{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T14:19:54Z","timestamp":1760710794943,"version":"3.41.2"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,24]],"date-time":"2021-12-24T00:00:00Z","timestamp":1640304000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008725","name":"Agencia Nacional de Investigaci\u00f3n e Innovaci\u00f3n","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Non-pregnant (NP) women have a progressive increase in arterial stiffness from central-to-peripheral arteries [\u201cstiffness gradient\u201d (SG)], which is of physiologic importance since excessive pulsatility is filtered by the creation of wave reflections. If the aorta gets stiff with minimal or no change in the periphery, the SG is dissipated transmitting pressure disturbances to the microcirculation. It remains unknown the status of the SG in both women with healthy pregnancies (HP) and complicated by pregnancy-associated hypertension (PAH).<\/jats:p><jats:p><jats:bold>Objective:<\/jats:bold> To determine whether HP and PAH are associated with changes in SG. Secondarily, we aim at identifying potential differences between the subgroups of PAH (pre-eclampsia and gestational hypertension).<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> HP (<jats:italic>n<\/jats:italic> = 10), PAH (<jats:italic>n<\/jats:italic> = 16), and healthy NP women (<jats:italic>n<\/jats:italic> = 401, to be matched for age, and cardiovascular risk with the pregnant women) were included. Carotid-to-femoral (cfPWV) and carotid-to-radial pulse wave velocity (crPWV), common carotid artery (CCA) and brachial artery (BA) diameters and elastic modulus (EM), and regional (cfPWV\/crPWV or \u201cPWV ratio\u201d) and local (CCA EM\/BA EM or \u201cEM ratio\u201d) SG were quantified.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> HP showed no changes in PWV ratio compared with NP, in the presence of significantly lower cfPWV and crPWV. HP exhibited higher arterial diameters and lower CCA EM\/BA EM compared to NP, without differences with PAH. PAH was associated with a significant increase in the PWV ratio that exceeded the levels of both NP and HP, explained by a lower (although significant) reduction of cfPWV with respect to that observed in HP with respect to NP, and a higher reduction in crPWV with respect to that observed between HP and NP. The blunted reduction in cfPWV observed in PAH coincided with an increase in the CCA EM.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Compared with NP, HP was associated with unchanged PWV ratio but with a reduction in CCA EM\/BA EM, in the setting of a generalized drop in arterial stiffness. Compared with NP and HP, PAH was associated with an \u201cexaggerated rise\u201d in the PWV ratio without changes in CCA EM\/BA EM, in the setting of a blunt reduction in cfPWV but exaggerated crPWV drop. The SG attenuation\/reversal in PAH was mainly driven by pre-eclampsia.<\/jats:p>","DOI":"10.3389\/fcvm.2021.766723","type":"journal-article","created":{"date-parts":[[2021,12,24]],"date-time":"2021-12-24T06:39:46Z","timestamp":1640327986000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Center-To-Periphery Arterial Stiffness Gradient Is Attenuated and\/or Reversed in Pregnancy-Associated Hypertension"],"prefix":"10.3389","volume":"8","author":[{"given":"Mar\u00eda M.","family":"Pereira","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Torrado","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudio","family":"Sosa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alejandro","family":"Diaz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Bia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanina","family":"Z\u00f3calo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,12,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1097\/AOG.0000000000003018","article-title":"202: gestational hypertension and preeclampsia","volume":"133","year":"2019","journal-title":"Obstet Gynecol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2323","DOI":"10.1016\/j.jacc.2020.03.028","article-title":"Incidence and long-term outcomes of hypertensive disorders of pregnancy","volume":"75","author":"Garovic","year":"2020","journal-title":"J Am Coll Cardiol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e2019364","DOI":"10.1001\/jamanetworkopen.2020.19364","article-title":"Hypertension in pregnancy in the US-One step closer to better ascertainment and management","volume":"3","author":"Kuklina","year":"2020","journal-title":"JAMA Netw Open."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1161\/01.HYP.0000188408.49896.c5","article-title":"Preeclampsia: recent insights","volume":"46","author":"Roberts","year":"2005","journal-title":"Hypertension."