Pulse pressure and echocardiographic findings in essential hypertension

Blood pressure, carotid-femoral pulse wave velocity and cardiac mass as judged on echocardiography were evaluated in 11 normal subjects and 36 patients with sustained essential hypertension of similar age. The hypertensive patients were divided into two groups of similar age, weight, height and mean arterial pressure: patients in the first group (Group I) had a pulse pressure inferior to 60 mmHg and in the second group (Group II) had a pulse pressure equal or superior to this value. Group II patients had significant higher values for cardiac mass (148.8 +/- 44.3 vs 116.3 +/- 19.8 g/m2; P less than 0.01) (+/- 1 s.d.) than Group I, while mean arterial pressure and pulse wave velocity were similar in the two groups. Stroke volume was significantly higher in Group II than in normal subjects (99.5 +/- 17.1 versus 82.7 +/- 16.9 ml; P less than 0.05). The study findings suggested that the increased pulse pressure in hypertensive patients might influence the development of cardiac hypertrophy independently of mean arterial pressure and aortic distensibility. The increased pulse pressure could reflect a disturbance between ventricular ejection and impedance affecting the ventricle with a resulting increase in pulsatile energy losses and further increase in cardiac mass.     

应用时间-空间相关成像技术评估妊娠期高血压疾病胎儿心功能

目的 探讨时间-空间相关成像(spatio-temporal image correlation,STIC)技术评价妊娠期高血压疾病胎儿心功能的临床应用。方法 运用STIC技术采集110例正常孕妇胎儿及84例妊娠期高血压疾病（PIH）孕妇胎儿心动周期图像,通过VOCAL功能获得容积参数,包括左、右心室舒张末期容积（LVEDV、RVEDV）,左、右心室收缩末期容积（LVESV、RVESV）,计算出左、右心室每搏量（LVSV、RVSV）,左、右心室射血分数（LVEF、RVEF）,左、右心室心排出量（LVCO、RVCO）。根据孕妇高血压严重程度及临床症状分为:PIH I组(孕妇血压轻度升高或轻度子痫前期):即孕妇妊娠20周后第1次出现血压升高,140/90 mmHg≤血压值<160/110 mmHg(1 mmHg=0.133 kPa),间隔6 h以上,至少出现过两次,尿蛋白弱阳性;PIH II组(重度子痫前期):血压≥160/110 mmHg,和(或)尿蛋白阳性或者强阳性(++),或伴有微血管溶血、神经系统及肺水肿等症状。结果 ①与对照组相比,PIH I组胎儿左、右EDV、ESV、SV、EF、CO差异均无统计学意义;②与对照组、PIH I组相比,PIH II组胎儿的左、右EDV、ESV增大、差异有统计学意义（P<0.05,P<0.01）,PIH II组胎儿的SV、EF、CO均减小,差异有统计学意义（P<0.05,P<0.01）。结论 STIC技术可以评价妊娠期高血压病胎儿心功能的变化。     

Acute reduction of blood pressure by nitroglycerin does not normalize large artery stiffness in essential hypertension

Stiffness of large elastic arteries is elevated in subjects with hypertension, an effect that could potentially be explained by increased distending pressure. We examined effects of an acute change in blood pressure on carotid-femoral pulse wave velocity and carotid artery distensibility (inversely related to stiffness) in normotensive control subjects (n=20, mean age 42) with mean arterial pressure (MAP) 84+/-1.7 mm Hg (mean+/-SE) and subjects with essential hypertension (n=20, mean age 45, MAP 104+/-2.0 mm Hg). Normotensive subjects received intravenous nitroglycerin (NTG) and angiotensin II to lower/increase blood pressure. Hypertensive subjects received NTG to lower blood pressure. Pulse wave velocity was 24% (95% CI: 12% to 35%) higher and carotid distensibility 47% (95% CI: 32% to 63%) lower in hypertensive subjects compared with controls. In normotensive subjects, acute changes in blood pressure produced expected changes in stiffness. However, in hypertensive subjects, despite reducing MAP by 22 mm Hg to the same level as in normotensive subjects, there was no detectable reduction in arterial stiffness: pulse wave velocity remained 24% (95% CI: 10% to 38%) higher and carotid distensibility 48% (95% CI: 31% to 63%) lower in hypertensive compared with normotensive subjects. Because blood pressure-independent effects of NTG are, if anything, to reduce stiffness, these results indicate that elevated carotid and aortic stiffness in hypertensive subjects is not explained by elevated blood pressure but relates to structural change in the arterial wall.     

