(Stroke. 2000;31:782.)
© 2000 American Heart Association, Inc.
Comments, Opinions, and Reviews |
Stiffness of Carotid Artery Wall Material and Blood Pressure in Humans
Application to Antihypertensive Therapy and Stroke Prevention
From the Department of Internal Medicine and INSERM (U337) (M.E.S., J.B., J.J.M.), Broussais Hospital, Paris, and the Department of Nephrology (G.M.L.), Manhès Center, Fleury-Merogis, France.
Correspondence to Prof Michel Safar, Médecine Interne 1, Hôpital Broussais, 96 rue Didot, Paris 75674, Cedex 14, France. E-mail michel.safar{at}brs.ap-hop-paris.fr
Background and Purpose—Because epidemiological studies show that increased pulse pressure and carotid wall–material stiffness are predictors of cardiovascular mortality independent of age, atherosclerosis, and conventional risk factors, the relationships between carotid wall stiffness and blood pressure are important to the optimization of cardiovascular prevention.
Summary of Review—In middle-aged hypertensive patients, mean and pulse pressures are increased, and systolic and diastolic pressures are increased to the same degree as mean pressure. Carotid hypertrophy is associated with normal wall stress, but no increased stiffness of wall material has been reported. With age, the normal wall stress is associated with a larger diameter and a stiffer material of carotid but not peripheral arteries. The stiffer wall involves calcifications, large amounts of collagen, and fragmentation and rupture of elastic tissue, which results in increased pulse-wave velocity and alterations of amplitude and timing of wave reflections and thus causes a disproportionate increase in systolic and pulse pressure. During this period, acutely administered nitrates in elderly subjects are able to reduce selectively systolic and pulse pressures without altering diastolic and mean blood pressure and composition of the carotid wall.
Conclusions—New therapeutic approaches acting mainly on the wall of large arteries are needed to treat hypertension in elderly patients and prevent stroke and myocardial infarction. These drugs could either selectively lower pulse pressure through changes in wave reflections (as nitrates do) or decrease arterial wall stiffness through modification of the composition of material (such as compounds that act on collagen cross-linking).
Key Words: arterial wall • hypertension
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