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The hemodynamics of hypertension and antihypertensive therapy have generally been approached in terms of the steady-flow load on the heart. Recent evidence, however, suggests that the pulsatile component of hemodynamic load may play a fundamental role in both the development and progression of hypertensive cardiovascular disease and its clinical sequelae. Pulse pressure, a correlate of conduit vessel stiffness, has been shown to be an important independent predictor of clinical events in hypertensive patients and in the general population. Unrecognized effects on pulsatile hemodynamics may account for the differential effects of various agents on left ventricular mass and events. A better understanding of abnormalities in pulsatile load in hypertension will facilitate risk stratification in and treatment of patients with hypertension.
Mitchell et al. (Wed,) studied this question.