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CLINICAL RESEARCH: ARTERIAL REFLECTIONS AND STIFFNESS

Increased Wave Reflection Rather Than Central Arterial Stiffness Is the Main Determinant of Raised Pulse Pressure in Women and Relates to Mismatch in Arterial Dimensions

A Twin Study

Marina Cecelja, BSc^_*, Benyu Jiang, PhD^_*, Karen McNeill^_*, Bernet Kato, PhD, James Ritter, PhD^_*, Tim Spector, MD and Phil Chowienczyk, BSc^_*,_*

^_* King's College London, Cardiovascular Division, London, United Kingdom
Department of Twin Research and Genetic Epidemiology, London, United Kingdom

Manuscript received October 31, 2008; revised manuscript received April 6, 2009, accepted April 14, 2009.

^_* Reprint requests and correspondence: Dr. Phil Chowienczyk, Department of Clinical Pharmacology, St. Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, United Kingdom (Email: phil.chowienczyk{at}kcl.ac.uk).

Objectives: Our aim was to examine the relative contributions of the first systolic shoulder (P1) and augmentation pressure (P_aug) to central pulse pressure (cPP), their relation to central arterial stiffness (pulse wave velocity [PWV]) and arterial diameters, and their respective heritability estimates.

Background: cPP is augmented above P1 by P_aug due to pressure waves reflected from the periphery of the circulation.

Methods: Women (n = 496) from the Twins UK adult twin registry (112 monozygotic, 135 dizygotic pairs) age 21 to 81 years were studied. cPP, P1, and P_aug were estimated using the SphygmoCor system (Atcor, West Ryde, Australia) from transformed radial waveforms. Carotid-femoral PWV was measured using the same system. Aortic and femoral artery diameters were measured by ultrasonography. Heritability was estimated using structural equation modeling.

Results: P1 and P_aug accounted for 22% and 76%, respectively, of the variance in cPP. After adjustment for mean arterial pressure and heart rate, P1 strongly independently positively correlated with PWV (standardized regression coefficient, β = 0.4, p < 0.0001), whereas P_aug did not independently correlate with PWV but independently negatively correlated with the ratio of the diameter of the femoral to that of the abdominal aorta (β = –0.12, p < 0.001). Estimates of heritability (h²) of cPP, PWV, P1, and P_aug were 0.43, 0.34, 0.31, and 0.62, respectively, after adjustment for mean arterial pressure and heart rate.

Conclusions: These results suggest that, in women, P_aug is highly heritable, is associated with the ratio of distal to proximal arterial diameters, and, independent of PWV, is a major determinant of cPP.

Key Words: central pulse pressure • arterial stiffness • wave reflection • augmentation pressure • aortic diameter

Abbreviations and Acronyms   AIx = augmentation index   cPP = central pulse pressure   CVD = cardiovascular disease   DZ = dizygotic   HR = heart rate   ISH = isolated systolic hypertension   MAP = mean arterial pressure   MZ = monozygotic   PP = pulse pressure   pPP = peripheral pulse pressure   PWV = pulse wave velocity   P1 = height of first systolic shoulder   SV = stroke volume   T1 = time of arrival of the reflected wave   Paug = augmentation pressure

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