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REFLECTIONS
Hypertension
Hypertension Global Newsletter #4 2023

Haemodynamic changes with arterial stiffness Hypertension
• Hyper-perfusion of high-flow organs causing microvascular damage
• Elevated systolic pressure and subsequent diastolic dysfunction via concentric left ventricular remodelling and hypertrophy

Measurement of the carotid-femoral pulse wave velocity (cfPWV) is an indicator of arterial stiffness. As arteries stiffen with age,
impedance and forward travelling pressure increase, leading to higher PWV.

Recent, longitudinal evidence from repeated measures of cfPWV in
3862 apparently healthy adolescents revealed that arterial stiffness may
causally precede elevated BP and hypertension in young adulthood.
The authors found that among boys, a higher cfPWV at 17.7 years
predicted elevated SBP and/or hypertension [OR 1.31 (CI 1.02–1.70)]
and elevated DBP and/or hypertension [OR 2.18 (CI 1.49–3.19)] at 24.5
years but not among girls [OR 1.09 (CI 0.83–1.42)] and [OR 1.40 (CI
0.91–2.16)], respectively. Adolescents in the highest quartile of cfPWV at
17.7 and 24.5 years had a two-fold increase in SBP and DBP during the
seven-year observation period when compared with those at the lower
second quartile of cfPWV.

There were some disparities in prospective studies on the effect of
childhood obesity on arterial stiffness. The dynamic changes in fat mass
from childhood through young adulthood may not be directly associated
with arterial stiffness progression, especially in a healthy population.
Further studies are needed to understand the complex and possibly
vascular adaptive relationships between obesity and arterial stiffness.

Emerging evidence suggests that arterial stiffness may predict
hyperinsulinemia in young adulthood. Arterial stiffness preceding
hyperinsulinemia and insulin resistance implicates insulin response
rather than production. Again, further studies are needed to understand
better the pathological mechanism by which arterial stiffness contributes
to metabolic alterations.

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