Skip to main content
SpringerLink
Log in

Vascular compliance in hypertension: Therapeutic implications

  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

One of three adults and more than 7 of 10 older persons in the United States have hypertension. Of those receiving antihypertensive medication, more than 40% have inadequate blood-pressure control. The predominant subtype of hypertension among older adults is isolated systolic hypertension, which results from stiffening of the wall of the aorta due to various factors, including loss and fragmentation of elastin, increased collagen synthesis, endothelial dysfunction, and higher levels of inflammatory cytokines. Analysis of the peripheral pulse waveform has become widely used as a surrogate marker of central aortic stiffness and a predictor of future cardiovascular disease events. It is a matter of debate whether increased pulse pressure in older adults results primarily from stiffening of the aortic wall and premature reflected pressure waves from peripheral arteries or increased forward pressure waves from a reduced aortic diameter. Anti-stiffening strategies depend on lifestyle changes and pharmacotherapy.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Rosamond W, Flegal K, Friday G, et al.: Heart disease and stroke statistics—2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2007, 115:e69–e171.

    Article  PubMed  Google Scholar 

  2. Chobanian AV, Bakris GL, Black HR, et al.: Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High BP, National Heart, Lung, and Blood Institute, National High BP Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High BP. Hypertension 2003, 42:1206–1252.

    Article  PubMed  CAS  Google Scholar 

  3. Wong ND, Lopez VA, L’Italien G, et al.: Inadequate control of hypertension in US adults with cardiovascular disease comorbidities in 2003–2004. Arch Intern Med 2007, 167:2431–2436.

    Article  PubMed  Google Scholar 

  4. Bautista LE: Predictors of persistence with antihypertensive therapy: results from the NHANES. Am J Hypertens 2008 Jan 10 (Epub ahead of print).

  5. Qureshi AI, Suri MF, Kirmani JF, et al.: Prevalence and trends of prehypertension and hypertension in United States: National Health and Nutrition Examination Surveys 1976 to 2000. Med Sci Monit 2005, 11:CR403–CR409.

    PubMed  Google Scholar 

  6. Vasan RS, Larson MG, Leip EP, et al.: Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study. Lancet 2001, 358:1682–1686.

    Article  PubMed  CAS  Google Scholar 

  7. Larson MG, Leip EP, Evans JC, et al.: Impact of high-normal BP on the risk of cardiovascular disease. N Engl J Med 2001, 345:1337–1340.

    Article  Google Scholar 

  8. Franklin SS, Mitchell GF: Aging, arterial function, and systolic hypertension. In Hypertension Primer: The Essentials of High Blood Pressure. Edited by Izzo JL Jr, Sica DA, Black HR. Philadelphia: Lippincott, Williams, and Wilkins; 2008:144–148.

    Google Scholar 

  9. Najjar SS, Scuteri A, Lakatta EG: Arterial aging: is it an immutable cardiovascular risk factor? Hypertension 2005, 46:454–462.

    Article  PubMed  CAS  Google Scholar 

  10. Burt VL, Whelton P, Roccella EJ, et al.: Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension 1995, 25:303–304.

    Google Scholar 

  11. Laurent S, Boutouyrie P, Asmar R, et al.: Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001, 37:1236–1241.

    PubMed  CAS  Google Scholar 

  12. Blacher J, Pannier B, Guerin AP, et al.: Carotid arterial stiffness as a predictor of cardiovascular and all-cause mortality in end-stage renal disease. Hypertension 1998, 32:570–574.

    PubMed  CAS  Google Scholar 

  13. Sutton-Tyrrell K, Najjar SS, Kupelian V, et al.: Aortic pulse wave velocity predicts mortality in a general population of well-functioning older adults. Circulation 2005, 111:3384–3390.

