From the Guidelines
Vascular disease and arterial stiffness significantly impact blood pressure readings, leading to falsely elevated measurements, particularly in systolic blood pressure, due to the loss of arterial elasticity and compliance. This phenomenon, often referred to as "pseudohypertension," can result in overdiagnosis of hypertension or overtreatment with antihypertensive medications 1. The stiffening of arteries, which can occur due to aging, atherosclerosis, or other vascular diseases, affects the way arteries expand and contract during the cardiac cycle. As a result, the pressure wave generated by the heart's contraction is not adequately absorbed, leading to increased systolic blood pressure readings. Furthermore, the faster return of pressure waves from the periphery amplifies systolic pressure while potentially lowering diastolic pressure, creating a widened pulse pressure.
Key Considerations
- Arterial stiffness is a significant predictor of cardiovascular risk and is associated with elevated systolic blood pressure and pulse pressure 1.
- The loss of arterial compliance can lead to pseudohypertension, where cuff measurements read higher than the actual intra-arterial pressure 1.
- Central aortic pressure measurements or 24-hour ambulatory monitoring may provide more accurate readings than peripheral cuff measurements in patients with significant vascular disease 1.
- Interventions that reduce arterial stiffness, such as ACE inhibitors, aerobic exercise, and dietary changes, may help mitigate the effects of vascular disease on blood pressure readings 1.
Clinical Implications
- Healthcare providers should consider the potential impact of vascular disease and arterial stiffness on blood pressure readings when diagnosing and managing hypertension.
- The use of multiple measurement methods, including central blood pressure measurements or 24-hour ambulatory monitoring, may be necessary to obtain accurate readings in patients with significant vascular disease.
- Lifestyle interventions, such as regular aerobic exercise and dietary changes, may help reduce arterial stiffness and improve blood pressure control 1.
From the Research
Vascular Disease and Arterial Stiffness
- Vascular disease and arterial stiffness are significant predictors of cardiovascular disease and mortality 2, 3, 4.
- Arterial stiffness is often increased in overweight/obese subjects before the development of hypertension, and it can be considered a good predictor of the development of subclinical cardiovascular dysfunction 3.
Impact on Blood Pressure Readings
- Arterial stiffening is the principal cause of increasing systolic pressure with advancing years and in patients with arterial hypertension 5.
- Increased arterial stiffness can lead to isolated systolic hypertension (ISH) in the middle-aged and elderly population, characterized by an increase in pulse pressure (PP) in association with a rise in systolic blood pressure (SBP) and a fall in diastolic blood pressure (DBP) 4.
- The relationship between arterial stiffness and blood pressure readings is complex, and changes in brachial systolic pressure with age may underestimate the rise in systolic pressure in the aorta and left ventricle 5.
Factors Influencing Arterial Stiffness
- Physical activity, irrespective of its intensity or pattern, is consistently associated with lower arterial stiffness 2.
- Dietary habits, such as a high intake of saturated fatty acids, trans fats, and cholesterol, can impair endothelial function and increase arterial stiffness, while a diet rich in fruits, vegetables, and whole grains can help reduce arterial stiffness 3.
- Reduction in wave reflection, which can be achieved through certain medications or lifestyle changes, can decrease aortic systolic pressure augmentation and reduce arterial stiffness 5.