Noninvasive evaluation of arterial abnormalities in hypertensive patients.
Morbidity and mortality in hypertension are mainly determined by arterial lesions which may occur in different regional circulations: kidney, cerebral, coronary ..., causing respectively nephroangiosclerosis, stroke or myocardial infarction... Despite the arteries heterogeneity, structural and functional abnormalities are usually observed at an early stage of hypertension in both large and small arteries. These alterations modify arterial wall physiological and mechanical properties which can be expressed clinically by increasing arterial pulsatility or pulse pressure; they facilitate establishment and progression of atherosclerosis and arteriosclerosis. Since arteries constitute the target, site and common denominator of hypertension cardiovascular complications, several noninvasive techniques may be usefull to assess their haemodynamic: casual and ambulatory blood pressure measurements can evaluate pulse pressure which can be also directly measured in different sites of the arterial tree using the "Tonometer" device; ultrasound techniques can be applied: Doppler signal to assess the arterial flow, video-echo signal to analyse the arterial structure such as intima-media thickness, or echo-tracking systems for direct measurements of arterial wall distension and thickness; pulse wave velocity is widely used as index of arterial distensibility; its assessment, using the Complior device showed that hypertensive patients present a decrease of arterial distensibility and that antihypertensive treatment do not always reverse this abnormality. Since cardiovascular morbidity and mortality are due to arterial lesions, it is important to evaluate the effect of cardiovascular prevention on the arterial wall. Large therapeutical trials, including arterial evaluation, are necessary to assess whether this consideration may particularize patients with high cardiovascular risk and contribute to their treatment and prognostic improvement.
Asmar
R G
RG
L'Institut Cardio-vasculaire, Paris, France.
D001158:Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000473:pathology; D014065:Tonometry, Ocular; D014463:Ultrasonography