Hemodynamic basis for the concept of resistance and impedance in hypertension

  • Michael F. O’Rourke
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 63)


Hypertension is caused by increased resistance to flow in peripheral vessels. This was appreciated by Bright [1] in 1827 as the probable cause of cardiac hypertrophy in patients with chronic nephritis‘ … that it so affects the minute and capillary circulation, as to render greater action necessary to force the blood through the distant subdivisions of the vascular system.’ This point of view was emphasised by Sutton and by Gull [2], who in a lecture at Guy’s Hospital, London in 1872 observed ‘It is always dangerous to rest in a narrow pathology; and I believe that to be a narrow pathology which is satisfied with what you now see before me on this table. In this glass you see a much hypertrophied heart and a very contracted kidney. This specimen is classical. It was, I believe, put up under Dr Bright’s own direction and with a view of showing that the wasting of the kidney was the cause of the thickening of the heart. I cannot but look upon it with veneration, but not with conviction. I think, with all deference to so great an authority, that the systemic capillaries, and had it been possible, the entire man, should have been included in this vase; then we should have had, I believe, a truer view of the causation of the cardiac hypertrophy and of disease of the kidney.’


Pulse Wave Velocity Pressure Wave Brachial Artery Diastolic Pressure Peripheral Resistance 
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© Martinus Nijhoff Publishers, Dordrecht. 1987

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  • Michael F. O’Rourke

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