Affiliation:
1. Cardiovascular Engineering Inc. Norwood MA
2. Boston University and NHLBI’s Framingham Study Framingham MA
3. Department of Biostatistics Boston University School of Public Health Boston MA
4. Biology Department, Vassar College Poughkeepsie NY
5. Cardiology and Preventive Medicine Sections, Department of Medicine Boston University Chobanian and Avedisian School of Medicine, Boston Medical Center Boston MA
6. Department of Epidemiology Boston University School of Public Health Boston MA
7. Evans Department of Medicine Boston MA
8. Whitaker Cardiovascular Institute Boston University Chobanian and Avedisian School of Medicine Boston MA
Abstract
Background
Systolic blood pressure increases with age after midlife, particularly in women, and contributes to development of wide pulse pressure hypertension in middle‐aged and older adults. Relative contributions of aortic stiffness and premature wave reflection to increases in pulse pressure remain controversial.
Methods and Results
We evaluated visit‐specific values and change in key correlates of pulse pressure, aortic characteristic impedance, forward and backward wave amplitude, and global reflection coefficient, at 3 sequential examinations of the Framingham Generation 3 (N=4082), Omni‐2 (N=410), and New Offspring Spouse (N=103) cohorts (53% women). Data were analyzed using repeated‐measures linear mixed models adjusted for age, sex, and risk factor exposures. Pulse pressure increased markedly with age after midlife (age and age‐squared terms,
P
<0.0001), particularly in women (age slope 3.1±0.2 mm Hg/decade higher in women,
P
<0.0001). In sex‐specific models, change in pulse pressure was closely related (all
P
<0.0001) to baseline (6.7±0.2 and 7.3±0.2 mm Hg/SD in men and women, respectively) and change (11.8±0.1 and 11.7±0.1 mm Hg/SD) in forward wave amplitude, whereas relations with baseline (2.1±0.15 and 2.0±0.14 mm Hg/SD) and change (4.0±0.13 and 3.4±0.11 mm Hg/SD) in global reflection coefficient were weaker. Global reflection coefficient fell as aortic characteristic impedance increased (
P
<0.0001), consistent with the hypothesis that impedance matching reduces relative wave reflection in the arterial system.
Conclusions
Proximal aortic stiffening, as assessed by higher aortic characteristic impedance and larger forward wave amplitude, is strongly associated with longitudinal increase in pulse pressure, especially in women, whereas wave reflection has more modest relations.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
3 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献