高血压病左室舒张功能与血管内皮功能的关系

目的:研究高血压病患者左室舒张功能与血管内皮功能改变之间的关系.方法:研究对象包括46例高血压病患者和20例健康对照者.应用高分辨率超声测量肱动脉充血后反应性扩张(DTRH)和含服硝酸甘油后血管内径的变化(DTNG).应用脉冲多普勒检测二尖瓣口血流及肺静脉血流频谱,测量二尖瓣舒张早期峰值血流速度(Ep)、舒张晚期峰值血流速度(Ap)和两者之比(Ep/Ap)、E峰减速时间(DT)及心房收缩期肺静脉反转血流峰值速度(Ar).检测等容舒张时间(IVRT).将患者分为左室舒张功能正常组(Ep/Ap＞l,Ar正常且DT和IVRT正常)和异常组(Ep/Ap＜1或Ep/Ap＞1且Ar异常或IVRT异常或DT异常).结果:高血压病患者DTRH均低于健康对照者(P＜0.01),且左室舒张异常的患者DTRH较左室舒张功能正常的患者显著减小[(4.70±1.86)%vs.(7.38±2.42)%,P＜0.01].而DTNG及年龄、血压、血脂、血糖的差异均无统计学意义(P＞0.05).相关分析显示:患者DTRH与Ep/Ap、Ep、Ap、Ar、DT、IVRT均存在有意义的相关性(Jp＜0.01).结论:高血压病患者左室舒张功能的改变与血管内皮功能变化密切相关,血管内皮功能障碍可能在左室舒张功能不全的发生发展中起作用.     

中年人运动中及恢复期血压变化及其与血浆一氧化氮的关系

目的探讨中年人群运动中及恢复期血压变化及其与血浆一氧化氮(NO)的关系。方法选择49例健康的中年志愿者,于单次极量运动平板试验前、运动高峰期和运动终止30 min后抽取静脉血样,测定血浆NO的稳定代谢产物硝酸盐及亚硝酸盐的浓度之和,同时在运动及恢复期过程中监测血压。采用Pearson相关分析法分析血浆NO浓度与运动及恢复期血压间的关系,并比较恢复期血浆NO明显增加者与降低者的血压变化情况。结果运动前基线血浆NO浓度为(44．42±23．34)μmol／L,与基线收缩压呈负相关(r =-0．284,P<0．05)。运动高峰期血浆NO平均值增至(68．86±29．45)μmol／L(P<0．01),与运动高峰期血压无相关性。恢复期血浆NO平均值为(67．07±43．21)μmol／L,与恢复期7 min收缩压呈负相关(r= -0．337,P<0．05)。运动终止30 min后的恢复期,约25％志愿者恢复期血浆NO与运动高峰期比较明显增加,50％维持相近水平,另有25％明显下降。恢复期血浆NO增加组(A组)Bruce 2级运动收缩压明显低于恢复期血浆NO降低组(B组)(P<0．05),运动收缩压的增加较B组慢(P<0．05),恢复期3次收缩压均低于B组(均P<0．05或0．01),且恢复较快(P<0．05)。结论NO可能参与运动前血管张力的调节及运动终止后收缩压的恢复过程,运动时外周血管舒张能力可能与恢复期血浆NO的水平有关。     

冠状动脉造影正常女性冠状动脉血流与血管舒张功能的相关研究

目的探讨冠状动脉造影正常女性冠状动脉血流与血管舒张功能的相关性。方法选取2006年3月至2008年10月在北京煤炭总医院进行冠状动脉造影正常的女性患者130例,其中慢血流者67例（慢血流组）,正常血流者63例（正常组）。以Gibson方法进行TIMI帧数的分析,测定两组患者血浆内皮素（ET-1）和一氧化氮（NO）浓度,并分析其与冠状动脉血流的相关性。结果慢血流组左前降支[（36．84-6．0）帧与（32．14-5．5）帧]、左回旋支[（23．14-4．2）帧与（9．1±3．0）帧]、右冠状动脉[（22．24-4．4）帧与（18．8±3．6）帧]内血流帧数均大于正常组差异均有统计学意义（P值分别为0．003,0．019,0．014）。静息时,慢血流组ET-1和NO浓度与正常组比较差异均有统计学意义（P值分别为0．031,0．010）。运动后,慢血流组ET-1和NO浓度与正常组比较差异均有统计学意义（P值分别为0．026,0．017）。校正帧数与NO呈负相关（r=-0．850,P=0．009）,而与ET-1浓度呈正相关（r=0．381,P=0．008）。结论冠状动脉造影正常的女性患者,冠状动脉血流和血管舒张功能具有相关性,血管舒张功能下降可能是导致女性冠状动脉硬化形成的主要机制。     

