Relation between central aortic pulse pressure and coronary artery disease: a coronary angiographic study in a tertiary care center

Authors

  • K. Subramanyam Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
  • Manohar J. Suranagi Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
  • K. S. Subramani Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
  • R. Rangaraj Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20200074

Keywords:

Aortic pulse pressure, Coronary artery disease, Coronary perfusion, Hypertension

Abstract

Background: Aortic pulse pressure is a significant marker of cardiovascular morbidity independently of mean blood pressure and pulse pressure of 60 mm Hg should be considered as the threshold at risk both in normotensives and hypertensives. Coronary perfusion is dependent on diastolic blood pressure and patients with CAD may be susceptible to the adverse effects of low diastolic blood pressure. This study conducted to examine the relation between central aortic pulse pressure and the prevalence and extent of CAD.

Methods: A cross sectional, hospital-based study conducted in Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, among patients undergoing diagnostic coronary angiography.

Results: Risk factors like Diabetes, Hypertension, Dyslipidemia and smoking rates were significantly higher in patients with PP of >60 mmHg (p<0.01). In the first group, the ratio of having normal coronaries is higher 61.9% vs 38% and diseased coronaries was lower when compared to the other group 38% vs 98%. In patients with aortic pulse pressure >60 mmHg, 4 patients had left main coronary artery (LMCA) disease, 20 patients had single vessel disease, 11 patients had two vessel disease and 20 patients had triple vessel disease.

Conclusions: In this study it was demonstrated aortic pulse pressure of more than 60 mm Hg is associated with significant CAD.

References

Madhavan S, Ooi WL, Cohen H, Alderman MH. Relation of pulse pressure and blood pressure reduction to the incidence of myocardial infarction. Hypertension. 1994;23:395-401.

Fang J, Madhavan S, Cohen H, Alderman MH. Measures of blood pressure and myocardial infarction in treated hypertensive patients. J Hypertens. 1995;13:413-9.

Benetos A, Safar M, Rudnichi A, Smulyan H, Richard JL, Ducimetieere P, et al. Pulse pressure: a predictor of long-term cardiovasculamortality in a french male population. Hypertension. 1997;30:1410-5.

Black HR. The paradigm has shifted to systolic blood pressure. Hypertension. 1999;34:386-7.

Girerd X, Laurent S, Pannier B, Asmar R, Safar M. Arterial distensibility and left ventricular hypertrophy in patients with sustained essential hypertension. Am Heart J. 1991;122:1210-4.

Darne B, Girerd X, Safar M, Cambien F, Guize L. Pulsatile versus steady component of blood pressure :a cross-sectional analysis and a prospective analysis on cardiovascular mortality. Hypertension. 1989;13:392-400.

Madhavan S, Ooi WL, Cohen H, Alderman MH. Relation of pulse pressure and blood pressure reduction to the incidence of myocardial infarction. Hypertension. 1994 Mar;23(3):395-401.

Lyon Rt, Runyon-Hass, A Davis HR, Glagov S, Zarins CK. Protection from atherosclerotic lesion formation by reduction of artery wall motion. J Vasc Surg. 1987;5:59-67.

Christenen KL. Reducing pulse pressure in hypertension may normalize small artery structure Hypertension. 1991:18;722-7.

James MA, Watt PAC, Potter JF, Thurston H, Swales JD. Pulse pressure and resistance artery structure in the elderly. Hypertension.1995:26;301-6.

Roman MJ, Devereux RB, Kizer JR, Lee ET, Galloway JM, Ali T, et al. Central pressure more strongly relates to vascular disease and outcome than does brachial pressure: the Strong Heart Study. Hypertension. 2007 Jul 1;50(1):197-203.

Mitchell GF, Moyé LA, Braunwald E, Rouleau JL, Bernstein V, Geltman EM, et al. Sphygmomanometrically determined pulse pressure is a powerful independent predictor of recurrent events after myocardial infarction in patients with impaired left ventricular function. Circulation. 1997 Dec 16;96(12):4254-60.

Nakayama Y, Tsumura K, Yamashita N, Yoshimaru K, Hayashi T. Pulsatility of ascending aortic pressure waveform is a powerful predictor of restenosis after percutaneous transluminal coronary angioplasty. Circulation. 2000 Feb 8;101(5):470-2.

Ozaki M, Masuoka H, Kawasaki A, Ito M, Nakano T. Intra aortic pulse pressure is correlated with coronary artery stenosis. Int Heart J. 2005;46(01):69-78.

O'Rourke MF. Wave travel and reflection in the arterial system. J hypertension. Supplement: Official J Inter Soc Hypertension. 1999 Dec;17(5):S45-7.

Oliver JJ, Webb DJ. Noninvasive assessment of arterial stiffness and risk of atherosclerotic events. Arteriosclerosis, Thrombosis, Vascular Biol. 2003 Apr 1;23(4):554-66.

Dunn RB, Griggs DM. Ventricular filling pressure as a determinant of coronary blood flow during ischemia. Am J Physiol. 1983;244:H429-H436.

Hirai T, Sasayama S, Kawasaki T Yagi S. Stiffness of systemic arteries in patients with myocardial infarction: a non-invasive method to predict severity of coronary atherosclerosis. Circulation. 1989;80:78-86.

Avolio AP, Deng FQ, Li WQ, Luo YF, Huang ZD, Xing LF, et al. Effects of aging on arterial distensibility in populations with high and low prevalence of hypertension: comparison between urban and rural communities in China. Circulation. 1985 Feb;71(2):202-10.

Salomaa V, Riley W, Kark JD, Nardo C, Folsom AR. Non–insulin-dependent diabetes mellitus and fasting glucose and insulin concentrations are associated with arterial stiffness indexes: the ARIC study. Circulation. 1995 Mar 1;91(5):1432-43.

Kelly R, Hayward C, Avolio A, O’Rourke M. Noninvasive determination of age related changes ithehumanarterialpulse. Circulation.1989:80:16559.

Benetos A, Laurent S, Hoeks AP, Boutouyrie PH, Safar ME. Arterial alterations with aging and high blood pressure. A noninvasive study of carotid and femoral arteries. Arteriosclerosis Thrombosis: J Vascular Biol. 1993 Jan;13(1):90-7.

Gokhan A. Relation between aortic pulse pressure and coronary artery disease; A coronary angiographic study. J Am Coll Cardiol. 2005;375:1014-138.

Chirinos JA, Zambrano JP, Simon C, Veerani A. Relation between ascending aortic pressures and outcomes in patients with angiographically demonstrated CAD- Am J Cardiol. 2005:96:645-8.

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Published

2020-01-23

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Original Research Articles