Hypertension and Peripheral Arterial Disease: A Plethysmographic Study

Abstract

Sixty patients suffering from arterial hypertension and/or obliterative arteriopathy of the lower limbs (20 hypertensive uncomplicated [H group], 20 normotensive affected by obliterative arteriopathy [A group], 20 suffering from both hypertension and peripheral arterial disease [HA group]) were studied, by strain gauge plethysmography, in compar ison with 20 healthy subjects (N group). The aims were to evaluate the arterial and venous hemodynamics of the lower limbs in such conditions and also to determine whether the vascular damage is primary or represents a consequence of the hypertensive pathology in the patients affected by both hypertension and peripheral arterial disease.

The resting blood flow did not show significant differences in the mean values, even if lightly decreased in hypertensive patients (with or without peripheral arteriopathy). The peak flow was reduced significantly both in the H group and in the A and HA groups. The half-time (t½) and total time (tT), which indicate vascular reactivity, were signifi cantly decreased in the H group, but they were increased in the A and HA groups. Finally, the venous compliance was decreased in the H group, did not vary significantly in the A group, and showed an intermediate behavior in the HA group.

These results suggest that hypertensive and arteriopathic patients develop similar arterial structural changes. However, they show a different behavior with regard to vascular reactivity and venous hemodynamics, as demonstrated by venous plethysmography.

Get full access to this article

View all access options for this article.

References

Brody MJ , Zimmerman BG : Peripheral circulation in arterial hypertension. Progr Cardiovasc Dis 18:323-340, 1976.

Lund Johansen P. : Newer thinking on the hemodynamics of hypertension . Curr Opin Cardiol 9:505-511,1994.

Girerd X. , Chanudet X. , Larroque P. , et al: Early arterial modifications in young patients with borderline hypertension. J Hypertension 7:45-52, 1989.

Milio G. , Cospite V. , Cospite M. : Hypertension and peripheral arterial hemodynamics. Angiology 46:1069-1074, 1995.

Safar ME , Laurent S. , London GM : The arterial system in essential hypertension. In: Clinical Research in Essential Hypertension, ed. by Safar ME , Stuttgart-New York : Shattavez, 1989, pp 115-127.

Armetano R. , Simon A. , Levenson J. , et al: Mechanical pressure versus intrinsic effects of hypertension on large arteries in humans. Hypertension 18:654-664, 1991.

Brusselmans F. , Duprez D. , De Buyzere M. , et al: Peripheral vascular changes and ambulatory blood pressure profiles. Int Angio 14(suppl 1):136, 1995.

Chobanian AV : Vascular effects of systemic hypertension . Am J Cardiol 69:3E-7E, 1992.

Chobanian AV (Corcoran Lecture 1989): Adaptive and maladaptive responses of the arterial wall to hypertension. Hypertension 5:666-674, 1990.

10.

Folkow B. : Structural factor in primary and secondary hypertension. Hypertension 16:89-101, 1990.

11.

Graham DI : Morphologic changes during hypertension. Am J Cardiol 63:6-10, 1989.

12.

Packer CS : Changes in arterial smooth muscle contractility, contractile proteins, and arterial wall structure in spontanoeus hypertension. Proc Soc Exp Biol Med 207:148-174, 1994.

13.

Safar ME , Laurent ST , Parneir BM , et al: Structural and functional modifications of peripheral large arteries in hypertensive patients. J Clin Hypert 3:360-367, 1987.

14.

Cangelosi MM , Del Sindaco D. , Baccifava G. , et al: Microcirculatory flow by strain-gauge plethysmography in essential hypertension. Int Angio 14(suppl 1):137, 1995.

15.

Greenberg S. , Wilborn W. : Functional and structural changes in veins in spontaneous hypertension. Arch Int Pharmacodyn 258:208-233, 1982.

16.