高血压患者血管内皮舒张功能与动脉弹性的关系研究

目的探讨高血压病患者血管内皮功能障碍与动脉弹性的关系。方法采用高分辨率血管超声法检测80例高血压病患者与40例正常对照组肱动脉血流介导的内皮依赖性血管舒张功能（EDD）;应用动脉弹性功能检测仪测定受试者的大动脉弹性指数（C1）和小动脉弹性指数（C2）。结果高血压病组血流介导的肱动脉舒张反应明显低于对照组[（5.46±3.12）%与（12.12±5.21）%,P〈0.01];高血压病组与正常对照组的C1差异无统计学意义[（10.75±5.12）ml/mmHg×10与（12.09±4.15）ml/mmHg×10,P〉0.05],但高血压病组的C2明显低于正常对照组[（3.42±1.87）ml/mmHg×100与（5.48±2.67）ml/mmHg×100,P〈0.01],高血压病组血流介导的肱动脉舒张反应与C2呈正相关（r=0.4852,P〈0.05）。结论高血压病患者肱动脉内皮依赖血管舒张功能受损和C2降低,且两者之间呈正相关,提示C2可作为一种评价血管内皮功能的新指标。     

肱动脉血流依赖性舒张功能与高血压的相关性研究

目的 通过肱动脉充血实验介导的血流依赖性舒张功能,进行高血压病患者和健康者内皮功能的比较.方法 选择60例高血压病患者和55例健康者进行肱动脉充血实验,测定反应性充血后动脉内径变化率(FMD).结果 高血压病患者肱动脉充血后内径变化率显著低于健康者.结论 高血压病患者存在内皮功能的下降.     

原发性高血压患者血管内皮舒张功能的超声研究

目的及方法 :本文应用血管超声技术对 2 8名原发性高血压患者 ( 期 17例 , 期 11例 )和 13名正常人前臂动脉血管内皮依赖性舒张功能进行了定量研究。结果 :高血压 组及 组患者反应性充血后血流介导的血管扩张 (FMD)均较正常人明显下降 (P<0 .0 5 ,P<0 .0 1)。高血压 组与 组患者充血反应 (RH)均较正常人明显减少 (P<0 .0 5 ) ,而平滑肌介导的血管扩张功能 (GNT- MD)在三组中无差异。正常人给予左旋精氨酸 (L - Arg)后 ,FMD及 RH增加 ,与用药前相比有明显差异 (P<0 .0 5 ) ,平滑肌介导的血管扩张功能 (GNT- MD)在用药前后无差异 ,而两组高血压患者给予 L - Arg后 ,FMD,RH及 GNT- MD在用药前后均无差异。结论 :无创性血管超声检查血管内皮功能的方法在临床应用中是可行的     

老年高血压患者血管内皮舒张功能与内皮素相关性

目的：研究老年高血压患内皮依赖性血管舒张功能和血浆内皮素（ET）的关系。方法：检测51例老年高血压患和15例正常血压老年患肱动脉的内皮依赖性及内皮非依赖性血管舒张功能，同时测定血浆ET－1含量。结果：ET－1含量随血压分级水平递增；高血压各级内皮依赖性血管舒张功能均较对照组明显减弱（P＜0．001）；线性回归分析表明，内皮依赖性血管舒张功能与血管内皮受损的ET释放水平呈负相关，多元逐步回归分析显示进入影响血管内皮舒张功能方程的唯一因素为收缩压。结论：ET测定与超声检测内皮依赖性血管舒张功能具有较好的相关性，但血浆ET水平不能预测内皮依赖性血管舒张功能的损害。高血压是内皮功能受损的独立危险因素。     

动态血压负荷与心脏舒张功能的关系

目的 评价动态血压负荷与轻、中度高血压患心功能的关系。方法 对25例高血压病人和25例健康对照行24h动态血压监测,同时进行彩色多普勒超声心动图检查,安血压负荷程度的不同分为A、B、C、D组,健康对照为N组,比较各组间心功能的差异。结果 A、B、C、D四组舒张早期血流峰值速度（VE）与N组相比均有显性差异;A、B组相比,C、D组相比,VE及VE/VA均有显性差异（P＜0.05) 。结论 血压负荷程度的升高可显影响轻、中度高血压患的心脏舒张功能,可作为预测高血压患的心脏舒张功能改变的敏感指标。     