Decreased venous distensibility in essential hypertension: lack of systemic hemodynamic correlates.

Venous distensibility in essential hypertension has been reported to be unchanged or decreased; its pathophysiologic role is uncertain. In 27 male hypertensive patients and 21 normotensive control subjects, forearm venous distensibility and capillary filtration rate at 30 cm of H2O distending pressure were measured by strain gauge plethysmography. Plasma renin activity (PRA), plasma volume (PV) by the Evans blue dye dilution technique, mean arterial pressure (MAP) by cuff, and cardiac output (CO) by the CO2 rebreathing method were also measured. Compared to values in normotensive control subjects, forearm venous distensibility in hypertensive subjects was decreased (P less than 0.05); the forearm venous pressure-volume curves (deflation phase) were shifted in the direction of the pressure axis (P less than 0.02); and the capillary filtration rate was increased (P less than 0.05). Venous distensibility changes in hypertensive subjects were unrelated to PRA, MAP, PV, CO, stroke volume, and total peripheral resistance. These findings confirm previous reports of decreased venous distensibility in hypertension and provide direct evidence for increased capillary filtration rate. In view of the lack of significant correlation between venous distensibility and the measured hemodynamic parameters, a patho-physiologic role for venous distensibility in hypertension could not be established.     

Vascular stiffness in chronic renal failure patients treated by hemodialysis

Cardiovascular disease is a major cause of morbidity in patients with end-stage renal failure. Arterial stiffness measured by pulse wave velocity (PWV) is an independent risk factor for morbidity in end stage renal failure patients. The aim of our study was to evaluate the arterial stiffness in patients with chronic renal failure. In 20 chronic renal failure patients treated by hemodialysis (HD) we assessed the PWV of the carotic artery as well as artery diameter and distensibility, systolic pressure (SBP), diastolic pressure (DBP), pulse pressure (PP), and basal biochemical parameters and compared them with the values determined in 20 healthy controls of comparable age. PWV and PP are significantly (p < 0.001, p < 0.05) higher and distensibility of the carotic artery was significantly lower (p < 0.001) compared to a control group SBP and DBP were < 140/90 mmHg in HD patients (high normotensive range) but were significantly (p < 0.05) higher than in a control group. In HD patients PP was correlated with arterial distensibility r = -0.600 (p < 0.005), and systolic artery rice r = -0.408 (p < 0.05). SBP was correlated with PP r = 0.689 (p < 0.0007) and with arterial distensibility r = -0.476 (p < 0.03), arterial diameter to systolic artery rice r = -0.463 (p < 0.03), systolic artery rice to arterial distensibility r = 0.885 (p < 0.00001), intima media to arterial distensibility r = 0.815 (p < 0.00001), intima media to arterial compliance r = 0.893 (p < 0.00001). Our results suggest that not only established hypertension but also high normotensive pressure could cause arterial stiffness absened in chronic renal failure patients.     

Advanced glycation endproduct crosslink breaker (alagebrium) improves endothelial function in patients with isolated systolic hypertension

