Aortic systolic and pulse pressure invasively and non-invasively obtained: Comparative analysis of recording techniques, arterial sites of measurement, waveform analysis algorithms and calibration methods.

Background: The non-invasive estimation of aortic systolic (aoSBP) and pulse pressure (aoPP) is achieved by a great variety of devices, which differ markedly in the: 1) principles of recording (applied technology), 2) arterial recording site, 3) model and mathematical analysis applied to signals, and/or 4) calibration scheme. The most reliable non-invasive procedure to obtain aoSBP and aoPP is not well established. Aim: To evaluate the agreement between aoSBP and aoPP values invasively and non-invasively obtained using different: 1) recording techniques (tonometry, oscilometry/plethysmography, ultrasound), 2) recording sites [radial, brachial (BA) and carotid artery (CCA)], 3) waveform analysis algorithms (e.g., direct analysis of the CCA pulse waveform vs. peripheral waveform analysis using general transfer functions, N-point moving average filters, etc.), 4) calibration schemes (systolic-diastolic calibration vs. methods using BA diastolic and mean blood pressure (bMBP); the latter calculated using different equations vs. measured directly by oscillometry, and 5) different equations to estimate bMBP (i.e., using a form factor of 33% ("033"), 41.2% ("0412") or 33% corrected for heart rate ("033HR"). Methods: The invasive aortic (aoBP) and brachial pressure (bBP) (catheterization), and the non-invasive aoBP and bBP were simultaneously obtained in 34 subjects. Non-invasive aoBP levels were obtained using different techniques, analysis methods, recording sites, and calibration schemes. Results: 1) Overall, non-invasive approaches yielded lower aoSBP and aoPP levels than those recorded invasively. 2) aoSBP and aoPP determinations based on CCA recordings, followed by BA recordings, were those that yielded values closest to those recorded invasively. 3) The "033HR" and "0412" calibration schemes ensured the lowest mean error, and the "033" method determined aoBP levels furthest from those recorded invasively. 4) Most of the non-invasive approaches considered overestimated and underestimated aoSBP at low (i.e., 80 mmHg) and high (i.e., 180 mmHg) invasive aoSBP values, respectively. 5) The higher the invasively measured aoPP, the higher the level of underestimation provided by the non-invasive methods. Conclusion: The recording method and site, the mathematical method/model used to quantify aoSBP and aoPP, and to calibrate waveforms, are essential when estimating aoBP. Our study strongly emphasizes the need for methodological transparency and consensus for the non-invasive aoBP assessment.

Brachial Blood Pressure Invasively and Non-Invasively Obtained Using Oscillometry and Applanation Tonometry: Impact of Mean Blood Pressure Equations and Calibration Schemes on Agreement Levels.

The use of oscillometric methods to determine brachial blood pressure (bBP) can lead to a systematic underestimation of the invasively measured systolic (bSBP) and pulse (bPP) pressure levels, together with a significant overestimation of diastolic pressure (bDBP). Similarly, the agreement between brachial mean blood pressure (bMBP), invasively and non-invasively measured, can be affected by inaccurate estimations/assumptions. Despite several methodologies that can be applied to estimate bMBP non-invasively, there is no consensus on which approach leads to the most accurate estimation. Aims: to evaluate the association and agreement between: (1) non-invasive (oscillometry) and invasive bBP; (2) invasive bMBP, and bMBP (i) measured by oscillometry and (ii) calculated using six different equations; and (3) bSBP and bPP invasively and non-invasively obtained by applanation tonometry and employing different calibration methods. To this end, invasive aortic blood pressure and bBP (catheterization), and non-invasive bBP (oscillometry [Mobil-O-Graph] and brachial artery applanation tonometry [SphygmoCor]) were simultaneously obtained (34 subjects, 193 records). bMBP was calculated using different approaches. Results: (i) the agreement between invasive bBP and their respective non-invasive measurements (oscillometry) showed dependence on bBP levels (proportional error); (ii) among the different approaches used to obtain bMBP, the equation that includes a form factor equal to 33% (bMBP = bDBP + bPP/3) showed the best association with the invasive bMBP; (iii) the best approach to estimate invasive bSBP and bPP from tonometry recordings is based on the calibration scheme that employs oscillometric bMBP. On the contrary, the worst association between invasive and applanation tonometry-derived bBP levels was observed when the brachial pulse waveform was calibrated to bMBP quantified as bMBP = bDBP + bPP/3. Our study strongly emphasizes the need for methodological transparency and consensus for non-invasive bMBP assessment.

