西拉普利与美托洛尔对高血压前臂动脉功能影响的临床研究

目的：比较西拉普利与美托洛尔长期治疗原发性高血压患者肱动脉功能的影响。方法：脉冲多普勒法。结果：两组原发性高血压患者分别接受西拉普利或美托洛尔治疗6个月后血压均明显下降,但西拉普利组的肱动脉管径、血流速度、血流量和扩张性增加,血流阻力减少;而美托洛尔治疗组的肱动脉管径、血流速度、血流量和扩张性有所下降或无明显改变。结论：西拉普利可以部分改善高血压者前臂动脉功能。     

原发性高血压肱动脉血液动力学的临床研究

目的：研究原发性高血压患者肱动脉血液动力学特征。方法：脉冲多普勒技术和脉搏波传导速度测定法。结果：与正常血压者相比，原发性高血压患者的肱动脉—桡动脉脉搏波传导速度加快，肱动脉内径和前臂阻力增加，平均血流速度、扩张性和顺应性降低，而血流量无明显差异；在反应性充血状态下，两组的肱动脉内径、平均血流速度和血流量增加，前臂阻力减小，但这些改变在正常血压者更为明显。结论：小于６０岁的无并发症的原发性高血压患者已有大动脉损害。     

长期应用氯吡格雷对冠心病患者血管内皮功能的影响

目的探讨长期应用氯吡格雷对冠心病患者血管内皮功能的保护作用。方法将166例经冠状动脉造影确诊为冠心病的患者(均予裸支架植入治疗)随机分为试验组和对照组,治疗的前6个月两组均应用氯吡格雷和阿司匹林6个月,6个月后对照组只应用阿司匹林,试验组继续应用氯吡格雷和阿司匹林6个月(其他冠心病基础用药一致)。分别于治疗6个月、12个月采用肱动脉超声和上臂反应性充血试验的方法观察并比较两组肱动脉舒张期内径、平均血流速度、血流量、动脉扩张性、血流阻力和肱动脉中膜厚度等反映患者血管内皮功能的指标。结果试验组肱动脉管径、血流速度、血流量和扩张性增加,血流阻力和肱动脉内膜中膜厚度降低;其应用12个月比6个月效果更明显。治疗12个月后试验组比对照组血管内皮功能指标改善更明显(P<0.05)。在反应性充血状态下,试验组肱动脉管径、血流速度、血流量增加,血流阻力降低;而对照组血流速度、血流量、血流阻力、肱动脉管径等指标治疗12个月与治疗6个月差异无统计学意义(P>0.05)。结论长期应用氯吡格雷对冠心病患者血管内皮功能可能有保护作用。     

西拉普利改善高血压动脉功能的临床研究

研究原发性高血压患者上臂动脉功能与血液动力学改变及西拉普利对其逆转效应。方法脉冲多普勒法。结果与血压正常者（ＮＴ）相比，高血压患者（ＨＴ）的前臂阻力（Ｒ）和肱动脉内径（Ｄｄ）增加，平均血流速度（Ｖｍ）减慢，扩张性（ＤＩＳ）和顺应性（ＣＯＭ）减小，但血流量（Ｑ）无差异；在反应性充血状态下，两组的Ｄｄ、Ｖｍ、Ｑ增加，Ｒ减小，但这种变化在ＮＴ更为明显。西拉普利治疗１２周后，ＨＴ的Ｄｄ、Ｖｍ、Ｑ、ＤＩＳ、ＣＯＭ增加，Ｒ减小，但仍与ＮＴ有差异。结论高血压患者早期已有动脉损害，西拉普利可部分逆转这种改变。     

硝普钠对高血压病患者动脉功能和血浆血管紧张素Ⅱ浓度的影响

目的　探讨硝普钠对高血压病患者肱动脉功能及血浆血管紧张素Ⅱ (ANGⅡ )含量的影响。方法　用脉冲多普勒检测肱动脉的功能 ;放射免疫法测定血浆ANGⅡ的含量。结果　硝普钠治疗后高血压病患者的血压显著下降 ,心率未见明显变化 ;接受硝普钠治疗后患者的肱动脉管径、血流速度、血流量和扩张性增加 ,血流阻力减少 (P <0 .0 5 ) ;血浆ANGⅡ的测定显示 ,硝普钠治疗后患者血浆ANGⅡ的含量明显降低 (P <0 .0 5 )。结论　硝普钠可明显改善高血压患者肱动脉的顺应性 ,其机制除涉及NO的生成外 ,可能还与血浆ANGⅡ的减少有关。     