OBJECTIVES: Arterial stiffening and endothelial dysfunction are hallmarks of aging, and advanced glycation endproducts (AGE) may contribute to these changes. We tested the hypothesis that AGE crosslink breakers enhance endothelial flow-mediated dilation (FMD) in humans and examined the potential mechanisms for this effect. METHODS: Thirteen adults (nine men, aged 65 +/- 2 years) with isolated systolic hypertension (systolic blood pressure > 140 mmHg, diastolic blood pressure < 90 mmHg or pulse pressure > 60 mmHg) on stable antihypertensive therapy were studied. Subjects received placebo (2 weeks) then oral alagebrium (ALT-711; 210 mg twice a day for 8 weeks). Subjects and data analyses were blinded to treatment. Arterial stiffness was assessed by carotid augmentation index (AI) and brachial artery distensibility (ArtD) using applanation tonometry and Doppler echo, and endothelial function by brachial FMD. Serum markers of collagen metabolism and vascular inflammation were assessed. RESULTS: Alagebrium reduced carotid AI by 37% (P = 0.007) and augmented pressure (16.4 +/- 10 to 9.6 +/- 9 mmHg; P < 0.001). Heart rate, arterial pressures, and ArtD, were unchanged. FMD increased from 4.6 +/- 1.1 to 7.1 +/- 1.1% with alagebrium (P < 0.05), and was unrelated to altered shear stress or regional arterial distensibility. However, FMD change was inversely related to markers of collagen synthesis, p-selectin and intracellular cell adhesion molecule (all P < 0.05). Alagebrium-associated changes in plasma nitrite plus nitrate was inversely correlated with plasma matrix metalloproteinase 9 and type I collagen (P = 0.007). CONCLUSIONS: Alagebrium enhances peripheral artery endothelial function and improves overall impedance matching. Improved endothelial function correlates better with reduced vascular fibrosis and inflammation markers than with vessel distensibility. AGE-crosslink breakers may reduce cardiovascular risk in older adults by reduced central arterial stiffness and vascular remodeling.     

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。     

Ambulatory measurement of the QKD interval normalized to heart rate and systolic blood pressure to assess arterial distensibility--value of QKD(100-60).

BACKGROUND: Reduced distensibility of large arteries plays an important role in cardiovascular risk. Determination of the QKD interval during the ambulatory measurement of blood pressure enables calculation of an index of arterial distensibility. This index, the QKD(100-60), is the theoretical value of QKD at systolic blood pressure of 100mmHg and heart rate of 60bpm obtained from the linear bivariate relationship linking QKD, systolic blood pressure and heart rate on a hundred successive values measured over 24h. This study was designed to examine the relationship between QKD and QKD(100-60) on heart rate and systolic function of the left ventricle, the two parameters governing the pre-ejection time which is part of the QKD interval. METHODS AND RESULTS: In a population of 203 untreated hypertensive patients having benefited from an ambulatory measurement of blood pressure over 24h with QKD monitoring and an M-mode echocardiographic recording of the left ventricle, we found that although mean QKD was linked to heart rate and systolic function of the left ventricle, QKD(100-60) was not. It fell significantly with age, and to a greater extent in the sustained hypertensives than in white-coat hypertensives. CONCLUSION: QKD(100-60) constitutes an index of arterial distensibility independent of the pre-ejection time. As an adjunct to the ambulatory measurement of blood pressure, its determination is simple and completely automatic, thus eliminating observer bias.     

Comparison of two indices of arterial distensibility: temporal apparitions of Korotkoff sounds and pulse wave velocy. A Doppler echocardiography and ambulatory blood pressure monitoring study

Arterial distensibility, one of the factors influencing afterload, plays a role in the development of left ventricular hypertrophy. The QKd, the delay before the perception of the Korotkoff sounds, is an index of arterial distensibility available from ambulatory blood pressure monitoring. The pulse wave velocity (PWV), another index of arterial distensibility, can be measured by Doppler echocardiography. The aim of this study was to compare these two indices with haemodynamic parameters of arterial distensibility and to determine their relationship to left ventricular geometry and function. Sixty-two consecutive patients, with and without cardiac disease, underwent simultaneous Doppler echocardiography and ambulatory blood pressure monitoring. A correlation was observed between QKd and PWV (N = 53, p = 0.007, r = 0.37). The QKd and PWV were correlated to the absolute index of arterial distensibility (systolic index/pulse pressure) (N = 51, p < 0.001, r = 0.48). QKd was correlated with indices of left ventricular function such as EF (N = 55, p < 0.001, r = 0.66) or the systolic pressure/end systolic dimension ratio (N = 54, p < 0.001, r = 0.75). When the ejection time was subtracted from QKd, only the end systolic pressure/end systolic dimension remained significantly correlated (N = 37, p = 0.005, r = 0.40). The authors conclude that PWV and QKd were correlated and were also correlated with indices of arterial distensibility. QKd is a composite index of left ventricular function and arterial distensibility. Doppler echocardiography and ambulatory blood pressure monitoring provide a non-invasive assessment of the aorta/LV couple.     

