Abstract
Arterial stiffness and central hemodynamics attract increasing scientific interest within the hypertensive community during the last decade. Accumulating evidence indicates that aortic stiffness is a strong and independent predictor of cardiovascular events and all-cause mortality in hypertensive patients, and its predictive value extends beyond traditional risk factors. The role of central hemodynamics and augmentation index (a marker of reflected waves), remains less established and requires further investigation. Several lines of evidence indicate that antihypertensive therapy results in significant reductions of pulse wave velocity and central hemodynamics. However, beta-blockers seem to be the only exception with significant within-class differences. Conventional beta-blockers, although equally effective in reducing pulse wave velocity, seem to be less beneficial on central hemodynamics and augmentation index than the other antihypertensive drug categories, whereas the newer vasodilating beta-blockers seem to share the benefits of the other antihypertensive drugs. In conclusion, aortic stiffness seems ready for ‘prime-time’ in the management of essential hypertension, while further research is needed for central hemodynamics and augmentation index.
Highlights
Aortic stiffness is considered the most important pathophysiologic mechanism mediating pulse pressure increase and isolated systolic hypertension with ageing
According to the recent 2013 guidelines of the European Society of Hypertension/European Society of Cardiology for the management of arterial hypertension, the evaluation of carotid-femoral pulse wave velocity should be considered in hypertensive patients to detect large artery stiffening, and this recommendation is based on IIa-B level of evidence [1]
The interest about arterial stiffness and central hemodynamics in the pathophysiology and management of essential hypertension is steadily increasing over the years
Summary
Aortic stiffness is considered the most important pathophysiologic mechanism mediating pulse pressure increase and isolated systolic hypertension with ageing. 76 The Open Hypertension Journal, 2013, Volume 5 evaluation of the waveforms in two different sites of the arterial tree (usually the carotid and femoral or radial artery) permits for the non-invasive estimation of pulse wave velocity (a measure of arterial stiffness), the augmentation index (a measure of the reflected wave), and central blood pressure. Accumulating data from many large longitudinal studies with long-term follow-up indicate that increased arterial stiffness, as assessed by pulse wave velocity, represents an independent predictor of cardiovascular morbidity and mortality, as well as of all-cause mortality.
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