Brachial Pressure Control Fails to Account for Most Distending Pressure-Independent, Age-Related Aortic Hemodynamic Changes in Adults

• Published in: American journal of hypertension 2016-05, Vol.29 (5), p.605-613
• Main Authors: Hodson, Bryan, Norton, Gavin R., Booysen, Hendrik L., Sibiya, Moekanyi J., Raymond, Andrew, Maseko, Muzi J., Majane, Olebogeng H.I., Libhaber, Elena, Sareli, Pinhas, Woodiwiss, Angela J.
• Format: Article
• Language: English
• Subjects: Adult; African Continental Ancestry Group; Age Factors; Aging - ethnology; Aorta - physiopathology; Arterial Pressure; Brachial Artery - physiopathology; Female; Humans; Hypertension - diagnosis; Hypertension - ethnology; Hypertension - physiopathology; Male; Manometry; Middle Aged; Pulse Wave Analysis; South Africa - epidemiology; Vascular Stiffness
• ISSN: 0895-7061; 1941-7225
• DOI: 10.1093/ajh/hpv140

BACKGROUND Although several characteristics of aortic function, which are largely determined by age, predict outcomes beyond brachial blood pressure (BP), the extent to which brachial BP control accounts for age-related variations in aortic function is uncertain. We aimed to determine the extent to which brachial BP control in the general population (systolic/diastolic BP < 140/90mm Hg) accounts for age-related aortic hemodynamic changes across the adult lifespan. METHODS Central aortic pulse pressure (PPc), backward wave pressure (Pb), pulse wave velocity (PWV), and PP amplification (PPamp) (applanation tonometry and SphygmoCor software) were determined in 1,185 participants from a community sample (age >16 years; 36.4% uncontrolled BP). RESULTS With adjustments for distending pressure (mean arterial pressure, MAP), no increases in PPc, Pb, or PWV and decreases in PPamp were noted in those with an uncontrolled brachial BP younger than 50 years. In those older than 50 years with an uncontrolled brachial BP, MAP-adjusted aortic hemodynamic variables were only modestly different to those with a controlled brachial BP (PPc, 46±14 vs. 42±15mm Hg, P < 0.02, Pb, 23±8 vs. 21±8mm Hg, PWV, 8.42±3.21 vs. 8.19±3.37 m/second, PPamp, 1.21±0.17 vs. 1.21±0.14). Nonetheless, with adjustments for MAP, marked age-related increases in PPc, Pb, and PWV and decreases in PPamp were noted in those with uncontrolled and controlled brachial BP across the adult lifespan (P < 0.0001). CONCLUSION Brachial BP control in the general population fails to account for most distending pressure-independent, age-related changes in aortic hemodynamics across the adult lifespan.