Central Blood Pressure Waves Assessment: A Validation Study of Non-invasive Aortic Pressure Measurement in Human Beings.

INTRODUCTION: Measurement of central (aortic) systolic blood pressure has been shown to provide reliable information to evaluate target organ damage. However, non-invasive central blood pressure measurement procedures are still under analysis. AIM: To compare human pressure waveforms invasively obtained in the aorta, with the corresponding waveforms non-invasively recorded using an oscillometric device (Mobil-O-Graph). METHODS: In this research were included 20 subjects in which invasive percutaneous coronary interventions were performed. They were 10 males (68 ± 12 y. o. , BMI: 27.4 ± 4.6 kg/m2) and 10 females (77 ± 8 y. o. , BMI: 28.5 ± 5.3 kg/m2). During the invasive aortic pressure recording, a synchronized non-invasive Mobil-O-Graph acquisition beat by beat and reconstructed central pressure wave was performed. Both, invasive and non-invasive pressure waves were digitized and stored for subsequent analysis and calculations. A computerized interpolation procedure was developed in our laboratory to compare these pressure waves. RESULTS: A significant correlation between Mobil-O-Graph central blood pressure measurements and the corresponding invasive values was found in males (r < 0.81; p < 0.01) and females (r < 0.93; p < 0.01). However, in both genders, the slope of the regression lines was lesser than 1 (males: y = 0.7354x + 18.998; females: y = 0.9835x + 2.8432). In the whole population (n = 20), a significant correlation between Mobil-O-Graph central blood pressure measurements and the corresponding invasive values was found (r < 0.89; p < 0.01) and the regression line was lesser than 1 (y = 0.9774x + 1.7603). CONCLUSIONS: In this research, a high correlation between invasive central blood pressure values and those measured with the Mobil-O-Graph device was found in males, females and the whole population. However, a sub estimation of Mobil-O-Graph central blood pressure values was observed.

Adaptive Filtering of the Arterial Wall: Frequency Response and Dynamical Parameters: Clinical Evaluation.

Adaptive identification systems focus on dynamical approaches based on the observed data from an experiment and/or clinical data. These systems establish a relationship between an input (arterial or vein instantaneous pressure) and an output (instantaneous arterial or vein diameter). Several dynamics relationships and applications can be established because of this adaptive identification as an arterial dynamic range (frequency response), biomechanical behavior of cryopreserved arteries, regional differences in veins as artery substitution, role of vascular smooth muscle in human hypertension and time invariance in the biomechanics of wall arteries. The aim of this review is to summarize some of those relevant results obtained from adaptive filter identification in cardiovascular dynamics research and clinical evaluation.

Central-To-Peripheral Arterial Stiffness Gradient in Hemodialyzed Patients Depends on the Location of the Upper-limb Vascular Access.

BACKGROUND: Pulse wave velocity ratio (PWV-ratio), a measure of central-to-peripheral arterial stiffness gradient, is calculated as a quotient between carotid-femoral and carotid-radial PWV (cf-PWV/cr-PWV). This new index has been reported to be significantly associated with increased mortality in hemodialyzed patients. Since several reports showed differences in arterial stiffness regarding the pathway where the vascular access (VA) is, the purpose of this research was: a) to compare arterial stiffness values obtained in the left and right sides of the body in hemodialyzed and non-hemodialyzed patients, and b) to analyze PWV-ratio values obtained on the side of the body where the VA was placed and compare them to its contralateral intact side. Since it is difficult to adequately measure cr-PWV in patients with a VA in the forearm, we measured the carotid- brachial PWV (cb-PWV) and used it to calculate PWV-ratio (cf-PWV/cb-PWV). METHODS: A Pearson's correlation and Bland & Altman analysis were performed in hemodialyzed (n=135) and non-hemodialyzed (n=77) patients, to quantify the equivalence between arterial stiffness parameters (cf-PWV, cb-PWV, PWV-ratio) obtained on each side of the body with respect to its contralateral side. RESULTS: We conclude that PWV-ratio values measured on the side where the VA is placed were significantly higher than those obtained in its contralateral side, in hemodialyzed patients included in this research. Moreover, cf-PWV, cb-PWV and PWV-ratio values obtained on one side of the body were always highly correlated with its contralateral side. CONCLUSION: According to this research, any research involving PWV-ratio should always consider the observed territory.

