Relationship of plasma interleukin-18 concentrations to traditional and non-traditional cardiovascular risk factors in patients with systemic lupus erythematosus

OBJECTIVES: Systemic lupus erythematosus (SLE) is associated with premature atherosclerosis. Recent studies indicated that the concentrations of circulating interleukin (IL)-18, a novel proinflammatory T helper-1 cytokine, in SLE patients were significantly higher than those in healthy control subjects. The objective of this study was to examine the relationship between IL-18 and cardiovascular risk factors in patients with SLE. METHODS: Both traditional and non-traditional cardiovascular risk factors including body mass index (BMI), systolic blood pressure, diastolic blood pressure (DBP), fasting insulin and glucose, plasma lipid profile, plasma homocysteine, thiobarbituric acid-reactive substances, titres of autoantibodies against oxidized low-density lipoprotein, and brachial-ankle pulse wave velocity (baPWV) were determined in a total of 72 female SLE patients. All patients were further classified into subgroups based on tertiles of plasma IL-18 concentrations. RESULTS: Plasma concentrations of IL-18 were significantly higher in SLE patients than age-matched healthy controls. SLE patients with IL-18 concentration in the top tertile compared with the bottom tertile had significantly higher plasma levels of insulin, triglyceride, homocysteine and values of homeostasis model assessment insulin resistance (HOMA IR) and HOMA beta-cell. In addition, plasma concentrations of IL-18 correlated positively and significantly with BMI, insulin, HOMA IR, HOMA beta-cell, triglyceride, homocysteine, DBP and baPWV in all SLE patients. CONCLUSIONS: This is th first report showing the relationship between IL-18 and cardiovascular risk factors in SLE. In patients with SLE, the synergistic effects of hyperinsulinaemia, insulin resistance, hyperhomocysteinaemia, and vascular stiffness most likely contribute to the elevation of plasma IL-18 concentrations.     

A positive correlation between homocysteine and brachial–ankle pulse wave velocity in patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is associated with premature atherothrombotic complications. Hyperhomocysteinemia is considered a cardiovascular risk factor. Increased vascular stiffness may increase cardiovascular mortality. Pulse wave velocity (PWV) is a noninvasive method of analyzing vascular stiffness in the assessment of atherosclerosis. The objective of this study was to identify the relationship between plasma homocysteine levels and brachial–ankle pulse wave velocity (baPWV) measurement in SLE. Plasma homocysteine, baPWV, ankle–brachial index, blood pressure, C3, C4, anticardiolipin antibody (aCL), and anti-double-stranded DNA antibodies were determined in a total of 58 female patients with SLE. The control group comprised 32 age-matched healthy females. In addition, all patients were further classified into subgroups according to the presence of aCL (SLE/aCL+, n=27 vs SLE/aCL−, n=31) to determine the effect of aCL on the tested variables. The mean values for plasma homocysteine and baPWV were 13.19 μmol/l and 1,482 cm/s, respectively. Plasma homocysteine levels were significantly elevated in SLE patients when compared with the healthy controls. SLE patients with aCL had a significantly higher plasma homocysteine level than those without aCL. A significant positive correlation between plasma homocysteine and baPWV was found in patients with SLE (r=0.335, P=0.028, n=58). Plasma homocysteine also significantly correlated with right baPWV in all SLE patients (r=0.371, P=0.014, n=58) and in the SLE/aCL+ group (r=0.523, P=0.031, n=27). These findings indicate a possible link between plasma homocysteine and baPWV in SLE. In conclusion, SLE patients had an increased level of plasma homocysteine, and this phenomenon appeared to be related to vascular stiffness.     

