Aortic stiffness increases central aortic pressure in patients with hypertension

Czech version

Authors: J. Bulas ¹; M. Potočárová ¹; J. Murín ¹; A. Šimková ¹; I. Janiga ²
Authors‘ workplace: I. interná klinika Lekárskej fakulty UK a UN Bratislava, Slovenská republika, prednostka doc. MUDr. Soňa Kiňová, PhD. ¹; Slovenská technická univerzita Bratislava, Slovenská republika, dekan prof. Ing. Ľubomír Šóoš, PhD. ²
Published in: Vnitř Lék 2012; 58(7 a 8): 190-194
Category: 60th Birthday prof. MUDr. Miroslav Souček, CSc.

Overview

Introduction:
Increased aortic stiffness belongs into the category of preclinical cardiovascular diseases. It is defined by pathologically increased velocity of carotido-femoral pulse wave velocity (PWV_Ao). In the group of treated hypertensive patients we measured the aortic pulse wave velocity and augmentation indices with the aim to define some parameters of central hemodynamics and to search for a relationship among them and the central aortic blood pressure.

Patient and methods:
We examined a group of 68 nonselected patient with arterial hypertension treated by combination therapy (mean of 3.4 drugs per patient). The arterial stiffness was measured using the Arteriograph-TensioMed, an equipment based on oscillometric principle, detecting the shape of brachial artery pulse by blood pressure cuff. It gives the values of brachial blood pressure, aortic pulse wave velocity, augmentation index, central systolic blood pressure and time indices of heart cycle.

Results:
We found a significant correlation of central aortic pressure and augmentation indices to aortic pulse wave velocity (aortic stiffness). These relationships were present despite the ongoing antihypertensive therapy with combination of drugs, as a matter of fact, a part of patients (23 persons) were treated by NO donors (nitrates and molsidomine).

Conclusion:
Measurements of central hemodynamic parameters as the augmentation index, central systolic blood pressure or aortic stiffness and indices derived, enable us to better estimate the load of the left ventricle and more precisely evaluate the efficiency of the antihypertensive therapy; their usage in the evaluation of antihypertensive therapy in a broader clinical practice, could improve prognosis of patients with arterial hypertension.

Key words:
aortic stiffness – pulse wave velocity – central aortic blood pressure – augmentation index – preclinical cardiovascular diseases

Sources

f1. London GM, Marchais SJ, Guerin AP et al. Arterial Stiffness: Pathophysiology and Clinical Impact. Clin exp hypertension 2004; 26: 689–699.

2. Laurent S, Cockroft J (ed.). Central aortic blood pressure. Neuilly-sur-Seine Cedex, France: Les Laboratoires Servier 2008.

3. Laurent S, Cockcroft J, Van Bortel L et al. European Network for Non-invasive Investigation of Large Arteries. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 2006; 27: 2588–2605.

4. Nakae I, Matsuo S, Matsumo T et al. Augmentation index and pulse wave velocity as indicators of cardiovasculat stiffness. Angiology 2008; 59: 421–426.

5. Miklos I. A new and fast screening method for measuring complex hemodynamical parameters and arterial stiffness noninvasively with a simple arm cuff. Am J Hypertens 2005; 18: 15A.

6. Baulmann J, Schillings U, Rickert S et al. A new oscillometric method for assessment of arterial stiffness: comparison with tonometric and piezo-electronic methods. J Hypertens 2008; 26: 523–528.

7. Wilkinson IB, McEniery CM, Cockroft JR. Central blood pressure estimation for the massess moves a step closer. J Hum Hypertens 2010; 24: 495–497.

8. Antonini-Canterin F, Carerj S, Di Bello V et al. Research Group of the Italian Society of Cardiovascular Echography (SIEC). Arterial stiffness and ventricular stiffness: a couple of diseases or a coupling disease? A review form the cardiologist’s point of view. Eur J Echocardiography 2009; 10: 36–43.

9. 2003 European Society of Hypertension-European Society of Cardiology Guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011-1053.

10. European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2007 Guidelines for the Management of Arterial Hypertension. The Task Force of European Society of Cardiology (ESC) and European Society of Hypertension (ESH) 2007.

11. Agabiti-Rosei E, Mancia G, O’Rourke MF et al. Central blood pressure measurement and antihypertensive therapy. A consensus document. Hypertension 2007; 50: 154–160.

12. De Buyzere ML, Segers P. Peripheral or central augmentation index: An esoteric question or non-invasive clue to central hemodynamics? J Hypertens 2007; 25: 289–293.

13. Lakatta EG, Levy D. Arterial and cardiac aging: Major shareholders in cardiovascular disease enterprises. Part I. Aging arteries: A „set up“ for vascular disease. Circulation 2003; 107: 139–146.

14. Cohn JN. Arterial stiffness, vascular disease, and risk of cardiovascular events. Circulation 2006; 113: 601–603.

15. O’Rourke MF, Adji A. An updated clinical primer on large artery mechanics: implications of pulse waveform analysis and arterial tonometry. Curr Opin Cardiol 2005; 20: 275–281.

16. Wiliams B, Lacy PS, Thom SM et al. The CAFE investigators. Anglo-Scandinavian Cardiac Outcomes Trial Investigators; CAFE Steering Committee and Writing Committee. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes. Principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 2006; 113: 1213–1225.

17. O’Rourke MF, Seward JB. Central arterial pressure and arterial pressure pulse: New views entering second century after Korotkov. May Clin Proc 2006; 81: 1057–1068.

18. Špác J, Souček M, Řiháček I et al. Rychlost aortální pulzové vlny u nemocných s metabolickým syndromem a hypertenzí léčených sartany. Vnitř Lék 2010; 56: 880–883.

19. Subherwal S, de las Fuentes L, Waggoner AD et al. Central aortic pressure is independently associated with diastolic function. Am Heart J 2010; 159: 1081–1086.

20. Kum F, Karalliedde J. Critical appraisal of the differential effects of antihypertensive agents on arterial stiffness. Integr Blood Press Control 2010; 3: 63–71.

21. Boutouyrie P, Lacolley P, Briet M et al. Pharmacological modulation of arterial stiffness. Drugs 2011; 71: 1689–1701.

22. Vlachopoulos C, Aznaouridis K, Stefanidis C. Prediction of cardiovascular events and all--cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 2010; 55: 1318–1327.