Relationship between occupational exposure to lead and local arterial stiffness and left ventricular diastolic function in individuals with arterial hypertension

Relationship between occupational exposure to lead and frequency of complications in persons with arterial hypertension has been poorly investigated. This study aimed at evaluation of the relationship between occupational exposure to lead and manifestation of an increased local arterial stiffness and left ventricular diastolic dysfunction. The studies included 105 men (mean age: 44.47 ± 9.12 years) with arterial hypertension, treated with hypotensive drugs: group I — men occupationally exposed to lead (n = 53), and group II — men not exposed to lead (n = 52). In echocardiographic examination, the left ventricular diastolic dysfunction was diagnosed significantly more frequently in group I than in group II. In eTracking examination mean values of stiffness parameter (β), augmentation index (AI) and one-point pulse wave velocity (PWV-β) were significantly higher and mean values of arterial compliance (AC) were significantly lower in group I than in group II. The logistic regression showed that in the group of persons with arterial hypertension occupationally exposed to lead a more advanced age, higher blood lead concentration and higher mean values of augmentation index represent independent risk factors of left ventricular diastolic dysfunction. The multifactorial regression showed that amongst persons with arterial hypertension occupationally exposed to lead higher blood zinc protoporphyrin concentration, a more advanced age and higher value of body mass index (BMI) represent independent risk factors of an increased local arterial stiffness. In summary, we should note that in the group of persons with arterial hypertension occupationally exposed to lead the study has demonstrated a significantly more frequent manifestation of left ventricular diastolic dysfunction and an increase in local arterial stiffness.     

Effects of salbutamol and glyceryl trinitrate on large arterial stiffness are similar between patients with hypertension and adults with normal blood pressure

AIMS: Endothelial function is characteristically impaired in patients with hypertension. Endothelial function was assessed in men and women with hypertension using a recently described, non-invasive method. METHODS: Twenty patients and 20 controls received salbutamol 400 microg and glyceryl trinitrate (GTN) 500 microg in a two-way randomized, single-blind study. Effects on augmentation index (AIx) were assessed using pulse wave analysis (PWA). RESULTS: Responses (absolute AIx reduction and 95% confidence interval) to salbutamol were 8.4% (6.2, 10.6) and 8.3% (7.0, 9.6) in patients and controls, respectively, and those to GTN were 13.6% (10.8, 16.4) and 15.5% (13.0, 17.0), respectively. CONCLUSIONS: Systemic arterial responses to endothelium-dependent and -independent vasodilators are preserved in patients with mild, uncomplicated hypertension, indicating normal large arterial endothelial function.     

高血压患者动态动脉硬化指数与颈动脉IMT的关系

目的探讨动脉动态硬化指数（AASI）与颈动脉内-中膜改变的相关性。方法我院高血压患者78例,均行动态血压监测、颈动脉内膜中层厚度（IMT）检查。并比较分析其结果。结果 AASI与颈动脉IMT呈明显正相关（r=0.669,P〈0.05）。结论 AASI与颈动脉IMT有明显相关关系。IMT越增厚,AASI越增大。     

Endothelial function,arterial stiffness and lipid lowering drugs

The endothelium is a dynamic organ that plays a pivotal role in cardiovascular homeostasis. Alteration in endothelial function precedes the development of atherosclerosis and contributes to its initiation, perpetuation and clinical manifestations. It has been suggested that the assessment of endothelial function could represent a barometer of vascular health that could be used to gauge cardiovascular risk. This review summarises the various methods used to assess endothelium-dependent vasodilatation and their potential prognostic implications. In addition, the techniques used to evaluate arterial stiffness are discussed. The latter is to some extent controlled by the endothelium and has been the subject of considerable research in recent years. This paper also discusses the effects of lipid lowering treatment on both endothelial function and arterial stiffness.     