硝苯地平控释片改善血管内皮功能的探讨

目的 :通过对原发性高血压患者的肱动脉超声及血管肽的测定探讨硝苯地平控释片 (拜新同 )改善内皮功能的机制。方法 :将 40例原发性高血压患者分为硝苯地平控释片组 (n =2 0 )及美托洛尔组 (n =2 0 )进行比较 ,均治疗 8周 ,并将 2 0例正常健康人作为对照 (正常对照组 )。采用肱动脉超声的方法进行血管内皮依赖性舒张功能的判断及放射免疫分析法进行治疗前、后的血管活性肽肾上腺髓质素 (ADM )、一氧化氮 (NO)、内皮素 1(ET 1)及血管紧张素Ⅱ (AngⅡ )的测定。结果 :①两组药物治疗后与治疗前比较血压均明显降低 ,有非常显著性差异 (P <0 .0 1)。②硝苯地平控释片组治疗后发现血流介导的肱动脉内径扩张率增加 11.2 % ,肱动脉血流速度增加 18.4ml/min ,血浆ADM、NO明显增加 ,AngⅡ降低 ,与治疗前比较均有显著性差异 (P <0 .0 5 ) ,而美托洛尔组无此变化。结论 :硝苯地平控释片可能通过促进血管内皮细胞对ADM的分泌及释放 ,介导了NO浓度的增高 ,从而改善了原发性高血压患者的内皮功能。     

福辛普利改善原发性高血压前臂动脉功能的临床研究

目的探讨福辛普利(fosinopril)对原发性高血压肱动脉血液动力学和内皮依赖性舒张功能的影响.方法80例原发性高血压患者随机分为福辛普利组(n＝42)和吲哚帕胺组(indapamide,n＝38)分别于治疗前、后4周和8周进行血压测量并采用高分辨超声技术检测肱动脉横断面顺应性(CSC)、容积扩张性(VD)和肱动脉内皮依赖性舒张功能,作为反映动脉功能的指标.结果分别接受福辛普利和吲哚帕胺治疗的2组原发性高血压患者,8周后血压均得到满意控制,福辛普利组肱动脉内径、CSC和VD均增加,阻力指数降低;血管内皮依赖性舒张功能显著改善.结论福辛普利可以改善高血压患者肱动脉的功能.     

非洛地平缓释片与美托洛尔缓释片对原发性高血压患者中心动脉压影响的对比研究

目的 比较两种降压方案对原发性高血压患者外周肱动脉压及中心动脉压的影响.方法 357例原发性高血压患者随机分为两组,分别给予非洛地平缓释片及培哚普利或美托洛尔缓释片及氢氯噻嗪两种不同降压方案,于治疗前及血压达标后3个月时(非糖尿病患者血压<140/90 mmHg,糖尿病患者血压<130/80 mmHg)分别测量患者肱动脉压及应用桡动脉脉搏波分析仪获得中心动脉压.结果 治疗后两组药物对患者外周肱动脉压的影响无明显不同(P>0.05);但非洛地平缓释片组较美托洛尔缓释片组中心动脉收缩压进一步下降4.5 mmHg(P<0.05).结论 虽然两种降压方案对外周肱动脉压影响相似,但非洛地平缓释片组降低中心动脉收缩压较美托洛尔缓释片组更显著.     

西拉普利对脑梗塞伴高血压患者运动及认知功能的影响

目的探讨西拉普利对脑梗塞伴高血压患者日常生活能力及认知功能的影响。 方法将42例脑梗塞伴高血压患者随机分为西拉普利治疗组22例和常规治疗组20例。西拉普利组给予一平苏2.5mg～5mg,每日一次;常规治疗组给予心痛定和／或利尿剂治疗。两组均行运动治疗、作业治疗及神经营养,治疗过程中每日两次测血压,在治疗前及治疗6周后采用简式Fugl-Meyer评估及Barthel指数分别评定肢体运动功能及日常生活能力(ADL),采用简明精神状态检查（MMSE）评估认知功能。 结果两组降压显效率及有效率无显著性差异,但西拉普利治疗组血压波动较小。与常规组比较,治疗组日常生活能力评分增高显著(P<0.05),且下肢运动功能恢复明显。治疗组认知功能评分与常规组比较无统计学差异,但治疗组定向力及记忆力改善明显优于常规组(P<0.05)。 结论西拉普利降压效果稳定可靠,可改善脑梗塞伴高血压患者日常生活能力及认知功能。     

彩色多谱勒超声对原发性高血压患者血管内皮功能的评价

目的探讨彩色多谱勒超声(CDU)评价高血压患者血管内皮功能的临床意义。方法将50例原发性高血压患者分为Ⅰ(低/中危组)、Ⅱ(高/极高危组)两个实验组,并设对照组Ⅲ,实验组患者给予卡维地洛(Carvedilol)治疗12周,用CDU测定治疗前后基础状态下、反应性充血时和含服硝酸甘油后肱动脉内径及血流量变化。结果(1)原发性高血压患者反应性充血时肱动脉内径的扩张程度及血流量与正常对照组相比有显著性差异;(2)原发性高血压患者卡维地洛治疗12周后反应性充血时肱动脉内径扩张程度及血流量与治疗前相比显著改善。结论应用CDU可较准确、简便、有效地评价高血压患者血管内皮功能,并对临床药物治疗效果的评定也有一定参考价值。     

