Microvascular changes during laboratory stimuli and structural haemodynamic indices: the role of pulse pressure

Office and ambulatory pulse pressure have been recognized as independent pr edictors of cardiovascular mortality and atherosclerosis in hypertensives a s well as in normotensives. On the other hand, the vascular reactivity, in subjects with high pulsatile component of blood pressure, has not been stud ied yet. The purpose of our study was to identify the regional muscular hem odynamics and the cutaneous microvascular changes during laboratory stimuli in young adult very mild hypertensives with high pulse pressure. The cardiovascular (Finapres), the forearm vascular (plethysmography) and t he microvascular cutaneous (laser-Doppler flowmetry and transcutaneous oxim etry) responses to psychophysiological stimuli were measured. In addition, the hyperemic forearm vascular response to the ischaemic test was measured as haemodynamic index of vascular damage. We studied 15 very mild hypertens ives with higher office pulse pressure and 15 patients with similar age, hi story of hypertension, metabolic parameters and systodiastolic blood pressu re but lower pulse pressure values. Patients with high pulse pressure demonstrated reduced hyperemic response a nd increased residual vascular resistance at the forearm ischaemic test. Th ey did not vary for all the parameters, except pulse pressure, during the b aseline period but the total stress response, as residualized area-under-th e-curve, was notably different. Patients with higher office pulse pressure demonstrated a significant increased heart rate, systolic and pulsatile blo od pressure reactivity. On the contrary, they showed a reduced forearm and cutaneous blood flow response combined to a reduced transcutaneous tissutal oxygenation. The findings suggest that the increased pulsatile component of blood pressu re might be associated to structural and functional vascular impairments si nce the very early stages of hypertension in young adults without metabolic disorders.