健康体检人群脉搏波传导速度的影响因素分析

目的了解健康体检人群肱踝脉搏波传导速度(ba PWV)的影响因素。方法选取2011年3月~2012年3在武警总医院健康医学中心体检的1579例体检者,检测其血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBG),同时测定体质指数(BMI)、收缩压(SBP)、收缩压(DBP)。采用动脉硬化测定仪测定双侧肢体的ba PWV,并以ba PWV≥14 m/s为动脉僵硬度增高。采用多因素Logistic回归分析确定影响动脉弹性的危险因素,采用ROC曲线判断相关影响因素对ba PWV的预测价值。结果 BMI、TG、TC、LDL-C、SBP、DBP、FBG、年龄在ba PWV正常组及升高组有显著差别(P均0.01);多因素Logistic分析显示,年龄、SBP、TG、BMI为ba PWV的独立影响因素(P均0.01);通过ROC曲线分析,AUC曲线下面积最高的为SBP,为0.81,SBP切点选择在135mm Hg时,敏感性为64%,特异性为81%。结论年龄、SBP、TG、BMI为ba PWV的独立影响因素;收缩压对ba PWV最有预测价值。     

老老年人群动态血压参数与动脉僵硬度的相关性

目的探讨老老年人群动态血压参数与动脉僵硬度的相关性。方法筛选年龄≥80岁的老老年人238例,以血压≥160/95 mm Hg(1 mm Hg=0.133 kPa)为标准,分为高血压组(134例)和对照组(104例),并进行臂-踝脉搏传导速度(baPWV)和24 h动态血压监测。用Pearson分析动态血压各参数与动脉僵硬度的相关性。结果高血压组baPWV高于对照组(P<0.05)。高血压组偶测收缩压,24 h、昼间和夜间收缩压、舒张压、脉压,收缩压负荷及舒张压负荷均高于对照组.夜间收缩压下降率、舒张压下降率低于对照组,差异有统计学意义(P<0.05,P<0.01)。baPWV与偶测血压;24 h收缩压、舒张压、脉压;昼间收缩压、舒张压、脉压、心率;夜间收缩压、舒张压、脉压;收缩压负荷、舒张压负荷呈正相关(P<0.05,P<0.01),而与夜间收缩压下降率呈负相关(P<0.01)。结论高血压是老老年人群动脉僵硬度增加的一个重要因素,动脉僵硬度与动态血压、脉压、心率及血压负荷相关。     

Correlation between arterial stiffness and coronary flow velocity reserve in subjects with pulse wave velocity >1400 cm/s

Brachial-ankle pulse wave velocity (ba-PWV) is an independent predictor for cardiovascular events. Coronary flow velocity reserve (CFVR) provides important information for coronary endothelial function. In the present study, we investigated the possible relationship between PWV and CFVR, especially in subjects with PWV?>?1400?cm/s. Seventy five subjects were divided into two groups based on baPWV value (baPWV?>?1400?cm/s versus baPWV?<?1400?cm/s). PWV and CFVR were measured by Colin VP-1000 apparatus and non-invasive Doppler echocardiography, respectively. Our results showed that CFVR was significantly lower in patients with baPWV?>?1400?cm/s than in patients with baPWV?<?1400?cm/s (2.57?±?0.68 versus 3.04?±?0.73, p?<?0.01). baPWV was negatively correlated with CFVR in the entire study group (r?=??0.45, p?<?0.0001) even adjusting for age, prevalence of diabetes mellitus and systolic blood pressure (r?=??0.33, p?=?0.044). Moreover, baPWV was markedly negatively correlated with CFVR in patients with baPWV?>?1400?cm/s (r?=??0.42, p?<?0.01). Multiple linear regressions showed that baPWV was independently associated with CFVR in the entire study group (β?=??0.702, p?<?0.001). Our results showed that large arterial stiffness was negatively correlated with decreased CFVR especially in subjects with baPWV?>?1400?cm/s, and baPWV was independently associated with CFVR.     

Selective angiotensin receptor antagonism with valsartan decreases arterial stiffness independently of blood pressure lowering in hypertensive patients.