Mechanical and circulating biomarkers in isolated clinic hypertension

1. This review examines the current evidence for altered mechanical and circulating biomarkers in isolated clinic hypertension and their potential significance. 2. Arterial stiffness, as assessed by central pulse wave velocity, is influenced by multiple cardiovascular risk factors; however, an independent association with isolated clinic hypertension (ICHT) has not been convincingly shown in four small studies. 3. Endothelial dysfunction, as assessed by brachial artery flow-mediated vasodilation, circulating levels of endothelial markers (e.g. nitrite/nitrate, von Willebrand factor, endothelin-1) and/or circulating levels of inhibitors of vascular nitric oxide (plasma asymmetric dimethylarginine, homocysteine), has been shown to be present in established hypertension and to a variable and inconsistent extent in subjects with ICHT. 4. Evidence of increased oxidative stress in ICHT versus normotensive subjects was found in two of three studies. 5. Circulating inflammatory markers C-reactive protein and plasminogen activator inhibitor-1 were significantly increased in two of three and two of two studies, respectively, in ICHT compared with normotensive subjects. 6. Urinary albumin excretion is a marker of both arterial and renal disease. The consensus from seven studies in patients with ICHT is that albuminuria is not an independent marker for ICHT. 7. Studies to date assessing biomarkers in ICHT have been small and cross-sectional. Larger, long-term longitudinal studies of arterial functional and circulating biomarkers are required to assess the potential vascular impact of ICHT.     

冠心病患者不同时段动态动脉硬化指数的临床观察

目的 研究冠状动脉病变与动态动脉硬化指数(AASI)的关系.方法 对所有入选病例行冠状动脉造影检查,并根据冠状动脉造影结果分为冠心病组和正常对照组.于冠状动脉造影前或后进行24h血压检测和心脏彩色多普勒检查,并计算AASI.结果 冠心病组与正常对照组AASI有统计学差异(P<0.05).结论 AASI与冠状动脉粥样硬化相关.     

卡维地洛、比索洛尔和多沙唑嗪降压疗效比较

目的：观察并比较卡维地洛（Car）、比索洛尔（Bis）和多沙唑嗪（Dox）治疗轻、中度原发性高血压的降压疗效和安全性。方法：选择48例原发性高血压患者,随机分成3组。Car组15例（Car25-50mg,po,qd）;Bis组16例（Bis5-10mg,po,qd）;Dox组17例（Dox4mg,po,qd）。3组疗程均为4wk。检测各组服药后的血压、心率、肝肾功能、血糖和血电解质等。结果：Car组的降压总有效率为80.0％,Bis组为81.25％,Dox组为70.59％,3组疗效无显著差别（P＞0.05）,Car与Dox对心率无影响,而Bis具有减慢心率作用。3种药物对肝肾功能、血糖和血电解质无明显影响。结论：Car、Bis和Dox疗效相似,均能有效降低轻、中度原发性高血压,且无明显不良反应。     

Relationship between arterial stiffness and glucose metabolism in women with metabolic syndrome

1. Cardiovascular risk factors associated with the metabolic syndrome affect vascular functions adversely. The aim of the present study was to assess the relationship between parameters of glucose homeostasis and arterial stiffness in women with characteristics of the metabolic syndrome. 2. Twenty post-menopausal women participated in a cross-sectional study in which systemic arterial compliance (SAC) and plasma glucose, lipids and glycosylated haemoglobin (HbA1c) were measured while subjects were maintained on a diet high in fibre, raised in protein and reduced in saturated fat. 3. Regression analysis suggested that mean ( +/-SD) fasting glucose of 5.9 +/- 1.7 mmol/L, glucose levels 2 h after a 75 g glucose load of 6.8 +/- 3.6 mmol/L, systolic blood pressure of 131 +/- 12 mmHg and HbA1c of 5.3 +/- 1.7% predicted SAC negatively. The following correlations were obtained between SAC and: (i) fasting glucose: R = -0.49, P = 0.028; (ii) 2 h glucose level post-glucose load: R = -0.42, P = 0.064; (iii) HbA1c: R = -0.42, P = 0.056; and (iv) systolic blood pressure: R = -0.55, P = 0.012. 4. Relationships between SAC and fasting glucose and systolic blood pressure were significantly independent of each other. There was no evidence of relationships between SAC and any plasma lipid parameter (other than a trend in relation to plasma triglyceride), bodyweight or waist circumference. 5. In conclusion, in post-menopausal women with metabolic syndrome, fasting plasma glucose and systolic blood pressure, and possibly HbA1c and the 2 h glucose post-glucose load, predicted increased arterial stiffness.     