High pulse pressure and low mean arterial pressure: two predictors of death after a myocardial infarction

OBJECTIVES: Although the negative prognostic implication of a clinical history of arterial hypertension in myocardial infarction (MI) survivors is well known, the predictive role of the blood pressure (BP) regimen after MI is not well defined. The aim of this study was to investigate the prognostic significance of different BP indices in post-MI. METHODS AND RESULTS: We evaluated the relationship between baseline systolic, diastolic, pulse and mean arterial pressure (MAP), measured by sphygmomanometry at discharge from hospital or within 3 months of an MI, and total and cardiovascular mortality in 11 116 patients enrolled in the GISSI-Prevenzione trial. Over 3.5 years of follow-up, 999 patients died, 657 of them from cardiovascular causes. Low mean and high pulse pressure were significantly associated with total and cardiovascular mortality after controlling for potential confounders in the multivariate analysis. As compared with patients with less extreme BP values, patients with MAP of 80 mmHg or less (n = 1241; 11.2%) had a 48% higher risk of cardiovascular death [95% confidenceinterval (CI) 1.16-1.87; P = 0.001] and those with pulse pressure greater than 60 mmHg (n = 958; 8.6%) had a 35% higher risk (95% CI 1.09-1.69; P = 0.007); only four subjects (0.04%) had both a high pulse pressure and a low MAP (relative risk of cardiovascular death 3.48; 95% CI 0.48-25.88; P = 0.218). CONCLUSIONS: Our results show for the first time an additional prognostic importance of two easily measurable components of BP, definitely high pulse pressure (> 60 mmHg) and low MAP (< or = 80 mmHg), in a large sample of non-selected patients surviving MI who entered a modern programme of cardiovascular prevention.     

Risk evaluation and therapeutical implications of pulse pressure in primary arterial hypertension

SUMMARY: Analysis of the results raised in the Framingham and the MRFIT study have clearly shown that increased pulse pressure is an independent cardiovascular risk factor. This is valid for all age groups and both sexes. The risk increases with pulse pressures over 60 - 65 mmHg for office blood pressure and 53 mmHg for 24-h-mean of ambulatory blood pressure. Pulse pressure is strongly correlated with systolic blood pressure and will be highest in case of isolated systolic hypertension. Urinary albumin excretion and left ventricular hypertrophy are closely associated with pulse pressure. With elevated pulse pressure cardiovascular risk is increased 2- to 4-fold in relation to age and endpoint. The risk of myocardial infarction is raised more if pulse pressure is associated with low mean arterial blood pressure while risk of stroke is increased with wide pulse pressure and high mean arterial pressure. The risk of pulse pressure can be seen in normotensives and in early pregnancy. Therapeutic management of pulse pressure will be similar to that of systolic blood pressure, since normalization of systolic blood pressure will also lower or normalize pulse pressure. Results of preliminary studies suggest that diuretics are superior to other drugs in decreasing pulse pressure. An increase of pulse pressure during therapy should be avoided since each 10 mmHg increase in pulse pressure will raise the risk of stroke and myocardial infarction about 24 % and 32 %.     

高血压病患者动态脉压与颈动脉粥样硬化关系的研究

为了探讨动态脉压与颈动脉粥样硬化之间的关系 ,将 172名高血压病人分为两组 ,2 4h平均脉压在 40～ 5 5mmHg者为一组 ,2 4h平均脉压 >5 5mmHg者为一组。所有病人同时经超声检测颈总动脉、颈内动脉和颈动脉分叉处的内膜中层厚度、血管内径及斑块发生率 ,并以颈总动脉最大内膜中层厚度作为评价颈动脉粥样硬化程度的指标。结果观察到 ,在同一平均动脉压水平下 ,脉压 >5 5mmHg者颈总动脉内径、颈总动脉最大内膜中层厚度及粥样斑块发生率均明显大于脉压为 40～ 5 5mmHg者 (P <0 .0 0 1)。Pearson相关分析显示平均脉压、年龄、平均收缩压、高血压病程与颈总动脉最大内膜中层厚度呈明显正相关 (r =0 .5 40 ,r=0 .470 ,r =0 .44 3 ,r =0 .2 31,P <0 .0 0 1) ,而平均舒张压与颈总动脉最大内膜中层厚度呈负相关 (r=- 0 .2 8,P <0 .0 5 )。逐步回归分析表明 ,夜间脉压、年龄与颈动脉粥样硬化独立相关。研究结果提示 ,动态脉压是颈动脉粥样硬化发展中的重要参数 ,可作为评估颈动脉粥样硬化程度的有效指标。     