Angiotensin II plays a key role in the development of vascular disease. We examined the long-term effects of selective angiotensin II receptor (ATR) blockade with valsartan on arterial wall stiffness. Brachial to ankle pulse wave velocity (baPWV) was measured in 28 women and 25 men with hypertension (mean age: 62+/-2 years). The measurements were repeated after 24 weeks of treatment with valsartan, 40 to 160 mg/day, with (n=10) or without (n=36) concomitant statin therapy. By multiple regression analysis, baseline baPWV was correlated with age (p<0.001), systolic blood pressure (SBP, p<0.0001), body mass index (p=0.018), and pulse pressure (p=0.005), but not with total cholesterol (p=0.446). Valsartan lowered mean SBP and diastolic blood pressure (DBP) from 155+/-3 to 140+/-3 mmHg and from 90+/-2 to 82+/-2 mmHg, respectively, and mean baPWV from 1,853+/-49 to 1,682+/-52 cm/s. Lowering of baPWV was not influenced by statin therapy. An overlap analysis was performed to separate the effect of angiotensin II receptor blockade from that of blood pressure (BP) lowering. The decrease in the baPWV value of 1,794+/-46 cm/s before valsartan (n=39) vs. 1,663+/-45 cm/s during valsartan (p=0.048, n=31) at a similar mean SBP level (149+/-2 vs. 146+/-3 mmHg, p=0.304) confirmed that ATR blockade had a beneficial effect independent of BP lowering. SBP strongly influences baPWV. However, the decrease in baPWV with valsartan was independent of BP lowering. Statins had no synergistic effect on baPWV. Lowering of baPWV may account for the therapeutic benefit conferred by valsartan independent of its BP-lowering effect.     

增龄是影响健康人臂踝脉搏波速度的主要因素

目的 探讨健康人群臂踝脉搏波速度(baPWV)和踝臂指数(ABI)作为反映血管功能状态的指标随增龄变化的规律.方法 以沈阳地区健康人群为基础的横断面研究,按性别分为男性和女性两组;年龄每10岁分为一组:44岁及以下、45～54岁、55～64岁、65～74岁、75岁及以上共5组,总计400人.检测血脂、血糖等生化指标;颈动脉超声检测颈总动脉内膜中膜厚度、双侧颈总动脉血流参数等指标;动脉硬化检测仪检测四肢血压(包括收缩压、平均动脉压、舒张压、脉压差)、baPWV和ABI等指标.结果 各年龄组间baPWV存在显著差异(P<0.05),随增龄baPWV变快,≤44岁年龄组和45～54岁年龄组baPWV值男性显著高于女性(P<0.05);不同性别各年龄组间ABI值均无显著差异.相关分析显示年龄与baPWV具有显著相关性(r=0.732,P<0.01);而baPWV与收缩压、脉压差、舒张压、颈动脉内膜中膜厚度、颈总动脉内径、收缩期峰值血流速度、颈动脉舒张期末血流速度亦显著相关(r分别为0.697、0.655、0.463、0.537、0.502、-0.277、-0.372,均P<0.01);baPWV与低密度脂蛋白、空腹血糖、总胆固醇、总甘油三酯的r值分别为0.176、0.163、0.125、0.099(均P<0.05).结论 年龄是影响健康人动脉僵硬度最主要的因素,baPWV可以反映随增龄动脉结构和功能的改变,可以有效评估健康人群血管健康状态.     

Elevation of fasting insulin and its association with cardiovascular disease risk in women with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is associated with premature atherosclerosis. We previously showed that SLE patients have a higher risk of insulin resistance (IR) and abnormal insulin secretion. The present study was to further investigate the relationship between fasting insulin levels and both classic and novel cardiovascular risk factors in patients with SLE. Body mass index (BMI), fasting glucose and insulin, lipid profile, oxidation markers, fibrinolytic factors, vascular function factors, and disease-specific variables were determined in a total of 87 female SLE patients. The homeostasis model assessment (HOMA) was used to evaluate the IR and secretion. SLE patients had significantly higher fasting insulin, HOMA IR, HOMA β-cell, titers of autoantibodies against oxidized low density lipoprotein, systolic blood pressure, homocysteine, and brachial-ankle pulse wave velocity (baPWV) than age-matched healthy controls. There were no statistical differences in disease duration, anti-dsDNA, C3, C4, disease activity, and medication dosage between SLE patients stratified by fasting insulin levels. However, mean values for BMI, insulin, HOMA IR, HOMA β-cell, triglyceride (TG), homocysteine, and baPWV were significantly higher in the SLE patients with hyperinsulinemia when compared with those SLE controls. In addition, fasting insulin levels were positively correlated with TG, homocysteine, blood pressure, plasminogen activator inhibitor 1, and baPWV in SLE patients. The elevation of fasting insulin levels in SLE patients is not only associated with IR, but is related to classic and novel cardiovascular risk factors. This study concludes that there is an insulin-related cardiovascular disease risk in SLE. T. K. Tso and W.-N. Huang have equal contributions to this work.     

