Journal Reading

ARTERIAL STIFFNESS AND HYPERTENSION

IN ELDERLY

Stephane Laurent, Pierre Boutoyrie

Assistance-Publique Hôpitaux de Paris, Université de Paris, Paris, France, 2 PARCC-INSERM

U970, Paris, France, 3 Department of Pharmacology and Hôpital Européen Georges Pompidou,
Paris, France
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 Introduction
AGE & HIGH BLOOD PRESSURE ARE TWO
MAIN DETERMINANTS OF ARTERIAL
SITIFFNESS

 Hypertension prevalence
increases with age

 In elderly hypertensives, large

arteries stiffen and systolic and
pulse pressure increase, due to
wave reflections

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 Introduction
Should we measure arterial stiffness in clinical practice???

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 Highlights of this review
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Discussion

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Cellular & Molecular determinants of arterial stiffness in
elderly hypertensives

604/07/21
What is arterial stiffness ?

704/07/21
Arterial stiffness : diminished arterial compliance
ELASTIC ARTERIES
When the stiffness is low (young healthy
subject), a large amount of cardiac energy is
redistributed along diastole and helps
decreasing post-load and improving organ
perfusion

STIFF ARTERIES
In elderly hypertensives, larger proportion
ofp the stroke volume flows through the
arerial system and peripheral tissues –> high
pressure in distal circulation  organ
damage

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Arterial stiffness and Wave reflection (2)

Young Normotensives

904/07/21
Arterial stiffness and Wave reflection (2)

Elderly Hypertensives
1004/07/21
Arterial stiffness and Blood Pressure
TRENDS IN BP
DBP plateaus around age 50 years, than
decrease
SBP continues to rise (even after 50 yo) in
response to age-induced increase in
arterial stiffness  PP begins to increase
after age 50
Isolated systolic hypertension (ISH) is
the most frequent subtype of
hypertension after age 60

By 7th decade, BP in women is higher than

men
Elderly women tend to have higher BP
than men (60% of all hypertensive are
women)
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Arterial stiffness and Blood Pressure

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 High Central Systolic and Pulse Pressures, Target
organ damage and CV events

CARDIAC DAMAGE BRAIN DAMAGE RENAL DAMAGE

Central SBP increases the
load on the ventricle thus
myocardial oxygen demand
High pulsatility reduced
coronal perfusion during
diastole  increased risk of IHD
damage of large and small
arteries can increase the risk
of ischemic stroke, and, likely
in parallel, white matter
lesions, lacunar infarcts, and
cognitive decline
Myogenic tone in the renal
circulation is impaired in the
elderly hypertensive, loss of
autoregulation  glomerular
injury
There were significant
relationships between
brachial pulse pressure &
eGFR

1304/07/21
New concept of Arterial Stiffening & Aging:
Early vascular
14 Aging (EVA) AND Supernormal Vascular Aging in Elderly
(SUPERNOVA) (1)

1404/07/21
New concept of Arterial Stiffening & Aging:
Early vascular
15 Aging (EVA) AND Supernormal Vascular Aging in Elderly
(SUPERNOVA) (2)
EVA SUPERNOVA
 patients who present an abnormally high  subjects are protected against the
arterial stiffness for their age and sex influence of CV risk factors, despite being
altered capacity in response to exposed to them
mechanical & oxidative stress
 a minority of elderly hypertensive may
 EVA-arterial stiffness has a higher have lower values of arterial stiffness
predictive value for CV events than than expected for their age and
classical CV risk scores (one-time BP hypertensive condition.
measurement, glycemia & cholesterol)

1504/07/21
How to do a clinical measurement of arterial stiffness? (1)

REGIONAL MEASUREMENT
is mainly determined through pulse
wave velocity between two arterial
sites

Carotid-femoral PWV
(cfPWV) is most often directly
measured along the aortic
and aorto-iliac pathway.
1604/07/21
How to do a clinical measurement of arterial stiffness? (2)
 Carotid-femoral PWV is measured using the
foot-to-foot velocity method
 The waveforms are usually obtained
transcutaneously at the right common carotid
artery and the right femoral artery.
 time delay (Δ t, or transit time) is measured
between the feet of the two waveforms.
 The distance (VL) covered by the waves is usually
assimilated to the surface distance between the
two recording sites, i.e., the common carotid
artery and the common femoral artery.

PWV is calculated as
PWV = 0.8 × Δ L (meters)/Δt (seconds)

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Predictive value of arterial stiffness

Two meta-analyses consistently showed the

independent predictive value of aortic
stiffness, measured by carotid-femoral PWV,
for fatal and non-fatal CV events in various
populations

Aortic stiffness has demonstrated an

independent predictive value for CV events
after adjustment to classical CV risk factors

1804/07/21
 Pharmacology of Arterial Stiffness
Several studies have reported the changes in arterial stiffness and
wave reflections in hypertensives after various interventions,
either non-pharmacologic or pharmacologic
Non-pharmacologic Pharmacologic
1)Weight loss 1)Antihypertensive treatment :
2)Exercise training diuretics, beta-blockers, ACEi/ARBs,
3)Dietary changes : low salt diet, CCB
moderate alcohol consumption 2)Treatment of CHF : ACEi/ARBs,
4)Hormone replacement therapy vasopeptide inhibitors
3)Hypolipidemic agents: statins
Antihypertensive treatment was able to reduce
4)Antidiabetics : TZDs, AGE-breakers
arterial stiffness and/or wave reflections
independently of the reduction in brachial BP. This (alagebrium)
was observed for long term CCB or ACEi consumption

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 One reason for which isolated
systolic hypertension
represents the most frequent
subtype of hypertension in the
elderly is because arterial
stiffness increases with aging
 High central systolic and pulse
pressures could cause target
organ damage
 In the elderly, arterial stiffness
has predictive value for CV
and renal events
 measurement of arterial
stiffness may help the
physician to better determine
the risk of CV complications &
adapt the therapeutic strategy
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THANK
YOU

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