Alteration of arterial distensibility in systemic sclerosis

Objectives. To evaluate the distensibility of large arteries in patients with systemic sclerosis (SSc).
Design. Prospective case-control study including unselected patients with SSc.
Setting. One cardiology and two internal medicine units in a teaching hospital.
Subjects. Eighteen patients with SSc and controls matched for age, sex, height, weight and 24-h ambulatory blood pressure (BP).
Intervention. The timing of Korotkoff's sounds ( QKD interval), a newly described noninvasive ambulatory method was used to measure arterial distensibility during 24 h.
Main outcome measures . Two endpoints were used: QKD 100–60 (normalized for a heart rate of 100 beats min^-1 and a systolic BP of 100 mmHg) and the slope of QKD against pulse pressure.
Results. The patients with SSc had a lower slope of QKD against pulse pressure than the controls (median 0.55, range 0–1.21, versus 0.92, range 0.5–1.34, respectively; P =0.003), and a lower QKD 100–60 (medians/ranges respectively 191 [162–216] and 203 [169–231]; P =0.01).
Conclusions. These results indicate that arterial distensibility of large arteries is decreased in SSc.     

高血压病人颈动脉缓冲功能与胰岛素抵抗关系的探讨

目的　探讨高血压病人颈动脉扩张性与胰岛素敏感性的变化 ,及高血压病人颈动脉缓冲功能与胰岛素抵抗是否相关。方法　选取原发性高血压病人 5 4例 ( EH组 ) ,健康志愿者 47例 ( HM组 ) ,应用二维超声评估颈动脉缓冲功能 ,应用胰岛素敏感指数评估胰岛素敏感性水平。结果　 EH组收缩压、舒张压、脉压、平均动脉压、空腹血清胰岛素和葡萄糖较 HM组显著升高 ( P<0 .0 1)。EH组颈动脉扩张性、胰岛素敏感指数较 HM组显著降低 ( P<0 .0 1)。胰岛素敏感指数、空腹血清胰岛素与高血压病人颈动脉扩张性密切相关 ( P<0 .0 1)。胰岛素敏感指数、空腹血清胰岛素、脉压、年龄、平均动脉压、空腹血清葡萄糖 ,与高血压病人颈动脉扩张性降低显著相关。其中胰岛素敏感指数和空腹血清胰岛素与高血压病人颈动脉扩张性降低的相关性尤为密切。结论　高血压病人颈动脉扩张性及胰岛素敏感性水平较健康人显著降低。高血压病人颈动脉缓冲功能与胰岛素敏感指数、空腹血清胰岛素和血压水平密切相关     

Arterial dysfunction after treatment of coarctation of the aorta

The long term follow-up after successful coarctation repair has a late cardiovascular morbidity, includes systemic hypertension at rest or/and after exercise. The pathophysiology mechanisms responsible have not been well determined. We studied 70 normotensive subjects at rest (age, 14 +/- 5 y; pressure, 116 +/- 13/56 +/- 9 mmHg), who had an isolated coarctation with a good repair defined by the absence of gradient between upper and lower right limb (0.-26 mmHg). After exercise testing we defined two groups: Coa HT: Hypertension at exercise equal or over 200 mmHg, n = 20 (228 +/- 23 mmHg) and Coa HT: Normotensive at exercise = 10 (163 +/- 24 mmHg). These subjects were mached sex-age and blood pressure to 70 controls (age, 13 +/- 3 y; pressure, 115 +/- 10/56 +/- 6 mmHg). Using a high-resolution echographic technique, we assessed the systolic, diastolic diameter and the intima media thickness (IMT) of the common carotid artery (CCA) to define mechanical indexes: Cross sectional compliance (CSC), distensibility (CSD) and incremental elastic modulus (Einc) in each group. CCA pressure waveform and the local pulse pressure were determined in 32 subjects to define augmentation index (AI). The changes of the brachial artery diameter in response to reactive hyperaemia (flow mediated dilation: FDM) and to glyceryltrinitrate (GTNMD) were measured. The IMT was significantly increased in the Coa group (by 8%, p < 0.001) and higher in the Coa HT group compared with the Coa NT group (0.57 +/- 0.04 mm vs 0.54 +/- 0.05 mm, p < 0.05). The CSD was lower and the Einc was higher in both groups. The carotid pulse pressure amplitude was significantly higher in the Coa HT Group (41 +/- 14 vs 33 +/- 7 mmHg; p < 0.05). The AI was higher in both Coa repair groups. Both flow-mediated dilation (FMD) and GTN-mediated dilation (GTNMD) of the brachial artery were lower in the Coa group (respectively 5 +/- 3 vs 7 +/- 3%; p < 0.01; 16 +/- 8 vs 23 +/- 9%; p < 0.01). GTNMD was inversely correlated with maximum systolic blood pressure on exercise (r = 0.31, p = 0.03). The IMT of the CCA was related to the local pulse pressure in both groups of coarctation repair. The combination of distensibility decrease in the proximal arterial bed with an impairment of distal artery reactivity would account for the elevation of exercise blood pressure in subjects who had coarctation repair. The increase of local pulse pressure influences the carotid wall hypertrophy.     

