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Arterial stiffness and diastolic blood pressure: what is the connection?
Artery Research volume 1, pages S1–S6 (2006)
Summary
Although brachial systolic blood pressure (SBP) is the overall best predictor of future cardiovascular risk for the entire hypertensive population, there is much that can be learned from assessing diastolic blood pressure (DBP) in relation to simultaneous levels of SBP, because the former is not distorted by pressure amplification. In very young (mean age of 20 years) hypertensives, discordantly low DBP, defined as isolated systolic hypertension (ISH), was associated with increased stroke volumes (SV), increased aortic stiffness or a combination of both. These individuals had a significantly higher mean central SBP than normotensive persons, and therefore, should not be classified as having spurious hypertension. In contrast, young adults with essential hypertension presented with elevated DBP and evidence of increased peripheral vascular resistance. Discordantly high DBP in young adults (mean age of 40 years) with isolated diastolic hypertension (IDH) was associated with a high prevalence of obesity and the metabolic syndrome; DBP was discordantly high because of a limited rise in SBP secondary to decreased pressure amplification. Discordantly very low DBP in the older age population (mean age ⩾60 years) with ISH defines a population with LVH, increased ventricular-arterial stiffness, and a propensity for diastolic dysfunction. Therefore, discordantly low DBP may be an early marker of increased SV and/or arterial stiffness in young adults and a late marker of ventricular-arterial stiffness in older adults. In contrast to risk prediction where brachial DBP may be of paramount importance, the therapeutic benefit of antihypertensive therapy is entirely related to decreased SBP.
References
Izzo JL, Levy D, Black HR. Clinical Advisory Statement. Importance of systolic blood pressure in older Americans. Hypertension. 2000 May;35(5):1021–4.
Black HR. The paradigm has shifted to systolic blood pressure. J Hum Hypertens. 2004 Dec;18(Suppl 2):S3–7.
Van Bortel LMAB, Struijker-Boudier HAJ, Safar ME. Pulse pressure, arterial stiffness, and drug treatment of hypertension. Hypertension 2001;38:914–21.
Nichols WW. Clinical measurement of arterial stiffness obtained from noninvasive pressure waveforms. Am J Hypertens 2005;18:3S–10S.
O’Brien, E, Asmar R, Bellin L, et al.; on behalf of the European Society of Hypertension Working Group on Blood Pressure Monitoring. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens 2003;21:821–48.
Zwifler AJ, Shahab ST. Pseudohypertension: a new assessment. J Hypertens 1993;11:1.
Nichols WW, O’Rourke MF. McDonald’s Blood Flow in Arteries: Theoretical, Experimental and Clinical Principles, 4th edn. London: Arnold; 1998.
Sorof JM, Prevalence and consequence of systolic hypertension in children. Am J Hypertens. 2002;15:57S–60S.
McEniery CM, Yasmin, Wallace S, et al.; on behalf of the ENIGMA Study Investigators. Increased stroke volume and aortic stiffness contribute to isolated systolic hypertension in young adults. Hypertension 2005;46:221–6.
O’Rourke MF, Vlachopoulos C, Fraham RM. Spurious systolic hypertension in youth. Vasc Med 2000;5:141–5.
Mahmud A, Feely J. Spurious systolic hypertension in youth: fit young men with elastic arteries. Am J Hypertens 2003;16: 229–32.
Fouad F, Tarazi R, Dustan H, et al. Haemodynamics of essential hypertension in young subjects. Am Heart J 1978;96:646–54.
Lund-Johansen P. Haemodynamics in essential hypertension. Clin Sci. 1980;59(Suppl 6):343s–354s.
Franklin SS, Pio JR, Wong ND, et al. Predictors of new-onset diastolic and systolic hypertension. The Framingham Heart Study. Circulation 2005;111:1121–7.
Franklin SS, Larson MG, Khan SA, et al. Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation 2001;103:1245–9.
Khattar RS, Swales JD, Dore C, et al. Effect of aging on the prognostic significance of ambulatory systolic, diastolic, and pulse pressure in essential hypertension. Circulation 2001;104: 783–9.
Assman G, Cullen P, Evers T, et al. Importance of arterial pulse pressure as a predictor of coronary heart disease risk in PROCAM. European Heart J 2005;26:2120–6.
