Role of Central Blood Pressure and Arterial Stiffening
Two concepts have gained a growing audience these last years: the pressure amplification between central and peripheral arteries in response to arterial stiffening and pressure wave reflection and the left ventricle (LV)-arterial system coupling in heart failure (notably with preserved ejection fraction also referred to as diastolic heart failure) as arterial stiffening can result in impaired active ventricular relaxation and passive ventricular compliance. The aims of this chapter are (1) to detail the haemodynamic characteristics of the arterial circulation in order to explain why it is important to measure arterial stiffness and central BP in hypertensive patients, (2) to describe the various non-invasive methods currently available to measure arterial stiffness and central BP and (3) to discuss how arterial stiffness and central BP measurements can help understanding the relationship between hypertension and heart failure.
KeywordsArterial stiffness Central blood pressure Heart failure Large artery Organ damage Wave reflection
This work was supported by INSERM, Assistance Publique—Hopitaux de Paris, and Paris Descartes University (SL).
- 2.Nichols WW, O’Rourke MF, Vlachopoulos C. Cardiac failure: clinical implications. In: Arnold H, editor. McDonald’s blood flow in arteries. Theoretical, experimental and clinical principles. 6th ed. London: CRC Press; 2011. p. 344–56.Google Scholar
- 6.Herbert A, Cruickshank K, Laurent S, Boutouyrie P, on behalf of The Reference Values for Arterial Measurements Collaboration. Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk-factors. Eur Heart J. 2014;35:3122–33.CrossRefGoogle Scholar
- 9.Laurent S, Boutouyrie P. What is the best method to evaluate central blood pressure? Dialog Cardiovasc Med. 2015;20(3):3–14.Google Scholar
- 11.Van Bortel LM, Laurent S, Boutouyrie P, Chowienczyk P, Cruickshank JK, De Backer T, Filipovsky J, Huybrechts S, Mattace-Raso FU, Protogerou AD, Schillaci G, Segers P, Vermeersch S, Weber T, on behalf of the Artery Society, the European Society of Hypertension Working Group on Vascular Structure and Function and the European Network for Noninvasive Investigation of Large Arteries. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens. 2012;30:445–8.CrossRefGoogle Scholar
- 12.Reference values for carotid-femoral pulse wave velocity in the reference values for arterial stiffness’ collaboration database. Eur Heart J. 2010;31:2338–50.Google Scholar
- 14.Giannattasio C, Achilli F, Failla M, Capra A, Vincenzi A, Valagussa F, Mancia G. Radial, carotid and aortic distensibility in congestive heart failure: effects of high-dose angiotensin-converting enzyme inhibitor or low-dose association with angiotensin type 1 receptor blockade. J Am Coll Cardiol. 2002;39:1275–82.CrossRefGoogle Scholar
- 23.Pandey A, Khan H, Newman AB, Lakatta EG, Forman D, Butler J, Berry JD. Arterial stiffness and risk of overall heart failure, heart failure with preserved ejection fraction, and heart failure with reduced ejection fraction. The Health ABC Study (Health, Aging, and Body Composition). Hypertension. 2017;69:267–74.CrossRefGoogle Scholar