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Association between Aortic Stiffness and Cerebral Pulsatility is Modestly Influenced by Augmentation Index
Artery Research volume 25, pages 95–100 (2019)
Abstract
Central Pulse Pressure (CPP) and Aortic Pulse Wave Velocity (aPWV) share a positive relationship with cerebral pulsatility and are associated with cerebrovascular disorders including stroke. Our aim was to examine the influence of Augmentation Index (AIx) upon this relationship, first by using a cross sectional design across a wide range of CPP and aPWV in healthy individuals and second, following administration of Glyceryl Trinitrate (GTN) to acutely change AIx. We measured CPP, aPWV, AIx and Middle Cerebral Artery Pulsatility Index (MCAPI) in 99 healthy individuals (54 females). In all individuals, after accounting for the effect of age and gender, MCAPI shared an independent inverse relationship with AIx (β = −0.515, R2 = 0.109; p = 0.001), and a positive relationship with CPP (β = 0.570, R2 = 0.093; p = 0.003) but not aPWV (p > 0.05). GTN was administered to 25 of these participants (14 females). Following GTN, AIx75 decreased in all participants relative to baseline (12 ± 19 to 5 ± 16%; p = 0.0001). In the 20 min following GTN administration, CPP shared a positive relationship with MCAPI (β = 0.305, R2 = 0.042; p = 0.002) while AIx, adjusted for heart rate (AIx75), shared an inverse relationship with MCAPI (β = −0.320, R2 = 0.019; p = 0.031). These findings indicate that the positive relationship between CPP and MCAPI may be somewhat modified by AIx. This suggests that an increased AIx may weakly attenuate increases in MCAPI that are associated with aortic stiffening in a healthy population at rest, but also following acute reductions in AIx75 after administration of GTN.
References
Mitchell GF, Parise H, Benjamin EJ, Larson MG, Keyes MJ, Vita JA, et al. Changes in arterial stiffness and wave reflection with advancing age in healthy men and women: the Framingham Heart Study. Hypertension 2004;43:1239–45.
McEniery CM, Yasmin, Hall IR, Qasem A, Wilkinson IB, Cockcroft JR. Normal vascular aging: differential effects on wave reflection and aortic pulse wave velocity: the Anglo-Cardiff Collaborative Trial (ACCT). J Am Coll Cardiol 2005;46:1753–60.
Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ, et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol 2014;63:636–46.
Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001;37:1236–41.
Laurent S, Katsahian S, Fassot C, Tropeano AI, Gautier I, Laloux B, et al. Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke 2003;34:1203–6.
O’Rourke MF, Safar ME. Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy. Hypertension 2005;46:200–4.
Gosling RG, Lo PTS, Taylor MG. Interpretation of pulsatility index in feeder arteries to low-impedance vascular beds. Ultrasound Obstet Gynecol 1991;1:175–9.
Reusch P, Wagdy H, Reusch R, Wilson E, Ives HE. Mechanical strain increases smooth muscle and decreases nonmuscle myosin expression in rat vascular smooth muscle cells. Circ Res 1996;79:1046–53.
Witteman JCM, Grobbee DE, Valkenburg HA, van Hemert AM, Stijnen Th, Burger H, et al. J-shaped relation between change in diastolic blood pressure and progression of aortic atherosclerosis. Lancet 1994;343:504–7.
Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, et al. Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation 2006;113:664–70.
Sörös P, Whitehead S, Spence JD, Hachinski V. Antihypertensive treatment can prevent stroke and cognitive decline. Nat Rev Neurol 2013;9:174–8.
Henskens LHG, Kroon AA, van Oostenbrugge RJ, Gronenschild EHBM, Fuss-Lejeune MMJJ, Hofman PAM, et al. Increased aortic pulse wave velocity is associated with silent cerebral small-vessel disease in hypertensive patients. Hypertension 2008;52:1120–6.
