Aortic input impedance in normal man and arterial hypertension: its modification during changes in aortic pressure

Merillon, J. P.; Fontenier, G.; Lerallut, J.F.; Jaffrin, Michel Y.; Motté, G; Genain, Claude P.; Gourgon, R

doi:10.1093/cvr/16.11.646

Cited by 92 publications

(50 citation statements)

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“…[69][70][71] Such an increase is accentuated in patients with hypertension 72,73 and ischemic heart disease. 74 Studies have also shown an increase in the late systolic augmentation (AIx) of radial, carotid and aortic pressure waveforms with an increase in age.…”

Section: Perspectivesmentioning

confidence: 99%

Pulse Wave Analysis and Pulse Wave Velocity A Review of Blood Pressure Interpretation 100 Years After Korotkov

Hirata

Kawakami

O’Rourke

2006

Circ J

153

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ncreasingly, in recent times, the value of the cuff sphygmomanometer that provides arterial pressures (brachial systolic and diastolic pressure) is coming under question. The concerns extend well beyond the familiar issue of "white coat" hypertension, home and 24-h blood pressure recordings, and the phase-out of mercury based instruments. These concerns relate to the inaccuracy of all cuff devices for measuring pressure within the brachial artery, the difference between pressures in the brachial artery and central aorta, and the interpretation of systolic, diastolic, mean and pulse pressure (PP). 1 The present questions can be seen in context when one considers the history of hypertensive disease and its assessment by clinicians over the past 2 centuries. Richard Bright was the first to study "high arterial tension" and its relationship with kidney disease, cardiac failure and stroke. 2 His assessment was made from the palpation of the pulse at the wrist, and the clinical recognition of a condition where the pulse required considerable force to obliterate and the pulse wave was sustained in late systole. Graphic methods to record the radial pulse were introduced in the late 19 th century, and used in clinical practice (and life insurance exams) by English pioneers of cardiology such as Mackenzie and Lewis. But these were hard to use and were quickly Circulation Journal Vol. 70, October 2006 replaced by the cuff sphygmomanometer as introduced by Riva-Rocci for recording of systolic pressure and by Korotkov for recording of systolic and diastolic pressure. 3,4 By 1916, the value of (systolic) pressure for predicting cardiovascular events in asymptomatic life insurance applicants was confirmed by Fisher. 1,5 Practitioners of the sphygmomanometer favored the use of diastolic rather than systolic pressure in the early 20 th century. Diastolic blood pressure was considered more reliable than systolic pressure because its value was agreed as being closer to mean pressure than systolic -and so a better guide to elevated peripheral resistance and hypertensive disease. This view was endorsed by Orr, in Mackenzie's name, that "Systolic blood pressure represents the maximum force of the heart, and diastolic blood pressure measures the resistance the heart has to overcome." -that is, that elevated diastolic pressure was bad but elevated systolic pressure was good. 6 Such a view became entrenched and was widely held until initially questioned by the Framingham results, 7 then contradicted by the US NIH's Systolic Hypertension in the Elderly Project (SHEP). 8 Up until 1991, studies on arterial pressure had consistently reported on the positive relationship between cardiovascular events and diastolic pressure (Fig 1). [9][10][11][12][13][14][15][16][17][18] There is good reason why diastolic pressure was preferred to systolic from the time of Korotkov until the SHEP results were published in 1991. 8 This was the period when hypertensive disease was rife and unchecked -when no effective therapy was available and the vicious c...

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Section: Perspectivesmentioning

confidence: 99%

Pulse Wave Analysis and Pulse Wave Velocity A Review of Blood Pressure Interpretation 100 Years After Korotkov

Hirata

Kawakami

O’Rourke

2006

Circ J

153

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“…However, very little data from hypertensive animals or humans were presented to substantiate these predictions. Merillon et al (4) found that compared with normal subjects those with hypertension had greater resistance, wave reflections, and fraction of pulsatile power, and an impedance spectrum further to the right but no difference in characteristic impedance. In contrast, Nichols et al (3) found that characteristic impedance also was greater in hypertensive as compared with normotensive patients with coronary artery disease.…”

Section: Introductionmentioning

confidence: 99%

Arterial hemodynamics in human hypertension.

