Pulsatile flow and oscillating wall shear stress in the brachial artery of normotensive and hypertensive subjects

Abstract

STUDY OBJECTIVE - The aim of the study was to examine oscillating arterial wall shear stress in hypertension. DESIGN - Pulsatile flow and oscillating wall shear stress were measured in brachial artery in hypertensive v normotensive subjects using pulsed Doppler apparatus. Methods were tested in four subjects using a micrometric procedure of Doppler probe displacement providing instantaneous real time velocity profiles. SUBJECTS - 19 ambulatory male patients with mild to moderate hypertension (diastolic blood pressure 95-114 mm Hg) and 11 normotensive male controls of similar age were studied. All were non-smokers. MEASUREMENTS and RESULTS - Arterial diameter and pulsatile centreline blood velocity were determined with pulsed Doppler, and blood viscosity was measured with a coaxial cylinder viscometer. Shear rates corresponding to maximum (gamma Vmax), minimum (gamma Vmin), and pulse (gamma Vpulse) velocities were evaluated with a simplified method of computation of Womersley equations. Corresponding shear stresses (tau Vmax, tau Vmin, tau Vpulse) were calculated as the product between shear rate and viscosity. The differences in wall shear rates obtained with the Womersley method and with the micrometric procedure were less than 10%. Compared to normotensives, hypertensives had greater arterial diameter [0.508(SEM0.006) v 0.446(0.014), p less than 0.001], lower maximum velocity [36.2(1.5) v 46.3(2.4) cm.s-1, p less than 0.001], lower absolute value of minimum velocity [-8.3(1.2) v -14.3(2.3) cm.s-1, p less than 0.01], lower pulse velocity [44.5(2.2) v 61.2(3.9) cm.s-1, p less than 0.001], and higher blood viscosity [4.77(0.08) v 4.28(0.09) mPa.s, p less than 0.001]. gamma and tau Vmax, Vmin and Vpulse were all lower in absolute value in hypertensives. Overall mean blood pressure in all subjects was negatively correlated to gamma Vmax (r = -0.65), tau Vmax (r = -0.46), gamma Vmin (r = -0.45), tau Vmin (r = -0.37), gamma Vpulse (r = -0.63), and tau Vpulse (r = -0.48). In hypertensives, age was correlated negatively to gamma Vmax (r = -0.44), tau Vmax (r = -0.46), gamma Vmin (r = -0.57), tau Vmin (r = -0.57), gamma Vpulse (r = -0.58), and tau Vpulse (r = -0.58). In normotensives, age was not correlated with shear parameters, except for tau Vmax (r = -0.60) and tau Vpulse (r = -0.66). CONCLUSIONS - The hypertensive state is associated with a reduction in oscillating wall shear in large arteries despite an increase in blood viscosity. Age in combination with hypertension also decreases wall shear conditions.