    Article  PubMed  Google Scholar 

  14. Williams B, Lacy PS, Thom SM, et al.: Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 2006, 113:1213–1225.

    Article  PubMed  CAS  Google Scholar 

  15. Vasan RS: Pathogenesis of elevated peripheral pulse pressure: some reflections and thinking forward. Hypertension 2008, 51:133–136.

    Google Scholar 

  16. O’Rourke MF, Nichols WW: Aortic diameter, aortic stiffness, and wave reflection increase with age and isolated systolic hypertension. Hypertension 2005, 45:652–658.

    Article  PubMed  CAS  Google Scholar 

  17. Mitchell GF, Conlin PR, Dunlap ME, et al.: Aortic diameter, wall stiffness, and wave reflection in systolic hypertension. Hypertension 2008, 51:105–111.

    Article  PubMed  CAS  Google Scholar 

  18. Dart AM, Gatzka CD, Kingwell BA, et al.: Brachial blood pressure but not carotid arterial waveforms predict cardiovascular events in elderly female hypertensives. Hypertension 2006, 47:785–790.

    Article  PubMed  CAS  Google Scholar 

  19. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report. National Institutes of Health. Obes Res 1998, 6(Suppl 2):51S–209S.

  20. Danias PG, Tritos NA, Stuber M, et al.: Comparison of aortic elasticity determined by cardiovascular magnetic resonance imaging in obese versus lean adults. Am J Cardiol 2003, 91:195–199.

    Article  PubMed  Google Scholar 

  21. Dengel DR, Kelly AS, Olson TP, et al.: Effects of weight loss on insulin sensitivity and arterial stiffness in overweight adults. Metabolism 2006, 55:907–911.

    Article  PubMed  CAS  Google Scholar 

  22. Gates PE, Tanaka H, Hiatt WR, et al.: Dietary sodium restriction rapidly improves large elastic artery compliance in older adults with systolic hypertension. Hypertension 2004, 44:35–41.

    Article  PubMed  CAS  Google Scholar 

  23. Seals DR, Tanaka H, Clevenger CM, et al.: Blood pressure reductions with exercise and sodium restriction in post-menopausal women with elevated systolic pressure: role of arterial stiffness. J Am Coll Cardiol 2001, 38:506–513.

    Article  PubMed  CAS  Google Scholar 

  24. Blendea MC, Bard M, Sowers JR, et al.: High-fat meal impairs vascular compliance in a subgroup of young healthy subjects. Metabolism 2005, 54:1337–1344.

    Article  PubMed  CAS  Google Scholar 

  25. Vaitkevicious PV, Fleg JL, Engel JH, et al.: Effects of age and aerobic capacity on arterial stiffness in healthy adults. Circulation 1993, 88:1456–1462.

    Google Scholar 

  26. Tanaka H, DeSouza CA, Seals DR: Absence of age-related increase in central arterial stiffness in physically active women. Arterioscler Thromb Vasc Biol 1998, 18:127–132.

    PubMed  CAS  Google Scholar 

  27. Tanaka FA, Dinenno KD, Monahan CM, et al.: Aging, habitual exercise, and dynamic arterial compliance. Circulation 2000, 102:1270–1275.

    PubMed  CAS  Google Scholar 

  28. Tanaka H, Safar ME: Influence of lifestyle modification on arterial stiffness and wave reflections. Am J Hypertens 2005, 18:137–144.

    Article  PubMed  Google Scholar 

  29. Miyachi M, Donato AJ, Yamamoto K, et al.: Greater age-related reductions in central arterial compliance in resistance-trained men. Hypertension 2003, 41:130–135.

    Article  PubMed  CAS  Google Scholar 

  30. Winer N, Sowers JR: Diabetes and arterial stiffening. Adv Cardiol 2007, 44:245–251.

    Article  PubMed  CAS  Google Scholar 

  31. Mahmud A, Feely J: Effect of smoking on arterial stiffness and pulse pressure amplification hypertension. Hypertension 2003, 41:183–187.

