Background: Central stiffness is associated with increased pressure wave reflection. It is lower than peripheral in most subjects, but the reversal of central to peripheral stiffness gradient may occur at higher age and it may influence the mechanisms of wave reflection.

Objective: To evaluate the relationships of central and peripheral arterial stiffness to the parameters of wave reflection.

Methods: 528 untreated subjects, aged 25 to 74 years, selcted from general population, were examined. Pulse wave velocity on aorta (aoPWV) and on lower extremity (periphPWV) were measured by Sphygmocor. Wave reflections were assessed using carotid pulse waveform analysis.

Results: 46 subjects with the reversal of stiffness gradient (aoPWV > periphPWV). They had longer effective reflection distance (ERD; p<0.001 in both sexes); their carotid augmentation pressure (CAP) was higher in males (p<0.01), but not in females. We further studied the simultaneous influence of central and peripheral stiffness on parameters of wave reflection in the whole population in multiple linear regression. AoPWV predicted highly significantly (p<0.001) the parameters of wave reflection in both sexes, while periphPWV was only weakly positively associated with CAP in females (p<0.01) and ERD in males (p<0.05).

Conclusions: Reversal of stiffness gradient was uncommon in our sample. It was associated with prolongation of ERD, but the augmentation pressure was not decreased. These results do not confirm the previously published hypothesis that the reversal results in lower reflected wave and is therefore beneficial in older patients. The contribution of muscular-type artery stiffness to the timing and amplitude of reflected wave was small.