title: Pulsatile hemodynamics and microcirculation: evidence for a close relationship in hypertensive patients.
abstract: The possible relationships between indicators of small resistance artery structure and of arterial stiffness and central hemodynamics have not yet been evaluated. Aim of this study was to assess the relationship between indicators of large arteries stiffness, including carotido-femoral pulse wave velocity and of vascular alterations in small resistance arteries (media/lumen ratio, M/L) in patients with primary and secondary hypertension. In 73 patients (mean age, 53±14 years, 34 females, 25 with type 2 diabetes mellitus, 18 never treated) with essential (n=37) and secondary (n=36) hypertension, carotido-femoral pulse wave velocity was measured. In all patients, small resistance arteries were dissected from subcutaneous fat biopsies and mounted on an isometric myograph, for the measurement of the M/L. Pulse wave analysis was performed in 67 patients. M/L ratio was significantly related to brachial systolic blood pressure and pulse pressure (r=0.36 and 0.31, P<0.001, respectively) and to central systolic and pulse pressure (r=0.44 and 0.42, P<0.001, respectively). A positive correlation was observed between M/L ratio and carotido-femoral pulse wave velocity (r=0.45; P<0.001); this correlation remained statistically significant after adjustment for age and mean blood pressure. M/L ratio was also associated to aortic augmentation index (r=0.33; P=0.008), and this correlations remained statistically significant after adjustment for potential confounders. In hypertensive patients, the presence of structural alterations of small resistance arteries may be associated with the increase in large arteries stiffness and possibly contribute to an increase in central pressure by increasing the magnitude of wave reflections.
authors.affiliation: Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy. muiesan@med.unibs.it
authors.forename: Maria Lorenza
authors.initials: ML
authors.lastname: Muiesan
authors.forename: Massimo
authors.initials: M
authors.lastname: Salvetti
authors.forename: Damiano
authors.initials: D
authors.lastname: Rizzoni
authors.forename: Anna
authors.initials: A
authors.lastname: Paini
authors.forename: Claudia
authors.initials: C
authors.lastname: Agabiti-Rosei
authors.forename: Carlo
authors.initials: C
authors.lastname: Aggiusti
authors.forename: Fabio
authors.initials: F
authors.lastname: Bertacchini
authors.forename: Deborah
authors.initials: D
authors.lastname: Stassaldi
authors.forename: Alice
authors.initials: A
authors.lastname: Gavazzi
authors.forename: Enzo
authors.initials: E
authors.lastname: Porteri
authors.forename: Carolina
authors.initials: C
authors.lastname: De Ciuceis
authors.forename: Enrico
authors.initials: E
authors.lastname: Agabiti-Rosei
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D011673:Pulsatile Flow / Q000502:physiology; D063177:Pulse Wave Analysis