A Novel Interpretation for Arterial Pulse Pressure Amplification in Health and Disease.

Arterial pressure waves have been described in one dimension using several approaches, such as lumped (Windkessel) or distributed (using Navier-Stokes equations) models. An alternative approach consists of modeling blood pressure waves using a Korteweg-de Vries (KdV) equation and representing pressure waves as combinations of solitons. This model captures many key features of wave propagation in the systemic network and, in particular, pulse pressure amplification (PPA), which is a mechanical biomarker of cardiovascular risk. The main objective of this work is to compare the propagation dynamics described by a KdV equation in a human-like arterial tree using acquired pressure waves. Furthermore, we analyzed the ability of our model to reproduce induced elastic changes in PPA due to different pathological conditions. To this end, numerical simulations were performed using acquired central pressure signals from different subject groups (young, adults, and hypertensive) as input and then comparing the output of the model with measured radial artery pressure waveforms. Pathological conditions were modeled as changes in arterial elasticity (E). Numerical results showed that the model was able to propagate acquired pressure waveforms and to reproduce PPA variations as a consequence of elastic changes. Calculated elasticity for each group was in accordance with the existing literature.

Conceptual model of arterial tree based on solitons by compartments.

Models define a simplification of reality, which help to understand function. The arterial system has been modeled in many ways: lumped models, tube models and anatomically based distributed models. In this work, arterial segments were modeled as thin nonlinear elastic tubes filled with an incompressible fluid, whose governing dynamics were denoted by the Korteweg and DeVries equation. In order characterize the pressure pulse propagation, a discrete multi-segmented conduit was proposed. Arterial wall mechanical parameters were obtained from existing literature and assigned to each individual segment. The numerical model was developed starting in the aortic arch, and ending at the femoral artery. The main idea of this article was to perform a computational simulation of pressure wave propagation, considered as a solitons combination, along several segments of the arterial tree.

Arterial pressure fractality is highly dependent on wave reflection.

UNLABELLED: Wave reflection is an important factor that influences pressure wave morphology and becomes more significant with aging, when cardiovascular risk increases. A pressure wave, measured at any location in the arterial tree, can be decomposed into its forward and backward components and depends on the corresponding amplitude and shifting time delays. Fractal dimension (FD) quantifies the time series complexity defined by its geometrical representation. OBJECTIVE: The aim of this study was to evaluate the arterial pressure and diameter time series in order to assess the relationship between wave reflection and arterial pressure fractal dimension (FD). METHODS: Simultaneous aortic pressure and diameter were measured in 14 conscious dogs. A pair of ultrasonic crystals, a pressure microtransducer and a pneumatic cuff occluder were positioned in the upper third of the descending aorta. RESULTS: Total reflection induced by the occlusion maneuver decreased FD concomitant to the aortic stiffening. CONCLUSION: Arterial pressure fractality is highly dependent on wave reflection.

Coronary arterial stiffness is related with a loss of fractal complexity in the aortic pressure.

UNLABELLED: Arterial stiffening is a common but highly variable disorder. Additionally, excessive arterial pulsatility is associated with various common diseases of aging and hypertension. Fractal dimension (FD) quantifies the time series complexity defined by its geometrical representation. OBJECTIVE: Arterial pressure and diameter time series were evaluated in order to assess the relationship between arterial stiffness and FD. METHODS: Three Corriedale male sheep were operated. Left anterior descending artery (LAD) was dissected and the external arterial diameter was measured trough sonomicrometry. Similarly, a pressure microtransducer was positioned in the upper third of the ascending aorta. Simultaneous pressure and diameter were measured in normal state and under smooth muscle activation. Each time series FD were assessed by the application of Higuchi's method while arterial wall elastic modulus was evaluated by means of the pressure-strain relationship. RESULTS: Coronary stiffness was increased from normal state to phenylephrine state (47.32%, 21.12%, 10.87%) while aortic pressure FD was decreased (2.11%, 2.57%, 6.85%), respectively. CONCLUSION: Acute hypertension induced by phenylephrine produces an increase in the coronary wall elastic modulus with a concomitant decrease in the fractal nature of the aortic pressure, suggesting that coronary stiffening is associated with an unwrinkled aortic pressure.

Impact of coronary artery calcium on cardiovascular risk categorization and lipid-lowering drug eligibility in asymptomatic hypercholesterolemic men.

