Skip to main content

Advertisement

Log in

Is Vascular Stiffness a Target for Therapy?

  • Published:
Cardiovascular Drugs and Therapy Aims and scope Submit manuscript

Abstract

Background

Early cardiovascular disease starts in the endothelium leading to functional changes in the vasculature. These changes can be depicted by assessment of arterial stiffness or elasticity. There are several techniques to assess arterial stiffness. Increased arterial stiffness or decreased arterial elasticity has been associated with cardiovascular risk factors. There is now evidence that small artery elasticity is a strong predictor for arterial hypertension. Moreover arterial elasticity provides extra prognostic information beyond arterial blood pressure measurement. Arterial stiffness attenuation may reflect the true reduction of arterial wall damage.

Results

ACE-inhibitors, angiotensin II receptor blockers, aldosterone antagonists and calcium antagonists have favorable effects in improving arterial elasticity, while beta-blockers have an inverse effect. Diuretics have not been evaluated. Lipid lowering therapy, some antidiabetic therapy have shown to reduce arterial stiffness. Inflammatory and infectious diseases have been associated with vascular inflammation and consequently increase in arterial stiffness. The effect of anti-inflammatory agents and antiretroviral therapy on arterial stiffness is under investigation.

Conclusions

Measurement of arterial stiffness will not only be helpful in the detection of early vascular disease but also as a tool in the selection and follow-up monitoring of therapeutic strategies aimed at preventing or delaying progression of vascular disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Nilsson PM, Lurbe E, Laurent S. The early life origins of vascular ageing and cardiovascular risk: the EVA syndrome. J Hypertens. 2008;26:1049–57.

    Article  CAS  PubMed  Google Scholar 

  2. Pepine CJ. The impact of nitric oxide in cardiovascular medicine: untapped potential utility. Am J Med. 2009;122:S10–5.

    Article  PubMed  Google Scholar 

  3. Duprez DA, Cohn JN. Identifying early cardiovascular disease to target candidates for treatment. J Clin Hypertens (Greenwich). 2008;10:226–31.

    Article  Google Scholar 

  4. Cohn JN, Duprez DA, Finkelstein SM. Comprehensive noninvasive arterial vascular evaluation. Future Cardiol. 2009;5:573–9.

    Article  PubMed  Google Scholar 

  5. Cohn JN. Vascular wall function as a risk marker for cardiovascular disease. J Hypertens Suppl. 1999;17:S41–4.

    Article  CAS  PubMed  Google Scholar 

  6. Sutton-Tyrrell K, Najjar SS, Boudreau RM, Venkitachalam L, Kupelian V, Simonsick EM, et al. Health ABC Study. Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults. Circulation. 2005;111:3384–90.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  8. Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, et al. Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation. 2006;113:657–63.

    Article  PubMed  Google Scholar 

  9. Meaume S, Benetos A, Henry OF, Rudnichi A, Safar ME. Aortic pulse wave velocity predicts cardiovascular mortality in subjects >70 years of age. Arterioscler Thromb Vasc Biol. 2001;21:2046–50.

    Article  CAS  PubMed  Google Scholar 

  10. Shokawa T, Imazu M, Yamamoto H, Toyofuku M, Tasaki N, Okimoto T, et al. Pulse wave velocity predicts cardiovascular mortality: findings from the Hawaii-Los Angeles-Hiroshima study. Circ J. 2005;69:259–64.

    Article  PubMed  Google Scholar 

  11. 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, Mar 2. [Epub ahead of print].

  12. Finkelstein SM, Cohn JN. First- and third-order models for determining arterial compliance. J Hypertens Suppl. 1992;10:S11–4.

    Article  CAS  PubMed  Google Scholar 

  13. Duprez DA, Cohn JN. Arterial stiffness as a risk factor for coronary atherosclerosis. Curr Atheroscler Rep. 2007;9:139–44.

    Article  PubMed  Google Scholar 

  14. Nakayama Y, Tsumura K, Yamashita N, Yoshimaru K, Hayashi T. Pulsatility of the ascending aortic pressure waveform is a powerful predictor of restenosis after percutaneous transluminal coronary angioplasty. Circulation. 2000;101:470–2.

    CAS  PubMed  Google Scholar 

  15. Weber T, Auer J, O’Rourke MF, Kvas E, Lassnig E, Lamm G, et al. Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary interventions. Eur Heart J. 2005;26:2657–63.

    Article  PubMed  Google Scholar 

  16. Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation. 2002;106:2085–90.

    Article  PubMed  Google Scholar 

  17. Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation. 1999;99:2434–9.

    CAS  PubMed  Google Scholar 

  18. Grey E, Bratteli C, Glasser SP, et al. Reduced small artery but not large artery elasticity is an independent risk marker for cardiovascular events. Am J Hypertens. 2003;16:265–9.

    Article  PubMed  Google Scholar 

  19. Stamler J, Neaton JD. The Multiple Risk Factor Intervention Trial (MRFIT)—importance then and now. JAMA. 2008;300:1343–5.

    Article  CAS  PubMed  Google Scholar 

  20. Giles TD, Materson BJ, Cohn JN, Kostis JB. Definition and classification of hypertension: an update. J Clin Hypertens (Greenwich). 2009;11:611–4.

