Arterial pulse wave and calcium-channel blockers in hypertension.

In contrast to mean blood pressure, arterial pulsatility represented by pulse pressure (PP) varies from heart to periphery. It depends on the stiffness of large arteries and the degree of arteriolar vasoconstriction. The central pulsatility, directly linked to left ventricular work, cannot be accurately evaluated by measurement of brachial PP. Moreover, the pulse wave reflection, when arriving in systole, increases the late-systolic pressure and the left ventricular afterload, particularly in older and hypertensive subjects. Analysis of the central pressure curve recorded by an accurate noninvasive method (applanation tonometry) may improve the hemodynamic evaluation of antihypertensive drugs. Calcium blockers reduce cardiac afterload in hypertension by their arteriolar vasodilating properties, by improving the compliance of large arteries, and also by reducing the central influences of the reflection wave, as shown after single administration and particularly after chronic treatment with calcium blockers.