BACKGROUND: Application of coronary artery calcium (CAC) for stratifying coronary heart disease (CHD) risk may change the proportion of subjects eligible for risk reduction treatment and decrease cost-effectiveness of primary prevention. We therefore aimed to analyze the impact of CAC on CHD risk categorization. METHODS: We measured CAC with electron beam computed tomography in 500 asymptomatic untreated hypercholesterolemic men and re-calibrated 10-year Framingham CHD risk by adding CAC score information (post CAC test risk) via an algorithm integrating relative risk and expected distribution of CAC in the population tested. Proportions of low (<10%), intermediate (10-20%) and high (>20%) risk categories, and of eligibility for lipid-lowering treatment, were compared between Framingham risk and post CAC test risk. RESULTS: In the overall population, post CAC test risk calculation changed risk categorization defined by Framingham assessment alone, with 10% more low risk and 10% less intermediate risk (p<0.01). Risk reclassifications were bidirectional since 30% of high and 30% of intermediate Framingham risk were downgraded to intermediate and low risk categories respectively, while 11% of low and 14% of intermediate Framingham risk were upgraded to intermediate and high-risk categories respectively. Post CAC test risk did not change the proportion of Framingham-based lipid-lowering treatment eligibility in the overall population but decreased it by 8% in intermediate Framingham risk subgroup (p<0.05). CONCLUSIONS: Addition of CAC to risk prediction resulted rather in downgrading than in upgrading risk and did not change treatment eligibility, except in intermediate risk subjects, less frequently eligible for treatment.

Age-related changes in reservoir and excess components of central aortic pressure in asymptomatic adults.

Study of humans aging has presented difficulties in separating the aging process from concomitant disease and/or in defining normality and abnormality during its development. In accordance with this, aging associates structural and functional changes evidenced in variations in vascular parameters witch suffer alterations during atherosclerosis and have been proposed as early markers of the disease. The absence of adequate tools to differentiate the expected (normal) vascular changes due to aging from those related with a vascular disease is not a minor issue. For an individual, an early diagnosis of a vascular disease should be as important as the diagnosis of a healthy vascular aging. Recent studies have proposed that the capacitive or reservoir function of the aorta and large elastic arteries plays a major role in determining the pulse wave morphology. The arterial pressure waveform can be explained in terms of a reservoir pressure, related to the arterial system compliance, and an "excess" or wave-related pressure, associated with the traveling waves. The aim of this study was to evaluate, by means of a mathematical approach, age-related changes in measured, reservoir and excess central aortic pressure in order to determine if age-related changes are concentrated in particular decades of life. Central aortic pressure waveform was non-invasively obtained in healthy subjects (age range: 20-69 years old). Age-related profiles in measured, reservoir and excess pressure were calculated.

Gender-related differences in the excess pressure component of central aortic pressure waveform of healthy young.

Gender-related difference in cardiovascular diseases is one of the most investigated and still unsolved issues. Finding an explanation to this topic might have important implications for the understanding of the differences between men and women in diseases and possibly lead to the development of gender-specific strategies for its management. Recent studies have proposed that the capacitive or reservoir function of the aorta and large elastic arteries plays a major role in determining the pulse wave morphology. The pressure waveform can be explained in terms of a reservoir pressure related to arterial compliance and an "excess" or wave-related pressure associated with traveling waves. Gender-differences in the ascending aorta pressure waveform reservoir and excess components are to be characterized. The aim of this study was to evaluate, by means of a mathematical approach, gender-related differences in the central aortic pressure waveform components. Central aortic pressure waveform was non-invasively obtained in 22 healthy subjects (Age: 20 years old; 11 female). Males and females showed differences in the level and time to maximal excess pressure component, but no gender-related differences were found in the reservoir one.

[A reduction in the magnitude and velocity of left ventricular torsion may be associated with increased left ventricular efficiency: evaluation by speckle-tracking echocardiography]. / La reducción en el nivel y la velocidad de la torsión ventricular puede asociarse a incremento en la eficiencia ventricular izquierda: evaluación mediante ecografía speckle-tracking.