老年高血压患者血管内皮舒张功能与内皮素相关性

目的研究老年高血压患者内皮依赖性血管舒张功能和血浆内皮素(ET)的关系。方法检测51例老年高血压患者和15例正常血压老年患者肱动脉的内皮依赖性及内皮非依赖性血管舒张功能,同时测定血浆ET-1含量。结果ET-1含量随血压分级水平递增;高血压各组内皮依赖性血管舒张功能均较对照组明显减弱(P<0.001);线性回归分析表明,内皮依赖性血管舒张功能与血管内皮受损的ET释放水平呈负相关,多元逐步回归分析显示进入影响血管内皮舒张功能方程的唯一因素为收缩压。结论ET测定与超声检测内皮依赖性血管舒张功能具有较好的相关性,但血浆ET水平不能预测内皮依赖性血管舒张功能的损害。高血压是内皮功能受损的独立危险因素。     

冠心病患者微量白蛋白尿与血管内皮舒张功能关系的探讨

目的 :探讨冠心病 (CHD)患者微量白蛋白尿 (Malb)与血管内皮舒张功能的关系。方法 :根据有无微量白蛋白尿 ,将 5 2例CHD患者分为 2组 :Malb组 2 0例 ,无Malb组 3 2例。采用高分辨彩色超声技术检测肱动脉舒张功能 :反应性充血后血管舒张 (FMD)、含服硝酸甘油后的血管舒张 (NID )并进行组间对比分析。结果 :CHD伴Malb组吸烟、合并高血压者明显高于不伴Malb组 (χ2分别为 6 93和 5 68,均P <0 0 5 ) ;Malb组的FMD显著低于无Malb组 [分别为 ( 5 96± 0 5 3 ) %和 ( 6 3 2± 0 62 ) % ,P <0 0 5 ] ;血脂、NID等在两组间差异无显著性 (P <0 0 5 )。结论 :伴有Malb的冠心病患者的血管内皮依赖性舒张功能障碍较无微量白蛋白尿者严重 ;Malb是微血管内皮舒张功能受损的临床表现 ;Malb可能是冠心病的又一预测标志和独立危险因素 ;吸烟、高血压病加重血管内皮舒张功能损害。     

Arm and ankle blood pressure response to treadmill exercise in normal people

Summary. Ninteen healthy volunteers, 10 men and nine women (mean age 38 and 30 years), exercised on a treadmill. The systolic blood pressure (BP) was measured at the ankle and in the arm after submaximal (8 min with a final load of 2 W kg^-1 body weight) and maximal exercise. The BP was measured for 10 min after exercise, or until the elimination of a negative pressure difference between ankle and arm. The pre-study resting systolic arm and ankle pressures were 122 ± 11 and 144 ± 13 mmHg. One minute after submaximal exercise, arm and ankle BP were 147 ± 18 and 159 ± 19 mmHg (ankle-arm pressure difference 12 ± 13 mmHg); 1 min after maximal exercise the corresponding figures were 182 ± 26 and 153 ± 35 mmHg (ankle-arm pressure difference -29 ± 33 mmHg). We conclude that maximal exercise, but not an appropriately chosen submaximal exercise level, causes a negative BP difference between ankle and arm in normal people.     

血液透析患者家庭自测血压与透析日血压的相关性研究

目的 调查家庭自测血压与血液透析中心测量血压的关联度,患者在透析中心测量的血压中,哪一个能更好反映非透析日血压的状态. 方法 有56名血液透析患者参与研究,分别采集患者家庭自测血压、上机前血压及上机后不同时间点血压情况,比较不同时间点血压测量值之间的相关性.结果 上机后1h血压判定为高血压组、正常血压组与家庭自测血压判定为高血压组、正常血压组的符合率最高,分别为81.8％、61.8％.将患者按照家庭自测血压状态分为高血压组和正常血压组后,可见高血压组上机前30min的收缩压、舒张压与家庭自测收缩压、舒张压的差值最小,而正常血压组,上机前30min的收缩压、舒张压与家庭自测收缩压、舒张压的差值最大. 结论 上机后1h血压判定为高血压组、正常血压组与家庭自测血压判定为高血压组、正常血压组的符合率最高,可以通过上机后1h血压状态估计患者透析间期的血压情况.     