Effects of valsartan and perindopril combination therapy on left ventricular hypertrophy and aortic arterial stiffness in patients with essential hypertension

Objective To compare the effects of combined therapy of an angiotensin II receptor blocker (ARB; valsartan) and an angiotensin converting enzyme inhibitor (ACEI; perindopril) on blood pressure (BP), metabolic profiles, plasma brain natriuretic peptide (BNP) levels, echocardiographic findings, and aortic pulse wave velocity (PWV) with those of respective monotherapy in never-treated patients with essential hypertension.Methods This was a prospective randomized trial, in which there were 31 patients with essential hypertension and left ventricular hypertrophy (LVH) who visited the outpatient clinic of Oita Red Cross Hospital (14 women and 17 men; mean±SD age, 59±5 years). Each patient was randomly assigned to receive valsartan (160 mg/day, V group, n=10), perindopril (8 mg/day, P group, n=11), or a combination of valsartan (80 mg/day) and perindopril (4 mg/day, V+P group, n=10) for 40 weeks. Ambulatory BP monitoring (ABPM), echocardiographic findings, metabolic findings, plasma BNP levels, and brachial-ankle PWV (baPWV) were evaluated before and after the 40-week therapy.Results The baseline and post-therapeutic BP levels were similar among the three groups. At baseline ABPM, non-dipping was observed in 80, 82, and 80% in the V, P, and V+P groups, respectively. Each 40-week therapy regimen comparably reduced ABP. The plasma BNP levels (P<0.0001 for each), left ventricular mass index (LVMI) (P<0.01 for each), and PWV values (P<0.0001 for each) were also reduced. However, when compared with either V or P group, the percentage reduction in LVMI (P<0.05 and P<0.005, respectively), BNP (P<0.05 for each), and baPWV values (P<0.005 and P<0.001, respectively) was greater in the V+P group.Conclusions Our findings suggest that, when compared with each monotherapy, perindopril and valsartan combination therapy exerts greater beneficial effects regarding the regression of LVH, reduction in BNP, and improvement of PWV in a selected group of essential hypertensive patients with LVH and high prevalence of non-dipping patterns.     

Hereditary and environmental influences on arterial function

1. With the ageing population and increasing heart failure, arterial function has been shown to contribute to cardiovascular risk because of its adverse effects on ventriculovascular coupling. Population studies have confirmed independent prognostic information of arterial stiffening on cardiovascular survival. 2. The term 'arterial function' encompasses a range of phenotypes, including measures of arterial structure/remodelling, measures of arterial wall mechanics, surrogate measures of stiffness and of wave reflection. There exists significant interaction between these measures and none is truly independent of the others. Added to this complexity is the recognition that, although arterial function has a strong genetic component, quantification requires a range of techniques from twin to family and population studies. 3. The contribution of heritability is often derived from statistical models with input from genomic scanning and candidate gene studies. Studies to date confirm a significant heritable component for the majority of phenotypes examined. However, it has also been recognized that the factors involved in blood pressure maintenance are likely to be separate to those in arterial structural degeneration with ageing. Candidate genes for arterial function go beyond those of the sympathetic and renin-angiotensin systems and include genes involved in signalling pathways and extracellular matrix modulation. 4. The present review examines the evidence for heritability of the major arterial function phenotypes with environmental and ageing modulation. A brief overview of the impact of atherosclerotic risk factors on arterial function is included.     