INTRODUCTION AND OBJECTIVES: The structural and functional changes observed in the left ventricle in professional soccer players could cause alterations in ventricular rotation (Rv) and ventricular torsion (Tv). Our aim was to characterize the changes in Tv that occur in professional soccer players. METHODS: In total, 17 professional soccer players and 10 healthy volunteers who had not undergone training (control subjects) were investigated by M-mode, B-mode and Doppler echocardiography. Left ventricular systolic and diastolic functional and structural parameters were measured. Basal and apical Rv, and Tv were determined using specially developed software (EchoPAC, GE Medical Systems). In addition, Tv was characterized in the time domain. RESULTS: In all subjects, left ventricular structural and functional parameters were within the normal ranges. Both left ventricular ejection fraction and shortening were greater in soccer players (P< .05). The magnitude of apical and basal Rv and the magnitude and velocity of Tv were all lower in soccer players (P< .05). In soccer players, there were negative correlations between the maximum Tv achieved and left ventricular shortening and ejection fraction (P< .05). CONCLUSIONS: The magnitude and velocity of Tv were lower in soccer players. A reduction in Tv might take place under certain physiological conditions and could represent an adaptive response that contributes to increased ventricular efficiency.

Differential functional coupling between human saphenous cryoallografts and arteries: importance of the arterial type and the biomechanical parameter evaluated.

The aim of this study was to characterize and compare human great saphenous veins (HGSVs), HGSV cryoallografts, expanded polytetrafluoroethylene (ePTFE) segments, and elastic and muscular arteries' biomechanics, so as to identify if the biomechanical coupling and the HGSV advantages with respect to ePTFE depend on the arterial type and/or on the biomechanical property considered. Pressure and diameter were measured in vitro, under arterial hemodynamic conditions, in elastic and muscular arteries, and in vascular substitutes: fresh and cryopreserved HGSV and ePTFE segments. The wall's dynamics (compliance, viscosity, and inertia), energy dissipation, and buffering were calculated. The coupling was quantified for each biomechanical parameter. Cryopreservation preserved HGSV biomechanics. The HGSV cryoallografts' dynamics, energetics, and buffering were lesser with respect to both arteries, but were higher than the ePTFE. The coupling differed, depending on the arterial type and property considered. The biomechanical coupling depended on the artery and property considered. HGSV cryoallograft advantages over ePTFE were arterial type and property independent.

Changes in vein dynamics ranging from low to high pressure levels as a determinant of the differences in vein adaptation to arterial hemodynamic conditions.

The causes of the regional differences in venous grafts patency rates are partially understood. Differences in vein dynamics during physiological situations could determine differences in veins' capability to face arterial conditions and could contribute to the dissimilar performance of veins as arterial grafts. In vitro pressure and diameter were measured in four different veins during physiological and arterial (graft) pressure conditions. A diameter-pressure transfer function was designed. Compliance, viscous and inertial properties; circumferential stresses and deformation; and buffering function were calculated. Regional differences in veins' dynamics, but not in buffering function were found during physiological and arterial conditions. The back vein (femoral) showed the least changes when submitted to arterial conditions. Arterial conditions represent different changes in vein dynamics depending on the segment considered. The regional differences in vein dynamics, both at physiological and graft conditions, could contribute to explain the dissimilar results of venous grafts.

Cryopreservation procedure does not modify human carotid homografts mechanical properties: an isobaric and dynamic analysis.

The viscoelastic and inertial properties of the arterial wall are responsible for the arterial functional role in the cardiovascular system. Cryopreservation is widely used to preserve blood vessels for vascular reconstruction but it is controversially suspected to affect the dynamic behaviour of these allografts. The aim of this work was to assess the cryopreservation's effects on human arteries mechanical properties. Common carotid artery (CCA) segments harvested from donors were divided into two groups: Fresh (n = 18), tested for 24-48 h after harvesting, and Cryopreserved (n = 18) for an average time of 30 days in gas-nitrogen phase, and finally defrosted. Each segment was tested in a circulation mock, and its pressure and diameter were registered at similar pump frequency, pulse and mean pressure levels, including those of normotensive and hypertensive conditions. A compliance transfer function (diameter/pressure) derived from a mathematical adaptive modelling was designed for the on line assessment of the arterial wall dynamics and its frequency response. Assessment of arterial wall dynamics was made by measuring its viscous (eta), inertial (M) and elastic (E) properties, and creep and stress relaxation time constant (tauC and tauSR, respectively). The frequency response characterization allowed to evaluate the arterial wall filter or buffer function. Results showed that non-significant differences exist between wall dynamics and buffer function of fresh and cryopreserved segments of human CCA. In conclusion, our cryopreservation method maintains arterial wall functional properties, close to their fresh values.

[Viscoelastic and functional similarities between native femoral arteries and fresh or cryopreserved arterial and venous homografts]. / Acoplamiento viscoelástico y funcional entre arterias femorales nativas y homoinjertos arteriales y venosos, frescos y criopreservados.

