Consequently, blood viscosity has been established as a major determinant of the work of the heart and tissue perfusion. Because of the dependence of systemic arterial BP on cardiac output and TPR, if blood viscosity and TPR rise, systolic BP must then increase for cardiac output to be maintained. Conversely, when viscosity decreases, blood flow and perfusion will increase. The relationship between BP and viscosity is such that, given a constant systolic BP, if blood viscosity increases, then the total peripheral resistance (TPR) will necessarily increase, thereby reducing blood flow. The factors that primarily determine the work of the heart include systolic blood pressure (BP), blood viscosity, and the volume of blood the myocardium has to pump. Increasing evidence supports the importance of hemodynamic forces that are directly related to the work of the heart as the primary triggering event of atherosclerosis and atherothrombosis.
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