I read the article by Oylumlu et al. with great interest (Citation1). They assessed the arterial stiffness using a non-invasive and simple oscillometric method in pregnant women with and without pre-eclampsia. All the arterial stiffness parameters were significantly higher in patients with pre-eclampsia. The women with severe pre-eclampsia had significantly higher blood pressures, pulse wave velocity (PWV) values, augmentation indices, and cardiac outputs when compared with the patients with mild pre-eclampsia. I congratulate the authors for this well presented study. However, I want to mention about the additional confounding factors influencing arterial stiffness.
Arterial stiffness is a complex process and it is closely associated with confounding factors. Recently, Cecelja et al. published a systematic review which showed that the contribution of cardiovascular risk factors other than age and blood pressure to aortic stiffness measured by carotid-femoral PWV is small or insignificant and age and blood pressure were consistently independently associated with aortic stiffness (Citation2). As a result, this systematic review showed that age and blood pressure were consistently independently associated with aortic stiffness in majority of studies. It has also been shown that some antihypertensive drugs like angiotensin-converting enzyme inhibitors, calcium channel blockers and spiranolactone reduce arterial stiffness (Citation3,Citation4). In addition, Khalil et al. showed that methyldopa reduces arterial stiffness in hypertensive pregnant women (Citation5). After methyldopa as a first line drug, labetalol and long-acting nifedipine can also be used as oral antihypertensive agents in pregnant women with mild to moderate hypertension. Whereas angiotensin converting enzyme inhibitors and angiotensin receptor blockers should be avoided. In the study by Oylumlu et al. there is no data of antihypertensive drugs used. Apart from antihypertensive drugs, statins also reduce arterial stiffness and there is also no data about statin use (Citation3). It would have been useful if the authors had provided this information.
Arterial stiffness describes the reduced capability of an artery to expand and contract in response to pressure changes and it is an independent predictor of cardiovascular morbidity and all-cause mortality (Citation3). It has been suggested that aortic stiffness occurs as a result of atherosclerosis along the aorta. However, it is closely associated with confounding factors like antihypertensive drugs and statins. Some antihypertensive drugs and statins can greatly influence arterial stiffness and these factors should be considered in arterial stiffness evaluation.
Declaration of interest
The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.
References
- Oylumlu M, Oylumlu M, Yuksel M, et al. A simple method for the assessment of arterial stiffness in pre-eclamptic patients. Clin Exp Hypertens 2014;36:531–7.
- Cecelja M, Chowienczyk P. Dissociation of aortic pulse wave velocity with risk factors for cardiovascular disease other than hypertension: a systematic review. Hypertension 2009;54:1328–36
- Cavalcante JL, Lima JA, Redheuil A, et al. Aortic stiffness: current understanding and future directions. J Am Coll Cardiol 2011;57:1511–22
- Dudenbostel T, Glasser SP. Effects of antihypertensive drugs on arterial stiffness. Cardiol Rev 2012;20:259–63
- Khalil A, Jauniaux E, Harrington K. Antihypertensive therapy and central hemodynamics in women with hypertensive disorders in pregnancy. Obstet Gynecol 2009;113:646–54