INTRODUCTION AND OBJECTIVES: It is not yet known whether cryopreservation enables vessels to retain their viscoelastic properties or whether cryopreserved homografts are biomechanically more like native arteries than currently used vascular prostheses. The study objectives were: a) to determine whether our cryopreservation methodology enables arterial and venous homografts to retain their viscoelastic and functional properties; and b) to assess similarities between patients' femoral arteries, homografts, and other vascular prostheses in common use. METHODS: The pressure and the diameter and parietal thickness of 15 muscular (femoral) arteries were measured in patients using tonometry and echography, both noninvasive techniques. In addition, the pressure in and diameter and parietal thickness of 15 fresh and 15 cryopreserved human muscular (femoral) artery segments, saphenous veins, and 15 expanded polytetrafluoroethylene (ePTFE) vascular prostheses were measured in vitro under hemodynamic conditions similar to those in patients. A Kelvin-Voigt model of the segment wall was used to derive elastic (Epd, mm Hg/mm) and viscous (Vpd, mm Hg x s/mm) pressure-diameter indices, the buffering function (Vpd/Epd), and the conduit function (1/Zc, where Zc is the characteristic impedance). The incremental Young modulus, the pressure-strain elastic modulus, and pulse wave velocity were also calculated. RESULTS: No difference was observed between either the viscoelastic or functional properties of fresh and cryopreserved homografts. Arterial homografts were the most similar to the patient's arteries. CONCLUSIONS: Cryopreservation enabled venous and arterial homografts to retain their viscoelastic and functional properties. Of all the grafts investigated, arterial homografts were most similar, both biomechanically and functionally, to the patient's femoral arteries.

Regional differences in vein wall dynamics under arterial hemodynamic conditions: comparison with arteries.

Factors that explain the different results among veins, and causes of the superior performance of vein grafts for small arterial reconstructions, remain unclear. The aim was to compare the biomechanical behavior of veins and arteries from different regions and sizes under arterial conditions. In vitro pressure and diameter were measured in four different veins and three different ovine arteries. A diameter-pressure transfer function was designed, and compliance, viscous, and inertial indexes, and viscous energy and buffering function were calculated. Regional differences in vein mechanical behavior and energy dissipation were found. Veins and arteries vary in mechanical properties and buffering, but the differences were lesser when considering the smallest artery. The differences among veins' viscosity, compliance, and energy dissipation, but not in the buffering capability, could be related to different performances of veins when used as arterial grafts. The major biomechanical matching could contribute to explain veins with better results in small arteries reconstruction.

Smart damping modulation of carotid wall energetics in human hypertension: effects of angiotensin-converting enzyme inhibition.

Damping is the conversion of mechanical energy of a structure into thermal energy, and it is related to the material viscous behavior. To evaluate the role of damping in the common carotid artery (CCA) wall in human hypertension and the possible improvement of angiotensin-converting enzyme (ACE) inhibition, we used noninvasive CCA pressure (tonometry) and diameter (B-mode echography) waveforms in normotensive subjects (NT group; n=12) and in hypertensive patients (HT group; n=22) single-blind randomized into HT-placebo (n=10) or HT-treated (ramipril, 5 to 10 mg/d during 3 months; n=12). Vascular smooth muscle (VSM) null tonus condition was achieved from in vitro pressure and diameter waveforms (Konigsberg microtransducer and sonomicrometry) measured in explanted human CCA (n=14). Arterial wall dynamics was described by viscous (eta), inertial (M), and compliance (C) parameters, mean circumferential wall stress, viscous energy dissipation (WD), peak strain energy (WSt), damping ratio (xi=WD/WSt), and modeling isobaric indexes CIso and WSt(Iso). The lack of VSM tonus isobarically increased wall stress and reduced eta, CIso, and damping (P<0.01). Wall stress, eta, and WD were greater in HT than in NT (P<0.015) and arrived near normal in HT-treated (P<0.032 respect to HT), with no changes in HT-placebo. Whereas CIso increased in HT-treated (P<0.01) approaching the NT level, xi did not vary among groups. During hypertension, because of the WSt increase, the arterial wall reacts increasing WD to maintain xi. ACE inhibition modulates VSM activation and vessel wall remodeling, significantly improving wall energetics and wall stress. This protective vascular action reduces extra load to the heart and maintains enhanced arterial wall damping.