Increased systolic pressure in chronic uremia. Role of arterial wave reflections.

Abstract

To assess the role of arterial wave reflections in the mechanism of systolic hypertension and altered pulsatile arterial dynamics in patients with end-stage renal disease (ESRD), 79 ESRD patients were compared with 73 age-matched control subjects with normal renal function and similar mean blood pressure. Wave reflections were investigated from the carotid pulse contour recorded by applanation tonometry using a Millar micromanometer-tipped probe. Wave reflections were quantified as the ratio (augmentation index, %) of the height of the late systolic peak to the total height of carotid pulse wave. Travel time of the reflected wave was timed from the foot of the pressure wave to the foot of the late systolic peak. Systolic and pulse pressure were increased in ESRD patients (p<0.001) and was not attributable to differences in left ventricular ejection pattern. The augmentation index was increased in ESRD patients (23.2 ±15.0 versus 9.8±15.6%;/><0.001) in association with a shorter travel time of reflected wave (109±24 versus 131 ±30 msec; p<0.001). Multiple regression analysis showed two principal factors associated (p<0.001) with the increase in augmentation index and shortened travel time of reflected wave: increased aortic pulse wave velocity and smaller stature with shorter body height in ESRD patients. The study points to the mle of arterial wave reflections in the mechanisms producing alterations in pulsatile arterial dynamics in ESRD and is the first, through the mechanisms of early wave reflections, to show in humans that the increase in systolic and pulse pressures is associated with lesser body size. (Hypertension

Quality of Life in Autosomal Dominant Polycystic Kidney Disease Patients not yet on Dialysis

“…The association of increased education level with a better quality of life has also been represented by greater income levels and was also found in this study (data not shown). Pulse pressure remained an independent contributor to the PCS score and is an indirect measure of vascular compliance that is altered in the hypertensive state and in individuals with renal insufficiency (27). Pulse pressure may represent more severe disease in ADPKD individuals with renal insufficiency and hypertension (1).…”

Long-term intervention with Lactobacillus helveticus fermented milk reduces augmentation index in hypertensive subjects

“…The time to return of the reflected wave (Tr) was calculated as the time from the beginning of the derived aortic systolic pressure waveform to the inflection point. Tr can be used as a substitute for pulse wave velocity (a higher pulse wave velocity will result in a shorter Tr) (London et al, 1992). Subjects were studied after a minimum 12-h fast in the morning between 0700 to 1000 hours and were asked to refrain from alcohol consumption and heavy exercise on the day before measurements.…”

Changes of central haemodynamic parameters during mental stress and acute bouts of static and dynamic exercise

“…Therefore, T i is used as an indicator of aortic PWV and AS, since it has been shown that there is very good association between these parameters. [22][23][24] It should be mentioned that the T i is a surrogate of aortic PWV and there are no studies that have definitively shown the clinical significance of this marker. The PPP/CPP ratio depends on both arterial wall properties and pressure augmentation from the reflected wave.…”

“…The former relates to coronary flow during diastole whereas the latter is an index of systolic stress relating to oxygen demand. 24 The SEVR gives information about the balance between oxygen demands and endocardial blood flow. 25 The PRP, which refers to the product of SBP and HR during exercise, is a good measure of myocardial oxygen uptake 26 and it depends on exercise intensity.…”