长期服用氢氯噻嗪对中心动脉压的影响

目的:观察长期服用单药氢氯噻嗪对高血压患者中心动脉压的影响。方法:回顾性分析了参加非洛地平降低心血管事件试验(FEVER)的3个研究中心的受试者资料,选择其中只服用氢氯噻嗪且完成3年以上脉搏波检查随访的76例患者的资料。脉搏波检查在入组时做1次作为基线值,随后每12个月1次至研究结束。观察的中心动脉脉搏波主要指标包括:中心动脉第一峰收缩压、中心动脉第二峰收缩压、中心动脉舒张压、反射波增压及反射波增压指数。结果:与基线值比较,12、24和36个月随访时肱动脉的收缩压和舒张压及中心动脉第一峰收缩压和中心动脉舒张压均有极显著的下降(P<0.001),反射波增压有所下降(P<0.05),而反射波增压指数和心率无显著变化(P>0.05)。结论:长期服用小剂量氢氯噻嗪降低肱动脉压及中心动脉压一样,对反射波增压指数无影响,提示不能产生额外的中心动脉降压获益。     

5-单硝酸异山梨醇酯改善高血压患者血压以及血管弹性的临床观察

目的观察5-单硝酸异山梨醇酯(IS-5-MN)对脉压≥60 mmHg高血压患者动脉弹性功能、反射波及血压的影响.方法选取符合入选条件的30例原发性高血压患者,分两组进行单盲、安慰剂对照研究,每组15人分别给予IS-5-MN(30 mg/d)或安慰剂,疗程四周.标准袖带水银血压计测量肱动脉血压,自动脉搏波速度测定仪测定颈动脉-股动脉脉搏波传导速度(CF-PWV),DO-2020动脉功能测定仪获得大动脉和小动脉弹性指数(C1和C2),桡动脉压力波形分析获得中心动脉压、外周反射波增压及增强指数.结果校正安慰剂效应后,(1)患者CF-PWV明显减慢,C1显著提高,C2无明显改变.(2)反射波增压和增强指数明显下降.(3)外周和中心动脉收缩压和脉压显著降低.结论 5-单硝酸异山梨醇酯明显改善脉压≥60 mmHg高血压患者的大动脉弹性,减弱外周波反射,降低了收缩压和脉压.     

5-单硝酸异山梨醇酯改善高血压患者血压以及血管弹性的临床观察

目的 观察5-单硝酸异山梨醇酯(IS-5-MN)对脉压≥60mmHk高血压患者动脉弹性功能、反射波及血压的影响。方法 选取符合人选条件的30例原发性高血压患者，分两组进行单盲、安慰剂对照研究，每组15人分别给予IS-5-MN(30mg／d)或安慰剂，疗程四周。标准袖带水银血压计测量肱动脉血压，自动脉搏波速度测定仪测定颈动脉-股动脉脉搏波传导速度(CF-PWV)，DO-2020动脉功能测定仪获得大动脉和小动脉弹性指数(C1和C2)，桡动脉压力波形分析获得中心动脉压、外周反射波增压及增强指数。结果 校正安慰剂效应后，(1)患者CF-PWV明显减慢，C1显著提高，C2无明显改变。(2)反射波增压和增强指数明显下降。(3)外周和中心动脉收缩压和脉压显著降低。结论 5-单硝酸异山梨醇酯明显改善脉压≥60mmHg高血压患者的大动脉弹性，减弱外周波反射，降低了收缩压和脉压。     

