Determinants Of Pulse Pressure Amplification In Drug Naive Hypertensive Patients

Objective: Normally there is an amplification of the pressure pulse wave from the large arteries to the smaller conduit arteries and this can be understood as a “gradual widening” of the pulse pressure as it travels distally. This is known as pulse pressure amplification and is defined as the peripheral pulse pressure/central pulse pressure ratio. Of course aging is correlated with PPA but few studies have been conducted to assess its correlations with peripheral arterial resistance. The aim of the present study was to find determinants of PPA in drug naïve hypertensive patients to get insights of this phenomenon. Design and method: We recruited 87 drug naïve (mean age = 52.2 ± 12.5) 55 females, newly diagnosed hypertensive patients that visited the hypertension clinic of a tertiary hospital. Central systolic aortic BP (CSBP), Central diastolic BP (CDBP) was assessed by applanation tonometry and PWV was measured by Sphygmocor (Atcor Medical) and clinic SBP and DBP were measured according to international guidelines. Hemodynamics were assessed by impendance cardiography (ICG) by means of the Cardioscreen 2000 rheocardiographic system. The PPA ratio was defined as the peripheral pulse pressure/central pulse pressure. We used Pearson's r correlation to identify significant correlations of PPA and measured parameters and used multivariate regression analysis to identify independent determinants of PPA. Results: PPA was significantly correlated with age, bmi, gender, heart rate, urea, potassium, augmentation index, velocity index (VI), acceleration index (AI), left ventricular ejection time (LVET), systolic time ratio index (STRI), Ejection time index (ETI), left stroke work index (LSWI). In the regression model heart rate (β = 0.41, p < 0.001) and augmentation index (β = −0.71, p < 0.001) were the two significant determinants of PPA accounting for 77.4% of its variability. Conclusions: PPA is determined by heart rate and thus sympathetic nervous system amplification, and also the augmentation index which is well known marker of arterial stiffness. Overall, these two markers eliminate all other hemodynamic markers as determinants of PPA.