    Article  PubMed  CAS  Google Scholar 

  32. Benowitz NL: Cigarette smoking and cardiovascular disease: pathophysiology and implications for treatment. Prog Cardiovasc Dis 2003, 46:91–111.

    Article  PubMed  CAS  Google Scholar 

  33. Siasos G, Tousoulis D, Vlachopoulos C, et al.: Short-term treatment with L-arginine prevents the smoking-induced impairment of endothelial function and vascular elastic properties in young individuals. Int J Cardiol 2007 Jun 22 (Epub ahead of print).

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

    Article  PubMed  CAS  Google Scholar 

  35. Rizzoni D, Porteri E, De Ciuceis, et al.: Effect of treatment with candesartan or enalapril on subcutaneous small artery structure in hypertensive patients with noninsulin-dependent diabetes mellitus. Hypertension 2005, 45:659–665.

    Article  PubMed  CAS  Google Scholar 

  36. Savoia C, Touyz RM, Amiri F, et al.: Selective mineralocorticoid receptor blocker eplerenone reduces resistance artery stiffness in hypertensive patients. Hypertension 2008, 51:432–439.

    Article  PubMed  CAS  Google Scholar 

  37. Pool JL: Direct renin inhibition: focus on aliskiren. J Manag Care Pharm 2007, 13(8 Suppl B):21–33.

    PubMed  Google Scholar 

  38. Bank AJ, Kelly AS, Thelen AM, et al.: Effects of carvedilol versus metoprolol on endothelial function and oxidative stress in patients with type 2 diabetes mellitus. Am J Hypertens 2007, 20:777–783.

    Article  PubMed  CAS  Google Scholar 

  39. Zanchetti A: Clinical pharmacodynamics of nebivolol: new evidence of nitric oxide-mediated vasodilating activity and peculiar haemodynamic properties in hypertensive patients. Blood Press Suppl 2004, 1:17–32.

    Article  PubMed  Google Scholar 

  40. Chang JJ, Luchsinger JA, Shea S: Antihypertensive medication class and pulse-pressure in the elderly: analysis based on the Third National Health and Nutrition Examination Survey. Am J Med 2003, 115:536–542.

    Article  PubMed  Google Scholar 

  41. Morgan T, Lauri J, Bertram D, Anderson A: Effect of different anti-hypertensive drug classes on central aortic pressure. Am J Hypertens 2004, 17:118–123.

    Article  PubMed  CAS  Google Scholar 

  42. Fitchett DH, Simkus GJ, Beaudry JP, et al.: Reflected pressure waves in the ascending aorta: effect of glyceryl trinitrate. Cardiovasc Res 1988, 22:494–500.

    Article  PubMed  CAS  Google Scholar 

  43. Coughlan MT, Forbes JM, Cooper ME: Role of the AGE crosslink breaker, alagebrium, as a renoprotective agent in diabetes. Kidney Int Suppl 2007, 106:S54–S60.

    Article  PubMed  CAS  Google Scholar 

  44. Zieman SJ, Melenovsky V, Clattenburg L, et al.: Advanced glycation endproduct crosslink breaker (alagebrium) improves endothelial function in patients with isolated systolic hypertension. J Hypertens 2007, 25:577–583.

    Article  PubMed  CAS  Google Scholar 

  45. Kass DA, Champion HC, Beavo JA: Phosphodiesterase type 5: expanding roles in cardiovascular regulation. Circ Res 2007, 101:1084–1095.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. State University of New York Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA

    Nathaniel Winer

Authors
  1. Ho Won Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jocelyn Karam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Babar Hussain
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nathaniel Winer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nathaniel Winer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, H.W., Karam, J., Hussain, B. et al. Vascular compliance in hypertension: Therapeutic implications. Curr Diab Rep 8, 208–213 (2008). https://doi.org/10.1007/s11892-008-0036-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-008-0036-8

Keywords

Search

Navigation