高血压病患者体循环动脉重构性变化

目的探讨高血压病患者血管重构性变化及影响因素.方法检测1～2级高血压病患者主动脉、颈动脉、肱动脉及桡动脉管径、内膜中层厚度和动脉扩张性、管壁顺应性等指标;以协方差分析校正其他因素的混杂影响后,比较高血压组63例与正常对照组31例间动脉结构和功能指标的差异,并通过多元逐步回归分析,甄选影响血管重构的独立影响因素.结果和结论高血压组主动脉、颈总动脉、肱动脉和桡动脉壁内膜中层厚度和面积及其与动脉内径和管腔面积的比值显著增大,主动脉、颈动脉、肱动脉扩张性和顺应性显著降低;校正Age, Sex, BMI, HR, MAP, PP, Smoke, FPG, LDL, TG等可能影响血管重构的因素影响后显著性依然存在.动脉平均压和脉压水平是血管重构的重要影响因素,血压水平越高,内膜中层厚度越大;脉压越大,动脉扩张性和顺应性越差.其他影响高血压病血管重构的因素,特别是体重指数、吸烟及血脂水平等,在高血压病心血管重构和器官损害的防治中应加强关注.     

高血压病患者体循环动脉重构性变化

目的 探讨高血压病患者血管重构性变化及影响因素。方法 检测1-2级高血压病患者主动脉、颈动脉、肱动脉及桡动脉管径、内膜中层厚度和动脉扩张性、管壁顺应性等指标；以协方差分析校正其他因素的混杂影响后，比较高血压组63例与正常对照组31例间动脉结构和功能指标的差异，并通过多元逐步回归分析，甄选影响血管重构的独立重影响因素。结果和结论 高血压组主动脉、颈总动脉、肱动脉和桡动脉壁内膜中厚度和面积及其与动脉内径和管腔面积的比值显著增大，主动脉、颈动脉、肱动脉扩张性和顺应性显著降低；校正Age，Sex,BMI,HR,MAP,PP,Smoke，FPG，LDL，TG等可能影响血管重构的因素影响后显著性依然存在。动脉平均压和脉压水平是血管重构的重要影响因素，血压水平越高，内膜中层厚度越大；脉压越大，动脉扩张性和顺应性越差。其他影响高血压病血管重构的因素，特别是体重指数、吸烟及血脂水平等，在高血压病心血管重构和器官损害的防治中应加强关注。     

高血压病心血管重构与血压昼夜节律性

目的 :研究血压昼夜节律性变化对高血压病患者心脏和大动脉重构的影响。方法 :对 64例 1～ 2级高血压病患者进行 2 4h动态血压监测 ,并以超声检测心脏结构指标及主动脉、股动脉、月国动脉管腔内径、内膜中层厚度等动脉结构指标及反映动脉顺应性或扩张性的功能指标。以协方差分析校正可能的混杂因素影响后 ,对比动态血压昼夜节律呈杓型和非杓型的高血压病患者心血管重构指标的差异 ,并以 3 6例正常血压者作对照。结果 :血压昼夜节律异常的非杓型组高血压病患者与正常血压对照组相比 ,左房内径、左室壁厚度、左室肌重量明显增加 ,主动脉、股动脉及月国动脉内膜中层厚度及面积增大 ,内膜中层厚度 /腔径比值及内膜中层面积 /管腔面积比值显著增高 ;主动脉还有管腔内径及面积增大 ,脉搏波速度明显增快 ,差异有统计学显著性 ,经协方差分析校正年龄、性别、体重指数、心率、吸烟情况、血糖血脂水平等可能对心血管重构的影响后 ,显著性仍然存在 ,仅股动脉重构性指标统计学显著性降低。而昼夜节律正常的杓型高血压组与正常血压对照组相比 ,心脏和血管重构性变化指标多无显著性差异 ,结论 :轻中度高血压病时 ,血压昼夜节律异常可能对心脏和大动脉重构有不利影响     

高血压患者动态脉压与颈动脉重构的相关性研究

目的研究高血压病患者24小时动态脉压与颈动脉结构和功能间的关系.方法选择1、2级高血压病患者57例作为研究对象,设21例年龄、性别与之无统计学差异的健康者作对照,对所有患者所行动态血压监测,作颈动脉血管超声测量颈总动脉内膜-中层厚度、颈总动脉收缩期和舒张期内径.结果高血压病患者其24小时脉压均值、白天脉压均值、夜间脉压均值及颈动脉僵硬度均较对照组明显升高,2级高血压组脉压大1级高血压组;高血压病患者颈动脉内膜中层厚度明显增厚,僵硬度增加,颈动脉可扩张性降低,以2级高血压组明显;直线相关分析显示脉压尤其是夜间脉压、内膜中层厚度、可扩张性、僵硬度及内径均密切相关.结论高血压病患者动态脉压,尤其是夜间脉压增高;颈动脉内膜中层增厚,可扩张性降低,僵硬度增加;脉压,尤其是夜间脉压与颈动脉内膜中层厚度及可扩张性、僵硬度明显相关.     