伊贝沙坦与依那普利联用改善高血压病早期肾损害的观察

目的: 评价伊贝沙坦合用依那普利对原发性高血压患者早期肾功能损害的有效性和安全性。方法: 将110例经血、尿中β2微球蛋白（β2-MG）检测证实具有早期肾功能损害的轻、中度高血压患者,随机分为3组, 即伊贝沙坦组(A组,50例):口服伊贝沙坦150~300 mg/d;依那普利组(B组,26例):口服依那普利5~10 mg/d及伊贝沙坦加依那普利组(C组,34例)。所有入选病例均治疗12周,治疗前后测量血压并采用ELISA法检测血、尿中β2-MG的水平;采用彩色超声多普勒仪检查肾血流量及肾血管重构的情况。结果: 与治疗前相比较,治疗12周后3组患者的收缩压、舒张压均明显下降（P<0.01）;血、尿中β2-MG的水平明显降低（P<0.01）;肾阻力指数（RI）、搏动指数（PI）及平均流速（Vm）明显改善（P<0.01）。治疗后肾血管管壁的厚度及肾动脉的内径与治疗前有显著性差异（P<0.05）。伊贝沙坦与依那普利联合治疗组与单用伊贝沙坦或依那普利治疗组比较,血、尿中β2-MG的水平及肾血管重构指标有显著改善（P<0.01或P<0.05）。 结论: 伊贝沙坦与依那普利联用对有早期肾功能损害的高血压患者,不仅有明显的降压作用,而且有明显改善肾功能的作用。     

原发性高血压患者经颅多谱勒脑动脉血流变化特征分析

目的 探讨原发性高血压患者脑动脉血流变化特征及其影响因素,为高血压防治提供依据。方法 对29名原发性高血压患者和16名健康人进行了经颅彩色多普勒脑血流成像技术（TCI）监测分析,观察大脑中动脉（MCA）的收缩期血流速度（Vs)平均血流速度（Vm)、舒张期血流速度（Vd)、搏动指数（PI）、阻力指数（RI）的变化特征,并与收缩压（SBP）、舒张压（DBP）、平均动脉压（MBP）、脉压进行了直线相关分析。结果 与健康对照组相比,高血压组患者收缩压（SBP）、舒张压（DBP）、平均动脉压（MBP）、脉压和体重指数（BMI）及PI、RI均明显升高（P＜0．01）;高血压组中DBP与Vs,Vm,Vd,PI,RI呈明显正相关（P＜0．05）,脉压与Vs,Vm,Vd及PI呈明显正相关（P＜0．05）。SBP、MBP均与脑血流指标相关不明显（P＞0．05）。结论 高血压患者脑动脉血流变化特征主要表现为PI和RI的显著升高,舒张压和脉压是影响脑血流变化的两个主要因子。TCI是一种简便的、有价值的检查方法。     

Pharmacokinetics, converting enzyme inhibition and peripheral arterial hemodynamics of ramipril in healthy volunteers

The effects of a 10 mg dose of ramipril, a new angiotensin I converting enzyme (ACE) inhibitor, on systemic blood pressure, heart rate, brachial artery blood flow, brachial artery diameter, carotid artery blood flow, carotid artery diameter, forearm vascular resistance, plasma ACE and renin activities and plasma aldosterone were investigated. Ramipril's effects in 6 healthy volunteers on a normal sodium diet were compared with those of placebo over a 24-hour period after oral drug intake in an open cross-over trial. Ramipril inhibited plasma ACE activity, an effect that peaked at 3 to 4 hours and persisted up to at least 24 hours. Plasma renin activity increased from 4 to 12 hours after drug intake and plasma aldosterone was slightly decreased. Systemic blood pressure in the supine position was slightly decreased between 6 and 8 hours after drug intake but heart rate remained unaffected. Ramipril significantly increased brachial artery blood flow, brachial artery diameter and carotid artery blood flow and decreased forearm vascular resistance between 3 and 8 hours after drug administration. These peripheral arterial vasodilating effects were more marked in the muscular resistance vessels and affected both large arteries and arterioles in the brachial vascular territory. A correlation was found between the log of plasma concentrations of ramipril diacid metabolite and the drug-induced plasma ACE activity inhibition and increase in brachial artery blood flow. There was also a correlation between these 2 latter effects. A plasma ACE activity inhibition of 80% was required to induce significant increases in brachial artery blood flow and carotid artery blood flow.     

