Editorial Commentary

Abstract

R isk factors for cardiovascular disease mediate their effects by altering the structure, properties, and function of wall and endothelial components of arterial blood vessels. 1 The ability to detect and monitor change in the physical properties of arteries, representative of the cumulative and integrated influence of hemodynamic, metabolic, and inflammatory stimuli in impairing arterial wall integrity, holds potential to intervene at a preclinical stage to prevent or attenuate disease progression. The importance of assessing arterial wall integrity has been highlighted by recent studies demonstrating that a decrease in the pulsatile function of large arteries represents an independent predictor for future cardiovascular events. 2 Information about the interaction between the left ventricle and the physical properties of the arterial circulation can be derived by the descriptive and quantitative analysis of the arterial pressure pulse waveform. 3 Consistent characteristic changes in the pressure pulse waveshape have been described with aging and disease states predisposing to an increase in vascular events. One such age-related change involves a steepening of the pressure decay in diastole, largely determined by impaired buffering function of the proximal aorta. 3,4 Loss of the oscillatory waveform that distorts the proximal portion of diastole from a pure exponential represents a further early and consistent finding with aging and risk factors for cardiovascular disease including hypertension, smoking, and diabetes mellitus. [3][4][5][6][7] This feature arises from reflection of the incident pressure wave generated by the left ventricle from peripheral reflecting sites with a major contribution originating from impedance mismatches in small arteries and arterioles. The progressive appearance of the reflected wave in systole and eventual summation with the forward incident wave results in augmentation of the systolic blood pressure. Given the proximity of the central aorta to the major peripheral reflecting sites in the lower limbs, augmentation of the systolic blood pressure occurs in this vessel before changes are recorded in the upper limb vessels. Recently, techniques based on the determination of a pressure transfer function between the radial artery and the aorta have been employed to provide an estimate of central pressure wave reflection. 8 In this issue of Hypertension, Millasseau et al 9 report on the accuracy of employing a generalized transfer function to the radial artery pressure pulse waveform to provide an estimate of the aortic augmentation index. The accuracy of the approach was assessed against data derived directly from the carotid pressure pulse waveform or after application of a transfer function to the waveform. The authors confirm prior observations that indicate the use of a general transfer function can show a considerable amount of bias and variation that limits the utility of this approach in accurately predicting the central augmentation index. 10,11 Further support for this content...

Ultrafiltration improves aortic compliance in haemodialysis patients

“…Although they result from altered mechanical properties of arteries, neither provides direct information on those properties. 22 AIC is a manifestation of arterial stiffness, and is influenced by confounding factors such as HR, age, gender and height, 23 although in our study HR did not change significantly. The function of small muscular arteries and arterioles can also affect AIC by changing the aortic wave reflection pattern independent of aortic PWV.…”

Effect of external cuff pressure on arterial compliance

“…Currently, there are three main noninvasive methodologies for assessing arterial compliance, which are based on analysis of pulse wave velocity [1], of pulse wave contour [2], and of direct measurement of arterial geometry and pressure [3]. It has also been known that a lot of factors influence arterial wall compliance, such as arterial pressure, temperature and age [4][5].…”

Aortic Pressure Augmentation Predicts Adverse Cardiovascular Events in Patients With Established Coronary Artery Disease

“…[1][2][3][4] In addition, measures of arterial stiffness correlate with the presence of angiographic coronary artery disease (CAD). [5][6][7] An increased pulse pressure (PP), which has been associated with increased arterial stiffness, is an adverse cardiovascular risk predictor.…”