老年高血压和糖尿病患者动脉僵硬度的影响因素分析

目的 评价老年高血压和(或)糖尿病患者动脉僵硬度及其影响因素. 方法 320例老年患者分为4组:对照组、糖尿病组、高血压组、高血压并存糖尿病组(联合患病组).收集年龄、体质指数、性别、吸烟、血压、脉压及平均动脉压,测定血清空腹血糖、血脂、糖化血红蛋白、超敏C反应蛋白等;并应用COLIN-VP1000动脉硬化测定仪测量入选者踝臂脉搏波传导速度(baPWV)以评价对动脉硬化的影响. 结果 联合患病组、糖尿病组、高血压组、对照组baPWV值分别为(2165.9±479.9)cm/s、(2158.6±386.9)cm/s、(1881.2±383.8)cm/s和(1667.2±279.3)cm/s,联合患病组、高血压组及糖尿病组的baPWV水平与对照组比较,差异均有统计学意义(F=8.473,P＜0.05),联合患病组与糖尿病组的baPWV值比较,差异无统计学意义,高血压组与糖尿病组及联合患病组的baPWV值比较,差异有统计学意义(均P＜0.05).联合患病组脉压、超敏C反应蛋白最高,与对照组比较,差异有统计学意义(均P＜0.05).多元线性回归分析结果显示,血清空腹血糖、平均动脉压、脉压、超敏C反应蛋白、低密度脂蛋白胆固醇与baPWV水平呈正相关(均P＜0.05). 结论 糖尿病、高血压是老年人动脉僵硬度增高的影响因素,而高血糖对老年人动脉僵硬度的影响可能起了更重要的作用.血糖、平均动脉压、脉压、超每C反应蛋白、低密度脂蛋白胆固醇均是影响动脉僵硬度的独立危险因素.     

Decreased serum bilirubin is associated with arterial stiffness in men

Background and aimsThe brachial-ankle pulse wave velocity (baPWV) is a marker for early atherosclerotic changes. Serum total bilirubin (TB) is an effective antioxidant and has been associated with carotid intima-media thickness, cardiovascular disease, stroke and peripheral arterial disease, all of which may be caused by arteriosclerosis. This study aimed to investigate the association of TB with arterial stiffness.Methods and resultsIn this cross-sectional study, we investigated the relationship between TB and baPWV in 2207 participants (1331 men, 876 women) in a general health examination. Different metabolic parameters were compared across TB quartiles. Age-adjusted mean values of baPWV gradually decreased with TB quartiles in men (Q1 = 1348, Q2 = 1266, Q3 = 1215, and Q4 = 1154 cm/s). However, the age-adjusted means of baPWV had no significance in women according to TB quartiles. Univariate analysis showed that age, smoking status, BMI, SBP, DBP, AST, ALT, GGT, TB, TG, and HDL-C were significantly associated with baPWV in men, whereas only age, BMI, SBP, DBP, TG and FPG were significantly associated with baPWV in women. In addition, BMI, SBP, TB, age, TG, and AST were significant factors in the multivariate model with baPWV in men; only BMI and FPG were significant factors with baPWV in women.ConclusionThe findings show that serum total bilirubin concentration is negatively correlated to arterial stiffness in Chinese men. Early detection of abnormal bilirubin levels could potentially serve as an early biomarker for arterial stiffness.     

