Arterial Flow, Pulse Pressure and Pulse Wave Velocity in Men and Women at Various Ages

  • Alberto P. Avolio
  • Tatiana Kuznetsova
  • Guy R. Heyndrickx
  • Peter L. M. Kerkhof
  • John K.-J. Li
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1065)


The increase in pulse pressure (PP) that occurs with advancing age is predominantly due to reduced arterial distensibility leading to decreased aortic compliance, particularly in the elderly, in whom high blood pressure mainly manifests as isolated systolic hypertension. Since age-related changes in stroke volume are minimal compared with changes in PP, PP is often considered a surrogate measure of arterial stiffness. However, since PP is determined by both cardiac and arterial function, a more precise and reliable means of assessment of arterial stiffness is arterial pulse wave velocity (PWV), a parameter that is only dependent on arterial properties. Arterial stiffness as measured by PWV has been found to be a powerful pressure-related indicator for cardiovascular morbidity and mortality. We analyzed PP and PWV in men and women of various age groups in healthy volunteers as well as cardiac patients with different types of diseases. The findings identified several striking sex-specific differences which demand consideration in guidelines for diagnostic procedures, for epidemiological analysis, and in evaluation of therapeutic interventions.


Pulse pressure Blood pressure Aging arterial system Arterial compliance Sex-specific analysis Pulse wave velocity Cardio-ankle vascular index Augmentation index 


