![]() Pressure wave amplification can be explained by the reflection phenomenon of the oscillating BP wave ( Benetos et al., 2011 McEniery et al., 2005). Karamanoglu et al., 1993 Kotsis et al., 2011).īP amplification is defined as the elevation of PP from the central aorta towards the periphery and is mainly attributed to an increase in SBP ( Benetos et al., 2011 McEniery et al., 2005). As a result, central SBP and PP become equal to or higher than peripheral (brachial) SBP and PP ( Figure 3) ( After the age of 55-60 years, as a result of arterial aging, central SBP and PP may increase even more than peripheral pressures. Consequently, the peripheral (brachial) SBP and PP overestimate central (aortic) values ( Central and peripheral MAP and DBP, however, are not significantly different. This is known as the amplification phenomenon ( As a result, SBP and PP increase significantly by about 12-14mmHg from central to peripheral arteries. ![]() In these subjects, the central arteries are more distensible and velocity of reflected pulse wave is low ( Kotsis et al., 2011). In contrast, in subjects younger than 50 years, brachial PP is not associated with a poor prognostic implication. Finally, the predictive power of PP has been demonstrated in subjects with evidence of other target organ involvement such as left ventricular dysfunction, endstage renal failure and in those with diabetes mellitus ( Schram et al., 2002). Further, the predictive value of PP was observed even in well controlled hypertensive subjects ( Benetos et al., 1998). ![]() Thus, normotensive men with PP > 55mmHg were shown to have a 40% increased cardiovascular risk compared to normotensive men with same age but PP< 45mmHg ( Benetos et al., 1998). Further, a level of PP that predicts cardiovascular events in hypertensive patients appears to be equal or greater than 60-63mmHg ( De Simone et al., 2005).Īn increased brachial PP is an independent predictor of cardiovascular mortality not only in hypertensive men but also in normotensive men aged 40-69 years ( Benetos et al., 1998). Several observational and clinical studies have indicated that, in both normotensive and hypertensive middle-aged and older subjects, wide PP is a better predictor of cardiovascular events and target organ disease than increased SBP and MAP adjusted for age, sex and other cardiovascular risk factors ( Relationship between increased arterial stiffness, increased pulse pressure and target organ disease. ![]() However, brachial PP is a widely accepted marker of arterial stiffness in the elderly and in some middle-aged individuals because central PP equalizes brachial PP during aging due to PP augmentation by early wave reflection ( Dart & Kingwell, 2001). Central PP is considered an accurate indicator of arterial stiffness ( Boutouyrie et al., 2002). Arterial stiffness has emerged as an important independent predictor of adverse cardiorenal outcome in the general population ( Figure 2) ( Boutouyrie et al., 2002). Increased pulse pressure (PP) defined as the difference between inappropriately elevated systolic blood pressure (SBP) and reduced diastolic blood pressure (DBP) at any value of mean arterial pressure (MAP) is a surrogate measure of increased arterial stiffness of central elastic arteries (aorta and its major branches) ( Figure 1) ( Dart & Kingwell, 2001 Safar et al., 2003). 2001& National High Blood Pressure Education Program Working Group, 1994). Both systolic and isolated systolic hypertension are characterized by wide (high) PP ( Franklin et al. 2001 National High Blood Pressure Education Program Working Group, 1994). The aging process is associated with an increased incidence of systolic hypertension, and in particular isolated systolic hypertension (ISH) ( Franklin et al., 1999 Franklin et al. This paradigm shift is attributed to the aging of the population. Recently, however, there has been increased recognition of the importance of high brachial pulse pressure (PP) as an important and independent predictor of increased cardiovascular morbidity and mortality, especially in senior subjects ( Hypertension is traditionally defined in terms of elevated systolic and or diastolic blood pressure (BP). Hypertension remains the major risk for cardiovascular disease, stroke and end-stage nephropathy.
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