2型糖尿病患者动态动脉硬化指数与颈动脉硬化及其危险因素关系研究

目的探讨2型糖尿病患者动态动脉硬化指数与颈动脉硬化及其危险因素的相关性。方法收集2型糖尿病患者共103例(T2DM组),非糖尿病患者41例为对照组(NDM组)。测定两组动态动脉硬化指数(AASI)、颈动脉内膜中层厚度(IMT)、体重指数(BMI)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、同型半胱氨酸(HCY)及超敏C反应蛋白(hs-CRP)、收缩压(SBP)、舒张压(DBP)、脉压差(PP)、甘油三酯(TG)、总胆固醇(TC)、高密度胆固醇(HDL-C)及低密度胆固醇(LDL-C),并对T2DM组进行相关性分析。结果 T2DM组患者的IMT、AASI、FPG、HCY及hs-CRP与NMD组比较有非常显著性差异(P<0.01),HbA1c有显著性差异(P<0.05)。2型糖尿病患者ASSI与IMT、糖尿病病程、FPG、HbA1c、SBP、PP、TC、LDL-C、HCY、hs-CRP等呈正相关关系。多元逐步回归分析提示2型糖尿病患者ASSI与IMT、HbA1c、PP、HCY、hs-CRP等有独立的相关关系(偏回归系数r分别为0.413、0.362、0.279、0.301、0.322,均为P<0.01)。结论 2型糖尿病患者ASSI与IMT、HbA1c、PP、HCY、hs-CRP等密切相关。     

Effects of doxazosin and atenolol on the fibrinolytic system in patients with hypertension and elevated serum cholesterol

Summary Disturbances in the fibrinolytic system have been associated with cardiovascular disease and its risk factors. In the present study the effects of an alpha₁-adrenoceptor inhibitor (doxazosin) and a selective beta-adrenoceptor blocker (atenolol) on the fibrinolytic system have been evaluated.Eighty four subjects with previously untreated mild to moderate hypertension and elevated serum cholesterol were randomized to receive atenolol or doxazosin in a double-blind study over 6 months. Tissue plasminogen activator(tPA) and plasminogen activator inhibitor (PAI-1) were measured in citrated plasma samples before and after venous occlusion before and at the end of the study period.tPA activity after venous occlusion and tPA capacity were significantly increased after doxazosin as compared to pretreatment values. The fibrinolytic variables did not change in the atenolol group.Thus, doxazosin but not atenolol, improved the activity of the fibrinolytic system in patients with hypertension and an elevated serum cholesterol level. This effect of doxazosin warrants consideration when selecting a first-line antihypertensive drug.Part of this study was presented at the 13th Scientific Meeting of the International Society of Hypertension, Montreal, in June 1990.     

Safety and effectiveness of tadalafil in patients with pulmonary arterial hypertension: Japanese post-marketing surveillance data

Objective: To evaluate the long-term safety and effectiveness of tadalafil in patients with pulmonary arterial hypertension (PAH) in real-world clinical practice.

Methods: This prospective, multicenter, noninterventional, post-marketing surveillance included patients with PAH who were observed for up to 2 years after initiation of tadalafil. Safety was assessed by analyzing the frequency of adverse drug reactions (ADRs), discontinuations due to adverse events (AEs), and serious adverse drug reactions (SADRs). Effectiveness measurements included the assessment of the change in World Health Organization (WHO) functional classification of PAH, 6-minute walk test, cardiac catheterization, and echocardiography.

Results: Among 1676 patients analyzed for safety, the overall incidence of ADRs was 31.2%. The common ADRs (≥1.0%) were headache (7.0%), diarrhea (1.9%), platelet count decreased (1.8%), anemia, epistaxis, and nausea (1.6% each), flushing (1.3%), hepatic function abnormal (1.1%), hot flush, and myalgia (1.0% each). The common SADRs (≥0.3%) were cardiac failure (0.7%), interstitial lung disease, worsening of PAH, and platelet count decreased (0.3% each). Among 1556 patients analyzed for effectiveness, the percentages of patients with improvement of WHO functional class at 3 months, 1 year, and 2 years after the initiation of tadalafil, and last observation were 17.1%, 24.8%, 28.9%, and 22.5%, respectively. At all observation points (except pulmonary regurgitation pressure gradient at end diastole at 3 months), the mean 6-minute walk distance, cardiac catheterization, and echocardiogram measurements showed statistically significant improvement.

Conclusion: This surveillance demonstrated that tadalafil has favorable safety and effectiveness profiles for long-term use in patients with PAH in Japan.     

