Heart rate, arterial stiffness, and wave reflections in paced patients

Elevated heart rate (HR) and pulse pressure (PP) have a cumulative effect o n cardiovascular risk, with the exception of HR greater than or equal to 10 0 bpm. How an increase in HR may influence the PP level has never been inve stigated. In 11 patients with pacemaker monitoring, aortic (pulse-wave anal ysis) and digital (photoplethysmographic device) blood pressure were measur ed at 3 different levels of HR, together with determinations of carotid dim ensions (echo tracking technique), wave reflections (pulse-wave analysis), and aortic pulse-wave velocity. Increased HR is associated with the followi ng: (1) a significant increase of digital systolic, diastolic, and mean blo od pressure; (2) a significant reduction of digital and carotid PP, with a more pronounced reduction of the carotid than of the digital PP, resulting in a significant PP amplification; and (3) a reduction in the time required for the backward pressure wave to return toward the heart, without any cha nge of arterial stiffness. Increased HR significantly enhances PP amplifica tion, leading to an increase of peripheral blood pressure without comparabl e change in central blood pressure. These results are important to consider for a better understanding of cardiovascular risk and the mechanism of whi te-coat hypertension.