高血压病患者动脉顺应性改变及其影响因素的研究

目的 探讨高血压病(EH)患者动脉顺应性的改变及其与血压、糖代谢、脂代谢之间的关系。方法 采用美国HDI公司CVProfilorTM DO-2020型动脉弹性功能测定仪检测133例EH患者和147例正常人大动脉顺应性(C1)、小动脉顺应性(C2)、糖代谢、脂代谢,并对可能影响动脉顺应性的因素进行多元逐步回归分析与偏相关分析。结果 不同年龄与性别组中,EH患者的C1和C2均较正常对照组降低;EH患者体重指数及空腹血糖增高,胰岛素敏感指数(ISI)下降(P<0.05);EH组中脉压、脉率、体表面积(BSA)和ISI是C1的决定因素,平均动脉压、BSA、血清总胆固醇是C2的决定因素,而在正常人群中年龄与ISI是正常人群C2的决定因素。结论 动脉顺应性在EH时降低,除受血压水平影响外,还与年龄、体表面积、血糖、脂代谢等因素有关。     

伊贝沙坦单剂及复方制剂治疗轻中度高血压降压疗效及对动脉功能的影响

目的评价依贝沙坦及其依贝沙坦同氢氯噻嗪的复方片剂在降血压的同时,对于血管顺应性的影响.方法采用随机、平行、活性药物对照的双盲(双模拟法)试验方法,对36例轻中度高血压患者进行为期8周的观察,并应用美国PULSEMETRIC公司的肱动脉无创血流动力学测定仪(型号DynaPulse 200M)检测患者在治疗前后的血压变化和动脉功能的改善情况.结果(1)两组患者在药物治疗8周后,收缩压和舒张压均有明显的下降,脉压下降.治疗前后心率的变化无显著性差异.(2)两组患者在药物治疗8周后,其系统动脉顺应性、肱动脉顺应性和肱动脉扩张性均明显改善.其中复方片剂对于小动脉顺应性的改善作用更加明显,同时对肱动脉扩张性的改善也优于单药片剂.结果轻中度高血压患者确实存在有动脉顺应性的降低.经过依贝沙坦及其依贝沙坦与氢氯噻嗪的复方片剂治疗8周,在血压和脉压降低的同时,对动脉顺应性均有明显的改善作用.     

高血压患者血压节律与动脉弹性的研究

目的比较高血压患者与正常人血压节律的变化及血压节律对动脉弹性的影响.方法采用美国Pulse MetricInc公司生产的无创血流动力学测定仪(型号Dynapulse5000A)分别对84例高血压患者及32例正常人进行24小时血压监测并同期测定动脉弹性参数系统血管顺应性、系统血管阻力、肱动脉扩张性、肱动脉阻力.结果高血压患者血压节律异常者高于正常对照组,高血压组非杓型血压比例占69%,而正常对照组仅6.2%.高血压患者的动脉弹性功能异常高于正常对照组,高血压组系统血管顺应性及肱动脉扩张性均较正常对照组减退,而系统血管阻力及肱动脉阻力均较正常对照组增加;而血压节律异常患者动脉弹性功能异常更为明显.结论高血压患者有更高的血压节律异常,血压节律异常的患者动脉弹性的减退更明显.     

不同血糖水平糖尿病患者动脉弹性指数的变化

目的 观察不同血糖水平糖尿病患者动脉弹性指数的变化及其与血压、糖代谢等因素的关系.方法 选取空腹血糖＞5.6 mmol/L的糖尿病患者共313人,男性176人,女性137人,年龄(52.9±11.5)岁.根据1999年WHO糖尿病诊断标准,将所有受试者按照口服葡萄糖耐量试验(OGTT)结果分为4组:正常血糖组(n=86)、空腹血糖受损组(IFG,n=36)、糖耐量减低组(IGT,n=45)和糖尿病组(n=146).采用美国HDI公司CVProfilorTMDO-2020型动脉弹性功能测定仪系统测量血管弹性.结果 1)校正年龄后,与血糖正常组、IFG组、IGT组相比,糖尿病组大动脉弹性指数(C1)、小动脉弹性指数(C2)明显下降.血糖正常组、IFG组、IGT组3组间的C1、C2差异无统计学意义.2)多元逐步回归分析显示:C1与脉压、脉率、年龄、餐后2 h血糖负相关.C2与年龄、餐后2 h血糖、平均动脉压负相关.结论 1)糖尿病患者动脉弹性指数降低,而糖尿病发病前状态(IFG,IGT)未见动脉弹性的异常.糖尿病对血管弹性的影响独立于血压水平.2)脉压对C1的影响较大,而餐后2 h血糖对C2的影响大于血压的影响.     

