Arterial Stiffness in Hypertension

est professeur des universités, praticien hospitalier, thérapeute et hypertensiologue à l'Hôtel-Dieu, Paris.

• I: Basic concepts of pulsatile arterial hemodynamicsPrinciples and definitions of arterial stiffness, wave reflections and pulse pressure amplification. Large arteries, microcirculation and the mechanism of hypertension.Direct measurement of local arterial stiffness and pulse pressure. Determination of systemic and regional arterial stiffness. Interrelations of structure and function of large arteries in epidemiology.II: Pathophysiological mechanismsMechanical stress and the arterial wall. Pulsatile stress, arterial stiffness and endothelial function. Endothelial-dependent vascular modulation by pulse perfusion. Central arterial aging: humans to molecules. Elastin, calcium and the arterial wall. Animal models for studies of arterial stiffness. Renin-angiotensin system, large arteries and micro-circulation. Arterial distensibility and the sympathetic nervous system.III: Arterial stiffness, wave reflections, cardiovascular risk and end-organ damageBrachial and central pulse pressure and cardiovascular risk. Large artery stiffness and cardiovascular risk: introduction to risk assessment and new strategies. Small artery elasticity index, endothelial function and cardiovascular risk. Genetic aspects of arterial stiffness and pulse pressure in clinical hypertension. Heart rate, pulse pressure and arterial stiffness. The relation of large arterial structure and function to cardiac hypertrophy in hypertension. Arterial stiffness in chronic heart failure. Arterial stiffness and various cardiovascular diseases. Arterial function in end-stage renal disease. Arterial changes in renal transplantation.Carotid intima-media thickness and arterial stiffness. IV: Clinical aspects of arterial stiffness and wave reflectionsAging: a physical perspective. Hypertension in women: is it different. Arterial stiffness and wave reflections at the different stages of the hypertensive vascular disease. Diabetes, lipids and other cardiovascular risk factors.V: Therapeutic aspects of arterial stiffness and wave reflectionsAntihypertensive drug treatment and cardiovascular prevention: an update including the 2003-2004 secondary prevention trials. Changing concepts on the role of blood pressure reduction in cardiovascular prevention. Principles of measurement, of preventing, and of treating arterial stiffness. Nitrates and endothelial function. De-stiffening strategy using sodium balance and blockade of the rennin-angiotensin system. Aldosterone antagonists, arterial stiffness and wave reflections. Drugs acting on collagen cross-linking. Long term effects of converting enzyme inhibitors, calcium antagonists and beta blocking agents on peripheral and central arteries. Statins and arterial stiffness. Non-pharmacological treatment of increased arterial stiffness and altered wave length reflections.