Salonen R, Salonen JT. Determinants of carotid intima-media thickness: a population-based ultrasonography study in eastern Finnish men. J Intern Med 1991;229:225–31.
Liao D, Cooper L, Cai J, Toole J, Bryan N, Burke G, et al. The prevalence and severity of white matter lesions, their relationship with age, ethnicity, gender, and cardiovascular disease risk factors: the ARIC Study. Neuroepidemiology 1997;16:149–62.
Tsao CW, Seshadri S, Beiser AS, Westwood AJ, Decarli C, Au R, et al. Relations of arterial stiffness and endothelial function to brain aging in the community. Neurology 2013;81:984–91.
Wong TY, Klein R, Sharrett AR, Couper DJ, Klein BEK, Liao DP, et al. Cerebral white matter lesions, retinopathy, and incident clinical stroke. JAMA 2002;288:67–74.
Au R, Massaro JM, Wolf PA, Young ME, Beiser A, Seshadri S, et al. Association of white matter hyperintensity volume with decreased cognitive functioning: the Framingham Heart Study. Arch Neurol 2006;63:246–50.
Kalaria RN, Akinyemi R, Ihara M. Does vascular pathology contribute to Alzheimer changes? J Neurol Sci 2012;322:141–7.
Mitchell GF. Effects of central arterial aging on the structure and function of the peripheral vasculature: implications for end-organ damage. J Appl Physiol (1985) 2008;105:1652–60.
Vlachopoulos C, Aznaouridis K, O’Rourke MF, Safar ME, Baou K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. Eur Heart J 2010;31:1865–71.
Safar ME, Nilsson PM, Blacher J, Mimran A. Pulse pressure, arterial stiffness, and end-organ damage. Curr Hypertens Rep 2012;14:339–44.
Tarumi T, Ayaz Khan M, Liu J, Tseng BM, Parker R, Riley J, et al. Cerebral hemodynamics in normal aging: central artery stiffness, wave reflection, and pressure pulsatility. J Cereb Blood Flow Metab 2014;34:971–8.
Nakano T, Munakata A, Shimaura N, Asano K, Ohkuma H. Augmentation index is related to white matter lesions. Hypertens Res 2012;35:729–32.
Kim MO, Li Y, Wei F, Wang J, O’Rourke MF, Adji A, et al. Normal cerebral vascular pulsations in humans: changes with age and implications for microvascular disease. J Hypertens 2017;35:2245–56.
Feihl F, Liaudet L, Waeber B. The macrocirculation and microcirculation of hypertension. Curr Hypertens Rep 2009;11:182–9.
Fitchett DH, Simkus GJ, Beaudry JP, Marpole DGF. Reflected pressure waves in the ascending aorta: effect of glyceryl trinitrate. Cardiovasc Res 1988;22:494–500.
Yaginuma T, Avolio A, O’Rourke M, Nichols W, Morgan JJ, Roy P, et al. Effect of glyceryl trinitrate on peripheral arteries alters left ventricular hydraulic load in man. Cardiovasc Res 1986;20:153–60.
O’Brien E, Mee F, Atkins N, Thomas M. Evaluation of three devices for self-measurement of blood pressure according to the revised British Hypertension Society Protocol: the Omron HEM-705CP, Philips HP5332, and Nissei DS-175. Blood Press Monit 1996;1:55–61.
Pauca AL, O’Rourke MF, Kon ND. Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform. Hypertension 2001;38:932–7.
Wilkinson IB, Fuchs SA, Jansen IM, Spratt JC, Murray GD, Cockcroft JR, et al. Reproducibility of pulse wave velocity and augmentation index measured by pulse wave analysis. J Hypertens 1998;16:2079–84.
Gosling RG, King DH. Arterial assessment by Doppler-shift ultrasound. Proc R Soc Med 1974;67:447–9.
Leenders KL, Perani D, Lammertsma AA, Heather JD, Buckingham P, Healy MJR, et al. Cerebral blood flow, blood volume and oxygen utilization: normal values and effect of age. Brain 1990;113:27–47.