Milio G. , Ferrara F. , Meli F. , et al: L'emodinamica venosa distrettuale nell'ipertensione arteriosa . Procedings of 5th National Congress of Phlebology and Italian-Beneluxian Meeting of Phlebology, Bologna, Monduzzi, 1988, pp 285-290.

17.

Takeshita A. , Mark AL : Decreased venous distensibility in borderline hypertension. Hypertension 1:202-206, 1979.

18.

Tarazi RC : Hemodynamic role of extracellular fluid in hypertension. Circ Res 38:73-78, 1976.

19.

Benetos A. , Safar M. : Drugs and arterial compliance. In: Advances in Vascular Pathology , ed. by Strano A , Novo S, New York: Elsevier, 1990, pp 529-533.

20.

Bergar DS , Li JK : Concurrent compliance reduction and increased peripheral resistances in the manifestation of isolated systolic hypertension. Am J Cardiol 65:67-72, 1990.

21.

Conway J. : A vascular abnormality in hypertension: A study of blood flow in the forearm . Circulation 27:520-529, 1986.

22.

Fujita T. , Katsuyuki A. , Ogata E. : Systemic and regional hemodynamics in patients with salt-sensitive hypertension . Hypertension 16:235-244, 1990.

23.

Novo S. , Scaglione R. , Abrignani MG , et al: Artrerial compliance and its relationship with the severity of the hypertensive state. In: Advances in Vascular Pathology , ed. by Strano A , Novo S , New York: Elsevier, 1989, pp 875-880.

24.

Solti F. , Varadi A. , Iskum N. : Characteristics of the limb circulation in Hypertension. Angiology 41:541-546, 1990.

25.

Takeshita A. , Mark AL : Decreased vasodilator capacity of forearm resistance vessels in borderline hypertension. Hypertension 2:610-615, 1980.

26.

Bondjers G. , Glukhova M. , Hansson GK , et al: Hypertension and atherosclerosis. Cause and effects or two effects with one unknown cause . Circulation 84:2-6, 1991.

27.

Egan B. , Schmouder R. , Arbor A. : The importance of hemodynamic considerations in essential hypertension . Am Heart J 106:594-599, 1988.

28.

Libretti A. , Catalano M. : Hypertension and peripheral arterial disease. In: Advances in Vascular Pathology, ed. by Strano A , Novo S , New York : Elsevier, 1989, pp 925-927.

29.

Thubrikar MJ , Robicsek F. : Pressure-induced arterial wall stress and atherosclerosis. Ann Thorac Surg 59:1594-1603, 1995.

30.

Forconi S. , Jageneau A. , Guerrini M. , et al: Strain gauge plethysmography in the study of circulation of the limbs. Angiology 30:487-497, 1979.

31.

Strandness DE Jr, Bell JW : Peripheral vascular disease ; diagnosis and objective evaluation using a mercury strain gauge. Ann Surg 161:1-9, 1965.

32.

Novo S. , Pinto A. , Abrignani MG , et al: Different pattern of calf hemodynamics in recent and permanent hypertension. In: Advances in Vascular Pathology, ed. by Strano A , Novo S , New York: Elsevier, 1990, pp 861-867.

33.

Safar ME , London GM , Weiss YA , et al: Cardiopulmonary blood volume in borderline hypertension. Clin Sci Mol Med 47:153-164, 1974.

34.

Ulrich M. , Frohlich E. , Tarazi RC , et al: Cardiac output and distribution of blood volume in central and peripheral circulations in hypertensive and normotensive man. Br Heart J 31:570-576, 1969.

35.

Borghi C. , Boschi S. , Costa FV , at al: Pattern of peripheral venous response to volume expansion in borderline systemic hypertension. Am J Cardiol 66:597-602, 1990.

36.

Takeshita A. , Tsutomu I. , Toshiaki A. , et al: Limited maximal vasodilator capacity of forearm resistance vessels in normotensive young men with a familial predisposition to hypertension. Circ Res 50:671-677, 1982.