Conventional ultrasonography Doppler in the assessment of arterial peripheral circulation

Ultrasonography Doppler in the assessment of arterial peripheral circulation. PURPOSE: The ultrasonography-Doppler study of peripheral arterial circulation requires measurements of arterial area and arterial blood flow. The aim of this study was to assess their variabilities, intra- and interobserver. METHODS: We studied brachial arterial circulation of 13 volunteers. Two experimented investigators carried out the examinations. Arterial blood pressure measurements were obtained at the level of the brachial artery of the left arm by means of a semi automated oscillometric device. The brachial artery was approached by ultrasound scan in semi-decubitus position, the arm in exterior rotation and abduction. Brachial artery cross-sectional areas were obtained by a transversal view with a depth of 4-15-cm upstream the antecubital fossa of the forearm. Cross sectional areas were measured at end diastole (SD) and end systole (SS). We measured maximal systolic and diastolic velocities (Vmax and Vmin), mean velocity (Vmoy) and velocity integral (ITV) of the blood flow. We deduced brachial output (D), resistance and pulsatility index (IR, IP), cross-sectional compliance coefficient (C). RESULTS: Intra- and interoperator variability as assessed by the Bland-Altman approach was acceptable SS, SD, ITV, D, Vmax, Vmoy, Vmin C, IR, and IP, in regard with values of variation coefficient, biais, and concordance limits. CONCLUSION: Conventional B-mode ultrasonography may offer a reliable method for arterial peripheral circulation evaluation.     

Study of flow-dependent vasodilation of the femoral artery in hypertensive and normal subjects

Flow dependent vasodilation of brachial artery is not significantly different in hypertensives as compared to normotensives. Since, in vitro, changes in vasomotor tone of large arteries in response to endothelial stimulation may differ depending on the territory, we re-examined phenomenon of flow-dependent vasodilation at the level of the femoral artery in 10 normotensives (NT) and 12 age matched (45 +/- 9 vs 43 +/- 4 yrs) hypertensives (HT). Systolo-diastolic variations of femoral artery diameter (D) were recorded using an original echo-tracking system based on doppler shift while blood flow velocity was measured at the same level using a bidimensional pulsed doppler system (V). A 10 min period of leg ischemia did not induce any significant change in D and V in each group but decreased foot skin blood flow (laser doppler). This decrease occurred to the same extent in NT and HT. During reactive hyperemia following release of the pneumatic cuff, V increased (from 2.1 +/- 0.3 to 12.5 +/- 2.4 cm/s in NT) and returned to control level at the 3rd min. Diastolic diameter (Dd) increased (max: 2nd min) in NT (9.3 +/- 0.8 vs 8.8 +/- 0.9 mm; p less than 0.001) and in HT (9.5 +/- 1.2 vs 8.4 +/- 1.2 mm; p less than 0.01). Dd increased to a greater extent in HT than in NT while reactive hyperemia (laser doppler) did not differ. Thus, a non-invasive method is able to demonstrate a flow-dependent vasodilation at the level of the femoral artery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of age on brachial artery wall properties differs from the aorta and is gender dependent: a population study

Compliance and distensibility are wall properties of large arteries, which may play a role in cardiovascular disease. The purpose of this study was to investigate whether the influence of age on these vessel wall properties differs between vascular territories and is gender-dependent. In a population sample of 498 men and women 20 to 79 years of age, diameter, distensibility, and compliance coefficient of the muscular brachial artery were measured with an echo-tracking device. Distensibility of the aorta was measured with the use of pulse-wave velocity. The effects of age and gender were assessed and adjusted for confounding factors such as mean blood pressure, pulse rate, body mass index, smoking, alcohol intake, and antihypertensive treatment. Covariance analysis showed no relation between gender and distensibility of the elastic aorta. Distensibility of the muscular brachial artery was lower in men, whereas men had a larger diameter and larger compliance of the brachial artery. With age, distensibility of the aorta decreased in both sexes to the same extent, whereas distensibility of the brachial artery did not change significantly. With age, brachial artery diameter increased; this increase was more pronounced in women. In men brachial artery compliance did not change with age, whereas in women compliance of the brachial artery increased with age. This study (1) confirms that distensibility of the aorta, an elastic artery, decreases with age. (2) In contrast to the aorta, after adjustment for confounding factors, in both men and women, no relation exists between age and distensibility of the muscular brachial artery. (3) Brachial artery diameter increase with age is more pronounced in women than in men. (4) In contrast to the well-known decrease in arterial compliance of elastic arteries with age, brachial artery compliance is not decreased with age and is increased in women. In conclusion, the effect of age on large-artery wall properties is not uniform but depends on gender and vascular territory.