From 24-Hour Blood Pressure Measurements to Arterial Stiffness

Abstract

The articles by Li et al1 and Dolan et al,2 in this issue of Hypertension and focused on the development of a new approach to estimate arterial stiffness, highlight the role of arterial mechanical properties in the determination of cardiovascular risk. In the past, arterial stiffening and increases in systolic blood pressure (SBP) and pulse pressure (PP) have been considered a part of normal aging, and no treatment for these alterations has been proposed. The pathophysiology, structural bases, and determinants of arterial stiffness have been extensively studied these last years.3–5 Although arterial stiffening is a common situation, it has now been confirmed that aortic stiffness is an independent predictor for total and cardiovascular mortality, coronary morbidity—mortality, and fatal stroke in patients with essential hypertension, diabetes mellitus, or end-stage renal failure, and in the general population in the elderly.6,7 It is therefore important to identify subjects who are at higher risk for developing arterial stiffness with aging and determine the environmental and genetic factors that can accelerate arterial stiffening. In recent years, several devices have been developed for the evaluation and measurement of arterial stiffness. Arterial stiffness can be quantified by the measurement of several parameters such as cross-sectional arterial distensibility and compliance, pulse wave velocity (PWV), analysis of pulse wave contours (mainly augmentation index and reflection waves), measurements of elastic modulus, stress-strain relationships, etc. During the past 5 years, among these approaches, PWV and augmentation index (AI) have become the most reliable for the evaluation of arterial stiffness in clinical and epidemiological studies.8 PWV depends mainly on the mechanical properties of large …