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By Michel E. Safar, Edward D. Frohlich

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In healthy individuals, peripheral systolic BP is usually higher than central systolic BP because increased impedance in vessels of decreasing caliber causes true PPA (and high apparent PPA) of the forward pressure wave. True PPA, the difference between the forward pressure wave peak centrally (first central systolic peak, horizontal dotted lines) and peripherally, is almost always due to intrinsic vascular properties affecting forward wave alone. Current custom is to report ‘apparent PPA,’ which is confounded by the fact that peak central SBP includes components related to both forward and reflected waves (the second systolic peak, horizontal solid lines).

In rats, chemical sympathectomy acutely increases aortic diameter and compliance but chronically reduces elastin content, vessel diameter and distensibility [29]. Exercise conditioning in rats reduces sympathetic nervous activity and lowers BP but does not affect the proportion of elastin or arterial wall constituents [30]. There are several lines of evidence that suggest a role for the renin-angiotensin-aldosterone system as an important modulator of arterial properties. Angiotensin II increases aortic wall thickness and stiffness in rats [31, 32].

Baumbach GL: Effects of increased pulse pressure on cerebral arterioles. Hypertension 1996;27: 159–167. James MA, Watt PA, Potter JF, Thurston H, Swales JD: Pulse pressure and resistance artery structure in the elderly. Hypertension 1995;26:301–306. Christensen KL: Reducing pulse pressure in hypertension may normalize small artery structure. Hypertension 1991;18:722–727. Ryan SM, Waack BJ, Weno BL, Heistad DD: Increases in pulse pressure impair acetylcholineinduced vascular relaxation. Am J Physiol 1995;268:H359–H363.

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