Determinant factors for arterial hemodynamics in hypertension: theoretical insights from a computational model-based study

TY - JOUR

T1 - Determinant factors for arterial hemodynamics in hypertension

T2 - theoretical insights from a computational model-based study

AU - Liang, Fuyou

AU - Guan, Debao

AU - Alastruey, Jordi

PY - 2018/1/17

Y1 - 2018/1/17

N2 - Hypertension is a well-documented predictive factor for cardiovascular events. Clinical studies have extensively demonstrated the differential hemodynamic consequences of various anti-hypertensive drugs, but failed to clearly elucidate the underlying mechanisms due to the difficulty in performing a quantitative deterministic analysis based on clinical data that carry confounding information stemming from inter-patient differences and the nonlinearity of cardiovascular hemodynamics. In the present study, a multi-scale model of the cardiovascular system was developed to quantitatively investigate the relationships between hemodynamic variables and cardiovascular properties under hypertensive conditions, aiming to establish a theoretical basis for assisting in the interpretation of clinical observations or optimization of therapy. Results demonstrated that heart period, central arterial stiffness and arteriolar radius were the major determinant factors for blood pressures and flow pulsatility indices both in large arteries and in the microcirculation. These factors differed in the degree and the way in which they affect hemodynamic variables due to their differential effects on wave reflections in the vascular system. In particular, it was found that the hemodynamic effects of varying arteriolar radius were considerably influenced by the state of central arterial stiffness, and vice versa, which implied the potential of optimizing anti-hypertensive treatment by selecting proper drugs based on patient-specific cardiovascular conditions. When analyzed in relation to clinical observations, the simulated results provided mechanistic explanations for the beneficial pressure-lowering effects of vasodilators as compared to ß-blockers, and highlighted the significance of monitoring and normalizing arterial stiffness in the treatment of hypertension.

AB - Hypertension is a well-documented predictive factor for cardiovascular events. Clinical studies have extensively demonstrated the differential hemodynamic consequences of various anti-hypertensive drugs, but failed to clearly elucidate the underlying mechanisms due to the difficulty in performing a quantitative deterministic analysis based on clinical data that carry confounding information stemming from inter-patient differences and the nonlinearity of cardiovascular hemodynamics. In the present study, a multi-scale model of the cardiovascular system was developed to quantitatively investigate the relationships between hemodynamic variables and cardiovascular properties under hypertensive conditions, aiming to establish a theoretical basis for assisting in the interpretation of clinical observations or optimization of therapy. Results demonstrated that heart period, central arterial stiffness and arteriolar radius were the major determinant factors for blood pressures and flow pulsatility indices both in large arteries and in the microcirculation. These factors differed in the degree and the way in which they affect hemodynamic variables due to their differential effects on wave reflections in the vascular system. In particular, it was found that the hemodynamic effects of varying arteriolar radius were considerably influenced by the state of central arterial stiffness, and vice versa, which implied the potential of optimizing anti-hypertensive treatment by selecting proper drugs based on patient-specific cardiovascular conditions. When analyzed in relation to clinical observations, the simulated results provided mechanistic explanations for the beneficial pressure-lowering effects of vasodilators as compared to ß-blockers, and highlighted the significance of monitoring and normalizing arterial stiffness in the treatment of hypertension.

KW - Journal Article

U2 - 10.1115/1.4038430

DO - 10.1115/1.4038430

M3 - Article

C2 - 29131886

SN - 0148-0731

VL - 140

SP - 031006-1-14

JO - Journal of Biomechanical Engineering

JF - Journal of Biomechanical Engineering

ER -