Coupling between the left ventricle and arterial system in hypertension

In youth and in health, a variety of factors combine to optimize coupling between the left ventricle and systemic circulation. In hypertension and with aging, optimal coupling is disturbed by increased arterial stiffness which increases systolic pressure through two different mechanisms. The first mechanism (reduced aortic compliance) is not directly affected by drugs, but the second (early wave reflection) is capable of modification by vasodilator therapy. Favourable effects of vasodilator agents may not be apparent when pressure is recorded conventionally in a peripheral artery but can be inferred from consideration of pressure wave contour. Recognition of these factors provides new strategies for dealing with hypertension and hypertensive heart failure in man.