ED 02-2 THE EFFECT OF AORTIC REMODELING ON CENTRAL BLOOD PRESSURE AND ARTERIOVENTRICULAR COUPLING.

With every cardiac contraction, a pressure wave is generated and propagated within the central large arteries. The characteristic shape of proximal aortic pressure waves (central blood pressure) has been shown to contain prognostic information on cardiovascular risk that is independent from conventional upper arm blood pressure, yet the mechanisms explaining differences in central blood pressure wave shape remain controversial. Uncertainty in this field requires resolution if central blood pressure is to be a target of hypertension management. Stiffness of the proximal aorta, as well as downstream vascular tone and left ventricular structure and function, all contribute to a complex dynamic relationship between arterial and cardiac function, also referred to as arterio-ventricular coupling. Animal and human studies have demonstrated that it is possible to experimentally remodel ('destiffen') the aorta independent from upper arm blood pressure using aldosterone blockade, which also has the effect of lowering central blood pressure and improving arterio-ventricular coupling. Thus, intervention with aldosterone blockade could be used to determine whether targeted central blood pressure lowering has cardiovascular benefits beyond upper arm blood pressure. This is the main aim of the LOW CBP study (targeted LOWering of Central Blood Pressure in patients with hypertension) in which baseline recruitment was recently completed and details of the rationale and study design will be presented.