Assessment of Aortic wall stiffness in Hypertensive patients by Echocardiography

Abstract

Large arteries were once considered as inert conduits, but are now recognized to play an important physiological role in buffering the oscillatory changes in blood pressure resulting from intermittent ventricular ejection. This action reduces pulse pressure, smoothies peripheral blood flow and improves the efficiency of the cardiovascular system as a whole. The normal human aorta is not a stiff tube, but is characterized by elastic properties with a buffering windkessel function. Aortic stiffening may cause an increase in aortic pulse pressure, left ventricular load, and ultimately left ventricular hypertrophy. This, together with the decreased diastolic trans myocardial pressure gradient, interacts with coronary flow and flow reserve Increased central arterial stiffening is a hallmark of the aging process and the consequence of many disease states such as diabetes, atherosclerosis, and chronic renal compromise. Accordingly, there is a marked increase in the incidence and prevalence of clinical surrogate markers of vascular stiffness, such as pulse pressure and isolated systolic hypertension, with age and these associated conditions Thus stiffening of large arteries leads to a number of adverse haemodynamic consequences, including a widening of pulse pressure and, ultimately, the development of isolated systolic hypertension. Aortic stiffness is a hallmark of aging, and classic cardiovascular risk factors play a role in accelerating this process. Current changes in medicine, which focus on preventive care, have led to a growing interest in noninvasive evaluation of aortic stiffness. Aortic stiffness has emerged as a good tool for further risk stratification because it has been linked to increased risk of atherosclerotic heart disease, myocardial infarction, heart failure, and stroke. This has led to the invention and validation of multiple methods to measure aortic stiffness Hypertension is a major risk factor for coronary, cerebrovascular, and renal diseases and is the greatest cause of stroke, the mechanisms of which are generally attributed to the reduction in the caliber or number of small arteries or arterioles with a resulting increase in total peripheral resistance and mean blood pressure (MBP). Arterial stiffness has long been viewed as a consequence of long-standing hypertension. However, recent studies have suggested that arterial stiffness may contribute to the pathogenesis of hypertension. Currently, carotid to femoral pulse-wave velocity (PWV) is the favored technique for assessing aortic