用桡动脉脉搏波估测硝酸甘油对中心动脉压的影响

目的：通过测量桡动脉波定量硝酸甘油降低中心动脉反射波增压的效应。方法：１９名志愿者,年龄５４±７岁,无严重器质性疾病,试验前停用所有心血管药物至少３天,试验当天禁食。先测基础仰卧位肱动脉血压和桡动脉脉搏波,随后随机贴上安慰剂或 ５ ｍｇ硝酸甘油贴剂,每隔半小时以同样的方式记录血压和脉搏波,共 ５个小时后撕去贴膜,再记录 ２ 小时。动脉脉搏波分析仪实时把桡动脉脉搏波换算为中心动脉脉搏波,显示中心动脉反射波增压（ＡＵＧ）和中心动脉反射波增压指数（ＡＩ）。结果：安慰剂组（９例）,用药前后比较,心率（ＨＲ）,射血时间（ＥＤ）,肱动脉收缩压（ＰＳＰ）,肱动脉舒张压（ＰＤＰ）和肱动脉平均压（ＰＭＰ）及计算的中心动脉波增压、增压指数、中心动脉收缩压等各项参数均无显著变化。 ５ ｍｇ硝酸甘油贴剂组 （ １０例）用药前后比较,射血时程、中心动脉波增压、增压指数、中心动脉收缩压在用药后半小时即显著下降,至３．５小时达高峰,撕去贴膜后２小时恢复到基础水平,但心率、肱动脉收缩压、肱动脉舒张压和肱动脉平均压无明显变化。结论：通过分析桡动脉脉搏波,可以定量中心动脉反射波增压,阐明硝酸甘油的作用,显示其起效、维持、撤除的动态变化,同时也阐明了硝酸     

转换酶抑制剂对原发性高血压患者大动脉功能的影响

目的 评价转换酶抑制剂咪达普利（商品名达爽），苯那普利（商品史洛汀新）对原发性高血压患者外周动脉压，中心动脉压及大动脉功能的影响。方法 采用随机，双盲，双模拟交叉对照法，30名高血压患者随机接受达爽－洛汀新顺序治疗或洛汀新－达爽顺序治疗。应用Sphygmocor动脉平面测压仪测定主动脉反射波增压指数及颈－股动脉PWV作为反映大动脉扩张性的参数，于治疗前后测定外周动脉压及脉搏波并与正常对照组比较。结果 与正常对照组相比，高血压患者反射波增压指数和颈－股动脉PWV明显增高。经达爽和洛汀新治疗10周后外周动脉压，中心动脉压明显降低，主动脉反射波增压指数及颈－股动脉PWV明显降低。结论 长效ACEI达爽和洛汀新在降低血压的同时降低脉搏传导速度和波反射，增加大动脉的顺应性，改善大动脉的缓冲功能。这种血管保护作用可能对于高血压患者的远期预后具有重要价值。     

通过脉搏波分析比较咪达普利对中心和外周动脉压的影响

目的:比较咪达普利对中心动脉压和外周动脉压的影响.方法:经2周的安慰剂洗脱后,年龄18～79岁的53例轻、中度原发性高血压患者每日服用咪达普利5～10 mg共治疗6周.所有患者在开始服药前及研究结束时均做脉搏波检查.只有完成6周治疗的患者列入最终分析.结果:共有48例患者完成该研究.经6周治疗后,脉搏波所有观察指标显著下降(P均＜0.05～0.001),且中心动脉收缩压和脉压下降幅度显著大于肱动脉收缩压和脉压下降(P值分别为0.002和0.003).结论:咪达普利降低外周动脉压和中心动脉压均有效,且降低收缩压和脉压在中心动脉比外周动脉显著,其差异可能系波反射降低所致.     

用桡动脉脉搏波估测硝酸甘油对中心动脉压的影响

目的:通过测量桡动脉波定量硝酸甘油降低中心动脉反射波增压的效应 .方法:19名志愿者,年龄54±7岁,无严重器质性疾病,试验前停用所有心血管药物至少3天,试验当天禁食.先测基础仰卧位肱动脉血压和桡动脉脉搏波,随后随机贴上安慰剂或5 mg硝酸甘油贴剂,每隔半小时以同样的方式记录血压和脉搏波,共5个小时后撕去贴膜,再记录2小时.动脉脉搏波分析仪实时把桡动脉脉搏波换算为中心动脉脉搏波,显示中心动脉反射波增压(AUG)和中心动脉反射波增压指数(AI).结果:安慰剂组(9例),用药前后比较,心率(HR),射血时间(ED),肱动脉收缩压(PSP),肱动脉舒张压(PDP)和肱动脉平均压(PMP)及计算的中心动脉波增压、增压指数、中心动脉收缩压等各项参数均无显著变化.5 mg硝酸甘油贴剂组 (10例)用药前后比较,射血时程、中心动脉波增压、增压指数、中心动脉收缩压在用药后半小时即显著下降,至3.5小时达高峰,撕去贴膜后2小时恢复到基础水平,但心率、肱动脉收缩压、肱动脉舒张压和肱动脉平均压无明显变化.结论:通过分析桡动脉脉搏波,可以定量中心动脉反射波增压,阐明硝酸甘油的作用,显示其起效、维持、撤除的动态变化,同时也阐明了硝酸甘油的有益效应伴随外周血管波反射降低所致的动脉脉搏波的显著变化.     

