Experimental and clinical study of the combined effect of arterial stiffness and heart rate on pulse pressure: Differences between central and peripheral arteries

1. Pulse pressure (PP) constitutes an independent predictor of cardiovascular events and mortality in various populations. Heart rate (HR) and arterial stiffness, in addition to their independent predictive value for cardiovascular complications, seem to interact with regard to the modification of PP. The aim of the present study was to investigate the association of PP with HR under different levels of arterial compliance (AC), revealing their synergistic effects. 2. Seventy-one normotensive and untreated hypertensive subjects were examined. Arterial compliance was measured by the 'area' method, whereas central blood pressures and wave reflections were evaluated using the Sphygmocor((R)) system (AtCor Medical, Sydney, NSW, Australia). A hydraulic Windkessel model was also used to evaluate the independent effect of HR and AC on PP. Peripheral PP was associated only with mean pressure and AC. In contrast, central PP was further related to HR (20 b.p.m. decrease in HR resulted in central PP augmentation by 5.6 mmHg) regardless of mean pressure, stroke volume, age and gender. However, this association was statistically significant only for subjects with lower AC (< 1.1 mL/mmHg) and not for those with more compliant arteries. These findings are also in accordance with the experimental data. 3. Aortic PP is affected to a greater degree by HR changes compared with peripheral PP. This response was observed only at high levels of arterial stiffness. 4. The present study provides the first evidence regarding the combined effect of AC and HR on aortic PP, which may lead to larger clinical or epidemiological studies aiming to optimization of drug treatment and to a possible reduction of cardiovascular risk.