Pressure-dependence of arterial stiffness: potential clinical implications.
BACKGROUND
Arterial stiffness measures such as pulse wave velocity (PWV) have a known dependence on actual blood pressure, requiring consideration in cardiovascular risk assessment and management. Given the impact of ageing on arterial wall structure, the pressure-dependence of PWV may vary with age.


METHODS
Using a noninvasive model-based approach, combining carotid artery echo-tracking and tonometry waveforms, we obtained pressure-area curves in 23 hypertensive patients at baseline and after 3 months of antihypertensive treatment. We predicted the follow-up PWV decrease using modelled baseline curves and follow-up pressures. In addition, on the basis of these curves, we estimated PWV values for two age groups (mean ages 41 and 64 years) at predefined hypertensive (160/90 mmHg) and normotensive (120/80 mmHg) pressure ranges.


RESULTS
Follow-up measurements showed a near 1 m/s decrease in carotid PWV when compared with baseline, which fully agreed with our model-prediction given the roughly 10 mmHg decrease in diastolic pressure. The stiffness-blood pressure-age pattern was in close agreement with corresponding data from the 'Reference Values for Arterial Stiffness' study, linking the physical and empirical bases of our findings.


CONCLUSIONS
Our study demonstrates that the innate pressure-dependence of arterial stiffness may have implications for the clinical use of arterial stiffness measurements, both in risk assessment and in treatment monitoring of individual patients. We propose a number of clinically feasible approaches to account for the blood pressure effect on PWV measurements.
aDepartment of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands bDepartment of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands cDepartments of Internal Medicine dRadiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
Bart
B
Spronck
Maarten H G
MH
Heusinkveld
Floris H
FH
Vanmolkot
Jos Op 't
JO
Roodt
Evelien
E
Hermeling
Tammo
T
Delhaas
Abraham A
AA
Kroon
Koen D
KD
Reesink
D000368:Aged; D000375:Aging / Q000502:physiology*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods*; D002339:Carotid Arteries / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D012307:Risk Factors; D059289:Vascular Stiffness / Q000502:physiology*
D000959:Antihypertensive Agents