Aging and disease modify vascular structure and function. Hypertension is associated with vasoconstriction, VSM hypertrophy and rarefaction in the microcirculation. Pulse volume, pressure, and velocity are important physiological variables that may function as biologic signals to the endothelium and VSM of the microcirculation. The capillary pulse volume modifies and in turn is modified by microcirculatory structure and function. For example, both MAP and PP affect glomerular filtration rate independently, presumably through direct effects on glomerular filtration pressure . Increased systolic BP or PP is associated with a variety of disorders related to aging, including atherosclerotic cardiovascular disease [ 62, 63], heart failure , stroke [65, 66], cognitive disorders [67-69], white matter lesions [ 70, 71], macular degeneration [ 72], renal dysfunction [ 73], osteoporosis , and glucose intolerance [75-77]. Abnormal microcirculatory pulsation may participate in the pathogenesis of organ dysfunction in these various disease states [7, 78-84]. Endothelial function in medium-sized and smaller arteries may also be impaired by increased pressure pulsatility [85, 86]. Capillary rarefaction has been demonstrated in young prehypertensive individuals with wide PP, suggesting a relation between PP and microcircula-tory surface area [87, 88]. Wide PP is also associated with increased albuminuria, a marker of microcirculatory damage . Since structure and function in small arteries may be adversely affected by exposure to high PP, the possibility exists that increased aortic stiffness and elevated PP may contribute directly to the pathogenesis of the various small vessel disorders and diseases described above, including hypertension.
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