The effect of age on vascular compliance in man: which are the appropriate measures?

Bulpitt, C J; Cameron, James D.; Rajkumar, C.; Armstrong, Sam; Connor, Martin J.; Joshi, Jayshree; Lyons, Declan; Moioli, O; Nihoyannopoulos, Petros

doi:10.1038/sj.jhh.1000879

Cited by 32 publications

(17 citation statements)

References 25 publications

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“…It has been recently shown that PWVcf is a more precise indicator of atherosclerosis than either PWVcr or femoral-posterior tibial PWV [14]. PWVcf increases with age, blood pressure, diabetes, male gender, chronic renal diseases and chronic inflammatory autoimmune diseases [15,16,17,18,19,20]. In our study, we observed a significant difference between psoriasis patients and controls in PWVcf, but not in PWVcr.…”

Section: Discussionsupporting

confidence: 60%

Chronic Plaque Psoriasis Is Associated with Increased Arterial Stiffness

et al. 2008

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Background: Patients with moderate to severe chronic plaque psoriasis have a higher prevalence of cardiovascular risk factors and atherosclerosis. Arterial stiffness is a measure of endothelial dysfunction and an independent predictor of cardiovascular events. Objectives: To investigate whether chronic plaque psoriasis is associated with an increased arterial stiffness. Methods: A cross-sectional study on 39 adult patients with moderate to severe chronic plaque psoriasis and 38 control patients with skin diseases other than psoriasis was conducted. Arterial stiffness was assessed by carotid-femoral and carotid-radial pulse wave velocity (PWVcf, PWVcr). Results: PWVcf was significantly higher in patients with psoriasis than in controls (means ± SD; 8.88 ± 1.96 vs. 7.57 ± 1.34 m/s; p = 0.001). Difference was still significant after adjustment for age, gender, smoking status, hypertension and body mass index (8.78 ± 1.98 vs. 7.78 ± 2.0 m/s; p = 0.03). There was a positive correlation between PWVcf and years of psoriasis duration (r = 0.58; p = 0.0001), but not with disease severity. Conclusion: Moderate to severe chronic plaque psoriasis may be independently associated with increased arterial stiffness. Psoriasis duration could be a risk factor for arterial stiffness and atherosclerosis.

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Section: Discussionsupporting

confidence: 60%

Chronic Plaque Psoriasis Is Associated with Increased Arterial Stiffness

et al. 2008

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“…This is not a significant drawback in the current study because the aim was not to compare absolute parameters between groups but to look at relationships within groups. Nevertheless, the results demonstrate why there is much controversy re- garding the effects of diabetes on arterial compliance, positive deleterious results arising from studies in younger persons, and negative studies in older subjects in which the normal control subjects also have impaired compliance (11,18,19). All arterial mechanical properties vary with blood pressure level.…”

