Central pulse pressure inversely tied to proximal aortic remodeling

An inverse association is found between aortic root z-score and invasively measured central pulse pressure in patients undergoing invasive coronary assessment, reveals a study.

“Hypertension leads to aortic stiffening and dilatation but unexpected data from the Framingham Heart Study showed an inverse relationship between brachial pulse pressure and aortic diameter,” the authors said. “Aortic dilatation would not only lead to lower pulse pressure but also to a worse prognosis (eg, cardiac events, heart failure).”

In this study, the relationship between invasively measured central blood pressure (BP) and proximal aortic diameter was assessed in 71 consecutive patients referred to invasive haemodynamic study. The authors evaluated proximal aortic remodeling in terms of z-score, comparing diameters measured at the sinus of Valsalva to the diameter expected according to patients’ age, sex, and body weight. Then, they recorded pressures directly in the proximal aorta using a catheter before coronary assessment.

The mean invasive aortic systolic and diastolic BP were 146±23 and 78±13 mm Hg, respectively, giving a central pulse pressure (cPP inv) of 68±21 mm Hg. Proximal aortic diameter was 34.9±19.4 mm, while z-score was –0.3±1.7.

Patients with higher cPP inv exhibited a markedly lower z-score (–0.789 vs 0.155; p=0.001). Of note, cPP inv showed an inverse association with z-score (R, –0.271; p=0.022), independently from age, mean BP, and heart rate (β, –0.241; p=0.011).

“Remodeling at the sinuses of Valsalva may be a compensatory mechanism to limit pulse pressure,” the authors said.