Consequences of elevated pulse pressure on renal function.

Peripheral pulse pressure (PP) is a marker of aging-associated arterial stiffening after the fifth decade. In addition, PP has emerged as a strong predictor of cardiovascular morbidity and mortality. A study of the relationship between renal function and aging of the arterial system using reliable methods of estimating renal haemodynamics (effective renal plasma flow) and function (glomerular filtration rate; GFR) was thus undertaken in a large number of never-treated individuals with essential hypertension. In 212 patients with isolated systolic hypertension, there was an inverse correlation between GFR and PP, but the correlation did not persist after adjustment for age. In fact, the deleterious effect of PP on GFR was observed, independent of age and mean arterial pressure, only in patients aged 60 years and over. In contrast, no clear influence of PP on GFR was detected in patients aged 40 years and over but less than 60 years and in those younger than 40 years. It is thus proposed that PP may have a detrimental influence on the age-related decline in GFR. Prospective studies on the influence of antihypertensive agents with possible effects on peripheral and central PP on the progressive decline of GFR are required.