硫氮[艹卓]酮对高血压患者中心动脉压和波反射的影响

对行左心导管术中高血压病患者分别静注硫氮革酮10mg（观察组）、舌下含化硝酸异山梨酯5mg（对照组），观察两组用药前后中心动脉压及波反射变化。结果用药后两组中心动脉收缩压和舒张压均明显下降，反射波增压值、反射波增压指数降低，以观察组舒张压降低明显。认为硫氮[艹卓]酮对高血压病患者中心动脉舒张压的影响优于硝酸异山梨酯。     

氨氯地平并培哚普利对合并心绞痛的高血压患者中心动脉压及血管弹性的效果

目的：观察氨氯地平并培哚普利对合并稳定型心绞痛的高血压患者中心动脉压、外周血压、动脉弹性功能及反射波的影响。方法：选取符合入选条件的46例合并稳定型心绞痛的原发性高血压患者,随机分两组进行双盲随机对照研究,治疗组24例分别给予氨氯地平（5mg／d）和培哚普利（4mg／d）,对照组22例给予氨氯地平（5mg／d）和氢氯噻嗪（12．5mg／d）,疗程半年。患者行冠脉造影确诊冠心病,造影结束后将造影导管撤到主动脉根部,测出中心动脉压．同时用标准袖带水银血压计测量肱动脉血压．自动脉搏波速度测定仪测定颈动脉一股动脉脉搏波传导速度（CF-PWV）．DO--2020动脉功能测定仪获得大动脉和小动脉弹性指数（C1和C2）．通过导管测量中心动脉压计算出反射波增压指数（AI％）,半年后复查上述指标。结果：经过半年治疗后．治疗组与对照组相比中心动脉收缩压和脉压降低更显著（P〈0．05）,而肱动脉血压二者无明显差异,CF—PwV明显减慢（P〈0．05）,c1显著提高（P〈0．05）,C2无明显改变,反射波增压指数明显下降（P〈0．05）。结论：氨氯地平联合培哚普利更显著地降低了合并稳定型心绞痛的高血压患者中心动脉压,明显改善高血压患者的大动脉弹性。     

转换酶抑制剂对原发性高血压患者大动脉功能的影响

目的评价转换酶抑制剂咪达普利(商品名达爽)、苯那普利(商品名洛汀新)对原发性高血压患者外周动脉压、中心动脉压及大动脉功能的影响.方法采用随机、双盲、双模拟交叉对照法,30名高血压患者随机接受达爽-洛汀新顺序治疗或洛汀新-达爽顺序治疗.应用Sphygmocor动脉平面测压仪测定主动脉反射波增压指数及颈-股动脉PWV作为反映大动脉扩张性的参数,于治疗前后测定外周动脉压及脉搏波并与正常对照组比较.结果与正常对照组相比,高血压患者反射波增压指数和颈-股动脉PWV明显增高.经达爽和洛汀新治疗10周后外周动脉压、中心动脉压明显降低,主动脉反射波增压指数及颈-股动脉PWV明显降低.结论长效ACEI达爽和洛汀新在降低血压的同时降低脉搏波传导速度和波反射,增加大动脉的顺应性,改善大动脉的缓冲功能.这种血管保护作用可能对于高血压患者的远期预后具有重要价值.     