高血压合并高脂血症对血管早期病变的影响

目的探讨高血压合并高脂血症患者肱踝脉搏波传导速度和踝臂指数的变化及相关影响因素。方法随机入选高血压合并高脂血症患者和单纯高血压患者各400例。检测肱踝脉搏波传导速度、踝臂指数、血糖、甘油三酯、低密度脂蛋白、高密度脂蛋白、总胆固醇等指标,比较两组肱踝脉搏波传导速度和踝臂指数值的差异,对血脂异常进行临床分型,比较各血脂异常亚型之间肱踝脉搏波传导速度值的差异,并对肱踝脉搏波传导速度相关影响因素进行相关分析。结果高血压合并高脂血症组肱踝脉搏波传导速度值(1674.0±13.0 cm/s)较单纯高血压组(1594.0±11.2 cm/s)显著升高(P<0.001);两组间踝臂指数值差异无统计学意义(P=0.897)。高血压病患者中,高甘油三酯血症、高胆固醇血症、混合型血脂异常组肱踝脉搏波传导速度值均显著高于单纯高血压组(P<0.001)。单因素相关分析表明,总胆固醇、低密度脂蛋白、总胆固醇/高密度脂蛋白均与动脉硬度指标肱踝脉搏波传导速度显著相关(P<0.05)。多元线性逐步回归分析结果表明,高血压患者中收缩压、年龄、总胆固醇/高密度脂蛋白、体质指数和空腹血糖与反映动脉僵硬度的肱踝脉搏波传导速度关系密切(P<0.05),总胆固醇/高密度脂蛋白(β=0.104,P<0.001),是仅次于收缩压和年龄的影响因素。结论血脂与肱踝脉搏波传导速度相关,高脂血症加速了高血压病患者的动脉硬化,高甘油三酯血症对动脉硬度的影响与高胆固醇血症相当,应引起足够的重视。     

Efficacy of various antihypertensive agents as evaluated by indices of vascular stiffness in elderly hypertensive patients.

When observed in elderly hypertensive patients, increased pulse pressure (PP) and arterial stiffness are known to be independent risk factors for cardiovascular diseases. Increased systolic blood pressure (SBP) leads to left ventricular hypertrophy, while decreased diastolic blood pressure (DBP) results in decreased coronary circulation. It is known that increased arterial stiffness is the major cause of increased PP. Thus basic morbid states of cardiac failure or ischemic heart diseases are more likely to develop in elderly hypertensive patients with increased PP and arterial stiffness, and there is need of antihypertensive drugs that decrease these effects in elderly hypertensives. In this study, we compared the effects of an angiotensin-receptor blocker (ARB: valsartan), an angiotensin-converting enzyme inhibitor (ACE-I: temocapril), and long-acting Ca antagonists (L- and N-type Ca channel blocker: cilnidipine; and L-type Ca channel blocker: nifedipine CR) on PP and arterial stiffness measured by pulse wave velocity in elderly hypertensive patients for 3 months. The ARB yielded the largest reductions in PP and brachial-ankle pulse wave velocity (baPWV), followed by the ACE-I and L- and N-type Ca channel blocker, while the L-type Ca channel blocker yielded no improvement. The effects on arterial stiffness and PP thus varied among the drug characteristics. Although ARB achieved the largest reduction in baPWV, this decrease was not associated with any reductions in PP, SBP, DBP, or mean blood pressure, as were the baPWV-decreases achieved by the other drugs, suggesting that ARB may further reduce the risk of arteriosclerosis in elderly hypertensive patients by decreasing arterial stiffness in addition to its antihypertensive effect.     

Metabolic Syndrome-Associated Risk Factors and High-Sensitivity C-Reactive Protein Independently Predict Arterial stiffness in 9903 Subjects With and Without Chronic Kidney Disease

Metabolic syndrome (MS), high-sensitivity C-reactive protein (hs-CRP), and chronic kidney disease (CKD) are related to cardiovascular diseases. Although MS is common in CKD subjects, the contribution of MS-associated risk factors and hs-CRP to arterial stiffness in CKD has not been well studied.In this cross-sectional cohort study, we enrolled 9903 subjects who underwent brachial-ankle pulse wave velocity (baPWV) measurements from our database of Health Care Center. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m². Comparing those grouped with and without CKD, multivariate linear regression analyses were used.Overall, baPWV was found to have an inverse relationship with eGFR (P for trend <0.001), which increased progressively with the presence of CKD, increasing number of MS-associated risk factors and hs-CRP (P for trend <0.001). In the non-CKD group, age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose, triglyceride, high-density lipoprotein cholesterol, and hs-CRP independently predicted baPWV, whereas in CKD, eGFR, age, gender, body mass index, SBP, DBP, and fasting glucose remained predictors.The number of MS-associated risk factors and hs-CRP remains a determinant of arterial stiffness in both CKD and non-CKD groups. The decline of renal function contributes to arterial stiffness only in CKD but not in non-CKD. Our findings suggest that for CKD subjects, renal function, BP, and glycemic control are potential targets for further interventional studies of arterial stiffness.     

