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. 2017 Jul 28;12(7):e0182173.
doi: 10.1371/journal.pone.0182173. eCollection 2017.

Evolution of aortic pressure during normal ageing: A model-based study

Stamatia Pagoulatou  1 , Nikolaos Stergiopulos  1
Affiliations

Evolution of aortic pressure during normal ageing: A model-based study

Stamatia Pagoulatou et al. PLoS One. .

Abstract

Background: The age-related increase in pulse pressure (PP) and systolic blood pressure (SBP) is often attributed to alterations in the wave reflection profile and augmented contributions of the reflected waves. However, clinical evidence shows that the stiffening of the proximal aorta with age and the consequent augmentation of the forward pressure wave plays an equally important role. The relative importance of the forward and reflected wave components in essential hypertension has not yet been fully elucidated.

Objective: The aim of the current investigation was to simulate the major ageing mechanisms in the arterial system and the heart using a mathematical one-dimensional model of the arterial tree and to assess the evolution of systolic and pulse pressure during normal (non-pathological) ageing.

Methods and results: Our state-of-the-art 1-D model was extended to include turbulence and inertial effects of the flow exiting the left ventricle. Literature data on the age-associated changes in arterial stiffness, peripheral resistance and cardiac contractility were gathered and used as an input for the simulations. The predicted evolution of pressure and augmentation index with age followed accurately the curves obtained in a number of large-scale clinical studies. Analysis of the relative contribution of the forward and backward wave components showed that the forward wave becomes the major determinant of the increase in central and peripheral SBP and PP with advancing age.

Conclusions: The 1-D model of the ageing tree and heart captures faithfully and with great accuracy the central pressure evolution with ageing. The stiffening of the proximal aorta and the resulting augmentation of the forward pressure wave is the major contributor of the systolic pressure augmentation with age.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Model pressure predictions against clinical data for the time frame of 30 to 80 years of age.
Panel A. Model-derived brachial SBP (dashed line) and aortic SBP and DBP (solid line) against the reference data [43,44] (squares). Panel B. Model-derived ratio of peripheral (brachial) PP to central (aortic) PP (solid line) against the measurements from ACCT trial [44] (squares-dotted line).
Fig 2
Fig 2. Pressure waveforms during ageing.
Aortic (left) and brachial (right) pressure waveforms for the age decades: 30 years (black solid line), 40 years (dashed line), 60 years (dotted line), 80 years (grey solid line).
Fig 3
Fig 3. Model predictions (solid line) against clinical data from Mitchell et al. [13] and Torjesen et al. [15] (black squares).
Panel A. Augmentation Pressure, Panel B. Augmentation index, Panel C. Inflection Point.
Fig 4
Fig 4. Contribution of forward pressure wave to pressure augmentation during ageing, as assessed by the PPforward/PPcentral ratio.
1-D model results (squares—solid line) compared to the 0-D model results [18] (dots–dashed line).
See this image and copyright information in PMC

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