CLINICAL RESEARCH: AGING AND VASCULAR FUNCTION
Normal Vascular Aging: Differential Effects on Wave Reflection and Aortic Pulse Wave Velocity
The Anglo-Cardiff Collaborative Trial (ACCT)
Carmel M. McEniery, PhD*,*,
Yasmin, PhD*,
Ian R. Hall, MB, MRCP ,
Ahmad Qasem, PhD ,
Ian B. Wilkinson, MA, DM, MRCP*,
John R. Cockcroft, BSc, MB, FRCP on behalf of the ACCT Investigators
* Clinical Pharmacology Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
Department of Cardiology, University of Wales, College of Medicine, University Hospital, Cardiff, United Kingdom
Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
Manuscript received March 9, 2005;
revised manuscript received July 1, 2005,
accepted July 4, 2005.
* Reprint requests and correspondence: Dr. Carmel M. McEniery, University of Cambridge, Clinical Pharmacology Unit, Addenbrooke's Hospital, Box 110, Cambridge, Cambridgeshire CB2 2QQ, United Kingdom
(Email: cmm41{at}cam.ac.uk).
OBJECTIVES: The aim of the current investigation was to test the hypothesis that age-related changes in augmentation index (AIx) are more prominent in younger individuals (<50 years), whereas changes in aortic stiffness per se are more marked in older individuals (>50 years).
BACKGROUND: Aging exerts a number of deleterious changes in the cardiovascular system, and, in particular, on the large arteries. Previous studies have suggested that AIx and pulse wave velocity (PWV) increase linearly with age, yet epidemiological data concerning pulse pressure suggest that large artery stiffening predominantly occurs later in life.
METHODS: Peripheral and central blood pressure, augmentation pressure (AP), and AIx were determined in 4,001 healthy, normotensive individuals, aged 18 to 90 years. Aortic and brachial PWV were also determined in a subset of 998 subjects.
RESULTS: Peripheral and central pulse pressure, AP, AIx, and aortic and brachial PWV all increased significantly with age; however, the age-related changes in AIx and aortic PWV were non-linear, with AIx increasing more in younger individuals, whereas the changes in PWV were more prominent in older individuals.
CONCLUSIONS: These data suggest that AIx might be a more sensitive marker of arterial stiffening and risk in younger individuals but aortic PWV is likely to be a better measure in older individuals.
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Abbreviations and Acronyms
| | ACCT = Anglo-Cardiff Collaborative Trial | | AIx = augmentation index | | ANOVA = analysis of variance | | AP = augmentation pressure | | CSBP = central systolic pressure | | HR = heart rate | | MAP = mean arterial pressure | | PP = pulse pressure | | PPP = peripheral PP | | PWV = pulse wave velocity | | Tr = time to return of the reflected pressure wave |
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M. E. Safar, A. D. Protogerou, and J. Blacher
Statins, Central Blood Pressure, and Blood Pressure Amplification
Circulation,
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119(1):
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B. E. Westerhof, J. P. van den Wijngaard, J. P. Murgo, and N. Westerhof
Response to Uncertainties in Estimating the Site of Arterial Wave Reflection
Hypertension,
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J. E Davies, K. H Parker, D. P Francis, A. D Hughes, and J. Mayet
What is the role of the aorta in directing coronary blood flow?
Heart,
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K. S. Heffernan, S. Y. Jae, K. R. Wilund, J. A. Woods, and B. Fernhall
Racial differences in central blood pressure and vascular function in young men
Am J Physiol Heart Circ Physiol,
December 1, 2008;
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[Abstract]
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B. E. Westerhof, J. P. van den Wijngaard, J. P. Murgo, and N. Westerhof
Location of a Reflection Site Is Elusive: Consequences for the Calculation of Aortic Pulse Wave Velocity
Hypertension,
September 1, 2008;
52(3):
478 - 483.
[Abstract]
[Full Text]
[PDF]
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S. Kinra, K V Rameshwar Sarma, Ghafoorunissa, V. V. R. Mendu, R. Ravikumar, V. Mohan, I. B Wilkinson, J. R Cockcroft, G. Davey Smith, and Y. Ben-Shlomo
Effect of integration of supplemental nutrition with public health programmes in pregnancy and early childhood on cardiovascular risk in rural Indian adolescents: long term follow-up of Hyderabad nutrition trial
BMJ,
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337(jul25_1):
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[Abstract]
[Full Text]
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E. Agabiti-Rosei and M. Salvetti
Gender Differences in the Regression of Electrocardiographic Left Ventricular Hypertrophy During Antihypertensive Therapy
Hypertension,
July 1, 2008;
52(1):
59 - 60.
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R. Pini, M. C. Cavallini, V. Palmieri, N. Marchionni, M. Di Bari, R. B. Devereux, G. Masotti, and M. J. Roman
Central But Not Brachial Blood Pressure Predicts Cardiovascular Events in an Unselected Geriatric Population: The ICARe Dicomano Study
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[Abstract]
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M Saito, H Okayama, K Nishimura, A Ogimoto, T Ohtsuka, K Inoue, G Hiasa, T Sumimoto, and J Higaki
Possible link between large artery stiffness and coronary flow velocity reserve
Heart,
June 1, 2008;
94(6):
e20 - e20.
