Arterial Compliance in Arterial Hypertension. From Pathophysiology to Clinical Relevance

Abstract

Arterial compliance as a term has been known in the pathophysiology of the cardiovascular system since the beginning of the 17^th century. For many years it has been underrated because of the predominant view that the development of arterial hypertension is determined by the systemic resistance, which is reflected in diastolic blood pressure level, the main factor for cardiovascular complications.
This view has been modified in the recent decade after the publication of the results of large randomized trials in patients with isolated systolic hypertension. In patients over 55 years of age blood pressure, an indirect marker of arterial stiffness has been found to be the strongest risk factor. For this reason the focus of interest has been shifted from vascular resistance to elastic properties of the arteries.
The present paper discusses the basics of morphology and pathophysiology of changes in the elastic properties of the arteries (stiffening), defines basic indices of arterial compliance and mathematical background. A chapter will be devoted to the effects of increased arterial stiffness on heart pathology and clinical implications of measuring this parameter. A state-of-the-art section will describe the relationship between arterial compliance and several physiological and pathological factors (sex, ageing, arterial hypertension, endocrine and metabolic dysfunction) as well as therapeutic interference with arterial compliance.