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
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Role of Central Blood Pressure and Arterial Stiffening Stéphane Laurent, Jean-Sébastien Hulot, and Pierre Boutouyrie
The relationship between brachial blood pressure (BP), hypertension and heart failure is well established. However, 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. An increasing number of physiological studies, as well as pathophysiological, epidemiological and pharmacological studies, have underlined the importance of measuring not only brachial systolic and pulse pressures but also central systolic and pulse (i.e. systolic minus diastolic) pressures and arterial stiffness. 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.
S. Laurent (*) · P. Boutouyrie Department of Pharmacology, Université Paris-Descartes, Assistance-Publique Hôpitaux de Paris, INSERM-PARCC U970, and Hôpital Européen Georges Pompidou, Paris, France e-mail: [email protected]; [email protected] J.-S. Hulot Université Paris-Descartes, Assistance-Publique Hôpitaux de Paris, INSERM-PARCC U970, and Clinical Investigation Center, Hôpital Européen Georges Pompidou, Paris, France e-mail: [email protected] © Springer Nature Switzerland AG 2019 M. Dorobantu et al. (eds.), Hypertension and Heart Failure, Updates in Hypertension and Cardiovascular Protection, https://doi.org/10.1007/978-3-319-93320-7_9
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Pathophysiology of Central Blood Pressure and Wave Reflection in Hypertension
9.1.1 Haemodynamic and Reflection of Pressure Waves During ventricular contraction, a part of the stroke volume is forwarded directly to the peripheral tissues, while the remainder is momentarily stored in the aorta and central arteries, thereby stretching the arterial walls and raising local blood pressure (Fig. 9.1). Part of the energy produced by the heart is thus used for the distension of arteries and is transferred to the vessel walls as potential energy by passive loading of elastic elements in the wall. During diastole, the aorta recoils, and the “stored” energy is restored to the arterial system, squeezing the accumulated blood forwards into the peripheral tissues, ensuring quasi-continuous flow, especially during diastole (Fig. 9.1). Cardiac work has two compon
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