title: Vascular compliance in blood pressure.
abstract: OBJECTIVE
  Vascular stiffening is a hallmark of the aging process. Improvements in the methods used to measure central stiffness, particularly applanation tonometry, and their use as therapeutic targets have generated great interest.
  
  
  RESULTS
  Vascular stiffness is associated with increases in pulse pressure (PP), aortic augmentation index, and pulse wave velocity (PWV). This last has emerged as the gold standard for evaluation of vascular stiffness, as it is an independent predictor of coronary heart disease, stroke, and mortality. Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium-channel blockers with or without diuretics are all commonly used to ameliorate vascular stiffness; however, selective β-1 blockers (β-blockers) may actually worsen aortic PP and aortic augmentation index.
  
  
  CONCLUSIONS
  Serial measurements of vascular stiffness, including PWV, augmentation index, and PP, may be especially beneficial in older patients to supplement brachial blood pressure. At present, given the lack of universally accepted normal values for vascular stiffness as measured by applanation tonometry, serial measurements over time may be more helpful than a single isolated value. In patients with suspected vascular stiffening, therapy should include inhibition of the renin-angiotensin-aldosterone system with ACE inhibitors or ARBs, calcium-channel blockers, and diuretics as needed to normalize blood pressure. β-Blockers should be reserved for patients with a history of myocardial infarction or congestive heart disease. It remains to be established whether β-blockers with vasodilator properties could improve the assessment of vascular compliance.
authors: Division of Nephrology and Hypertension, University of Miami, Miami, Florida 33125-1624, USA. LRaij@med.miami.edu
authors: Leopoldo
authors: L
authors: Raij
authors: Alba M
authors: AM
authors: Gonzalez-Ochoa
mesh_terms: D000367:Age Factors; D000375:Aging; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001158:Arteries / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology*; D001794:Blood Pressure / Q000187:drug effects; D003187:Compliance; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D008365:Manometry; D011237:Predictive Value of Tests; D011673:Pulsatile Flow
chemical_list: D000959:Antihypertensive Agents