TY - JOUR
T1 - Longitudinal Hemodynamic Correlates of and Sex Differences in the Evolution of Blood Pressure Across the Adult Lifespan
T2 - The Framingham Heart Study
AU - Mitchell, Gary F.
AU - Rong, Jian
AU - Larson, Martin G.
AU - Cooper, Leroy L.
AU - Xanthakis, Vanessa
AU - Benjamin, Emelia J.
AU - Hamburg, Naomi M.
AU - Vasan, Ramachandran S.
N1 - Funding Information:
This study was supported by National Heart, Lung, and Blood Institute contracts N01-HC-25195, HHSN268201500001l, and 75N92019D00031 (R.S.V.), and R01-DK-080739 (R.S.V.) and R01-HL-107385, 1R01HL126136-01A1, HL93328, HL142983, HL143227 and HL131532 (R.S.V., G.F.M.), and 1RO1-HL-70100, R01HL092577, 2U54HL120163, 1R01AG066010 (E.J.B.). R.S.V. was supported in part by the Evans Medical Foundation and the Jay and Louis Coffman Endowment from the Department of Medicine, Boston University Chobanian and Avedisian School of Medicine.
Publisher Copyright:
© 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2023/6/20
Y1 - 2023/6/20
N2 - BACKGROUND: Systolic blood pressure increases with age after midlife, particularly in women, and contributes to development of wide pulse pressure hypertension in middle-aged and older adults. Relative contributions of aortic stiffness and premature wave reflection to increases in pulse pressure remain controversial. METHODS AND RESULTS: We evaluated visit-specific values and change in key correlates of pulse pressure, aortic characteristic impedance, forward and backward wave amplitude, and global reflection coefficient, at 3 sequential examinations of the Framingham Generation 3 (N=4082), Omni-2 (N=410), and New Offspring Spouse (N=103) cohorts (53% women). Data were analyzed using repeated-measures linear mixed models adjusted for age, sex, and risk factor exposures. Pulse pressure increased markedly with age after midlife (age and age-squared terms, P<0.0001), particularly in women (age slope 3.1±0.2 mm Hg/decade higher in women, P<0.0001). In sex-specific models, change in pulse pressure was closely related (all P<0.0001) to baseline (6.7±0.2 and 7.3±0.2 mm Hg/SD in men and women, respectively) and change (11.8±0.1 and 11.7±0.1 mm Hg/SD) in forward wave amplitude, whereas relations with baseline (2.1±0.15 and 2.0±0.14 mm Hg/SD) and change (4.0±0.13 and 3.4±0.11 mm Hg/SD) in global reflection coefficient were weaker. Global reflection coefficient fell as aor-tic characteristic impedance increased (P<0.0001), consistent with the hypothesis that impedance matching reduces relative wave reflection in the arterial system. CONCLUSIONS: Proximal aortic stiffening, as assessed by higher aortic characteristic impedance and larger forward wave am-plitude, is strongly associated with longitudinal increase in pulse pressure, especially in women, whereas wave reflection has more modest relations.
AB - BACKGROUND: Systolic blood pressure increases with age after midlife, particularly in women, and contributes to development of wide pulse pressure hypertension in middle-aged and older adults. Relative contributions of aortic stiffness and premature wave reflection to increases in pulse pressure remain controversial. METHODS AND RESULTS: We evaluated visit-specific values and change in key correlates of pulse pressure, aortic characteristic impedance, forward and backward wave amplitude, and global reflection coefficient, at 3 sequential examinations of the Framingham Generation 3 (N=4082), Omni-2 (N=410), and New Offspring Spouse (N=103) cohorts (53% women). Data were analyzed using repeated-measures linear mixed models adjusted for age, sex, and risk factor exposures. Pulse pressure increased markedly with age after midlife (age and age-squared terms, P<0.0001), particularly in women (age slope 3.1±0.2 mm Hg/decade higher in women, P<0.0001). In sex-specific models, change in pulse pressure was closely related (all P<0.0001) to baseline (6.7±0.2 and 7.3±0.2 mm Hg/SD in men and women, respectively) and change (11.8±0.1 and 11.7±0.1 mm Hg/SD) in forward wave amplitude, whereas relations with baseline (2.1±0.15 and 2.0±0.14 mm Hg/SD) and change (4.0±0.13 and 3.4±0.11 mm Hg/SD) in global reflection coefficient were weaker. Global reflection coefficient fell as aor-tic characteristic impedance increased (P<0.0001), consistent with the hypothesis that impedance matching reduces relative wave reflection in the arterial system. CONCLUSIONS: Proximal aortic stiffening, as assessed by higher aortic characteristic impedance and larger forward wave am-plitude, is strongly associated with longitudinal increase in pulse pressure, especially in women, whereas wave reflection has more modest relations.
KW - aging
KW - arterial stiffness
KW - blood pressure
KW - pulsatile hemodynamics
KW - sex differences
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U2 - 10.1161/JAHA.122.027329
DO - 10.1161/JAHA.122.027329
M3 - Article
C2 - 37318016
AN - SCOPUS:85163629938
SN - 2047-9980
VL - 12
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 12
M1 - e027329
ER -