{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T21:34:21Z","timestamp":1790890461406,"version":"4.1.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,6,20]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Systolic blood pressure increases with age after midlife, particularly in women, and contributes to development of wide pulse pressure hypertension in middle\u2010aged and older adults. Relative contributions of aortic stiffness and premature wave reflection to increases in pulse pressure remain controversial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      We evaluated visit\u2010specific values and change in key correlates of pulse pressure, aortic characteristic impedance, forward and backward wave amplitude, and global reflection coefficient, at 3 sequential examinations of the Framingham Generation 3 (N=4082), Omni\u20102 (N=410), and New Offspring Spouse (N=103) cohorts (53% women). Data were analyzed using repeated\u2010measures linear mixed models adjusted for age, sex, and risk factor exposures. Pulse pressure increased markedly with age after midlife (age and age\u2010squared terms,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.0001), particularly in women (age slope 3.1\u00b10.2\u2009mm\u2009Hg\/decade higher in women,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.0001). In sex\u2010specific models, change in pulse pressure was closely related (all\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.0001) to baseline (6.7\u00b10.2 and 7.3\u00b10.2\u2009mm\u2009Hg\/SD in men and women, respectively) and change (11.8\u00b10.1 and 11.7\u00b10.1\u2009mm\u2009Hg\/SD) in forward wave amplitude, whereas relations with baseline (2.1\u00b10.15 and 2.0\u00b10.14\u2009mm\u2009Hg\/SD) and change (4.0\u00b10.13 and 3.4\u00b10.11\u2009mm\u2009Hg\/SD) in global reflection coefficient were weaker. Global reflection coefficient fell as aortic characteristic impedance increased (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.0001), consistent with the hypothesis that impedance matching reduces relative wave reflection in the arterial system.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Proximal aortic stiffening, as assessed by higher aortic characteristic impedance and larger forward wave amplitude, is strongly associated with longitudinal increase in pulse pressure, especially in women, whereas wave reflection has more modest relations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.122.027329","type":"journal-article","created":{"date-parts":[[2023,6,15]],"date-time":"2023-06-15T06:27:17Z","timestamp":1686810437000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Longitudinal Hemodynamic Correlates of and Sex Differences in the Evolution of Blood Pressure Across the Adult Lifespan: The Framingham Heart Study"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5643-3145","authenticated-orcid":false,"given":"Gary F.","family":"Mitchell","sequence":"first","affiliation":[{"name":"Cardiovascular Engineering Inc. Norwood MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Rong","sequence":"additional","affiliation":[{"name":"Boston University and NHLBI\u2019s Framingham Study Framingham MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9631-1254","authenticated-orcid":false,"given":"Martin G.","family":"Larson","sequence":"additional","affiliation":[{"name":"Boston University and NHLBI\u2019s Framingham Study Framingham MA"},{"name":"Department of Biostatistics Boston University School of Public Health Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9764-0837","authenticated-orcid":false,"given":"Leroy L.","family":"Cooper","sequence":"additional","affiliation":[{"name":"Biology Department, Vassar College Poughkeepsie NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7352-621X","authenticated-orcid":false,"given":"Vanessa","family":"Xanthakis","sequence":"additional","affiliation":[{"name":"Cardiovascular Engineering Inc. Norwood MA"},{"name":"Boston University and NHLBI\u2019s Framingham Study Framingham MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4076-2336","authenticated-orcid":false,"given":"Emelia J.","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Boston University and NHLBI\u2019s Framingham Study Framingham MA"},{"name":"Cardiology and Preventive Medicine Sections, Department of Medicine Boston University Chobanian and Avedisian School of Medicine, Boston Medical Center Boston MA"},{"name":"Department of Epidemiology Boston University School of Public Health Boston MA"},{"name":"Evans Department of Medicine Boston MA"},{"name":"Whitaker Cardiovascular Institute Boston University Chobanian and Avedisian School of Medicine Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5504-5589","authenticated-orcid":false,"given":"Naomi M.","family":"Hamburg","sequence":"additional","affiliation":[{"name":"Evans Department of Medicine Boston MA"},{"name":"Whitaker Cardiovascular Institute Boston University Chobanian and Avedisian School of Medicine Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7357-5970","authenticated-orcid":false,"given":"Ramachandran S.","family":"Vasan","sequence":"additional","affiliation":[{"name":"Boston University and NHLBI\u2019s Framingham Study Framingham MA"},{"name":"Cardiology and Preventive Medicine Sections, Department of Medicine Boston University Chobanian and Avedisian School of Medicine, Boston Medical Center Boston MA"},{"name":"Department of Epidemiology Boston University School of Public Health Boston MA"},{"name":"Evans Department of Medicine Boston MA"},{"name":"Whitaker Cardiovascular Institute Boston University Chobanian and Avedisian School of Medicine Boston 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