Atherosclerosis, Large Arteries and Cardiovascular Risk ( by Michel E. Safar, Edward D. Frohlich

By Michel E. Safar, Edward D. Frohlich

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Extra resources for Atherosclerosis, Large Arteries and Cardiovascular Risk ( Advances in Cardiology Vol 44)

Example text

PPA is variable between individuals but follows certain rules [47]. With normal aging, there is a reversal of the normal tendency for distal arterial stiffness (PWV) to exceed central arterial stiffness, a phenomenon that would be expected to lower the degree of PPA observed [9]. g. brachial or femoral arteries) in hypertension do not usually differ from normal arteries in their stiffness, probably due in large measure to the fact that they also dilate with age, presumably by the same pressure-dependent mechanisms that affect the aorta [39].

Amplification and Reflection: Central vs. Peripheral BP The morphology of a pulse contour at any point along the vascular tree represents the sum of the forward and reflected pressure waves at that point. Pulse wave morphology is unique in each artery because of differences in time of arrival of the forward and reflected pressure waves. Unlike diastolic or mean BP, systolic BP is thus not constant throughout the arterial tree. In the arm, the amplitude of the forward wave is generally much greater than the amplitude of the reflected wave, so brachial cuff systolic BP conveys information primarily about the forward wave, including PPA, but is largely blind to changes in wave reflection (fig.

Such studies suggest that non-invasive assessment of central systolic BP may be useful in assessing cardiac loading characteristics and the relative benefits of different antihypertensive drug classes [60]. Small Arteries and Arterioles Aging and disease modify vascular structure and function. Hypertension is associated with vasoconstriction, VSM hypertrophy and rarefaction in the microcirculation. Pulse volume, pressure, and velocity are important physiological variables that may function as biologic signals to the endothelium and VSM of the microcirculation.

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