Peripheral augmentation index defines the relationship between central and peripheral pulse pressure

Peripheral systolic blood pressure is amplified above central aortic systolic pressure, but the late systolic shoulder of the peripheral pulse may approximate central systolic pressure. Because late systolic pressure also determines the peripheral augmentation index, a measure of pressure wave reflection within the systemic circulation, this implies a direct relationship between amplification and augmentation. We compared the late systolic shoulder of the peripheral pressure waveform with estimates of central systolic pressure obtained using a transfer function in 391 subjects undergoing diagnostic coronary angiography and/or elective angioplasty (30% with insignificant coronary artery disease). In a subset (n=12) we compared the late systolic shoulder of the peripheral pulse with central pressure obtained with a catheter placed in the aortic root. Measurements were made at baseline, during atrial pacing, and during administration of nitroglycerin. Late systolic shoulder pressure closely approximated transfer function estimates of central pressure (R=0.96; P<0.0001; mean difference+/-SD: 0.5+/-5.2 mm Hg). Despite changes in waveform morphology induced by pacing and nitroglycerin (reducing mean values+/-SE of the augmentation index from 76+/-3.8% to 66+/-4.6% and 60+/-3.3%, respectively), there was close agreement between the late systolic shoulder of the peripheral pulse and measured values of central pressure (R=0.96; P<0.001; mean difference: 1.7+/-4.8 mm Hg). In conclusion, the late systolic shoulder of the peripheral pulse closely approximates central systolic pressure and peripheral augmentation index, the ratio of central:peripheral pulse pressure. Interventions to lower augmentation index and peripheral vascular resistance will have multiplicative effects in lowering central blood pressure.     

老年隐性高血压患者中心动脉压与脉搏波传导速度的相关性研究

目的探讨老年隐性高血压患者中心动脉压及增强指数与脉搏波传导速度(PWV)的相关性。方法选择临床诊断血压正常者250例,根据血压诊断标准分为血压正常(正常组)169例和隐性高血压(隐性组)81例,及高血压患者(高血压组)150例。监测24 h动态血压。并采用大动脉测量仪测量中心动脉压及其反射波;采用PWV测定仪测量颈桡动脉PWV(crPWV)。结果隐性组中心动脉收缩压、中心动脉舒张压、中心脉压、平均收缩压、平均舒张压、收缩末压、增强压、crPWV明显高于正常组,明显低于高血压组(P<0.05,P<0.01)。多元线性回归分析显示,中心动脉收缩压、中心脉压、LDL-C是crPWV的主要影响因素(β=0.268、β=0.313、β=0.311,P<0.01)。结论老年隐性高血压患者中心动脉压及增强指数明显升高,提示动脉弹性下降,中心动脉收缩压、中心脉压、LDL-C是影响动脉僵硬度的主要危险因素。     

Central aortic blood pressure and augmentation index during normal pregnancy

The current study tested the hypothesis that pregnancy-related changes are more pronounced in central hemodynamics, and both central aortic systolic blood pressure (cSBP) and augmentation index (AIx) are independent from brachial systolic blood pressure (bSBP) in normal pregnant subjects. In 830 healthy pregnant women from 12 to 36 weeks gestation, we measured cSBP and AIx-75 (AIx at heart rate of 75 beats per minute) non-invasively by pulse waveforms of the radial artery using an automated applanation tonometric system. In 69 pregnant women, we recorded these data longitudinally. cSBP and AIx-75 significantly declined during pregnancy, reaching its nadir in mid-pregnancy and rising towards term. Pregnancy-related changes were more pronounced in AIx-75 compared with cSBP, but less evident in bSBP. AIx-75, but not cSBP, was independent from bSBP throughout pregnancy. cSBP and AIx-75, but not bSBP, were significantly increased in healthy pregnant women older than 35 years. This study established normal values for pulse wave analysis parameters throughout pregnancy, and indicated that pulse wave analysis might offer additional and independent information about maternal arterial compliance to conventional brachial blood pressure measurements. These data may be used as the basis for further investigation into the role of pulse wave analysis in the assessment, management and prediction of disorders, which might interfere with pregnancy-related cardiovascular adaptations.     

Arterial stiffness assessed by pulse wave analysis in essential hypertension: relation to 24-h blood pressure profile