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.     

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。     

老年高血压患者脉压与颈动脉内膜中层厚度关系

目的 观察老年高血压患者动态血压的变化,以及脉压与颈动脉内膜中层厚度的相关性。方法 测量103例老年高血压患者24h动态血压,计算昼夜之脉压及脉压的变化幅度,根据脉压分为两组：脉压小于60mmHg的低脉压组和脉压大于或等于60mmHg的高脉压组;用多普勒超声检查颈动脉内膜中层厚度。比较两组血压参数与内膜中层厚度的差异,分析内膜中层厚度和脉压各项指标的相关性。结果 高脉压组与低脉压组的颈动脉内膜中层厚度差异有统计学意义（P〈0.01）,脉压与颈动脉内膜中层厚度有较好的相关性。结论 老年高血压患者的脉压尤其是夜间脉压与颈动脉内膜中层厚度明显相关。     

原发性高血压患者动态脉压与颈动脉粥样硬化的关系

根据动态全天平均脉压将171例原发性高血压患者分为脉压40～60mmHg组和〉60mmHg组,采用超声检测患者颈动脉内膜中层厚度、血管内径及斑块发生率,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。结果脉压〉60mmHg组患者颈总动脉内径、颈总动脉最大内膜中层厚度、颈动脉斑块发生率明显高于脉压为40—60mmHg组（P〈0．01）。患者平均脉压、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（P〈0．01）,而平均舒张压与颈总动脉最大内膜中层厚度呈负相关（P〈0．05）。认为脉压增加可使颈动脉粥样硬化性病变的患病率增加。     

老年高血压患者动态脉压与颈动脉重构的相关性

为探讨高血压病患者24h动态脉压与颈动脉结构和功能间的关系.以1、2级高血压病患者57例作为研究对象,设21例年龄、性别与之无统计学差异的健康者作对照,对所有患者行动态血压监测,作颈动脉血管超声测量颈总动脉内膜中膜厚度、颈总动脉收缩期和舒张期内径.结果发现,高血压病患者24 h脉压平均值、白天脉压平均值、夜间脉压平均值及颈动脉僵硬度均较对照组明显升高,2级高血压组脉压大于1级高血压组;高血压病患者颈动脉内膜中膜厚度明显增厚,僵硬度增加,颈动脉可扩张性降低,以2级高血压组明显;直线相关分析发现,脉压尤其是夜间脉压与内膜中膜厚度、可扩张性、僵硬度及内径均密切相关.该研究证实动态脉压在评估高血压病患者颈动脉结构和功能改变方面有着重要意义.     

老年高血压患者动态脉压与颈动脉重构的相关性

为探讨高血压病患者24h动态脉压与颈动脉结构和功能间的关系。以1、2级高血压病患者57例作为研究对象，设21例年龄、性别与之无统计学差异的健康者作对照，对所有患者行动态血压监测，作颈动脉血管超声测量颈总动脉内膜中膜厚度、颈总动脉收缩期和舒张期内径。结果发现，高血压病患者24h脉压平均值、白天脉压平均值、夜间脉压平均值及颈动脉僵硬度均较对照组明显升高，2级高血压组脉压大于1级高血压组；高血压病患者颈动脉内膜中膜厚度明显增厚，僵硬度增加，颈动脉可扩张性降低，以2级高血压组明显；直线相关分析发现，脉压尤其是夜间脉压与内膜中膜厚度、可扩张性、僵硬度及内径均密切相关。该研究证实动态脉压在评估高血压病患者颈动脉结构和功能改变方面有着重要意义。     

Parallel cardiac and vascular adaptation in hypertension.

