confidence intervals for development of hypertension needing antihypertensive treatment from a multivariable logistic regression. Notes: Odds ratios represent risk of hypertension for the three groups of hypertensive versus normotensive subjects; P values are adjusted for age, gender, body mass index, parental hypertension, physical activity, smoking, coffee, alcohol, body mass index change, follow-up duration, average 24-hour systolic blood pressure, diastolic blood pressure, and heart rate. Data from Saladini et al. Abbreviations: NT, normotensives; ISH low, isolated systolic hypertensives with low central systolic blood pressure; ISH high, isolated systolic hypertensives with high central systolic blood pressure; SDH, systolic-diastolic hypertensives.

Figure 3

Trend of 12-year cardiovascular (CV) mortality rate in relation to pulse pressure and systolic pressure. Notes: Classes are <50, 50–75, 75–100, 100–125, and >125 mmHg for pulse pressure, and <100, 100–125, 125–150, 150–175, and >175 mmHg for systolic pressure; the slope of pulse pressure is steeper and more linear than that of systolic pressure, that shows a J-shaped trend; data from 11,861 men and women aged 18–95 years from four Italian general populations.,,,,