轻、中度高血压病病人口服多沙唑嗪控释片与贝那普利比较

目的 :评价多沙唑嗪控释片对轻、中度高血压病病人降压有效性及安全性。方法 :采用双盲、双模拟、随机化、平行对照研究方法。 5 8例服多沙唑嗪控释片 4mg ,poqd× 8wk ,5 6例服贝那普利 10mg ,poqd× 8wk。此外 ,对 3 3例开放服多沙唑嗪控释片 4mg ,qd× 8wk。服药前后行 2 4h动态血压监测 (2 4hABPM)。结果 :2组均能有效地降压 ,有效率分别为 81%及 77% (P >0 .0 5 )。多沙唑嗪组不良反应明显少于贝那普利组 (3 %及 2 0 % ) ,P <0 .0 1,无体位性低血压及反射性心动过速。 2 4hABPM示等幅度降日间血压及夜间血压。谷 /峰比值 :SBP为 0 .69,DBP为 0 .5 9。结论 :多沙唑嗪控释片是一种有效安全的长效肾上腺素α1受体阻滞剂。     

氟哌噻吨美利曲辛片对高血压合并焦虑抑郁患者血压变异性及动态动脉硬化指数的影响

目的 探讨氟哌噻吨美利曲辛片对高血压合并焦虑抑郁患者血压变异性及动态动脉硬化指数的影响。方法 选取2014年9月至2016年10月南阳医专第一附属医院门诊或住院收治的原发性高血压且汉密尔顿焦虑量表（HAMA）评分≥14分和/或汉密尔顿抑郁量表（HAMD）评分≥20分的患者126例为研究对象,经降压药物治疗并行动态血压检测血压达标后（24 h动态血压<130/80 mmHg）,按随机数字表法分为观察组和对照组,每组各63例。观察组在降压药物基础上加用氟哌噻吨美利曲辛片,并辅助心理疏导;对照组在降压药物基础上单纯辅助心理疏导。治疗24周后比较两组患者治疗前、后动态血压、血压变异性（BPV）[包括24小时平均收缩压（24 h mSBP）、24小时平均舒张压（24 h mDBP）、24小时收缩压标准差（24 h SSD）、24小时舒张压标准差（24 h DSD）、白天收缩压标准差（dSSD）、白天舒张压标准差（dDSD）、夜间收缩压标准差（nSSD）、夜间舒张压标准差],动态动脉硬化指数（AASI）、HAMA评分、HAMD评分。采用pearson相关性分析HAMA评分HAMD评分与AASI的相关性。结果 治疗前两组患者HAMA评分、HAMD评分与AASI呈正相关（r=0.477,0.552,P均<0.05）;治疗后观察组BPV较治疗前下降,治疗后观察组BPV低于对照组,差异均有统计学意义（P<0.05）;治疗后观察组AASI较治疗前下降,治疗后观察组AASI低于对照组,差异均有统计学意义（P<0.05）;治疗后两组患者HAMA评分及HAMD评分均较治疗前下降,且治疗后观察组低于对照组,差异均具有统计学意义（P<0.05）。结论 氟哌噻吨美利曲辛片不仅可改善高血压合并焦虑抑郁患者症状,还能降低BPV及AASI。     

糖尿病及糖尿病合并高血压对动脉僵硬度的影响

目的探讨糖尿病及糖尿病合并高血压患者动脉僵硬度的变化。方法将188例患者分为健康对照组(A组,30例),单纯糖尿病组(B组,33例),单纯高血压病组(C组,46例)及糖尿病合并高血压组(D组,79例)。测量臂-踝脉搏波速度(baPWV)、踝臂指数(ABI);检测血脂、糖化血红蛋白(HbA1c)、血糖及肾功能。结果 D组baPWV大于B组和C组,B组、C组及D组均大于A组(P<0.05)。多元逐步回归分析提示年龄、收缩压(SBP)和HbA1c是baPWV的独立影响因素。结论糖尿病合并高血压患者动脉僵硬度大于单纯糖尿病或单纯高血压患者;年龄、SBP和HbA1c是baPWV的独立影响因素。     