Acute effects of oral melatonin administration on arterial distensibility, as determined by carotid-femoral pulse wave velocity, in healthy young men

The aim of the present study was to investigate the effects of melatonin administration on arterial distensibility by using carotid-femoral (aortic) pulse wave velocity (PWV) measurements in healthy young men. Ten men were studied (five men in the melatonin group and five men in the placebo group) by physicians. Carotid-femoral (aortic) PWV, blood pressure and plasma melatonin were measured in the supine position before and 60 min after oral administration of melatonin or placebo. Although carotid-femoral (aortic) PWV, systolic blood pressure and mean blood pressure were decreased, pulse wave propagation time and plasma melatonin levels were increased at 60 min after oral melatonin (1 mg) administration (P=0.04, P=0.04, P=0.04, P=0.04 and P=0.04, respectively). No significant differences were found between all parameters in the placebo group (P>0.05). In conclusion, these findings indicate that melatonin administration, compared with placebo, decreased carotid-femoral PWV and systolic blood pressure in the supine position in healthy young men. Administration of melatonin may have an inhibitory effect on sympathetic tone.     

Age-based differences between mercury sphygmomanometer and pulse dynamic blood pressure measurements

BACKGROUND: Both the mercury sphygmomanometer and oscillometric measurement methods are widely in use for pediatric, adult, and geriatric patients. However, inherent differences between the methods of measurement may create varying degrees of sensitivity to age and potentially result in differences between measurements for these two techniques. DESIGN: Measurements of systolic and diastolic blood pressures in 154 subjects were obtained using the mercury sphygmomanometer and pulse dynamic oscillometric methods in accordance with the 1987 Association for the Advancement of Medical Instrumentation guidelines. Subjects were separated into three age groups and their data analyzed for differences between measurements for these two techniques. METHODS: Two qualified nurses derived systolic and diastolic blood pressures using phase I and phase IV Korotkoff sounds, respectively, during simultaneous monitoring with the pulse dynamic oscillometric method. RESULTS: Inter-nurse variabilities for measurement derived by mercury sphygmomanometer were 1.8 +/- 4.1 for systolic and 0.9 +/- 3.9for diastolic blood pressure. Mean differences (reference-device) of -5 +/- 5 mmHg (pulse dynamic value higher) for systolic and 1 +/- 5 mmHg (pulse dynamic value lower) for diastolic blood pressure between pulse dynamic and mercury sphygmomanometer values were found for all subjects. However, pulse dynamic systolic blood pressure was significantly higher than mercury sphygmomanometer systolic blood pressure for group 1 (n = 51, aged 11-22 years, mean difference -5.6 mmHg, P = 0.03). A similar trend was observed with group 2 (n = 51, aged 23-54 years, mean difference -4.3 mmHg, P = 0.06). We observedf no significant difference for systolic blood pressure with group 3 (n = 52, aged 55-85 years, mean difference -3.8 mmHg, P > 0.1). For all three groups we found no significant difference for diastolic blood pressure. CONCLUSION: The variation in the agreement of systolic blood pressure measurements can be attributed to the differing effects of age-dependent arterial changes on the measurement methods. The findings indicate that, although the pulse dynamic oscillometric method and mercury sphygmomanometer correlate well when patients of all ages were evaluated as a group, agreement between measurements of systolic blood pressure is dependent on age and the method of measurement employed.     

