End-Organ Damage Mechanisms · USMLE Step 1

Why does arterial stiffness contribute to end-organ damage in the brain and kidneys?

  1. It decreases pulse pressure transmission to organs
  2. It enhances the Windkessel effect, giving stable flow
  3. It raises pulsatile pressure in the microcirculation, harming microvessels
  4. It substantially reduces overall cardiac output
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Correct answer: It raises pulsatile pressure in the microcirculation, harming microvessels

Stiffened arteries lose elastic buffering (Windkessel effect), causing increased pulse pressure transmitted into microcirculation — damaging small vessels in high-flow organs like brain and kidneys.

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