局部运动与动脉血压及动脉血管顺应性的相关性研究

目的研究血压正常人群,局部运动与动脉血压及动脉血管顺应性的关系。方法入选高校在校健康学生50名（男生20名,女生30名）,均无吸烟史,父和（或）母均无高血压。受试前保持安静、休息5-10min。分别于运动前、运动后3min即刻及运动后休息10min后心率、双下肢血压及左、右侧脉搏波传导速度（PWV）,比较3次所测观察指栆血压、脉搏波速及心率有无统计学意义。结果运动后即刻测得各项指标与辐动前相比,辐动侧收缩压、舒张压及PWV均无明显变化（P〉0.5、0.05〈P〈0.1和0.4〈P〈0.5）、对侧肢体运动后与运动前相比收缩压有统计学意义（0.02〈P〈0.05）;舒张压及PWV均无明显变化（0.05〈P〈0.1和P〉0.5）。休息10min后双侧收缩压、舒张压均下降（P〈0.05）,PWV明显下降（P〈0.001）且下降程度比运动3min时明显;运动前与运动后即刻及运动后休息10min时的心率相比无明显改变（0.1〈P〈0.2和0.05〈P〈0.1）。结论局部运动可影响动脉血压及血管顺应性。     

Effect of aspirin on vasodilation to bradykinin and substance P in patients with heart failure treated with ACE inhibitor

AIMS: We wanted to examine some of the mechanisms by which aspirin might be responsible for counteraction of the effects of ACE inhibitors. Aspirin has been reported to counteract the effects of ACE inhibitors in patients with heart failure. Despite this, there is little evidence on what the mediator of such an effect might be, although there is some evidence to implicate bradykinin and, perhaps, substance P. METHODS: Twelve patients with congestive heart failure treated with an ACE inhibitor were studied on two occasions, after abstaining from aspirin for 14 days, and after 14 days of aspirin 150 mg once daily. Forearm blood flow was measured by venous occlusion plethysmography during intrabrachial infusions of bradykinin and substance P, before and after intrabrachial aspirin. RESULTS: Bradykinin caused profound vasodilation (peak 390%, 95% confidence intervals (CI) 300, 480%; P < 0.01), substance P slightly less (peak 222%, 95% CI 162, 283%; P < 0.01). Intra-brachial aspirin had no effect on its own. The response to bradykinin was unchanged by intrabrachial aspirin (peak 404%, 95% CI 304, 504%) or oral aspirin (peak 320%, 95% CI 209, 431%; P = 0.2). The response to substance P was unchanged by intrabrachial aspirin (peak 226%, 95% CI 171, 281%) or oral aspirin (peak 220%, 95% CI 142, 297%; P = 0.86). CONCLUSIONS: Aspirin has no effect on the vasodilator response to bradykinin and substance P in patients with heart failure treated with an ACE inhibitor. Neither bradykinin nor substance P is likely to contribute to the reported interaction between aspirin and ACE inhibitors.     

Reciprocal relationship between plasma ghrelin level and arterial stiffness in hypertensive subjects

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Age, hypertension and arterial function

1. Ageing exerts a marked effect on the cardiovascular system and, in particular, the large arteries. Using a variety of techniques to assess arterial stiffness, many cross-sectional studies have demonstrated a significant relationship between age and aortic stiffness, although the age-related changes observed in peripheral arteries appear to be less marked. 2. The relationship between arterial stiffness and hypertension is more complex. The distending, or mean arterial, pressure is an important confounder of measurements of arterial stiffness and, therefore, must be taken into consideration when assessing arterial stiffness in hypertensive subjects or investigating the effect of antihypertensive agents. Current methods for correcting for differences in distending pressure involve pharmacological manipulation, statistical correction or mathematical manipulation of stiffness indices. 3. Many studies have provided evidence that both peripheral (muscular) and central (elastic) arteries are stiffer in subjects with mixed (systolic/diastolic) hypertension compared with normotensive subjects. However, it is unclear to what extent differences in mean arterial pressure explain the observed differences in hypertensive subjects. In contrast, isolated systolic hypertension is associated with increased aortic, but not peripheral artery, stiffness, although the underlying mechanisms are somewhat unclear. 4. Traditional antihypertensive agents appear to reduce arterial stiffness, but mostly via an indirect effect of lowering mean pressure. Therefore, therapies that target the large arteries to reduce stiffness directly are urgently required. Agents such as nitric oxide donors and phosphodiesterase inhibitors may be useful in reducing stiffness via functional mechanisms. In addition, inhibitors or breakers of advanced glycation end-product cross-links between proteins, such as collagen and elastin, hold substantial promise.