男性高血压患者睾酮与动脉顺应性关系的研究

目的 探讨男性高血压患者睾酮与动脉顺应性的关系.方法 按照收缩压≥140 mm Hg(1 mm Hg=0.133 kPa)和(或)舒张压≥90 mm Hg诊断为高血压的标准,将277例受试者分为男性对照组、男性高血压组、女性对照组和女性高血压组.采用CVProfilor DO-2020动脉脉搏分析仪分别测定各组受试者大动脉顺应性(C1)、小动脉顺应性(C2),用酶促化学发光法检测血清睾酮浓度,用放免法检测血清胰岛索浓度.结果 (1)男女性高血压组C1、C2均显著低于相应对照组,血清睾酮浓度在男性高血压组低于男性对照组(P均<0.01),而在女性两组问比较差异无统计学意义.(2)睾酮在男性组与C1、C2正相关,与血压、甘油三酯、血糖、体质指数、胰岛素抵抗指数负相关.在女性组与体质指数负相关(P均<0.05).(3)多元逐步回归分析表明,年龄、睾酮足影响男性血压的主要因素,年龄、C2、体质指数是影响女性血压的主要因素.结论 动脉顺应性减退是高血压的预测指标;中年男性血清睾酮水平下降与动脉顺应性减退密切相关,是男性发生高血压的主要危险因素之一.     

颈动脉内膜-中膜厚度与血压及动脉弹性的关系

该文分析了血压、动脉弹性及颈动脉内膜-中膜厚度（IMT）之间关系。方法：采用血管外超声及美国PMI公司生产的DP200M动脉仪测定2003—2004年北京大学人民医院收治的69例急性脑梗死患者的颈动脉IMT、血压、动脉弹性及顺应性。结果：（1）高血压组较血压正常组颈动脉IMT增加；年龄、胆固醇、甘油三酯、尿酸、血糖、系统血管顺应性（SVC）、系统血管阻力（SVR）、肱动脉顺应性（BAC）、肱动脉扩张性（BAD）及肱动脉阻力（BAR）等，差异均无统计学意义（P〉0．05）。     

尼群地平对高血压病患者动脉和血液动力学的影响

本文用二维一脉冲多普勒超声心动图观察尼群地平对高血压患者动脉的效应。结果表明,尼群地平不仅扩张小动脉,降低外周阻力,使血压明显下降;增加动脉顺应性;直接扩张外周大动脉,改善外周循环;降低外周大动脉壁切线张力;而且不影响外周大动脉壁切应力。总之,尼群地平在高血压病患者,可产生良好的动脉效应。     

血尿酸与高血压患者彩色多普勒能量图肾小动脉阻力损伤的相关性研究

目的研究高血压患者血尿酸对肾小动脉张力调节功能损伤的危险性.方法分别选到正常对照组12例,非糖尿病高血压组28例,2型糖尿病高血压组25例.检测入选对象血尿酸水平,使用彩色多普勒能量图检测主肾动脉,段动脉,叶间动脉(IRA)的阻力指数(RI),脉搏波动指数(PI).结果血尿酸(UA)检测结果比较,两高血压组分别显著高于对照组,P＜0.01,2型糖尿病组显著高于非糖尿病组,P＜0.029.各级肾小动脉RI参数比较,两高血压组分别显著高于对照组;2型糖尿病组显著高于非糖尿病组,P＜0.05或P＜0.01.UA及IRA-RI参数可因心功能损害加重,利尿剂用量增大,糖化血红蛋白A1水平异常增高.两高血压组UA水平与IRA-RI参数分别呈直线相关(r=0.842,r=0.797,P=0.000,P=0.000).结论高血压患者血尿酸水平与肾小动脉阻力指数密切相关.血尿酸,氧合黄嘌呤代谢途径对高血压患者肾小动脉张力调节功能受损起一定作用.     

吸烟加重高血压病患者大中动脉硬化

目的 探讨吸烟对高血压病患者大动脉结构和功能的影响.方法 用超声检测75例吸烟高血压病患者及70例不吸烟高血压病患者主动脉、颈动脉和肱动脉管径、内膜中膜厚度,内膜中层面积及动脉扩张性、管壁顺应性等指标,用协方差分析校正其它因素的混杂影响后比较吸烟组和不吸烟组动脉结构和功能指标的差异.结果 吸烟组主动脉、颈动脉和肱动脉内膜中膜厚度和内膜中层面积显著增加,动脉的扩张性和管壁顺应性降低,即使校正了年龄、体质量指数、心率、血压、脉压、空腹血糖、低密度脂蛋白胆固醇及三酰甘油这些可能影响血管结构和功能的因素后,差异显著性依然存在.结论 吸烟加重了高血压患者大中动脉硬化.     

