To the best of our knowledge, there are some data available on the association between arterial stiffness and diastolic function among subjects with cardiovascular risk factor, especially metabolic syndrome or obesity,10)
and those with manifested arterial disease.12)
However, little is known about this association in patients only with hypertension without any other diseases.
It has been shown that the local measurement of arterial stiffness may be useful for the detection of early arterial changes.13)
Several plausible pathways exist whereby arterial compliance may contribute to the pathological changes in the LV that form the substrate for diastolic dysfunction.14)
Increased stiffness of conduit arteries is associated with higher velocity of transmission of the pulse wave generated by LV ejection; early return of reflected waves that arrive back at the heart during LV systole may lead to augmentation of the central aortic pressure wave amplitude, thus increasing LV afterload and central PP.15)
Increased afterload may promote myocyte hypertrophy and may also directly slow LV relaxation.16)
The arterial stiffness leads to increased PP and to LV hypertrophy, which is one of the major determinants of cardiac diastolic dysfunction. Furthermore, in patients with presumed diastolic heart failure (HF) (clinical HF with preserved ejection fraction), Hundley et al.,17)
observed reduced proximal aortic distensibility, which correlated strongly with exercise intolerance.
Previous studies on hypertensive patients have also reported an association between arterial stiffness and LV structural changes,18)
including concentric remodelling and hypertrophy,19)
which are themselves associated with diastolic dysfunction.20)
However, in this study, even in subjects with hypertension with normal LV mass, carotid stiffness was increased with diastolic dysfunction. Therefore the measurement of carotid stiffness may be a good tool for early detection of decreased carotid dispensability.
The relationship between elastic properties of the arteries and LV diastolic function has been demonstrated in different clinical scenarios. Sakane et al.,22)
found in 119 patients that cardio-ankle vascular index was independently related to E/A ratio in patients with preserved LV ejection fraction. Abhayaratna et al.,23)
demonstrated that in a cohort of 188 patients (aged ≥ 65 years), increasing arterial stiffness detected with applanation tonometry was associated with the severity of LV diastolic dysfunction. Vinereanu et al.,24)
showed that arterial stiffness was inversely related to long axis LV function (systolic and early diastolic mitral annular velocities) and LV flow propagation velocity. In a study on a hypertension patient group, Mottram et al.,14)
showed that arterial compliance, measured using applanation tonometry, is an independent predictor of diastolic dysfunction. These authors also showed that arterial stiffness was independently related to early diastolic tissue velocity (=e') and suggested a possible causal link through the promotion of subendocardial ischaemia.
The relation between arterial compliance and diastolic dysfunction may be particularly important with respect to hypertensive women, who have a higher prevalence of diastolic HF than do men.25
Experimental and clinical studies suggest that, in response to increased afterload, women exhibit a greater degree of concentric remodelling,28)
which as discussed is associated with both arterial stiffness and diastolic dysfunction. In addition, several studies have reported increased values of arterial stiffness in women.30)
In the present study, sex was associated with reduced E' velocity and independently related to arterial stiffness in hypertensive patients (). After adjustment for other factors, female sex was independently predictive of diastolic dysfunction. In addition, the results indicate that an interaction between sex and arterial compliance may be important, such that arterial dysfunction may contribute to diastolic dysfunction in hypertensive women to a greater extent than in hypertensive men who also have diastolic dysfunction.
In this article, we calculated carotid artery stiffness using distensibility (strain) and pressure-strain elasticity modulus. Since this procedure enables relatively accurate data to be acquired easily and other cardiovascular events to be predicted, it would be important to pay more attention to performing the assessment of arterial stiffness in patients with early-stage hypertension or normal LV mass to prevent LV diastolic dysfunction and maintain normal blood pressure especially in women.