title: Aortic diameter, wall stiffness, and wave reflection in systolic hypertension.
abstract: Systolic hypertension is associated with increased pulse pressure (PP) and increased risk for adverse cardiovascular outcomes. However the pathogenesis of increased PP remains controversial. One hypothesis suggests that aortic dilatation, wall stiffening and increased pulse wave velocity result from elastin fragmentation, leading to a premature reflected pressure wave that contributes to elevated PP. An alternative hypothesis suggests that increased proximal aortic stiffness and reduced aortic diameter leads to mismatch between pressure and flow, giving rise to an increased forward pressure wave and increased PP. To evaluate these two hypotheses, we measured pulsatile hemodynamics and proximal aortic diameter directly using tonometry, ultrasound imaging, and Doppler in 167 individuals with systolic hypertension. Antihypertensive medications were withdrawn for at least 1 week before study. Patients with PP above the median (75 mm Hg) had lower aortic diameter (2.94+/-0.36 versus 3.13+/-0.28 cm, P<0.001) and higher aortic wall stiffness (elastance-wall stiffness product: 16.1+/-0.7 versus 15.7+/-0.7 ln[dyne/cm], P<0.001) with no difference in augmentation index (19.9+/-10.4 versus 17.5+/-10.0%, P=0.12). Aortic diameter and wall stiffness both increased with advancing age (P<0.001). However, an inverse relation between PP and aortic diameter remained significant (P<0.001) in models that adjusted for age, sex, height, and weight and then further adjusted for aortic wall stiffness, augmentation index, and mean arterial pressure. Among individuals with systolic hypertension, increased PP is primarily attributable to increased wall stiffness and reduced aortic diameter rather than premature wave reflection.
authors: Cardiovascular Engineering Inc, University Office Park, Bldg. 2, Suite 100, 51 Sawyer Road, Waltham, MA 02453, USA. GaryFMitchell@mindspring.com
authors: Gary F
authors: GF
authors: Mitchell
authors: Paul R
authors: PR
authors: Conlin
authors: Mark E
authors: ME
authors: Dunlap
authors: Yves
authors: Y
authors: Lacourcière
authors: J Malcolm O
authors: JM
authors: Arnold
authors: Richard I
authors: RI
authors: Ogilvie
authors: Joel
authors: J
authors: Neutel
authors: Joseph L
authors: JL
authors: Izzo
authors: Marc A
authors: MA
authors: Pfeffer
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology; D001011:Aorta / Q000473:pathology* / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology; D002339:Carotid Arteries / Q000473:pathology / Q000503:physiopathology; D015331:Cohort Studies; D004548:Elasticity; D004562:Electrocardiography; D005260:Female; D005263:Femoral Artery / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012039:Regional Blood Flow / Q000502:physiology; D012044:Regression Analysis; D012307:Risk Factors