ABSTRACT
This chapter in the jubilee edition introduces wave reflection and largely explains differences in pressure and flow waves in different arteries under different conditions, as set out in the next chapter. It also refers to other chapters where change in wave reflection explains apparent paradoxes in management of heart failure (Mullens et al., 2008; O’Rourke and Nichols, 2009a) and differences between achieved blood pressure and outcome in clinical trials (Yusuf et al., 2000; ALLHAT, 2002; Dahlo¨f et al., 2002; Sever et al., 2005; Williams et al., 2006; Jamerson et al., 2008) and smaller trials (Asmar et al., 2001b; Matsui
et al., 2009). It provides a mechanism to explain effects of aging and of diseases such as aortic coarctation (Chapters 19 and 24). It can also explain differences in severity of hypertensive disease in black and white people (Heffernan et al., 2008), and the greater susceptibility of black people to heart failure (Bibbins-Domingo et al., 2009), and differences between males and females (Cecelja et al., 2009). It explains why the same classes of drug are so effective in improving outcomes of patients with hypertension and with systolic heart failure, and probably diastolic heart failure as well – on the basis of reduction in early wave reflection (Chapter 26). Yet wave reflection is barely mentioned in textbooks of medicine or cardiology, and rarely discussed on the main stage of scientific cardiac meetings. And, there is still confusion in the existing literature on the intensity and importance of wave reflection (Table 9.1). Understanding of wave reflection played a key part in the development of scientific surgery.