Genetic Variation in the Renin-Angiotensin System and Arterial Stiffness. The Rotterdam Study

We studied the associations of three renin-angiotensin system polymorphisms, angiotensin-converting enzyme (ACE) I/D, angiotensinogen 235 M/T, and angiotensin II receptor type I 573 C/T, with arterial stiffness. The study was embedded in the Rotterdam Study, a population-based study older adults. The association of the polymorphisms with pulse wave velocity, the carotid distensibility, and pulse pressure was investigated in 3706 subjects. We found no association of the ACE I/D polymorphism with pulse wave velocity, but the D-allele was associated with a lower distensibility coefficient (p = 0.05) and higher pulse pressure (p = 0.01). For the angiotensinogen 235 M/T polymorphism, no significant associations with either pulse wave velocity (p = 0.71), the distensibility coefficient (p = 0.16) or pulse pressure (p = 0.34) were found. Also, we found no significant associations of pulse wave velocity (PWV) (p = 0.32), the distensibility coefficient (p = 0.08), and pulse pressure (p = 0.09) with the angiotensin II receptor type 1 573C/T polymorphism. No epistatic effects were observed between the three renin-angiotensin system (RAS) genes with arterial stiffness. Our findings suggest that genetic variation in the renin-angiotensin system may play a role in determining carotid distensibility and pulse pressure.     

脉压及平均动脉压对中老年人脑卒中预测价值的队列研究

目的探讨中老年人脉压及平均动脉压水平对脑卒中发病的预测价值。方法对10 867例中老年人群进行基线调查,其中中年组7 635例,老年组3 232例,随访8年,应用Cox回归分析脉压、平均动脉压对脑卒中的预测价值。结果脉压、平均动脉压均为中老年人脑卒中发病的危险因子。校正其他因素及舒张压后,中年人脉压、平均动脉压每增加10 mm Hg(1 mm Hg=0.133 kPa),脑卒中的发病危险分别增加32.4%和100.8%,且平均动脉压与脑卒中发病危险独立于收缩压;老年人脉压每增加10 mm Hg,脑卒中的危险增加9.1%,但不独立于收缩压。结论平均动脉压对中年人脑卒中的预测作用大于脉压,且独立于收缩压。脉压能在平均动脉压、舒张压水平上提供额外的危险分层信息,但不独立于收缩压。     

Isolated systolic hypertension: data on a cohort of young subjects from a French working population (IHPAF)

Elderly patients with isolated systolic hypertension (ISH)--systolic blood pressure (SBP) > or =140 mmHg and diastolic blood pressure (DBP) <90 mmHg--have increased mortality and morbidity. The aim was to study the incidence of ISH in a younger population of between 15 and 60 years of age, and to measure pulse pressure (PP), mean arterial pressure (MAP) and heart rate (HR) in these subjects. The study population consisted of 27 783 subjects, aged 15-60 years, untreated for hypertension (HT) from a cohort of employees formed to study the incidence of HT in the French working population (AIHFP). BP and HR were measured with a validated, automatic device after 5, 6 and 7 min at rest. The prevalence of ISH was 6.9% in men, 2.3% in women. This prevalence was over 5% in young men and increased at 40-44 years; it was negligible in young women, but increased at 50-54 years to about 10% (ie to the same level as in men of the same age): PP in subjects with ISH (46.9 mmHg) was significantly higher than in the normotensive group (NT-40.9 mmHg); it was comparable in both young men (65.5 mmHg) and older men (66 mmHg); it was higher in men (63.1 mmHg) than in women (61.5 mmHg). HR was higher in ISH than in NT and it was higher in women ( approximately 5 bpm) in whom it decreased with age. The prevalence of ISH is not negligible in HT (30% men, 25% women), with a high prevalence in young subjects and elevated PP, MAP and HR values. These data should be taken into account as elevated ISH, PP and HR are considered as cardio-vascular risk factors.