Noninvasive evaluation of arterial abnormalities in hypertensive patients

Morbidity and mortality in hypertension are mainly determined by arterial l esions which may occur in different regional circulations: kidney, cerebral , coronary..., causing respectively nephroangiosclerosis, stroke or myocard ial infarction... Despite the arteries heterogeneity, structural and functi onal abnormalities are usually observed at an early stage of hypertension i n both large and small arteries. These alterations modify arterial wall phy siological and mechanical properties which can be expressed clinically by i ncreasing arterial pulsatility or pulse pressure; they facilitate establish ment and progression of atherosclerosis and arteriosclerosis. Since arterie s constitute the target, site and common denominator of hypertension cardio vascular complications, several noninvasive techniques may be usefull to as sess their haemodynamic: casual and ambulatory blood pressure measurements can evaluate pulse pressure which can be also directly measured in differen t sites of the arterial tree using the "Tonometer" device; ultrasound techn iques can be applied: Doppler signal to assess the arterial flow, video-ech o signal to analyse the arterial structure such as intima-media thickness, or echo-tracking systems for direct measurements of arterial wall distensio n and thickness; pulse wave velocity is widely used as index of arterial di stensibility; its assessment, using the Complior(R) device showed that hype rtensive patients present a decrease of arterial distensibility and that an tihypertensive treatment do not always reverse this abnormality. Since card iovascular morbidity and mortality are due to arterial lesions, it is impor tant to evaluate the effect of cardiovascular prevention on the arterial wa ll. Large therapeutical trials, including arterial evaluation, are necessar y to assess whether this consideration may particularize patients with high cardiovascular risk and contribute to their treatment and prognostic impro vement.