高脂血症患者血压变异性与动脉血管弹性的关系

目的: 通过对高脂血症总胆固醇(TC)/高密度脂蛋白胆固醇(HDL-C)比率>5.0患者与健康人群比较,探讨高脂血症的血压变异性（BPV）和动脉顺应性的关系。方法: 高脂血症患者33例和血脂代谢正常的健康体检者33例,记录24 h动态血压监测(ABPM)和测量动脉顺应性,两组间经年龄、性别、体质量配对后比较。 结果: 高脂血症患者组24 h收缩期BPV［(20±6)mmHg vs (16±4)mmHg,P<0.01,1 mmHg=0.133 kPa］、舒张期BPV ［(17±5)mmHg vs (14±5)mmHg,P<0.05］和平均动脉压的BPV［(16±5)mmHg vs (13±5)mmHg, P<0.05］明显高于血脂代谢正常的健康体检者。两组间大、小动脉顺应性无显著性差异;健康对照者24 h收缩期BPV与大动脉顺应性呈显著负相关(r=-0.46,P<0.05)。而两组受试者24 h、白天及夜间的BPV与小动脉的顺应性无相关性。结论: 高脂血症患者BPV比血脂代谢正常的健康体检者高,但高脂血症患者大动脉顺应性与收缩压无相关性。     

Post-synaptic alpha-blockade and brachial artery compliance in essential hypertension

Central (six patients) and brachial (12 patients) haemodynamics were studied in men with sustained essential hypertension before and after intravenous administration of an alpha post-synaptic adrenergic blocking drug, urapidil. Brachial arterial compliance was evaluated non-invasively from the simultaneous measurement of pulse wave velocity and arterial diameter. In basal conditions, arterial compliance was reduced in hypertensives. Urapidil caused a significant drop in blood pressure, due to a significant decrease in total peripheral resistance with no change in cardiac output and heart rate. Brachial arterial diameter and compliance did not change significantly. The results show that the decreased arterial compliance in hypertensive patients was not due exclusively to the elevation of blood pressure or to a predominant activation of the autonomic nervous system, or both. Such observations suggest that, in men with sustained essential hypertension, the decreased compliance was probably related to structural alterations of large arteries.     

Arterial properties of early hypertension.

In addition to high blood pressure, hypertension is characterised by metabolic and cardiovascular abnormalities, including decreased arterial compliance. To evaluate arterial involvement in early hypertension, we have employed a technique that analyses the arterial pulse wave contour to separately quantify proximal compliance (aorta and large arteries) and distal compliance (small arteries and arterioles). Proximal compliance was 24% lower in patients with borderline (diastolic BP 90-99 mmHg, n = 22) and 33% lower in patients with established (n = 19) hypertension than in normals (n = 15); distal compliance was 58% and 61% lower. These differences were not age-dependent, for in 27 age-matched pairs, proximal and distal compliances were 22% (P less than 0.01) and 55% (P less than 0.01) lower in hypertensives (diastolic BP greater than or equal to 95 mmHg) than in normotensives. Moreover, independent of BP or age, both proximal (P less than 0.05) and distal (P less than 0.01) compliance values were significantly lower in subjects with a family history of hypertension than in those without. Proximal compliance correlated inversely with indices of BP variability and heart work measured by automated whole-day blood pressure monitoring. Thus, changes in the elastic properties of the distal arterial circulation, reflected by decreased compliance, occur at the initiation of hypertension and may be an early diagnostic marker. Low proximal compliance appears to be associated with established hypertension, and might be a determinant of cardiovascular prognosis.     

Effect of nitroglycerin and N-ethoxycarbonyl-3-morpholinosydnonomine on the walls of large arteries