Correlation between brachial-ankle pulse wave velocity and arterial compliance and cardiovascular risk factors in elderly patients with arteriosclerosis.

The objective of this study was to investigate an association between major cardiovascular risk factors and each of brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI), capacitive arterial compliance (C1), and oscillatory arterial compliance (C2) in elderly patients with arteriosclerosis. We analyzed 160 elderly patients with arteriosclerosis. Vessel wall properties were assessed by baPWV and ABI using a VP-1000 Automatic Arteriosclerosis Measurement System, and C1 and C2 were measured using a DO-2020 Cardiovascular Profiling Instrument. In multiple regression analysis, baPWV was significantly correlated with systolic blood pressure (SBP), mean artery pressure, pulse pressure, diastolic blood pressure (DBP), age, and heart rate (r = 0.670, 0.627, 0.580, 0.523, 0.490, 0.200; p < 0.05), ABI was significantly correlated with pulse pressure, SBP and age (r = -0.250, -0.206, -0.168; p < 0.05), C1 was significantly correlated with pulse pressure, SBP, mean artery pressure, age, DBP and heart rate (r = -0.481, -0.469, -0.363, -0.356, -0.239, -0.188; p < 0.05), and C2 was significantly correlated with age, SBP, pulse pressure, DBP, fasting blood glucose, mean artery pressure and heart rate (r = -0.411, -0.395, -0.383, -0.277, -0.213, -0.183, -0.173; p < 0.05). There were no close correlations between baPWV, ABI, or C1 and fasting blood glucose, total cholesterol, triglycerides, or body mass index. Moreover, there were significant correlations between baPWV and C1 (r = -0.444, p < 0.001), and between baPWV and C2 (r = -0.257, p < 0.01). In conclusion, these findings underscore the efficacy of baPWV and ABI in identifying the vascular damage of the aged.     

降压达标干预对原发性高血压患者臂踝脉搏波传导速度的影响

目的 探讨原发性高血压患者降压干预对臂踝脉搏波传导速度(baPWV)的影响.方法 150例高血压患者接受包括缬沙坦80 mg/d在内的降压治疗6个月[降压达标定义为＜140/90 mm Hg(1 mm Hg=133 kPa)]和正常对照组135例,应用欧姆龙-VP1000自动测量baPWV,对其进行标准化的心血管病危险因素调查、体格检查及实验室检查.结果 高血压组baPWV为(2105.8±378.4)cm/s,高于正常对照组的(1371.5±1 76.5)cm/s(t=4.05,P＜0.001).高血压组和对照组的动脉硬化的检出率分别为82.0%和21.8%;高血压组患者的年龄(r=0.51,P＜0.001)、收缩压(r=0.53,P＜0.001)、脉压、(r=0.43,P＜0.05),脉压指数(PPI)(r=0.51,P＜0.05)、空腹血糖(r=0.39,P＜0.01)均与baPWV呈正相关;高血压组的baPWV由(2105.8±378.4)cm/s降低至(1704.2±332.0)cm/s(t=3.85,P＜0.05).降压达标组的baPWV[(1588.8±278.7)cm/s]明显低于未达标组[(1857.7±324.9)cm/s(t=3.67,P＜0.001)].结论 年龄和收缩压是高血压患者baPWV的主要影响因素,降压达标可以改善baPWV,减轻动脉僵硬度.

Abstract：

Objective To investigate the effect of antihypertensive therapy on brachial-ankle pulse wave velocity (baPWV) in patients with essential hypertension (EH). Methods The 150 EH patients (EH group)receiving antihypertensive therapy with valsartan 80 mg/d, and 135 healthy controls (control group) were enrolled in this study. Automatic pulse wave velocity (PWV)measurement system was employed to examine baPWV, and the investigation about cardiac risk factors, physical and laboratory examination was performed. The baPWV was used as an index to show artery stiffness.Results The baPWV was significantly higher in EH group than in control group [(2105.8±378.4) cm/svs. (1371.5±176.5) cm/s, t=4.05, P＜0.001]. The detection rate of atherosclerosis was 82.0% and 21.8% in EH and control group respectively. In EH group, there were positive relationships between age and baPWV (r= 0.51, P＜0. 001), SBP and baPWV (r=0.53, P＜0.001), pulse pressure (PP) and baPWV (r=0.43, P＜0. 05), PP index (PPI) and baPWV (r=0.51, P＜0.05), blood glucose and baPWV (r=0.39, P＜0.01). The baPWV decreased significantly from (2105.8±378.4) cm/s to (1704.2±332.0) cm/s (t=3.85, P＜0. 05) in EH group. The baPWV was significantly lower in the subgroup with a target BP than without a target BP in EH patients [(1588.8±278.7) vs. (1857.7±324.9) cm/s, t=3.67, P＜0.001].Conclusions The age and SBP are primary risk factors for baPWV in EH patients. The antihypertensive therapy can relieve baPWV with a target blood pressure.     