Ting¹,

Brin²,

Lin³

et al. 1986

J. Clin. Invest.

130

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Differences in aortic impedance between normotensives and hypertensives are not well characterized. We examined impedance in 8 normotensive and 11 hypertensive (mean 96.7 vs. 122.2 mmHg) age-matched, Chinese patients undergoing cardiac catheterization at rest, during nitroprusside, and handgrip exercise before and after beta blockade (propranolol). Hypertensives had higher resistance (2,295 vs. 1713 dyn-s/cm5), characteristic impedance (145.7 vs. 93.9 dyn-s/cm5), total external power (1,579 vs. 1174 mW), peripheral reflections (ratio of backward to forward wave components of 0.54 vs. 0.44), and first zero crossing of impedance phase angle (4.15 vs. 2.97 Hz). These abnormalities were eliminated with vasodilatation. Differences between groups were not further exacerbated when pressure was increased during handgrip exercise. Beta blockade further increased resistance and reflections. Thus, hemodynamic abnormalities of essential hypertension (increased resistance, reflections, and pulse wave velocity, and decreased compliance) are compatible with an increased vasomotor tone that is further unmasked during generalized beta blockade.

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“…Detailed hemodynamic studies in humans have clarified the role of arterial distensibility, 8 vascular impedance, 9 pulse wave velocity, 10 and pulse wave reflection 11 in determination of the amplitude of systolic pressure in systemic arteries. The most recent work has shown that systolic pressure in the central aorta in humans is markedly increased in hypertension and in the elderly as a consequence of early return of wave reflection caused by arterial stiffening and degeneration.…”

mentioning

confidence: 99%

Arterial dilation and reduced wave reflection. Benefit of dilevalol in hypertension.

et al. 1989

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We compared dilevalol (an isomer of labetalol), 200-400 mg daily, against atenolol, 50-100 mg daily, in a double-blind, crossover, placebo-controlled trial with respect to effects on arterial distensibility (measured as pulse wave velocity [FVW]) and wave reflection (assessed from carotid pressure wave contour). Twelve patients of mean age 58 years (range 44-73 years) with essential hypertension (supine diastolic blood pressure 95-114 mm Hg) took active therapy for 12 weeks, separated by a 2-4-week placebo period. Carotid pressure waveforms were recorded noninvasively by applanation tonometry with a Millar micromanometer-tipped probe. PVW was measured between carotid and femoral arteries (aortic PWV), carotid and radial arteries (arm PVW), and femoral and pedal arteries (leg PWV). Early wave reflection was calculated from the ratio of the height of the peak of the carotid wave above its shoulder to the pulse pressure and was expressed as an augmentation index. Both drugs were equally effective in reducing brachial sphygmomanometric pressure and PWV in all three regions (active vs. placebo, p<0.001), but there was no significant difference between the two active therapies. However, the augmentation index (averaged during the treatment period) was significantly lower with dilevalol (19%) than with atenolol (28%, /;<0.01), corresponding to a greater decrease of 5-8 mm Hg in carotid systolic pressure compared with the brachial artery. Although both drugs were equally effective in reducing arterial distensibility, the vasodilating action of dilevalol gave added benefit in reducing wave reflection, presumably through its vasodilatory effect on peripheral conduit arteries. (Hypertension 1989;14:14-21)

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Aortic input impedance in normal man and arterial hypertension: its modification during changes in aortic pressure

Cited by 92 publications

References 0 publications

Pulse Wave Analysis and Pulse Wave Velocity A Review of Blood Pressure Interpretation 100 Years After Korotkov

Pulse Wave Analysis and Pulse Wave Velocity A Review of Blood Pressure Interpretation 100 Years After Korotkov

Arterial hemodynamics in human hypertension.

Arterial dilation and reduced wave reflection. Benefit of dilevalol in hypertension.

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