The incremental value of brachial flow-mediated dilation measurements in risk stratification for incident cardiovascular events: A systematic review

Abstract

Adequate risk assessment for cardiovascular disease (CVD) is essential as a guide to initiate drug treatment. Current methods based on traditional risk factors could be improved considerably. Although brachial flow-mediated dilation (FMD) predicts subsequent cardiovascular events, its predictive value on top of traditional risk factors is unknown. We performed a systematic review to evaluate the incremental predictive value of FMD on top of traditional risk factors in asymptomatic individuals.

Using PubMed and reference tracking, three studies were identified that reported on the incremental value of FMD using change in the area under the curve (AUC). Two large cohort studies found no improvement in AUC when FMD was added to traditional risk prediction models, whereas one small case-control study found an improvement. One study used the net reclassification improvement (NRI) to assess whether FMD measurement leads to correct risk stratification in risk categories. Although this study did not find an improvement in AUC, the NRI was statistically significant. Based on the reclassification results of this study, FMD measurement might be helpful in risk prediction.

Evidence supporting the use of FMD measurement in clinical practice for risk stratification for CVD on top of traditional risk factors is limited, and future studies are needed.     

Increased dilator response to nitrate and decreased flow-mediated dilatation in migraineurs

Background.—It has been known that in a migraine attack intracranial and extracranial arteries on the headache side dilate and when the migraine attack has subsided, the intracranial arteries show segmental narrowing. We hypothesized that patients with migraine had an underlying systemic vasomotion abnormality and there might be an increased nitrate-mediated vasodilatory response in the brachial artery of migraineurs. Accordingly we aimed to measure endothelium dependent and independent functions of brachial artery in migraineurs and healthy subjects.
Materials and Methods.—Twenty-four patients who fulfilled the diagnostic criteria of migraine were enrolled in the study. Twenty-six age- and sex-matched healthy control subjects comprised the control group. Flow-mediated dilatation and nitrate-mediated dilatation were measured in all patients and control subjects by means of brachial artery ultrasonography.
Results.—Flow-mediated dilatation of patients with migraine was significantly lower than that of control subjects (7.6 ± 3.7% vs 10.4 ± 3.5%, respectively, P = .008). However, nitrate-mediated dilatation in migraineurs was significantly higher than that of nonmigraineurs (25% vs 14%, respectively, P < .001).
Conclusion.—We have shown that migraineurs have decreased endothelium dependent function whereas increased nitrate-mediated response in their brachial artery. It can be suggested that the mechanism underlying migraine may be a diffuse vascular vasomotion abnormalities and migraine may be a local manifestation of systemic vascular abnormality rather than a primary cerebral phenomenon.     

Physiological characteristics and hormonal profile of young normotensive men with exaggerated blood pressure response to exercise

Exaggerated blood pressure (BP) response to exercise in normotensive subjects is considered as a predictor of future hypertension. The aim of the study was to find out whether elevated BP response to exercise is associated with any other haemody-namic, metabolic or hormonal abnormalities. Abnormal BP response to exercise, i.e. systolic BP (SBP)>200 mmHg at 150 W or lower workload, was found in 37 out of 180 normotensive, male students, aged 20–24 years. Fifteen students with elevated exercise BP (group E) volunteered for further examinations. Their resting and ambulatory BP showed high normal values. Eight of them had a family history of hypertension. Four subjects met the criteria of cardiac hypertrophy. Significant correlations were found between exercise SBP and left ventricular mass index, average 24 h and daytime SBP recordings. In comparison with normal subjects of the same age (group N, n=13), those from group E did not differ in body mass index, plasma lipid profile, fasting glucose, insulin and catecholamine (CA) concentrations, but had increased erythrocyte sodium content, slightly elevated plasma renin activity and cortisol level. During exercise, E subjects showed greater cardiac output (CO) increases with normal heart rate, total peripheral resistance (TPR) and plasma CA. There were no significant differences between groups in haemodynamic and plasma CA responses to posture change from supine to standing. Glucose ingestion (75 g) caused smaller increases in CO and smaller decreases in TPR in E than in N subjects without differences in BP, blood glucose, plasma insulin and CA. It is concluded that young normotensive men with exaggerated BP response to exercise show some other characteristics that may be considered as markers of predisposition to hypertension or factors promoting the development of hypertension.     