肱踝脉搏波速度测定在心血管病风险评估中的应用

目的 探讨肱踝脉搏波速度（baPWV）与心血管病危险因素的相关性，以及在心血管病风险评估中的价值。 方法 入选309例具有心血管病危险因素的患者，测量baPWV、身高、体质量、腰围、血压，检测血脂、血糖、尿酸、肌酐、血同型半胱氨酸等，收集临床资料，并进行Framingham风险评分（FRS）。比较高baPWV组（≥1750 cm/s）与低baPWV组（<1750 cm/s）心血管病危险因素的差异。分析baPWV与心血管危险因素积累和FRS之间的关系。 结果 两组在年龄、甘油三酯、血糖、尿酸、收缩压、舒张压、脉压、高血压史、糖尿病史、心血管病家族史有统计学差异（均P<0.05），多因素Logistic回归分析显示主要影响因素为年龄（P<0.01）、收缩压（P=0.01）、高血压病（P<0.01）和心血管病家族史（P<0.05）。而且，随着心血管危险因素个数的积累，baPWV水平呈逐渐上升趋势（P<0.01）。随着FRS风险等级的增加，baPWV水平呈上升趋势（P<0.01）。 结论 baPWV升高可能预示着心血管病危险因素累积个数增加和（或）心血管病风险升高。年龄、收缩压、高血压病史和心血管病家族史是影响baPWV的主要危险因素。     

Age,Arterial Stiffness,and Components of Blood Pressure in Chinese Adults

Blood pressure (BP) changes with age. We conducted a cross-sectional study in rural Chinese adults to investigate: (1) what is the relationship between age, arterial stiffness, and BP in Chinese men and women; and (2) to what degree can the age–BP relationship be explained by arterial stiffness, controlling for other covariables.These analyses included a total of 1688 subjects (males/females: 623/1065), aged 40 to 88 years. Among them, 353 (20.9%) had hypertension (defined as systolic blood pressure (SBP) ≥140 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg). Arterial stiffness was measured by brachial–ankle pulse wave velocity (baPWV).baPWV appeared to be more strongly correlated with BP (including SBP, DBP, mean arterial pressure [MAP], pulse pressure [PP]) than age (P < 0.001 for comparisons between Spearman correlation coefficients). Furthermore, baPWV was associated with BP (including SBP, DBP, MAP, and PP) and risk of hypertension in a dose–response fashion, independent of age; in contrast, the age–BP associations were either attenuated or became negative after adjusting for baPWV.Arterial stiffness appears to be an independent contributor to hypertension, even after adjusting for age and other covariables. In contrast, age–BP associations became attenuated or negative after adjusting for baPWV. The utility of baPWV as a diagnostic, prognostic, and therapeutic indicator for hypertension warrants further investigation.     