BACKGROUND: Arterial stiffness is a risk factor for cardiovascular morbidity and mortality and appears to be increased in arterial hypertension. The purpose of the present study was to relate systemic arterial stiffness assessed by pulse wave analysis to variables of 24-h ambulatory blood pressure monitoring (ABPM) in patients with essential hypertension. METHODS: Seventy-two subjects with untreated mild to moderate arterial hypertension underwent evaluation with 24-h ambulatory blood pressure monitoring. In the same subjects, applanation tonometry and pulse wave analysis was performed for evaluation of systemic arterial stiffness expressed as augmentation index and estimated aortic pulse wave velocity. RESULTS: Clinic systolic blood pressure, mean heart rate during 24-h blood pressure monitoring and height were independent predictors of augmentation index and estimated aortic pulse wave velocity. The 41 patients with blunted reduction in nighttime blood pressure (nondippers) showed higher mean systolic blood pressure (p=0.02), lower systolic and diastolic blood pressure variability (p<0.001), higher pulse pressure during 24-h monitoring (p=0.05) and higher estimated aortic pulse wave velocity (p=0.03), indicating stiffer arteries in this group. CONCLUSIONS: These results suggest that blood pressure change from day- to nighttime is an important determinant of arterial stiffness assessed by pulse wave analysis; this association could contribute to the higher cardiovascular risk in nondippers.     

以钙拮抗剂为基础的联合降压对高血压患者中心动脉压和脉搏波传导速度的对比研究

目的探讨氨氯地平联合复方阿米洛利或联合替米沙坦对高血压患者中心动脉压(CAP)和脉搏波传导速度(PWV)的影响。方法采用随机抽样方法选取2008-03-2011-02济南4个社区查体人群中高血压患者275例,年龄50～79岁。随机分为氨氯地平联合复方阿米洛利组(A组,134例)或联合替米沙坦组(B组,141例)。排除68例应用调脂药物的患者后,对207例(A组,102例;B组,105例)患者进行分析。在基线、治疗12、24月,分别应用动脉脉搏波分析仪测量CAP和增强指数,应用PWV测定仪测定颈桡动脉PWV(crPWV)。结果两组治疗12月后,中心动脉收缩压、舒张压、脉压,增强指数及crPWV均明显降低。24月时,B组crPWV较12月时进一步降低[(8.9±2.0)比(9.5±2.2)m/s,P<0.05],然而A组患者的crPWV并未随着时间的延长进一步改善(P>0.05)。治疗12和24月后,B组crPWV下降幅度[12月(-3.5±2.1)m/s,24月(-4.1±2.3)m/s]均较A组[12月(-2.3±1.6)m/s,24月(-2.5±1.8)m/s]更明显(均P<0.01)。结论以钙拮抗剂氨氯地平为基础,联合替米沙坦或复方阿米洛利均能够降低CAP、增强指数和改善大动脉顺应性,其中氨氯地平联合替米沙坦改善动脉弹性更明显,并且随着治疗时间的延长,效果更佳。     

Differential effects of nebivolol and metoprolol on central aortic pressure and left ventricular wall thickness

The aim of this study was to investigate the effects of the vasodilating β-blocker nebivolol and the cardioselective β-blocker metoprolol succinate on aortic blood pressure and left ventricular wall thickness. We conducted a randomized, double-blind study on 80 hypertensive patients. The patients received either 5 mg of nebivolol or 50 to 100 mg of metoprolol succinate daily for 1 year. Their heart rate, central and brachial blood pressures, mean arterial pressure, augmentation index, carotid-femoral pulse wave velocity, and left ventricular wall thickness were measured at baseline and at the end of the study. Nebivolol and metoprolol significantly reduced heart rate, brachial blood pressure, and mean arterial pressure to the same degree. However, reductions in central systolic and diastolic blood pressures, central pulse pressure, and left ventricular wall thickness were significant only in the nebivolol group. The change in left ventricular septal wall thickness was significantly correlated with central systolic blood pressure change (r=0.41; P=0.001) and with central pulse pressure change (r=0.32; P=0.01). No significant changes in augmentation index or carotid-femoral pulse wave velocity were detected in either treatment group. This proof-of-principle study provides evidence to suggest that β-blockers with vasodilating properties may offer advantages over conventional β-blockers in antihypertensive therapy; however, this remains to be tested in a larger trial.     

