Heart rate and pulse pressure amplification in hypertensive subjects.
BACKGROUND
Although mean blood pressure (MBP) remains unmodified along the arterial tree, pulse pressure (PP) increases physiologically from the central to the peripheral arteries. Amplification of PP is known to be influenced by heart rate (HR), but the impact of this alteration has never been tested in patients with hypertension.


METHODS
A total of 712 hypertensive subjects, either treated or untreated, were divided into three classes of HR level. Carotid and brachial systolic blood pressure (SBP), carotid augmentation index, a marker of wave reflections, and carotid-brachial PP amplification were measured using applanation tonometry.


RESULTS
Independent of age, sex, and antihypertensive drugs, subjects with HR >80 beats/min were characterized, in comparison with those with lower HR, by reduced carotid SBP, PP, and augmentation index, resulting in a significant increase in PP amplification. In men but not in women, this pattern was associated with higher values of brachial SBP and DBP and by higher incidences of elevated glycemia and atherosclerotic alterations. In the male population, PP amplifications was, independent of HR, associated with the presence of beta blocking agents (negative association) and elevated plasma glucose.


CONCLUSIONS
Hypertensive men and women with high HR have significant PP amplifications, principally because of reduced central SBP and disturbed wave reflections. beta-blocking agents and plasma glucose independently alter PP amplification in men but not in women. Whether these opposite patterns influence the gender difference in cardiovascular risk should be prospectively studied.
Department of Internal Medicine, Broussais Hospital, Paris, France.
Pierre
P
Laurent
Pierre
P
Albaladejo
Jacques
J
Blacher
Annie
A
Rudnichi
Harold
H
Smulyan
Michel E
ME
Safar
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001783:Blood Flow Velocity / Q000502:physiology; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology*; D015992:Body Mass Index; D001916:Brachial Artery / Q000503:physiopathology; D017536:Carotid Artery, Common / Q000503:physiopathology; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D012307:Risk Factors; D012737:Sex Factors; D013223:Statistics as Topic; D013599:Systole / Q000502:physiology
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D001786:Blood Glucose