},{"key":"B5","doi-asserted-by":"publisher","first-page":"H2011","DOI":"10.1152\/ajpheart.01005.2020","article-title":"Role of arterial impairment in preeclampsia: should the paradigm shift?","volume":"320","author":"Pereira","year":"2021","journal-title":"Am J Physiol Heart Circ Physiol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1002\/uog.17494","article-title":"Placental histopathology associated with pre-eclampsia: systematic review and meta-analysis","volume":"50","author":"Falco","year":"2017","journal-title":"Ultrasound Obstet Gynecol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1097\/GCO.0000000000000419","article-title":"Cardiovascular origins of preeclampsia","volume":"29","author":"Kalafat","year":"2017","journal-title":"Curr Opin Obstet Gynecol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1016\/j.jacc.2019.07.012","article-title":"Large-Artery stiffness in health and disease: jacc state-of-the-art review","volume":"74","author":"Chirinos","year":"2019","journal-title":"J Am Coll Cardiol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"H1681","DOI":"10.1152\/ajpheart.1994.267.5.H1681","article-title":"Functional origin of reflected pressure waves in a multibranched model of the human arterial system","volume":"267","author":"Karamanoglu","year":"1994","journal-title":"Am J Physiol."},{"key":"B10","doi-asserted-by":"crossref","DOI":"10.1201\/b13568","volume-title":"McDonald's Blood Flow in Arteries","author":"Vlachopoulos","year":"2011"},{"key":"B11","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1038\/ki.2012.131","article-title":"Arterial stiffness and pulse pressure in CKD and ESRD","volume":"82","author":"Briet","year":"2012","journal-title":"Kidney Int."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1161\/ATVBAHA.120.313128","article-title":"Central versus peripheral artery stiffening and cardiovascular risk","volume":"40","author":"Yu","year":"2020","journal-title":"Arterioscler Thromb Vasc Biol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1007\/s40292-017-0178-3","article-title":"Aortic-Radial pulse wave velocity ratio in end-stage renal disease patients: association with age, body tissue hydration status, renal failure etiology and five years of hemodialysis","volume":"24","author":"Bia","year":"2017","journal-title":"High Blood Press Cardiovasc Prev."},{"key":"B14","doi-asserted-by":"publisher","first-page":"3398","DOI":"10.1093\/brain\/awr253","article-title":"Arterial stiffness, pressure and flow pulsatility and brain structure and function: the age, gene\/environment susceptibility\u2013reykjavik study","volume":"134","author":"Mitchell","year":"2011","journal-title":"Brain."},{"key":"B15","doi-asserted-by":"publisher","first-page":"169","DOI":"10.3389\/fcvm.2019.00169","article-title":"Measuring the interaction between the macro- and micro-vasculature","volume":"6","author":"Climie","year":"2019","journal-title":"Front Cardiovasc Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"11","DOI":"10.3109\/08037050903464535","article-title":"Aortic stiffness in normal and hypertensive pregnancy","volume":"19","author":"Avni","year":"2010","journal-title":"Blood Press."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1475","DOI":"10.1111\/j.1471-0528.2005.00701.x","article-title":"Peripheral arterial pulse wave analysis in women with pre-eclampsia and gestational hypertension","volume":"112","author":"Spasojevic","year":"2005","journal-title":"BJOG."},{"key":"B18","doi-asserted-by":"publisher","first-page":"720683","DOI":"10.1155\/2015\/720683","article-title":"Preeclampsia is associated with increased central aortic pressure, elastic arteries stiffness and wave reflections, and resting and recruitable endothelial dysfunction","volume":"2015","author":"Torrado","year":"2015","journal-title":"Int J Hypertens."},{"key":"B19","doi-asserted-by":"publisher","first-page":"250951","DOI":"10.1155\/2015\/250951","article-title":"Normal pregnancy is associated with changes in central hemodynamics and enhanced recruitable, but not resting, endothelial function","volume":"2015","author":"Torrado","year":"2015","journal-title":"Int J Reprod Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.preghy.2019.09.013","article-title":"Sequential profile of endothelial functions and arterial stiffness in preeclampsia during the course of pregnancy","volume":"18","author":"Garg","year":"2019","journal-title":"Pregnancy Hypertens."},{"key":"B21","doi-asserted-by":"publisher","first-page":"e18703","DOI":"10.1371\/journal.pone.0018703","article-title":"Maternal arterial stiffness in women who subsequently develop pre-eclampsia","volume":"6","author":"Savvidou","year":"2011","journal-title":"PLoS ONE."},{"key":"B22","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1159\/000438852","article-title":"Arterial stiffness gradient","volume":"3","author":"Fortier","year":"2016","journal-title":"Pulse."},{"key":"B23","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3390\/jcdd8010003","article-title":"Physiological age- and sex-related profiles for local (aortic) and regional (carotid-femoral, carotid-radial) pulse wave velocity and center-to-periphery stiffness gradient, with and without blood pressure adjustments: reference intervals and agreement between methods in healthy subjects (3-84 years)","volume":"8","author":"Bia","year":"2021","journal-title":"J Cardiovasc Dev Dis."},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.5603\/CJ.a2020.0031","article-title":"Stroke volume and cardiac output non-invasive monitoring based on brachial oscillometry-derived pulse contour analysis: explanatory variables and reference intervals throughout life (3-88 years)","author":"Z\u00f3calo","year":"2020","journal-title":"Cardiol J."