Arterial–ventricular coupling and parameters of vascular stiffness in hypertensive patients: Role of gender

OBJECTIVE The present study was designed to investigate the relationship between left ventricular elastance (ELV), arterial elastance (EA), parameters of vascular stiffness and the influence of gender in a population of hypertensive individuals at high cardiovascular (CV) risk. DESIGN AND METHOD Seventy eight subjects participated in the study. Trans-thoracic cardiac ultrasound exam and parameters of aortic stiffness (carotid-femoral pulse wave velocity, PWV) wave reflection (augmentation index, AIx), aortic and carotid pulse pressure (PP) were obtained. Ultrasound images of the common carotid artery were acquired for the assessment of intima-media thickness (IMT) as well as carotid compliance (CC) and distensibility coefficient (DC). RESULTS The mean age of subjects was 62,5 years old, 37,2% had diabetes, 48,7% dyslipidemia, 7,7% previous CV events. Women (43%) and men were superimposable for CV risk factors except for older age (63.3 ± 9.2 vs 57.5 ± 10.4 years, p < 0.001) and greater prevalence of dyslipidemia (66% vs 35%, p = 0.04).In the overall population ELV was significantly correlated with EA (r = 0.79,p < 0.001), age, gender and BMI (r = 0.30,p = 0.07,r = -0.64,p < 0.001,r = -0.32,p = 0.004 respectively), AIx (r = 0.53,p < 0.001), aortic PP (r = 0.39,p < 0.001) CC (r = -0.44, p < 0.001) and DC (r = -0.27, p = 0.02), but not with PWV (r = 0.13,p = 0.28). In the multiple regression model including EA, ELV was still significantly correlated with EA, BMI, gender (all p < 0.001) and aortic PP (p = 0.004). Conversely, DC and PWV were not.DC, CC, PWV and IMT were similar in men and women. ELV (p < 0.0001) and EA (p = 0.0002) were higher in women than in men, while EA/ELV was lower (p = 0.0003). While EA and BMI were significantly correlated with ELV both in men (r = 0.74,p < 0.0001) and women (r = 0.77,p < 0.0001), DC was correlated with ELV only in women (women r = 0.04,p = 0.03, men r = -0.21,p = 0.17), and aortic PP (men r = 0.44,p = 0.002, women r = 0.44, p = 0.01) and AIX (men r = 0.37,p = 0.002, women r = 0.33, p = 0.06) only in men. CONCLUSIONS In hypertensive individuals, main determinants of ventricular elastance are arterial elastance as an integrated index of arterial vascular load, central PP, gender and BMI. However, large artery stiffness in women and pressure augmentation in men might play an additional role.