title: Arterial stiffness, central hemodynamics, and cardiovascular risk in hypertension.
abstract: This review summarizes several scientific contributions at the recent Satellite Symposium of the European Society of Hypertension, held in Milan, Italy. Arterial stiffening and its hemodynamic consequences can be easily and reliably measured using a range of noninvasive techniques. However, like blood pressure (BP) measurements, arterial stiffness should be measured carefully under standardized patient conditions. Carotid-femoral pulse wave velocity has been proposed as the gold standard for arterial stiffness measurement and is a well recognized predictor of adverse cardiovascular outcome. Systolic BP and pulse pressure in the ascending aorta may be lower than pressures measured in the upper limb, especially in young individuals. A number of studies suggest closer correlation of end-organ damage with central BP than with peripheral BP, and central BP may provide additional prognostic information regarding cardiovascular risk. Moreover, BP-lowering drugs can have differential effects on central aortic pressures and hemodynamics compared with brachial BP. This may explain the greater beneficial effect provided by newer antihypertensive drugs beyond peripheral BP reduction. Although many methodological problems still hinder the wide clinical application of parameters of arterial stiffness, these will likely contribute to cardiovascular assessment and management in future clinical practice. Each of the abovementioned parameters reflects a different characteristic of the atherosclerotic process, involving functional and/or morphological changes in the vessel wall. Therefore, acquiring simultaneous measurements of different parameters of vascular function and structure could theoretically enhance the power to improve risk stratification. Continuous technological effort is necessary to refine our methods of investigation in order to detect early arterial abnormalities. Arterial stiffness and its consequences represent the great challenge of the twenty-first century for affluent countries, and "de-stiffening" will be the goal of the next decades.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Padova, Padua, Italy. palatini@unipd.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Palatini
authors.forename: Edoardo
authors.initials: E
authors.lastname: Casiglia
authors.forename: Jerzy
authors.initials: J
authors.lastname: Gąsowski
authors.forename: Jerzy
authors.initials: J
authors.lastname: Głuszek
authors.forename: Piotr
authors.initials: P
authors.lastname: Jankowski
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Narkiewicz
authors.forename: Francesca
authors.initials: F
authors.lastname: Saladini
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Stolarz-Skrzypek
authors.forename: Valérie
authors.initials: V
authors.lastname: Tikhonoff
authors.forename: Luc
authors.initials: L
authors.lastname: Van Bortel
authors.forename: Wiktoria
authors.initials: W
authors.lastname: Wojciechowska
authors.forename: Kalina
authors.initials: K
authors.lastname: Kawecka-Jaszcz
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000235:genetics / Q000503:physiopathology*; D008875:Middle Aged; D011674:Pulse; D012307:Risk Factors; D017673:Sodium Chloride, Dietary; D013564:Sympathetic Nervous System / Q000503:physiopathology; D059289:Vascular Stiffness; D055815:Young Adult
chemical_list: D017673:Sodium Chloride, Dietary