},{"key":"B25","doi-asserted-by":"publisher","first-page":"e0254869","DOI":"10.1371\/journal.pone.0254869","article-title":"Age- and sex-related profiles for macro, macro\/micro and microvascular reactivity indexes: association between indexes and normative data from 2609 healthy subjects (3-85 years)","volume":"16","author":"Z\u00f3calo","year":"2021","journal-title":"PLoS ONE."},{"key":"B26","doi-asserted-by":"publisher","first-page":"729309","DOI":"10.3389\/fphys.2021.729309","article-title":"Sex-and age-related physiological profiles for brachial, vertebral, carotid and femoral arteries blood flow velocity parameters during growth and aging (4-76 y): comparison with clinical cut-off levels","volume":"12","author":"Z\u00f3calo","year":"2021","journal-title":"Front Physiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1109\/TITB.2012.2190990","article-title":"Health informatics design for assisted diagnosis of subclinical atherosclerosis, structural, and functional arterial age calculus and patient-specific cardiovascular risk evaluation","volume":"16","author":"Santana","year":"2012","journal-title":"IEEE Trans Inf Technol Biomed."},{"key":"B28","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1109\/TITB.2011.2169977","article-title":"Integrated e-Health approach based on vascular ultrasound and pulse wave analysis for asymptomatic atherosclerosis detection and cardiovascular risk stratification in the community","volume":"16","author":"Santana","year":"2012","journal-title":"IEEE Trans Inf Technol Biomed."},{"key":"B29","doi-asserted-by":"publisher","first-page":"20","DOI":"10.3390\/jcdd8020020","article-title":"Changes in body size during early growth are independently associated with arterial properties in early childhood","volume":"8","author":"Castro","year":"2021","journal-title":"J Cardiovasc Dev Dis."},{"key":"B30","doi-asserted-by":"publisher","first-page":"e0226709","DOI":"10.1371\/journal.pone.0226709","article-title":"Aortic pressure and forward and backward wave components in children, adolescents and young-adults: agreement between brachial oscillometry, radial and carotid tonometry data and analysis of factors associated with their differences","volume":"14","author":"Zinoveev","year":"2019","journal-title":"PLoS ONE."},{"key":"B31","doi-asserted-by":"publisher","first-page":"11","DOI":"10.3390\/jcdd7010011","article-title":"Carotid and femoral atherosclerotic plaques in asymptomatic and non-treated subjects: cardiovascular risk factors, 10-years risk scores, and lipid ratios' capability to detect plaque presence, burden, fibro-lipid composition and geometry","volume":"7","author":"Marin","year":"2020","journal-title":"J Cardiovasc Dev Dis."},{"key":"B32","doi-asserted-by":"publisher","first-page":"62","DOI":"10.3390\/jcdd8060062","article-title":"Physical activity, sedentary behavior and sleep time: association with cardiovascular hemodynamic parameters, blood pressure and structural and functional arterial properties in childhood","volume":"8","author":"G\u00f3mez-Garc\u00eda","year":"2021","journal-title":"J Cardiovasc Dev Dis."},{"key":"B33","doi-asserted-by":"publisher","first-page":"e13947","DOI":"10.14814\/phy2.13947","article-title":"Wave reflections and global arterial compliance during normal human pregnancy","volume":"6","author":"Rodriguez","year":"2018","journal-title":"Physiol Rep."},{"key":"B34","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1177\/0003319715590056","article-title":"Pulse pressure amplification and arterial stiffness in low-risk, uncomplicated pregnancies","volume":"67","author":"Gomez","year":"2016","journal-title":"Angiology."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1161\/HYPERTENSIONAHA.107.106062","article-title":"Maternal wave reflections and arterial stiffness in normal pregnancy as assessed by applanation tonometry","volume":"51","author":"Macedo","year":"2008","journal-title":"Hypertension."},{"key":"B36","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1002\/uog.17326","article-title":"Longitudinal study of vascular structure and function during normal pregnancy","volume":"49","author":"Iacobaeus","year":"2017","journal-title":"Ultrasound Obstet Gynecol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1016\/j.bpobgyn.2013.08.001","article-title":"Alterations in physiology and anatomy during pregnancy","volume":"27","author":"Tan","year":"2013","journal-title":"Best Pract Res Clin Obstet Gynaecol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1202","DOI":"10.1016\/S0300-8932(03)77039-0","article-title":"The vascular smooth muscle of great arteries: local control site of arterial buffering function?","volume":"56","author":"Bia","year":"2003","journal-title":"Rev Esp Cardiol."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.766723\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,24]],"date-time":"2021-12-24T06:39:50Z","timestamp":1640327990000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.766723\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,24]]},"references-count":38,"alternative-id":["10.3389\/fcvm.2021.766723"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2021.766723","relation":{},"ISSN":["2297-055X"],"issn-type":[{"type":"electronic","value":"2297-055X"}],"subject":[],"published":{"date-parts":[[2021,12,24]]},"article-number":"766723"}}