Systemic arterial compliance was measured in 20 patients with left ventricular failure due to congestive cardiomyopathy. The method consisted in evaluating arterial compliance by analysing the exponential fall of the arterial pressure curve on a simple visco-elastic model. In the patient group, significant correlations were found between arterial compliance and age (r = 0,64 ; p less than 0,01) and arterial compliance and systolic blood pressure (r = -0,58 ; p less than 0,001). These relationships suggest that arterial compliance depends on the height of the systolic blood pressure and/or the elasticity of the arterial walls. Two groups of patients were defined : Group I (10 patients) given a single oral dose of 7,5 mg of nitroglycerine (Lenitral), and Group II (10 patients) giben a single oral dose of 4 mg N ethoxycarbonyl-3-morpholinosydnonomine (Molsidomine). There was no significant difference in the hemodynamic parameters or arterial compliance between the two groups before administration of these drugs. However, systolic blood pressure was significantly lower (p less than 0,01) and compliance significantly higher (p less than 0,05) after treatment in Group II. In Group I, nitroglycerine caused a significant increase in compliance (p less than 0,01), a significant decrease in systolic (p less than 0,02) and mean blood pressure (p less than 0,05) whilst heart rate, cardiac output and total systemic resistance remained unchanged. In Group II, Molsidomine caused a significant increase in arterial compliance (p less than 0,01), a decrease in systolic (p less than 0,001), diastolic (p less than 0,01) and mean blood pressure (p less than 0,01) and in cardiac output (p less than 0,01), whilst heart rate and total systemic resistance remained unchanged. This study shows that both drugs studied had significant effects on the walls of the large arteries.     

Age-related abnormalities in arterial compliance identified by pressure pulse contour analysis: aging and arterial compliance.

The objective of this study was to evaluate age-related changes in pulsatile arterial function. Aging alters arterial pulsatile function and produces consistent changes in the pressure pulse contour. A reduced systemic arterial compliance that can be derived from analysis of the pulse contour is regarded as the best clinical index of impaired pulsatile arterial function and may mark the presence of early vascular damage. We analyzed intra-arterial brachial artery waveforms in 115 healthy normotensive volunteers (83 men, 32 women) and radial artery waveforms obtained with the use of a calibrated tonometer device in 212 healthy volunteers (147 women, 65 men). A computer-based assessment of the diastolic pressure decay and a modified Windkessel model of the circulation were used to quantify changes in arterial waveform morphology in terms of large artery or capacitive compliance, oscillatory or reflective compliance in the small arteries, inertance, and systemic vascular resistance. Large artery compliance and oscillatory compliance correlated negatively with age for both invasive and noninvasive groups (r=-0.50 and r=-0.55; r=-0.37 and r=-0.66; P<0.001 for all). The slopes of the regression lines for the decline in oscillatory compliance with age were significantly steeper than those recorded for large artery compliance estimates. The change in blood pressure with age independently contributed to the decrease in large artery compliance but not oscillatory compliance in both groups. Consistent age-related changes were found in the pressure pulse contour by analysis of waveforms obtained invasively or noninvasively from the upper limb. The change in the oscillatory or reflective compliance estimate was independent of blood pressure change and may represent a better marker than large artery or capacitive compliance of the degenerative aging process in altering pulsatile arterial function.     

The effect of hormone replacement therapy on arterial blood pressure and vascular compliance in postmenopausal women with arterial hypertension

Arterial pathology is a major contributor to cardiovascular disease, morbidity and mortality. Women are at higher risk of cardiovascular disease after menopause. Arterial stiffness determined by pulse wave velocity, increases with age both in men and women, whereas arterial compliance in premenopausal women is greater than in men of similar age. This difference is lost in the postmenopausal years, with evidence of rapid decline in arterial compliance in the perimenopausal period. Loss of hormonal modulation is a likely explanation for reduced arterial compliance in postmenopausal women. Long-term treatment with hormone replacement therapy (HRT) may be expected to partially reverse the increase in arterial stiffness. The aim of the study was to analyse the effect of HRT on blood pressure and arterial compliance in postmenopausal women with arterial hypertension receiving hypotensive drugs. The results in the present study of postmenopausal women with mild to moderate arterial hypertension receiving HRT showed only a transient tendency towards lower blood pressure. In our study HRT was found to improve arterial compliance at 3 months after HRT, and the effect was maintained throughout 12 months. The increased arterial compliance in women receiving HRT was independent of blood pressure. In parallel with decreasing pulse wave velocity women receiving HRT had lower total and low-density lipoprotein cholesterol. The conclusions were that after 1 year HRT in postmenopausal women with arterial hypertension improves circadian blood pressure pattern, but it does not affect significantly blood pressure values and variability. The present study also shows that HRT significantly inhibits age-related rigidity of large arteries.     

