Abstract
BackgroundThe age-related increase in pulse pressure (PP) and systolic blood pressure (SBP) is often attributed to alterations in the wave reflection profile and augmented contributions of the reflected waves. However, clinical evidence shows that the stiffening of the proximal aorta with age and the consequent augmentation of the forward pressure wave plays an equally important role. The relative importance of the forward and reflected wave components in essential hypertension has not yet been fully elucidated.ObjectiveThe aim of the current investigation was to simulate the major ageing mechanisms in the arterial system and the heart using a mathematical one-dimensional model of the arterial tree and to assess the evolution of systolic and pulse pressure during normal (non-pathological) ageing.Methods and resultsOur state-of-the-art 1-D model was extended to include turbulence and inertial effects of the flow exiting the left ventricle. Literature data on the age-associated changes in arterial stiffness, peripheral resistance and cardiac contractility were gathered and used as an input for the simulations. The predicted evolution of pressure and augmentation index with age followed accurately the curves obtained in a number of large-scale clinical studies. Analysis of the relative contribution of the forward and backward wave components showed that the forward wave becomes the major determinant of the increase in central and peripheral SBP and PP with advancing age.ConclusionsThe 1-D model of the ageing tree and heart captures faithfully and with great accuracy the central pressure evolution with ageing. The stiffening of the proximal aorta and the resulting augmentation of the forward pressure wave is the major contributor of the systolic pressure augmentation with age.
Highlights
Hypertension has been recognized as a major contributor to cardiovascular morbidity and mortality [1,2]
The stiffening of the proximal aorta and the resulting augmentation of the forward pressure wave is the major contributor of the systolic pressure augmentation with age
The continuous rise of systolic blood pressure (SBP) and pulse pressure (PP) over time is mainly attributed to age-associated changes in the big elastic vessels, i.e. the aorta and its major branches, which undergo gradual stiffening and dilation [3,4]
Summary
Hypertension has been recognized as a major contributor to cardiovascular morbidity and mortality [1,2]. The continuous rise of systolic blood pressure (SBP) and pulse pressure (PP) over time is mainly attributed to age-associated changes in the big elastic vessels, i.e. the aorta and its major branches, which undergo gradual stiffening and dilation [3,4]. These alterations in the arterial properties and the resulting augmentation in cardiac afterload affect the cardiac structure and function, which in turn further contribute to the development of hypertension [5,6]. Editor: Petter Bjornstad, University of Colorado Denver School of Medicine, UNITED STATES
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