title: Gender differences in the timing of arterial wave reflection beyond differences in body height.
abstract: OBJECTIVE
  The timing of arterial wave reflection affects the shape of the arterial waveform and thus is a major determinant of pulse pressure. This study assessed differences in wave reflection between genders beyond the effect of body height.
  
  
  METHODS
  From 1123 elderly (aged 71 +/- 5 years) currently untreated hypertensives, we selected 104 pairs of men and women with identical body height (average 164 +/- 4 cm). All subjects underwent echocardiography, including measurement of aortic arch expansion, automated blood pressure measurements, measurement of ascending aortic blood flow and simultaneous carotid artery tonometry.
  
  
  RESULTS
  Women had higher pulse (80 +/- 17 versus 74 +/- 17 mmHg, P < 0.05) and lower diastolic pressure (79 +/- 11 versus 82 +/- 10 mmHg, P < 0.05). Whilst heart rate was similar, women had a longer time to the systolic peak (210 +/- 28 versus 199 +/- 34 ms, P < 0.01) and a longer ejection time (304 +/- 21 versus 299 +/- 25 ms, P < 0.001). Wave reflection occurred earlier in women (time between maxima 116 +/- 55 versus 132 +/- 47 ms, P < 0.05) and augmentation index was higher (36 +/- 11 versus 28 +/- 12%, P < 0.001). Aortic diameter was smaller in women and the aortic arch was stiffer (median Ep 386 versus 302 kN/m2, P < 0.05). Hence, systemic arterial compliance was less in women (0.8 +/- 0.2 versus 1.0 +/- 0.3 ml/mmHg).
  
  
  CONCLUSIONS
  We conclude that elderly hypertensive men and women have a different timing of both left ventricular ejection and arterial wave reflection when both genders are matched for body height. Women have smaller and stiffer blood vessels resulting in an earlier return of the reflected wave, which is likely due to an increased pulse wave velocity in women.
authors.affiliation: Alfred and Baker Medical Unit, Baker Medical Research Institute, Prahran, Melbourne, Australia. c.gatzka@alfred.org.au
authors.forename: C D
authors.initials: CD
authors.lastname: Gatzka
authors.forename: B A
authors.initials: BA
authors.lastname: Kingwell
authors.forename: J D
authors.initials: JD
authors.lastname: Cameron
authors.forename: K L
authors.initials: KL
authors.lastname: Berry
authors.forename: Y L
authors.initials: YL
authors.lastname: Liang
authors.forename: E M
authors.initials: EM
authors.lastname: Dewar
authors.forename: C M
authors.initials: CM
authors.lastname: Reid
authors.forename: G L
authors.initials: GL
authors.lastname: Jennings
authors.forename: A M
authors.initials: AM
authors.lastname: Dart
mesh_terms: D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology; D001158:Arteries / Q000503:physiopathology*; D001794:Blood Pressure; D001827:Body Height; D003187:Compliance; D003971:Diastole; D004548:Elasticity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D011674:Pulse; D012727:Sex Characteristics; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D014463:Ultrasonography