Franklin SS, Jacobs MJ, Wong ND, et al. Predominance of isolated systolic hypertension among middle-aged and elderly US hypertensives Hypertension 2001;37:869–74.
Blank SG, Mann SJ, James GD, et al. Isolated elevation of diastolic blood pressure. Real or artifactual? Hypertension 1995;26:383–9.
Fang J, Madhavan S, Cohen H, et al. Isolated diastolic hypertension. A favorable finding among young and middle-aged hypertensive subjects. Hypertension 1995;25:377–82.
Petrovitch H, Curb JD, Bloom-Marcus E. Isolated systolic hypertension and risk of stroke in Japanese-American men. Stroke 1995;26:25–9.
Nielsen WB, Lindenstrom E, Vestbo J, et al. Is diastolic hypertension an independent risk factor for stroke in the presence of normal systolic blood pressure in the middle-aged and elderly? Am J Hypertens 1997;10:634–9.
Strandberg TE, Saloman VV, Vanhanen HT, et al. Isolated diastolic hypertension, pulse pressure, and mean arterial pressure as predictors of mortality during a follow-up of up to 32 years. J Hypertens 2002;20:399–404.
Franklin SS, Barbosa MG, Pio JR, et al. Blood pressure categories, hypertensive subtypes, and the metabolic syndrome. J Hypertens 2006;24 (in press).
Safar ME, Thomas F, Blacher J, et al. Metabolic syndrome and age-related progression of aortic stiffness. J Am Coll Cardiol 2006;47:72–5.
London GM, Guerin AP, Pannier BM, et al. Body height as a determinant of carotid pulse contour in humans. J Hypertens. 1992;10:93–5.
Wilkinson IB, Franklin SS, Hall IR, et al. Pressure amplification explains why pulse pressure is unrelated to risk in young subjects. Hypertension 2001;38:1451–5.
Millasseau S, Ritter JM. Chowienczyk P. Relationship between blood pressure and aortic pulse wave velocity in young and old subjects with essential hypertension. J Hypertens. 2003; 21(Suppl 4):S253.
Nurnberger J, Dammer S, Saez AO, et al. Diastolic blood pressure is an important determinant of augmentation index and pulse wave velocity in young, healthy males. J Human Hypertens 2003;17:153–8.
Franklin SS, Gustin W, Wong ND, et al. Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation 1997;96:308–15.
Benetos A, Adamopouolos C, Bureau J-M, et al. Determinants of accelerated progression of arterial stiffness in normotensive subjects and in treated hypertensive subjects over a 6-year period. Circulation 2002;105:1202–7.
Kass DA, Bronzwaer JGF, Paulus WJ. What mechanisms underlie diastolic dysfunction in heart failure. Cir Res 2004;94:1533–42.
Chen CH, Nakayama M, Nevo E, et al. Coupled systolic-ventricular and vascular stiffening with age. Implications for pressure regulation and cardiac reserve in the elderly. J Am Coll Cardiol 1998;32:1221–7.
Kawaguchi M, Hay I, Fetics B, et al. Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction. Implications for systolic and diastolic reserve limitations. Circulation 2003;107:714–20.
Peng X, Haldar S, Deshpande S, et al. Wall stiffness suppresses Akt/eNOS and cytoprotection in pulse-perfused endothelium. Hypertension 2003;41:378–81.
Somes GW, Pahor M, Shorr RI, et al. The role of diastolic blood pressure when treating isolated systolic hypertension. Arch Intern Med 1991;265:3255–64.
Wang JG, Staessen JA, Franklin SS, et al. Systolic and diastolic blood pressure lowering as determinants of cardiovascular outcome. Hypertension 2005;45:907–13.
Koch-Weser J. Correlation of pathophysiology and pharma-cotherapy in primary hypertension. Am J Cardiol 1973;32:499–510.
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Franklin, S.S. Arterial stiffness and diastolic blood pressure: what is the connection?. Artery Res 1 (Suppl 1), S1–S6 (2006). https://doi.org/10.1016/S1872-9312(07)70001-7
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DOI: https://doi.org/10.1016/S1872-9312(07)70001-7