Ainslie PN, Cotter JD, George KP, Lucas S, Murrell C, Shave R, et al. Elevation in cerebral blood flow velocity with aerobic fitness throughout healthy human ageing. J Physiol 2008;586:4005–10.
Wilkinson IB, MacCallum H, Flint L, Cockcroft JR, Newby DE, Webb DJ. The influence of heart rate on augmentation index and central arterial pressure in humans. J Physiol 2000;525: 263–70.
Webb AJS, Simoni M, Mazzucco S, Kuker W, Schulz U, Rothwell PM. Increased cerebral arterial pulsatility in patients with leukoaraiosis: arterial stiffness enhances transmission of aortic pulsatility. Stroke 2012;43:2631–6.
Mitchell GF, van Buchem MA, Sigurdsson S, Gotal JD, Jonsdottir MK, Kjartansson Ó, et al. Arterial stiffness, pressure and flow pulsatility and brain structure and function: the Age, Gene/Environment Susceptibility – Reykjavik study. Brain 2011;134:3398–407.
Xu TY, Staessen JA, Wei FF, Xu J, Li FH, Fan WX, et al. Blood flow pattern in the middle cerebral artery in relation to indices of arterial stiffness in the systemic circulation. Am J Hypertens 2012;25:319–24.
Young VG, Halliday GM, Kril JJ. Neuropathologic correlates of white matter hyperintensities. Neurology 2008;71:804–11.
Boutouyrie P, Bussy C, Lacolley P, Girerd X, Laloux B, Laurent S. Association between local pulse pressure, mean blood pressure, and large-artery remodeling. Circulation 1999;100:1387–93.
Bots ML, Breslau PJ, Briët E, de Bruyn AM, van Vliet HH, van den Ouweland FA, et al. Cardiovascular determinants of carotid artery disease. The Rotterdam Elderly Study. Hypertension 1992;19:717–20.
Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study. Circulation 1997;96:1432–7.
Folkow B, Griyby G, Thulesius O. Adaptive structural changes of the vascular walls in hypertension and their relation to the control of the peripheral resistance. Acta Physiol Scand 1958;44:255–72.
Mattace-Raso FUS, van der Cammen TJM, Hofman A, van Popele NM, Bos ML, Schalekamp MADH, et al. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation 2006;113:657–63.
Mitchell GF, Hwang SJ, Vasan RS, Larson MG, Pencina MJ, Hamburg NM, et al. Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation 2010;121:505–11.
Sutton-Tyrrell K, Najjar SS, Boudreau RM, Venkitachalam L, Kupelian V, Simonsick EM, et al. Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults. Circulation 2005;111:3384–90.
Darne B, Girerd X, Safar M, Cambien F, Guize L. Pulsatile versus steady component of blood pressure: a cross-sectional analysis and a prospective analysis on cardiovascular mortality. Hypertension 1989;13:392–400.
Springo Z, Toth P, Tarantini S, Ashpole NM, Tucsek Z, Sonntag WE, et al. Aging impairs myogenic adaptation to pulsatile pressure in mouse cerebral arteries. J Cereb Blood Flow Metab 2015;35:527–30.
Toth P, Tarantini S, Springo Z, Tucsek Z, Gautam T, Giles CB, et al. Aging exacerbates hypertension-induced cerebral microhe-morrhages in mice: role of resveratrol treatment in vasoprotection. Aging Cell 2015;14:400–8.
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Data availability statement: The data that support the findings of this study are available from the corresponding author (BMD), upon reasonable request.
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Pearson, J., Watkeys, L.J., Coulson, J.M. et al. Association between Aortic Stiffness and Cerebral Pulsatility is Modestly Influenced by Augmentation Index. Artery Res 25, 95–100 (2019). https://doi.org/10.2991/artres.k.191212.001
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DOI: https://doi.org/10.2991/artres.k.191212.001