NONINVASIVE EVALUATION OF ARTERIAL ABNORMALITIES IN HYPERTENSIVE PATIENTS

Arterial abnormalities in hypertension Morbidity and mortality in hype rtension are mainly determined by arterial lesions which may occur in different regional circulations (e.g. kidney, cerebral, coronary circu lations, causing nephroangiosclerosis, stroke or myocardial infarction , respectively), Despite arterial heterogeneity, structural and functi onal abnormalities are usually observed at an early stage of hypertens ion in both large and small arteries, These alterations modify physiol ogical and mechanical properties of the arterial wall, which may becom e clinically evident by increasing arterial pulsatility or pulse press ure; the alterations facilitate the establishment and progression of a therosclerosis and arteriosclerosis. Methods of assessing arterial abn ormalities Several noninvasive techniques can be used to assess haemod ynamic properties of arteries: (1) casual and ambulatory blood pressur e measurements can be used to evaluate pulse pressure; (2) pulse press ure can be measured directly in different sites of the arterial tree u sing the Tonometer device; (3) ultrasound techniques can be applied, i ncluding Doppler signals to assess the arterial flow, video-echo signa ls to analyse the arterial structure such as the intimal-medial thickn ess and echo-tracking systems far direct measurements of arterial wall distension and thickness;(4) pulse wave velocity is widely used as an index of arterial distensibility; this parameter, assessed by the Com plier device, has shown that hypertensive patients have decreased arte rial distensibility and that antihypertensive treatment does not alway s reverse this abnormality. Treatment It is important to evaluate the effect of cardiovascular risk-reduction measures on the arterial wall, Large therapeutic trials are necessary to show whether an evaluation of arterial abnormalities can identify patients with a high cardiovasc ular risk and contribute to their treatment and prognostic improvement .