Association of augmentation index of radial pressure wave form with diurnal variation pattern of blood pressure in untreated patients with essential hypertension

OBJECTIVES: The augmentation index of the radial pulse wave has been reported to be a sensitive aortic stiffness marker in relatively young but not in older individuals. We studied the relationship between augmentation index and the diurnal blood pressure profiles. PATIENTS AND METHODS: Twenty-four-hour ambulatory blood pressure monitoring was performed in 90 untreated patients with uncomplicated essential hypertension. The patients were classified into four groups: dippers, extreme dippers, nondippers, and risers. Augmentation index was calculated as the percentage of the second systolic peak relative to the first systolic peak. RESULTS: No significant differences in the averaged whole 24-h systolic or diastolic blood pressure were observed in the whole set of patients or in subgroup patients with age 60 years or under. In the whole set of patients (58.7 +/- 12.9 years), there were significant differences in augmentation index between patients with abnormal (other than dippers) and normal diurnal blood pressure profiles (dippers). In subgroup patients with age 60 years or below (49.1 +/- 9.1 years, n = 48), the abnormal diurnal blood pressure profile group showed significantly higher augmentation index (89.6 +/- 10.3%) than dippers (80.5 +/- 11.8%). The area under the curve in the receiver operating characteristics curve for distinguishing between dippers than other dippers was 0.73 (P < 0.01). Multivariate analysis demonstrated that abnormal diurnal blood pressure profile was independently associated with increase in augmentation index. In contrast, these relationships were not significant in the over 60 years subgroup patients (69.8 +/- 5.6 years old, n = 42). CONCLUSIONS: The present study revealed that augmentation index was associated with dipping blood pressure patterns in untreated hypertensive patients aged 60 years or younger. Augmentation index determination would be useful for initial assessment in connection with possible abnormal diurnal blood pressure variability in patients with age 60 years or younger.     

Central blood pressure is associated with trunk flexibility in older adults

BackgroundIncrease in central blood pressure is more predictive of future cardiovascular disease than increased brachial blood pressure. Arterial stiffness causes an early return of the reflected pressure wave to the aorta, with subsequently augmented central systolic pressure. It has been reported that arterial stiffness is associated with poor trunk flexibility; however, the effect of flexibility fitness on central blood pressure remains unclear. The purpose of the present study was to examine the relationship between trunk flexibility and central blood pressure using a cross-sectional design.MethodsA total of 198 middle-aged (50–64 years) and older (65–75 years) adults participated in this study. We measured central blood pressure, carotid-femoral pulse wave velocity (cfPWV), and sit-and-reach flexibility as an index of body trunk flexibility. Study subjects were divided into either poor- or high-flexibility fitness group for each age category.ResultsAmong middle-aged subjects, there were no significant differences in any hemodynamic parameters between the two groups. Among older subjects, the central systolic blood pressure and central pulse pressure in the high-flexibility group were lower than that in the poor-flexibility group. cfPWV was also lower in older subjects with high flexibility than those with poor flexibility. Furthermore, sit-and-reach flexibility was significantly correlated with central systolic blood pressure and central pulse pressure.ConclusionWe demonstrated that trunk flexibility is correlated to central systolic blood pressure and pulse pressure in the elderly.     

Superior effect of an angiotensin-converting enzyme inhibitor over a diuretic for reducing aortic systolic pressure

BACKGROUND: In recent studies, benefit has been shown for angiotensin-converting enzyme (ACE) inhibitors and calcium antagonists over a beta-blocker in hypertension, through a greater reduction in aortic than brachial systolic and pulse pressure. No data are available on diuretics, even though these are the preferred initial treatment of patients with mild hypertension. METHODS: In this study, 101 patients with mild essential hypertension were randomly assigned to an 8-week period of monotherapy with enalapril 10 mg a day or indapamide 2.5 mg a day. Central as well as brachial systolic, augmented, and pulse pressure were determined using SphygmoCor, as in the REASON and CAFE trials. RESULTS: Enalapril and indapamide reduced brachial systolic, diastolic, mean and pulse pressure to the same extent, and the heart rate was unchanged. Although there was no difference in brachial pressure with enalapril and indapamide, enalapril caused a greater fall in estimated aortic systolic, and pulse pressures. The augmentation index, an index of wave reflection, fell from 33.7 to 28.3% with enalapril but was unchanged with indapamide. CONCLUSION: Results infer a reduction in wave reflection with enalapril, causing a fall in aortic pressure augmentation, and a corresponding fall in aortic systolic and pulse pressure. These were not apparent from brachial cuff measurements. Results show that a diuretic, like a beta-blocker agent, is not as effective a therapy as an ACE inhibitor in reducing aortic systolic and pulse pressure, and that the difference is not attributable to a change in heart rate.