Section: Statisticsmentioning

confidence: 83%

The Aging of Elastic and Muscular Arteries

et al. 2003

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OBJECTIVE -To compare age-related changes in the mechanical properties of different arterial segments in normal volunteers and subjects with type 2 diabetes.RESEARCH DESIGN AND METHODS -In 169 subjects (diabetic n ϭ 57 and nondiabetic n ϭ 112), we assessed the mechanical properties of three arterial segments of differing wall composition. Pulse wave velocity (PWV) was measured noninvasively in a thoracoabdominal segment (carotid femoral PWV [PWV cf ]), in an upper limb muscular artery (carotid radial PWV [PWV cr ]), and from the aorta to the finger (PWV from the aorta to the finger [PWV fin ]). Central aortic compliance (CAC) was also measured.RESULTS -Average CAC was lower (0.662 vs. 0.850, P Ͻ 0.05) and all measures of PWV tended to be faster in diabetic subjects despite the fact that they were, on average, 10 years younger. However, these measures were not related to age in diabetic subjects. After correcting for blood pressure, only PWV cf was associated with age in nondiabetic subjects (P Ͻ 0.001). Expressing results as ratios of nonelastic to elastic arterial segments (i.e., PWV cr -to-PWV cf and PWV fin -to-PWV cf ) improved the relationship with age. Both PWV cr -to-PWV cf and PWV fin -to-PWV cf were significantly associated with age in nondiabetic subjects (r ϭ Ϫ0.59, P Ͻ 0.001; r ϭ Ϫ0.57, P Ͻ 0.001) but not in diabetic subjects (r ϭ Ϫ0.15, P ϭ 0.302; r ϭ Ϫ0.24, P ϭ 0.129). Multivariate analysis showed that the ratios were not associated with systolic blood pressure.CONCLUSIONS -There are significant differences in the rate of age-related decline in vascular stiffness in elastic arteries of nondiabetic compared with diabetic arteries. Diabetic arteries appear to age at an accelerated rate at an earlier age and then reach a functional plateau. Diabetes Care 26:2133-2138, 2003T he mechanical properties of the large conduit arteries are now recognized as an important component of cardiovascular pathophysiology. Less compliant arteries are associated with suboptimal cardiac energy supplydemand balance with reduced subendocardial blood flow and increased left ventricular afterload (1). There are also adverse effects of poor compliance on wave reflection and systolic blood pressure (SBP) (2). It is usually accepted that the age-related increase in SBP and decrease in diastolic blood pressure (DBP) are largely due to decreased proximal aortic compliance, causing more rapid diastolic run-off of a lower-contained volume (hence decreasing DBP) along with an early return of the reflected pressure wave in systole, causing increased pressure augmentation (increased SBP). Thus, increased aortic stiffness is the predominant cause of increased pulse pressure (3).Pulse pressure is a marker of cardiovascular risk in a general population (4) and, independent of SBP and DBP, has been shown to be a predictor of cardiovascular events (5), particularly in older individuals (6). It has also been shown that aortic stiffness (measured as pulse wave velocity [PWV]) is an independent predictor of cardiovascular risk (7) and all-ca...

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“…In older hypertensive patients, cardiac output is usually decreased and peripheral resistance increased because of accelerated age-related decline in vascular compliance [52,53]. Sensitivity of the baroreceptor reflex is often impaired accompanied by a reduction in intravascular volume predisposing orthostatic hypotension [54,55].…”

Section: Hypertension and Heart Failure In Elderly Patientsmentioning

confidence: 99%

Pathways involved in the transition from hypertension to hypertrophy to heart failure. Treatment strategies

2007

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The renin-angiotensin-aldosterone system (RAAS) is critical in regulating systemic blood pressure, water and electrolyte balance, and pituitary gland hormones. These physiologies appear to be primarily mediated by the angiotensin II/AT(1) receptor subtype system. Overstimulation of this system can predispose cardiovascular disease (CVD) characterized by excessive vasoconstriction, fibrosis, and cardiac remodeling. If untreated, the patient typically displays a continuum of pathophysiologic conditions progressing from atherosclerosis to left ventricle hypertrophy (LVH), coronary thrombosis, myocardial infarcts, with heart failure as an endpoint. Intervention with antihypertensive therapy is necessary to inhibit this progression. RAAS blocking drugs appear to be the most effective approach. Diastolic heart failure patients benefit from treatment with angiotensin converting enzyme (ACE) inhibitors and angiotensin AT(1) receptor blockers (ARBs). Elderly CVD patients evidence age-related changes in body composition that alter the distribution and half-life of medications, thus presenting special challenges to treatment. The presence of comorbidities such as diabetes, renal dysfunction, liver insufficiency further complicates any therapeutic strategy. In addition, noncompliance because of cognitive impairment, depression, confusion due to the complexity of dose regimens, and lack of an appropriate social support system can disrupt positive outcome. The present review discusses the roles of an overactive RAAS and sympathetic nervous system as primary contributors to CVD. In addition, treatment strategies are discussed, focusing on middle aged and elderly hypertensive and heart failure patients.

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The effect of age on vascular compliance in man: which are the appropriate measures?

Cited by 32 publications

References 25 publications

Chronic Plaque Psoriasis Is Associated with Increased Arterial Stiffness

Chronic Plaque Psoriasis Is Associated with Increased Arterial Stiffness

The Aging of Elastic and Muscular Arteries

Pathways involved in the transition from hypertension to hypertrophy to heart failure. Treatment strategies

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