Key result
Arterial stiffness and wave reflections independently predict elderly CV events via augmented central pulse pressure.
Why the study?
Arterial stiffness and wave reflections predict cardiovascular events in elderly hypertensive patients, and recent concepts like Early and Supernormal Vascular Ageing help identify modifiable determinants to limit target organ damage.
Arterial stiffness is a key determinant of cardiovascular risk in elderly hypertensives, and understanding concepts like Early Vascular Ageing can help limit target organ damage.
Supports stiffness assessment for risk stratification in elderly hypertensives; leaves open whether targeting early vascular ageing improves outcomes.
Hypertension prevalence increases with age. Age and high blood pressure are the two main determinants of arterial stiffness. In elderly hypertensives, large arteries stiffen and systolic and pulse pressures increase, due to wave reflections. A major reason for measuring arterial stiffness in clinical practice in elderly hypertensive patients comes from the repeated demonstration that arterial stiffness and wave reflections have a predictive value for CV events. A large body of evidence has been published during the last two decades, concerning the epidemiology, pathophysiology, and pharmacology of large arteries in hypertension in various settings of age. Particularly, two expert consensus documents have reviewed the methodological agreements for measuring arterial stiffness. The concepts of Early Vascular Ageing (EVA) and Supernormal Vascular Ageing (SUPERNOVA) help to better understand on which determinants of arterial stiffness it is possible to act, in order to limit target organ damage and cardiovascular complications. This review will address the issues of the cellular and molecular mechanisms of arterial stiffening in elderly hypertensives, the consequences of arterial stiffening on central systolic and pulse (systolic minus diastolic, PP) pressures and target organs, the methodology for measuring arterial stiffness, central pulse pressure and wave reflection, the epidemiological determinants of arterial stiffening in elderly hypertensives, the pharmacology of arterial destiffening, and how the concepts of EVA and SUPERNOVA apply to the detection of organ damage and prevention of CV complications.
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Laurent et al. (2020) conducted a review in Hypertension and Arterial Stiffness. Arterial stiffness and wave reflections increase with age and hypertension, leading to augmented central pulse pressure and target organ damage, and serve as independent predictors of cardiovascular events in the elderly.
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