Hyperreactivity of the humeral artery to noradrenaline in essential hypertension patients

The hyperresponsiveness of small arteries to norepinephrine is well documented in essential hypertensive patients. Our objective was to investigate in situ the reactivity to norepinephrine of the diameter of large arteries which are involved in the arterial disease of hypertension as well as small arteries. Brachial artery diameter, blood flow velocity, local volumic blood flow and local vascular resistances were determined non invasively using a pulsed Doppler system in 19 patients with essential hypertension and 9 normotensive subjects, before and after placebo (glucose) or increasing doses of norepinephrine (10, 20 and 40 ng/kg/min; i.v.) given in a single blind fashion. In hypertensive patients, norepinephrine (40 ng/kg/min) induced (i) a significant decrease in brachial artery diameter, local blood velocity, volumic flow and conductance and (ii) a small increase in mean arterial pressure. These hemodynamic changes did not occurred in the placebo group and were significantly greater in hypertensive patients than in normotensive subjects although plasma norepinephrine increased to the same extent in both groups. We conclude that in hypertensive patients, the increase in vascular reactivity to norepinephrine involves not only the resistive vessels, but also the large arteries thus decreasing their conducting and buffering function.     

Pathophysiology of Hypertension in the Elderly

Systolic hypertension is the most common type of hypertension in the elderly and a major modifiable cardiovascular risk factor. Systolic hypertension is associated with a wide pulse pressure resulting largely from excessive large artery stiffness. Arterial stiffness increases with age independently of mean blood pressure or the presence of other risk factors. In this review, the authors discuss the effects of age and blood pressure on arterial stiffness, the physiology of arterial compliance, and the anatomic changes of large arteries with aging. In most studies reported in the literature, elderly populations are relatively small. The role of both age and gender on arterial stiffness and wave reflection has been poorly investigated, particularly in subjects over 70 years. In this elderly population, further research is needed concerning the pathophysiology, epidemiology, and pharmacology of hypertension.     

The effect of acutely induced hypervolemia on resistance to pulmonary blood flow and pulmonary arterial compliance in patients with chronic obstructive lung disease

The presence of alveolar hypoxia and respiratory acidemia in patients with chronic obstructive lung disease alters the normal relation between pulmonary arterial and left heart pressures at the end of diastole; usually these pressures are the same. With vasoconstriction of the small pulmonary arteries the pulmonary arterial diastolic pressure rises, whereas the mean wedge pressure remains unchanged. Thus, a pressure gradient across the pulmonary circulation appears at the end of diastole representing an increased resistance to pulmonary blood flow. The magnitude of this gradient is closely related to the systemic arterial blood oxyhemoglobin saturation, which is used as an index of alveolar oxygen tension, and to the blood hydrogen ion concentration. In the present study acutely induced hypervolemia caused striking alterations in mean wedge pressure and blood flow. However, the diastolic gradient did not change. The pulmonary diastolic pressure gradient reflects the degree of resistance to pulmonary blood flow regardless of the level of the left heart pressure or the cardiac output. On the other hand, left heart pressure does contribute to the level of the pulmonary arterial diastolic pressure.The pulse pressures recorded in the elastic pulmonary arteries reflect their compliance characteristics and the effect of stroke volume imposed upon them. We have assessed compliance indirectly by examining the relationships between pulmonary arterial systolic pressure, diastolic pressure and stroke volume. The compliance characteristics of the elastic arteries in patients with chronic obstructive lung disease do not differ from normal before or during acutely induced hypervolemia.     

Pulse wave analysis to assess vascular compliance changes in stable renal transplant recipients

BACKGROUND: Calcineurin inhibitor drugs (cyclosporine and tacrolimus) given to renal transplant recipients to prevent rejection are associated with an increased incidence of hypertension. Reduced arterial compliance, which is a consequence of hypertension, is associated with an increased risk of cardiovascular disease and can be measured noninvasively using pulse wave analysis technology. The purpose of the study was to determine whether calcineurin inhibitor drugs have any effect on arterial compliance. METHODS: A total of 36 stable renal transplant recipients were evaluated using pulse wave analysis to determine large and small vessel compliance. Of the patients, 18 were receiving cyclosporine and 18 tacrolimus. Patients were matched for age and sex. RESULTS: No significant differences in systolic blood pressure, diastolic blood pressure, heart rate, or small vessel compliance were observed. There was a significant decrease in large vessel compliance in patients receiving tacrolimus versus those receiving cyclosporine, respectively (13.5 +/- 4.0 mL/mm Hg x 10 v 9.9 +/- 3.3 mL/mm Hg x 10; P =.005). CONCLUSIONS: Differences in large vessel compliance in renal transplant subjects may depend on the choice of calcineurin inhibitor. Specifically, decreased large vessel compliance in tacrolimus-treated subjects may be associated with an increased cardiovascular risk. This may be due to a difference in vascular collagen accumulation or to elastin loss in large elastic arteries.