[Abstract]
[Full Text]
[PDF]
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C. M. McEniery, Yasmin, B. McDonnell, M. Munnery, S. M. Wallace, C. V. Rowe, J. R. Cockcroft, I. B. Wilkinson, and on Behalf of the Anglo-Cardiff Collaborative Trial
Central Pressure: Variability and Impact of Cardiovascular Risk Factors: The Anglo-Cardiff Collaborative Trial II
Hypertension,
June 1, 2008;
51(6):
1476 - 1482.
[Abstract]
[Full Text]
[PDF]
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N L Mills, J J Miller, A Anand, S D Robinson, G A Frazer, D Anderson, L Breen, I B Wilkinson, C M McEniery, K Donaldson, et al.
Increased arterial stiffness in patients with chronic obstructive pulmonary disease: a mechanism for increased cardiovascular risk
Thorax,
April 1, 2008;
63(4):
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[Abstract]
[Full Text]
[PDF]
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J. E. Sharman, C. M. McEniery, R. Campbell, P. Pusalkar, I. B. Wilkinson, J. S. Coombes, and J. R. Cockcroft
Nitric Oxide Does Not Significantly Contribute to Changes in Pulse Pressure Amplification During Light Aerobic Exercise
Hypertension,
April 1, 2008;
51(4):
856 - 861.
[Abstract]
[Full Text]
[PDF]
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M. Shimizu and K. Kario
Review: Role of the augmentation index in hypertension
Therapeutic Advances in Cardiovascular Disease,
February 1, 2008;
2(1):
25 - 35.
[Abstract]
[PDF]
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J.-C. Philips, M. Marchand, and A. J. Scheen
Squatting Amplifies Pulse Pressure Increase With Disease Duration in Patients With Type 1 Diabetes
Diabetes Care,
February 1, 2008;
31(2):
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[Abstract]
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S. S. DeLoach and R. R. Townsend
Vascular Stiffness: Its Measurement and Significance for Epidemiologic and Outcome Studies
Clin. J. Am. Soc. Nephrol.,
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[Abstract]
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D. A. McAllister, J. D. Maclay, N. L. Mills, G. Mair, J. Miller, D. Anderson, D. E. Newby, J. T. Murchison, and W. MacNee
Arterial Stiffness Is Independently Associated with Emphysema Severity in Patients with Chronic Obstructive Pulmonary Disease
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December 15, 2007;
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[Abstract]
[Full Text]
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F. Verbeke, W. Van Biesen, P. Peeters, L. M. Van Bortel, and R. C. Vanholder
Arterial stiffness and wave reflections in renal transplant recipients
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[Abstract]
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M. F. O'Rourke and J. Hashimoto
Mechanical Factors in Arterial Aging: A Clinical Perspective
J. Am. Coll. Cardiol.,
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[Abstract]
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S. M.L. Wallace, Yasmin, C. M. McEniery, K. M. Maki-Petaja, A. D. Booth, J. R. Cockcroft, and I. B. Wilkinson
Isolated Systolic Hypertension Is Characterized by Increased Aortic Stiffness and Endothelial Dysfunction
Hypertension,
July 1, 2007;
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[Abstract]
[Full Text]
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E. Agabiti-Rosei, G. Mancia, M. F. O'Rourke, M. J. Roman, M. E. Safar, H. Smulyan, J.-G. Wang, I. B. Wilkinson, B. Williams, and C. Vlachopoulos
Central Blood Pressure Measurements and Antihypertensive Therapy: A Consensus Document
Hypertension,
July 1, 2007;
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[Full Text]
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R. Sabit, C. E. Bolton, P. H. Edwards, R. J. Pettit, W. D. Evans, C. M. McEniery, I. B. Wilkinson, J. R. Cockcroft, and D. J. Shale
Arterial Stiffness and Osteoporosis in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med.,
June 15, 2007;
175(12):
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[Abstract]
[Full Text]
[PDF]
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P. Segers, E. R. Rietzschel, M. L. De Buyzere, S. J. Vermeersch, D. De Bacquer, L. M. Van Bortel, G. De Backer, T. C. Gillebert, P. R. Verdonck, and on behalf of the Asklepios investigators
Noninvasive (Input) Impedance, Pulse Wave Velocity, and Wave Reflection in Healthy Middle-Aged Men and Women
Hypertension,
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49(6):
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[Abstract]
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S. Laurent and P. Boutouyrie
Recent Advances in Arterial Stiffness and Wave Reflection in Human Hypertension
Hypertension,
June 1, 2007;
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[Full Text]
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G. F. Mitchell
Response to Timing and Amplitude of Wave Reflection
Hypertension,
January 1, 2007;
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[Full Text]
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S. Laurent, J. Cockcroft, L. Van Bortel, P. Boutouyrie, C. Giannattasio, D. Hayoz, B. Pannier, C. Vlachopoulos, I. Wilkinson, H. Struijker-Boudier, et al.
Expert consensus document on arterial stiffness: methodological issues and clinical applications
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[Abstract]
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M. F. O'Rourke and S. S. Franklin
Arterial stiffness: reflections on the arterial pulse
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C Vlachopoulos, K Aznaouridis, and C Stefanadis
Clinical appraisal of arterial stiffness: the Argonauts in front of the Golden Fleece
Heart,
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[Abstract]
[Full Text]
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G. F. Mitchell
Triangulating the Peaks of Arterial Pressure
Hypertension,
October 1, 2006;
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