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Feature Article

The aorta: a central player in hypertension

Benedict T Costello, Andrew Wilson

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Abstract

Aortic stiffening occurs progressively throughout life and leads to increased pulse pressure and systolic hypertension. This process is also impacted by cardiovascular risk factors such as diabetes, smoking and renal impairment. Medical therapy directed at this process is not yet available, and as such aortic stiffening contributes to resistant hypertension.

Key Points

  • Aortic stiffening occurs progressively throughout life from infancy and can be detected from the third decade, well before end-organ effects occur.
  • As aortic stiffness progresses, the aorta loses its cushioning function. This reduces the capacity to convert pulsatile to continuous flow, which raises systolic blood pressure (BP) and lowers diastolic BP, thereby reducing coronary artery flow and increasing cardiac workload.
  • Central (aortic) BP is now known to be a better predictor of cardiovascular risk and mortality than peripheral BP.
  • Antihypertensive agents can have a different effect on central and peripheral BP and this discordance may be important when accounting for treatment response to specific agents when assessing peripheral BP.
  • The ability to recognise aortic stiffening early may enable timely interventions to halt the progression of hypertension and break the cycle leading to drug resistance.

    Picture credit: © William B. Westwood and Charles H. Boyter

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