  1. 1.
    Li JK-J. The arterial circulation: physical principles and clinical applications. Totowa: Humana Press; 2000.CrossRefGoogle Scholar
  2. 2.
    O’Rourke MF, Taylor MG. Input impedance of the systemic circulation. Circ Res. 1967;20(4):365–80.CrossRefPubMedGoogle Scholar
  3. 3.
    Vatner SF, et al. Effects of isoproterenol on regional myocardial function, electrogram, and blood flow in conscious dogs with myocardial ischemia. J Clin Invest. 1976;57(5):1261–71.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kerkhof PLM. Beat-to-beat analysis of high-fidelity signals obtained from the left ventricle and aorta in chronically instrumented dogs. Automedica. 1986;7:83–90.Google Scholar
  5. 5.
    Pagani M, et al. Effects of age on aortic pressure-diameter and elastic stiffness-stress relationships in unanesthetized sheep. Circ Res. 1979;44(3):420–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Hayashi K, et al. Single-beat estimation of ventricular end-systolic elastance-effective arterial elastance as an index of ventricular mechanoenergetic performance. Anesthesiology. 2000;92(6):1769–76.CrossRefPubMedGoogle Scholar
  7. 7.
    Vaccarino V, Holford TR, Krumholz HM. Pulse pressure and risk for myocardial infarction and heart failure in the elderly. J Am Coll Cardiol. 2000;36(1):130–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Franklin SS, et al. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham heart study. Circulation. 1999;100(4):354–60.CrossRefPubMedGoogle Scholar
  9. 9.
    Kannel WB. Historic perspectives on the relative contributions of diastolic and systolic blood pressure elevation to cardiovascular risk profile. Am Heart J. 1999;138(3 Pt 2):S205–10.CrossRefGoogle Scholar
  10. 10.
    Herbert A, et al. 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(44):3122–33.CrossRefPubMedGoogle Scholar
  11. 11.
    Garcia J, et al. Distribution of blood flow velocity in the normal aorta: effect of age and gender. J Magn Reson Imaging. 2017;47:487–98.CrossRefPubMedGoogle Scholar
  12. 12.
    Avolio AP, et al. Effects of aging on arterial distensibility in populations with high and low prevalence of hypertension: comparison between urban and rural communities in China. Circulation. 1985;71(2):202–10.CrossRefPubMedGoogle Scholar
  13. 13.
    Chen CH, et al. Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure. Validation of generalized transfer function. Circulation. 1997;95(7):1827–36.CrossRefPubMedGoogle Scholar
  14. 14.
    Namasivayam M, Adji A, O'Rourke MF. Influence of aortic pressure wave components determined noninvasively on myocardial oxygen demand in men and women. Hypertension. 2011;57(2):193–200.CrossRefPubMedGoogle Scholar
  15. 15.
    Namekata T, et al. Establishing baseline criteria of cardio-ankle vascular index as a new indicator of arteriosclerosis: a cross-sectional study. BMC Cardiovasc Disord. 2011;11:51.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Spronck B, et al. Direct means of obtaining CAVI0-a corrected cardio-ankle vascular stiffness index (CAVI)-from conventional CAVI measurements or their underlying variables. Physiol Meas. 2017;38(10):N128–37.CrossRefPubMedGoogle Scholar
  17. 17.
    Leeson P. Hypertension and cardiovascular risk in young adult life: insights from CAVI. Eur Heart J. 2017;19(Suppl B):B24–9.CrossRefGoogle Scholar
  18. 18.
    Schillaci G, et al. The impact of the cardio-ankle vascular index on left ventricular structure and function. Eur Heart J Suppl. 2017;19(Suppl B):B30–4.CrossRefGoogle Scholar
  19. 19.
    Ayer JG, et al. Central arterial pulse wave augmentation is greater in girls than boys, independent of height. J Hypertens. 2010;28(2):306–13.CrossRefPubMedGoogle Scholar
  20. 20.
    Barraclough JY, et al. Sex differences in aortic augmentation index in adolescents. J Hypertens. 2017;35(10):2016–24.CrossRefPubMedGoogle Scholar
  21. 21.
    Ye Z, Pellikka PA, Kullo IJ. Sex differences in associations of cardio-ankle vascular index with left ventricular function and geometry. Vasc Med. 2017;22(6):465–72.CrossRefPubMedGoogle Scholar
  22. 22.
    Hayward CS, Kelly RP. Gender-related differences in the central arterial pressure waveform. J Am Coll Cardiol. 1997;30(7):1863–71.CrossRefPubMedGoogle Scholar
  23. 23.
    Jiang X, et al. Blood pressure tables for Chinese adolescents: justification for incorporation of important influencing factors of height, age and sex in the tables. BMC Pediatr. 2014;14:10.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Staessen J, Fagard R, Amery A. Isolated systolic hypertension in the elderly: implications of Systolic Hypertension in the Elderly Program (SHEP) for clinical practice and for the ongoing trials. J Hum Hypertens. 1991;5(6):469–74.PubMedGoogle Scholar
  25. 25.
    Li JK, et al. Pulse wave propagation. Circ Res. 1981;49(2):442–52.CrossRefPubMedGoogle Scholar
  26. 26.
    Li JK-J. Dynamics of the vascular system. Singapore: World Scientific; 2004.CrossRefGoogle Scholar
  27. 27.
    Mohiaddin RH, et al. Regional aortic compliance studied by magnetic resonance imaging: the effects of age, training, and coronary artery disease. Br Heart J. 1989;62(2):90–6.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Berger DS, Li JK. Concurrent compliance reduction and increased peripheral resistance in the manifestation of isolated systolic hypertension. Am J Cardiol. 1990;65(1):67–71.CrossRefPubMedGoogle Scholar
  29. 29.
    Li JK, et al. Allometric hemodynamic analysis of isolated systolic hypertension and aging. Cardiovasc Eng. 2007;7(4):135–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Berger DS, Li JK, Noordergraaf A. Differential effects of wave reflections and peripheral resistance on aortic blood pressure: a model-based study. Am J Phys. 1994;266(4 Pt 2):H1626–42.Google Scholar
  31. 31.
    Li JK-J, et al. Noninvasive pulse wave velocity and apparent phase velocity in normal and hypertensive subjects. J Cardiovas Diagn Procedures. 1996;13:31–6.Google Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Biomedical Sciences, Faculty of Medicine and Health SciencesMacquarie UniversitySydneyAustralia
  2. 2.Department of Cardiovascular SciencesUniversity of LeuvenLeuvenBelgium
  3. 3.Cardiovascular CenterAalstBelgium
  4. 4.Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular SciencesVU University Medical CenterAmsterdamThe Netherlands
  5. 5.Department of Biomedical EngineeringRutgers UniversityPiscatawayUSA

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