Arterial Stiffness are Related to the Severity of Isolated Diastolic Dysfunction in Elderly Hypertensive Patients

ABSTRACT

Background: Reduced arterial compliance has recently been reported in patients with diastolic dysfunction and correlated with the severity of diastolic dysfunction. We tried to investigate the relation of arterial compliance to diastolic dysfunction in elderly hypertensive patients. Subjects and Methods: 250 medically treated elderly hypertensive patients without clinical atherosclerotic cardiovascular disease (131 men, 71.5+/-5.1 years) and 15 normotensive controls were enrolled. Using an automated wave form analyzer, the pulse wave velocity(PWV) and augmentation index (AI) were simultaneously measured as indices of arterial compliance. Diastolic function was determined based on Doppler echocardiography. Results: According to conventional Doppler echocardiography of transmitral and pulmonary venous flow, diastolic function was classified as relaxation abnormality in 220 patients and pseudonormal in 30 patients. hfPWV and baPWV were lowest in controls (842.0+/-251.9, 1,463.3+/-265.9 m/sec) and became progressively higher in patients with hypertension and relaxation abnormality (1,171.5 +/-234.5, 1,824.2+/-389.9 m/sec), and pseudonormalization (1,433.3+/-344.4, 2,009.3+/-579.4 m/sec; p<0.001 in both). In patients with diastolic dysfunction, hfPWV and baPWV were related to age (p<0.001), blood pressure (p<0.001), and E/Ea (p< 0.01). hfPWV was directly deceleration time (p=0.01) and Aa (r=0.13, p=0.03). After adjustment for age, sex, blood pressure, parameters of arterial compliance worked as independent predictors of diastolic dysfunction. Conclusions: In elderly hypertensive patients, diastolic function is inversely related with arterial compliance. Arterial compliance is an independent predictor of diastolic dysfunction in elderly patients with hypertension and should be considered a potential target to optimize ventriculo-arterial coupling and cardiac performance in diastolic HF.