title: Progression of central pulse pressure over 1 decade of aging and its reversal by nitroglycerin a twin study.
abstract: OBJECTIVE
  The goal of this study was to examine the progression of central arterial pulse pressure (cPP) in women and the degree to which this can be reversed by nitrovasodilation.
  
  
  BACKGROUND
  cPP can be partitioned into height of the first systolic shoulder (P1), generated by a forward pressure wave and related to arterial stiffness, and augmentation pressure (AP), thought to be influenced by pressure wave reflection from muscular arteries and/or aortic reservoir.
  
  
  METHODS
  Using a longitudinal cohort design, cPP, P1, and AP were estimated (using the SphygmoCor System [AtCor Medical Pty Ltd., West Ryde, Australia]) in 411 female twins over a mean follow-up of 10.8 years. In a subsample (n = 42), cPP, arterial stiffness (using pulse wave velocity [PWV]) and arterial diameters (using ultrasonography) were measured before and after nitroglycerin administration (400 μg s/l).
  
  
  RESULTS
  cPP increased more than peripheral pulse pressure (10.3 and 9.2 mm Hg, respectively; p < 0.0001). In women <60 years of age at follow-up, AP contributed more to the increase in cPP than did P1 (increases of 6.5 ± 6.4 mm Hg and 4.2 ± 7.8 mm Hg, respectively). P1 was significantly positively correlated to PWV (p < 0.0001); AP was correlated to aorto-femoral tapering (p < 0.0001) but not PWV. Nitroglycerin reduced cPP by 10.0 ± 6.0 mm Hg (p < 0.0001), equivalent to a decade of aging. The reduction in cPP was entirely explained by a decrease in AP, with no significant change in P1 or PWV but an increase in large artery diameters of 4% to 18% (p < 0.0001).
  
  
  CONCLUSIONS
  Age-related widening of cPP is driven in large part by an increase in AP, which can be reversed by selective dilation of muscular arteries, independent of PWV.
authors.affiliation: King's College London, British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, St. Thomas' Hospital, London, United Kingdom.
authors.forename: Marina
authors.initials: M
authors.lastname: Cecelja
authors.forename: Benyu
authors.initials: B
authors.lastname: Jiang
authors.forename: Tim D
authors.initials: TD
authors.lastname: Spector
authors.forename: Phil
authors.initials: P
authors.lastname: Chowienczyk
mesh_terms: D000375:Aging / Q000502:physiology*; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000187:drug effects / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D001795:Blood Pressure Determination; D004305:Dose-Response Relationship, Drug; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000187:drug effects / Q000502:physiology; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013997:Time Factors; D014427:Twins; D014463:Ultrasonography; D059289:Vascular Stiffness / Q000502:physiology*; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin