Central Hemodynamics and Arterial Stiffness

Current Pharmaceutical Design, 2009, Vol. 15, No. 3

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Editorial Central Hemodynamics and Arterial Stiffness: Methodological, Clinical and Pharmaceutical Considerations Arterial stiffness and central hemodynamics is a hot topic with increasing research and clinical interest. There is now ample evidence supporting that arterial stiffness and central hemodynamic indices have an independent predictive value for cardiovascular events and mortality. The present issue of Current Pharmaceutical Design is mainly focused on pathophysiology and treatment of arterial stiffness and central hemodynamics. The development of new technologies for the non-invasive assessment of central blood pressure (BP) and arterial stiffness has allowed their widespread evaluation. Although several methods now exist for non-invasive estimation of central BP, current technologies are still under evaluation and several technical and methodological issues are debated. In this issue, several methods and technologies currently available for the assessment of central BP are reviewed. Methodological and technical procedures as well as their accuracy, reproducibility and limitations are presented and discussed [1]. The article of Sabovic, Safar and Blacher [2] aims to answer two crucial questions regarding the clinical value of central BP. First, is central BP better than brachial BP as a predictor of cardiovascular (CV) outcome?; and second, can the improvement of central BP result in concomitant reduction in CV events? For centuries, the assessment of BP was based exclusively on measurements of peripheral (brachial) BP. However, there is now a growing interest in the investigation of central (aortic) BP, since it is now accepted that central hemodynamics, reflected by central pressure wave forms and arterial stiffness, can provide new and better insight into the pathophysiology of cardiovascular disorders associated with ageing, hypertension, diabetes, as well as end-stage renal disease. The article of Sabovic et al., provide the pathophysiology and the predictive role of central pressure wave forms for cardiovascular events that are beyond peripheral BP. Crucially, they review data supporting the view that improvement of central BP can result to a reduction of cardiovascular events. Protogerou et al., in the first part of their review [3] deal with the mechanisms underlying the genesis and recording of BP difference between central and peripheral arteries (pressure amplification). In addition, the rationale of differential effect of antihypertensive drugs on pressure amplification is discussed. Finally, the pathophysiological role of pressure amplification on CV disease as well as its clinical and research implications are presented. In the second part of their review, Protogerou et al. [4], summarize and discuss the so far available evidence regarding the specific class-effect of antihypertensive drugs on central BP beyond peripheral BP, as well as the potential underlying hemodynamic mechanisms. Also a head to head comparison of the effect of different classes of antihypertensive drugs on central BP is being made, while the effect of combination drug treatment on central BP is discussed. Finally, the authors attempt an extrapolation of the above evidence on the results and conclusions derived from large epidemiological studies based on peripheral BP recording [4]. There is a strong body of evidence demonstrating that arterial stiffness is an independent predictor of cardiovascular outcome. Mean arterial pressure and changes in the arterial wall properties are the main factors regulating stiffness; however it has become apparent that inflammation also plays an important role in arterial stiffening. Numerous small-scale interventional studies have demonstrated that inflammation-reduction either by traditional anti-inflammatory drugs or with cholesterolreduction therapies, ameliorates arterial stiffness in numerous patient groups. Mki-Petj and Wilkinson [5], explored the published data investigating the role of inflammation on arterial stiffening and review the results from the studies investigating the effect of anti-inflammatory drugs and statins on arterial stiffness. Finally, they discuss the potential mechanisms by which these drugs may reduce arterial stiffness. The article of Nichols and Epstein [6] is aimed at highlighting the importance of arterial stiffness and wave reflections, reviewing the impact of various hormones on arterial structure and function, and also reviewing what is known about the impact of drug therapy on arterial properties and wave reflection [6]. Food and drinks or other nutritional factors that might influence arterial stiffness and central hemodynamics are of great importance, since there might be natural substances with beneficial influence on heart and vessel function like those found in red wine (mainly ethanol and antioxidants). The effect of red wine on central hemodynamics has been partially explored with divergent results. It seems that data regarding the possible consequences of acute and long term intake on arterial stiffness, wave reflections and central BP are limited and sometimes unclear. Karatzi et al. [7], gathered and discuss all the existing data regarding the effects of red wine consumption on arterial stiffness and central hemodynamics. Antoniades et al. [8], provide an overview of reactive oxygen species (ROS) physiology in human vessels. They describe the sources of vascular oxidative stress and seek to highlight the effects of ROS on vascular redox signaling and vascular homeostasis. Finally, the possible therapeutic strategies for targeting redox signaling in the vascular wall at a clinical level are discussed. There is now a great body of evidence supporting the relation of arterial stiffness and central hemodynamics with cardiovascular risk and mortality. The ultimate objective in many clinical and experimental studies and a great future challenge is the investigation of drugs that can reduce central BP and arterial stiffness independently from the peripheral BP response, resulting to an additional reduction of cardiovascular risk and mortality.

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Central Hemodynamics and Arterial Stiffness

References [1] Papaioannou TG, Protogerou AD, Stamatelopoulos KS, Vavuranakis M, Stefanadis C. Non-invasive methods and techniques for central blood pressure estimation: procedures, validation, reproducibility and limitations. Curr Pharm Des 2009; 15(3): 245-253. Sabovic M, Safar ME, Blacher J. Is there any additional prognostic value of central blood pressure wave forms beyond peripheral blood pressure? Curr Pharm Des 2009; 15(3): 254-266. Protogerou AD, Papaioannou TG, Lekakis JP, Blacher J, Safar ME. The effect of antihypertensive drugs on central blood pressure beyond peripheral blood pressure. Part I: (Patho)-physiology, rationale and perspective on pulse pressure amplification. Curr Pharm Des 2009; 15(3): 267-271. Protogerou AD, Stergiou GS, Vlachopoulos C, Blacher J, Achimastos A. The effect of antihypertensive drugs on central blood pressure beyond peripheral blood pressure. Part II: Evidence for specific class-effects of antihypertensive drugs on pressure amplification Curr Pharm Des 2009; 15(3): 272-289. Mki-Petj KM, Wilkinson IB. Anti-inflammatory drugs and statins for arterial stiffness reduction. Curr Pharm Des 2009; 15(3): 290-303. Nichols WW, Epstein BJ. Actions of selected cardiovascular hormones on arterial stiffness and wave reflections Curr Pharm Des 2009; 15(3): 304-320. Karatzi K, Papaioannou TG, Papamichael C, Lekakis J, Stefanadis C, Zampelas A. Red wine, arterial stiffness and central hemodynamics. Curr Pharm Des 2009; 15(3): 321-328. Antoniades C, Antonopoulos AS, Bendall JK, Channon KM. Targeting redox signaling in the vascular wall: From basic science to clinical practice. Curr Pharm Des 2009; 15(3): 329-342.

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Theodore G. Papaioannou and Christodoulos Stefanadis 1st Dept. of Cardiology Hippokration Hospital Medical School National & Kapodistrian University of Athens Greece Fax: 0030 210 8254791 E-mail: theopap@mail.ntua.gr