有创血压监测值与无创血压监测值相关性分析

目的 探讨有创血压监测值与无创血压监测值之间的线性关系,为临床血压监测提供参考.方法 选取ICU监测无创血压与有创血压的患者32例,采取自身对照的方法,同时监测患者有创血压及无创血压值,采集数据资料进行比较,并进行线性关系分析.结果 采集有效数据98对,所得数据有创血压收缩压及舒张压值分别为(146.93±21.426),(71.32±13.152) mm Hg,均高于无创血压值的(124.02±19.417),(68.86±15.251)mmHg,差异均有统计学意义(t分别为15.301,3.363;P＜0.05);有创血压与无创血压存在线性关系(r =0.880,P＜0.05).结论 有创血压与无创血压所得监测值之间有差异,不可相互替代,可使用无创血压监测值推导计算有创血压监测值.     

Abnormal vascular reactivity at rest and exercise in obese boys

Background Obese children exhibit vascular disorders at rest depending on their pubertal status, degree of obesity, and level of insulin resistance. However, data regarding their vascular function during exercise remain scarce. The aims of the present study were to evaluate vascular morphology and function at rest, and lower limb blood flow during exercise, in prepubertal boys with mild‐to‐moderate obesity and in lean controls. Materials and methods Twelve moderately obese prepubertal boys [Body Mass Index (BMI: 23·9 ± 2·6 kg m^?2)] and thirteen controls (BMI:17·4 ± 1·8 kg m^?2), matched for age (mean age: 11·6 ± 0·6 years) were recruited. We measured carotid intima‐media thickness (IMT) and wall compliance and incremental elastic modulus, resting brachial flow‐mediated dilation (FMD) and nitrate‐dependent dilation (NDD), lower limb blood flow during local knee‐extensor incremental and maximal exercise, body fat content (DEXA), blood pressure, blood lipids, insulin and glucose. Results Compared to lean controls, obese boys had greater IMT (0·47 ± 0·06 vs. 0·42 ± 0·03 mm, P < 0·05) but lower FMD (4·6 ± 2·8 vs. 8·8 ± 3·2%, P < 0·01) in spite of similar maximal shear rate, without NDD differences. Lower limb blood flow (mL min^?1·100 g^?1) increased significantly from rest to maximal exercise in both groups, although obese children reached lower values than lean counterparts whatever the exercise intensity. Conclusions Mild‐to‐moderate obesity in prepubertal boys without insulin resistance is associated with impaired endothelial function and blunted muscle perfusion response to local dynamic exercise without alteration of vascular smooth muscle reactivity.     

活动平板运动试验中血压异常增高的意义

目的探讨活动平板运动试验所激发的血压异常增高的现象及临床意义。方法从561例受检者中选择运动中SBP≥200mmHg45例作为血压异常增高组,高血压血压反应正常组40例,对照组54例,比较3组间运动与血压反应关系。结果血压异常增高组:运动前静息时的血压(SBP/DBP)均高于其他两组(P<0.001);运动中SBP、血压上升幅度(ΔSBP)显著增高,有统计学意义(P<0.001);而运动时间(time)、代谢当量(Mets)均小于其他两组(P<0.05),说明该组病人运动耐量有不同程度的减退。结论运动所激发的血压异常增高可预示发生高血压的可能性,而对高血压患者应注意运动时血压高峰的控制及运动处方的制定。     

The role of obesity,salt and exercise on blood pressure in children and adolescents

The increasing trends of blood pressure (BP) in children and adolescents pose great concern for the burden of hypertension-related cardiovascular disease. Although primary hypertension in childhood is commonly associated with obesity, it seems that other factors, such as dietary sodium and exercise, also influence BP levels in children and adolescents. Several studies support that sympathetic nervous system imbalance, impairment of the physiological mechanism of pressure natriuresis, hyperinsulinemia and early vascular changes are involved in the mechanisms causing elevated BP in obese children and adolescents. Under the current evidence on the association of salt intake and BP, dietary sodium restriction appears to be a rational step in the prevention of hypertension in genetically predisposed children and adolescents. Finally, interventional studies show that regular aerobic exercise can significantly reduce BP and restore vascular changes in obese with hypertensive pediatric patients. This article aims to summarize previous studies on the role of obesity, salt intake and exercise on BP in children and adolescents.