    Article  Google Scholar 

  21. Peralta CA, Adeney KL, Shlipak MG, Jacobs Jr D, Duprez D, Bluemke D, et al. Structural and functional vascular alterations and incident hypertension in normotensive adults: the multi-ethnic study of atherosclerosis. Am J Epidemiol. 2010;171:63–71.

    Article  PubMed  Google Scholar 

  22. Winer N, Weber MA, Sowers JR. The effect of antihypertensive drugs on vascular compliance. Curr Hypertens Rep. 2001;3:297–304.

    Article  CAS  PubMed  Google Scholar 

  23. Mallareddy M, Parikh CR, Peixoto AJ. Effect of angiotensin-converting enzyme inhibitors on arterial stiffness in hypertension: systematic review and meta-analysis. J Clin Hypertens (Greenwich). 2006;8:398–403.

    Article  CAS  Google Scholar 

  24. Vyssoulis GP, Karpanou EA, Kyvelou SM, Adamopoulos DN, Antonakoudis GC, Deligeorgis AD, et al. Beneficial effect of angiotensin II type 1 receptor blocker antihypertensive treatment on arterial stiffness: the role of smoking. J Clin Hypertens (Greenwich). 2008;10:201–7.

    Article  Google Scholar 

  25. Duprez DA, Florea ND, Jones K, Cohn JN. Beneficial effects of valsartan in asymptomatic individuals with vascular or cardiac abnormalities: the DETECTIV Pilot Study. J Am Coll Cardiol. 2007;50:835–9.

    Article  CAS  PubMed  Google Scholar 

  26. White WB, Duprez D, St Hillaire R, Krause S, Roniker B, Kuse-Hamilton J, et al. Effects of the selective aldosterone blocker eplerenone versus the calcium antagonist amlodipine in systolic hypertension. Hypertension. 2003;41:1021–6.

    Article  CAS  PubMed  Google Scholar 

  27. Cohn JN, Wilson DJ, Neutel J, Houston M, Weinberger MH, Grimm Jr R, et al. Coadministered amlodipine and atorvastatin produces early improvements in arterial wall compliance in hypertensive patients with dyslipidemia. Am J Hypertens. 2009;22:137–44.

    Article  CAS  PubMed  Google Scholar 

  28. Mahmud A, Feely J. Antihypertensive drugs and arterial stiffness. Expert Rev Cardiovasc Ther. 2003;1:65–78.

    Article  CAS  PubMed  Google Scholar 

  29. Resnick LM, Lester MH. Differential effects of antihypertensive drug therapy on arterial compliance. Am J Hypertens. 2002;15:1096–100.

    Article  CAS  PubMed  Google Scholar 

  30. Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005;366:895–906.

    Article  PubMed  Google Scholar 

  31. Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, et al. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes. Circulation. 2006;113:1213–5.

    Article  CAS  PubMed  Google Scholar 

  32. Duprez DA. Role of the renin-angiotensin-aldosterone system in vascular remodeling and inflammation: a clinical review. J Hypertens. 2006;24:983–91.

    Article  CAS  PubMed  Google Scholar 

  33. Schiffrin EL. Remodeling of resistance arteries in essential hypertension and effects of antihypertensive treatment. Am J Hypertens. 2004;17:1192–200.

    Article  CAS  PubMed  Google Scholar 

  34. Bakris G. An in-depth analysis of vasodilation in the management of hypertension: focus on adrenergic blockade. J Cardiovasc Pharmacol. 2009;53:379–87.

    Article  CAS  PubMed  Google Scholar 

  35. Grossman E, Messerli FH. Long-term safety of antihypertensive therapy. Prog Cardiovasc Dis. 2006;49:16–25.

    Article  CAS  PubMed  Google Scholar 

  36. Duprez DA, Cohn JN. Monitoring vascular health beyond blood pressure. Curr Hypertens Rep. 2006;8:287–91.

    Article  PubMed  Google Scholar 

  37. Tziomalos K, Athyros VG, Karagiannis A, Mikhailidis DP. Endothelial function, arterial stiffness and lipid lowering drugs. Expert Opin Ther Targets. 2007;11:1143–60.

    Article  CAS  PubMed  Google Scholar 

  38. Goldberg RB. Thiazolidinediones and vascular damage. Curr Opin Endocrinol Diabetes Obes. 2007;14:108–15.

    CAS  PubMed  Google Scholar 

  39. Crilly MA, Kumar V, Clark HJ, Scott NW, Macdonald AG, Williams DJ. Arterial stiffness and cumulative inflammatory burden in rheumatoid arthritis: a dose-response relationship independent of established cardiovascular risk factors. Rheumatology (Oxford). 2009;48:1606–12.

    Article  CAS  Google Scholar 

  40. Baker JV, Duprez D, Rapkin J, Hullsiek KH, Quick H, Grimm R, et al. Untreated HIV infection and large and small artery elasticity. J Acquir Immune Defic Syndr. 2009;52:25–31.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Daniel A. Duprez.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Duprez, D.A. Is Vascular Stiffness a Target for Therapy?. Cardiovasc Drugs Ther 24, 305–310 (2010). https://doi.org/10.1007/s10557-010-6250-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10557-010-6250-z

Key words

Navigation