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      The Arterial System in Hypertension : A Prospective View

      Author(s): 1 , 1
      Publication date Created:
      Publication date (Print):
      Journal: Hypertension
      Publisher: Ovid Technologies (Wolters Kluwer Health)

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          Abstract

          Hypertension has long been considered a hemodynamic disorder, the hallmark of which is an increased total peripheral resistance that is more or less uniformly distributed in the arterioles of the component organ circulations. In recent years, because of the introduction of innovative technologies and methods, it is now possible to obtain a meaningful assessment of the physiological role of the larger arteries, thereby providing an index of arterial distensibility and compliance and a new means to assess the role of pulsatile pressure and arterial stiffening in hypertension and its comorbid diseases (eg, arteriosclerosis, diabetes mellitus). This discussion addresses these newer methodological aspects in assessing arterial stiffening in systemic hypertension and other cardiovascular disorders. In addition, the epidemiological, the molecular biological, and genetic, as well as certain therapeutic, aspects of pulse pressure in these circumstances are discussed.

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          Relation of pulse pressure and blood pressure reduction to the incidence of myocardial infarction.

          M H Alderman, W. Ooi, Gary Cohen … (1994)
          The prognostic value of pretreatment pulse pressure as a predictor of myocardial infarction and the relation of pulse pressure and in-treatment diastolic blood pressure reduction to myocardial infarction were investigated in a union-sponsored systematic hypertension control program. In a prospective study, 2207 hypertensive patients with a pretreatment systolic blood pressure greater than or equal to 160 mm Hg and/or diastolic pressure greater than or equal to 95 mm Hg grouped according to tertile of pulse pressure (PP1, or = 63 mm Hg) were further stratified by the degree of diastolic fall: large (L), > or = 18; moderate (M), 7 to 17; small (S), < or = 6 mm Hg. During an average follow-up of 5 years, 132 cardiovascular events (50 myocardial infarctions, 23 strokes) were observed. Myocardial infarction rates per 1000 person-years were positively related to pulse pressure (PP1, 3.5; PP2, 2.9; PP3, 7.5; PP3 versus PP1, P = .02). Wide pulse pressure was identified as a predictor of myocardial infarction (PP3 versus [PP1 + PP2]: relative risk [RR] = 2.2, 95% confidence interval [CI] = 1.2-4.1), controlling for other known risk factors by Cox regression. A curvilinear relation (resembling a J shape) between diastolic fall and myocardial infarction was observed in patients with the widest pulse pressure, PP3 (L, 9.5; M, 3.9; S, 11.2; L versus M: RR = 2.5, 95% CI = 1.0-6.2; S versus M: RR = 2.9, 95% CI = 1.1-8.0).(ABSTRACT TRUNCATED AT 250 WORDS)
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            Small artery structure in hypertension. Dual processes of remodeling and growth.

            N Korsgaard, M J Mulvany, Stuart Bund … (1993)
            Article 0 comments Cited 63 times – based on 0 reviews     Review now
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              Pulsatile versus steady component of blood pressure: a cross-sectional analysis and a prospective analysis on cardiovascular mortality.

              Banaz Safar, F A Cambien, L Guize … (1989)
              Studies on the prognostic significance of blood pressure on cardiovascular disease have essentially investigated the levels of diastolic or systolic blood pressure. However, blood pressure may also be divided into two other components: steady (mean arterial pressure) and pulsatile (pulse arterial pressure). The relations of these two components with cardiovascular risk factors and cardiovascular mortality were investigated in 18,336 men and 9,351 women aged 40-69 years, who were followed up for a mean period of 9.5 years. However, the interpretation of the relations is complicated by the strong correlation existing between these two components. A principal component analysis was performed to obtain two independent parameters: a steady and a pulsatile component index, strongly correlated with mean and pulse arterial pressure, respectively. In the cross-sectional analysis, relations were stronger with the steady component index than with the pulsatile component index; an association was found between left ventricular hypertrophy and the pulsatile component index in both sexes. The survival analysis was not performed in women under 55 as only 11 cardiovascular deaths occurred in this group. The steady component index was a strong prognostic factor of all types of cardiovascular death in both sexes. In women, the pulsatile component index was positively correlated to death from coronary artery disease and inversely correlated to stroke. In conclusion, the steady component of blood pressure is a strong risk factor for cardiovascular death in both sexes; the pulsatile component could be a risk factor independent of the steady component in women older than 55 years.
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                Author and article information

                Journal
                Title: Hypertension
                Abbreviated Title: Hypertension
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Print): 0194-911X
                ISSN (Electronic): 1524-4563
                Publication date Created: July 1995
                Publication date (Print): July 1995
                Volume: 26
                Issue: 1
                Pages: 10-14
                Affiliations
                [1 ]From the Department of Internal Medicine and INSERM (U337), Broussais Hospital, Paris, France, and the Alton Ochsner Medical Foundation, New Orleans, La.
                Article
                DOI: 10.1161/01.HYP.26.1.10
                PubMed ID: 7607711
                SO-VID: 00b28cf2-5b4e-4dac-bb6d-ce8edcbbd227
                Copyright © © 1995
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