培哚普利、氨氯地平、替米沙坦对血压及臂踝脉搏波传导速度的影响

目的 比较培哚普利、氨氯地平、替米沙坦i种降压药在改善高血压患者动脉弹性功能方而的差异.方法 112例高血压患者被随机分成三个治疗组:培哚普利组38例、氨氯地平组37例、替米沙坦组37例,每组有34例纳入最终统计数据,在服药前和服药1、3个月后应用科林波形分析仪PWV/ABI型仪器测量患者的臂踝脉搏波传导速度(baPWV).结果 (1)降压治疗后所有三组的收缩压、舒张压、脉压均较治疗前明显降低(P<0.001);心率则未见明显变化.(2)baPWV在三组经降压治疗后均有所下降,治疗前培哚普利组、氨氯地平组、替米沙坦组baPWV分别为(1859±492)cm/s、(1780±335)cm/s、(1859±337)cm/s;治疗1个月后培哚普利组、氨氯地平组、替米沙坦组baPWV分别为(1757±508)cm/s、(1647±285)cm/s、(1632±261)cm/s;治疗3个月后培哚普利组、氨氯地平组、替米沙坦组baPWV分别为(1702±538)cm/s、(1559±288)cm/s、(1566±326)cm/s.治疗1个月后与治疗前比较P<0.001;治疗3个月后与治疗前比较P<0.001;治疗3个月后与治疗1个月后比较培哚普利组和替米沙坦组P<0.01,氨氯地平组P<0.001.(3)降压治疗1个月后三组的baPWV均数差值变化及降压治疗3个月后三组的baPWV均数差值变化均为替米沙坦组最大[分别为(227±195)cm/s、(293±243)cm/s],在三组间比较差异有统计学意义(降压治疗1个月后P<0.01,降压治疗3个月后P<0.05).降压治疗3个月后与降压治疗1个月后比三组baPWV均有进一步的下降(P<0.01).结论 (1)本研究结果提示应用培哚普利、氨氯地平、替米沙坦降压均能改善高血压患者动脉弹性功能.(2)降压治疗1个月及3个月时,替米沙坦改善动脉弹性的作用最为明显.(3)血压降至正常并平稳后继续应用培哚普利、氨氯地平、替米沙坦降压治疗对于动脉弹性仍然存在持续的改善作用.     

脉搏波速度在心血管病中的临床应用

目的：观察心血管病患者臂踝脉搏波速度（baPWV）与心血管事件和心血管危险因素的相关性。方法：连续收集296例心血管病高危患者,进行病史采集,baPWV、身高、体重、腰围、血压、心率测量及血生化检查。比较高baPWV组（≥1700cm／s,138例）与低baPWV组（〈1700cm／s,158例）患者具有危险因素的个数和临床心血管事件发生情况。结果：与低baPWV组相比,高baPWV组心血管事件发生率较高（46．8％：73．9％,P〈0．01）,心血管危险因素数目较多[（3．8±1．0）;（4．7±1．1）,P〈0．001]。影响baPWV的因素主要为年龄（OR=4．985,P〈0．001）、收缩压（OR=4．012,P〈0．01）和脉压（OR=2．691,P〈0．05）。结论：在心血管病患者中,baPWV较高的患者心血管事件发生率高,心血管危险因素多。年龄、收缩压和脉压是影响baPWV的独立危险因素。     

Reproducibility of arterial stiffness indices (pulse wave velocity and augmentation index) simultaneously assessed by automated pulse wave analysis and their associated risk factors in essential hypertensive patients.

Arterial stiffness is a strong determinant of cardiovascular risk. Pulse wave velocity (PWV) and the augmentation index (AIx) are widely used as arterial stiffness indices. We studied the reproducibility of these indices and their association with cardiovascular risk factors in hypertensives. We measured brachial blood pressure (BP), brachial-ankle PWV (baPWV) and carotid AIx (cAIx) twice (at the baseline and 4 weeks after the baseline) using an automatic device in 103 hypertensives. The mean intraobserver-intersession difference was 29.0 cm/s with an SD of 201.6 cm/s for baPWV, and 0.5% with an SD of 5.9% for cAIx, and the Bland-Altman plots demonstrated the good reproducibility of baPWV and cAIx. Both baPWV and cAIx (the average of the 1st and the 2nd measurements) were significantly correlated with age, systolic BP (SBP), and pulse pressure (all, p <0.005); however, these factors were not correlated with each other (r =0.06, NS). cAIx was correlated with height, heart rate (HR), total cholesterol, and low density lipoprotein cholesterol (LDL-C) (all, p <0.05). In multiple regression analysis, age, SBP, and HR emerged as significant independent predictors of baPWV (adjusted R(2)=0.43, p <0.0001), while height, SBP, HR, and LDL-C emerged as significant independent predictors of cAIx (adjusted R(2)=0.58, p <0.0001). Both PWV and AIx measured using an automatic device were fairly reproducible, and their associated risk factors appeared to be different. Automated simultaneous measurement of these arterial stiffness indices may be useful for risk stratification of hypertensives.