BACKGROUND. Although vascular damage in the noncoronary circulation is a major cause of complications in hypertension, relatively little is known of the in vivo geometry and function of the arterial circulation in patients with uncomplicated hypertension or of their relation to left ventricular hypertrophy, a marker of enhanced risk of cardiovascular complications. METHODS AND RESULTS. Wall thickness and internal diameter of the common carotid artery and the presence of atherosclerosis within the extracranial carotid arteries were determined by ultrasound in 43 asymptomatic hypertensive patients and 43 normotensive subjects matched for sex, age, and body size. Vascular stiffness was estimated from simultaneous superimposed carotid pressure waveforms obtained with an external solid-state transducer. Left ventricular size and function were determined echocardiographically. Compared with normal subjects, hypertensive patients had greater left ventricular absolute and relative wall thicknesses, left ventricular mass, and carotid absolute and relative wall thicknesses (p < 0.005). Carotid intimal-medial thickness exceeded the 95th percentile of normal values in 28% of hypertensive patients (p < 0.01). Carotid atherosclerosis was equally prevalent within the two blood pressure groups and was associated with older age, larger left ventricular and carotid wall thicknesses, and carotid diameter. Despite similar carotid pulse pressures, vascular stiffness was significantly increased in the hypertensive patients. Among the population as a whole, significant relations existed between cardiac and vascular wall thicknesses and internal dimensions. In multivariate analyses, these relations were statistically independent of age and blood pressure. CONCLUSIONS. The present study documents the presence of geometric and functional changes within the common carotid artery in uncomplicated hypertension that parallel findings within the left ventricle. The potential contribution of these changes to the cardiovascular complications of hypertension, particularly in the setting of left ventricular hypertrophy, is unknown.     

Functional and morphological pattern of vascular responses in two models of experimental hypertension

OBJECTIVES:

To determine the reactivity and accompanying structural changes in thoracic aorta and carotid artery from nitric oxide (NO)-deficient hypertensive and spontaneously hypertensive rats (SHR).

ANIMALS AND METHODS:

For the functional study, isolated rat arterial rings were precontracted with a submaximal concentration of phenylephrine (1 μM) and relaxant responses to cumulative concentrations of acetylcholine were obtained. For the morphological study, arteries were processed by a standard method for electron microscopy. The geometry of the arteries – the inner diameter and the wall thickness (tunica intima plus tunica media) – was evaluated by light microscopy.

RESULTS:

Increased systolic blood pressure was accompanied by increased heart weight to body weight ratio in both NO-deficient and SHR compared with normotensive controls, indicating cardiac hypertrophy. Morphometry of the thoracic aorta and carotid artery in both models of hypertension showed increased wall thickness, cross-sectional area and wall to diameter ratio. The inner diameter increased in aorta but not in carotid artery. In isolated arteries from normotensive rats, the addition of acetylcholine to precontracted vessels resulted in dose-dependent relaxation. The relaxing effect was more prominent in thoracic aorta than in carotid artery. Endothelium-dependent relaxation of arteries from NO-deficient hypertensive rats was markedly reduced. On the other hand, in aorta and carotid artery from SHR, the endothelium-dependent relaxation in response to acetylcholine was not significantly attenuated. The relaxation of arteries from SHRs, as well as the residual relaxation of arteries from NO-deficient hypertensive rats, was abolished by addition of N^G-nitro-l-arginine methyl ester, an inhibitor of NO synthase, to the incubation medium.

CONCLUSIONS:

These results suggest that increased systolic blood pressure and accompanying structural changes are not primarily responsible for impairment of endothelium-dependent relaxation in experimental hypertension.     

White-coat hypertension contributes to the presence of carotid arteriosclerosis.

It remains unclear whether white-coat hypertension is associated with vascular organ damage (e.g., carotid arteriosclerosis) in the same way sustained hypertension is. We therefore compared the progression of carotid arteriosclerosis among Japanese individuals showing normal blood pressures, sustained hypertension or white-coat hypertension. A total of 30 subjects (mean age, 58 years) with white-coat hypertension, 30 (mean age, 54 years) with untreated sustained hypertension who had no plaque formation in the carotid arteries, and 30 normotensive subjects (mean age, 58 years) were enrolled in this study. The white-coat and sustained hypertensive subjects were matched with respect to their clinical blood pressures, but their ambulatory blood pressures differed. Conversely, white-coat hypertensive and normotensive subjects were matched with respect to ambulatory blood pressures, but their clinical blood pressures differed. Carotid intimal-medial thickness was measured by B-mode ultrasonography, and the cross-sectional area of the common carotid artery was calculated. The three groups were similar with respect to age, sex ratio, height, laboratory data and the incidence of smoking. Body weights and body mass indexes were significantly higher among patients with sustained hypertension than among either normotensive or white-coat hypertensive patients. Intimal-medial thicknesses and carotid cross-sectional areas were similar in patients with white-coat and sustained hypertension and significantly higher than in normotensive subjects. Collectively, these findings suggest that white-coat hypertension contributed to the presence of carotid arteriosclerosis in our subjects in a manner similar to sustained hypertension. Thus, clinical evaluation of white-coat hypertension should be conducted with the potential for target organ damage in mind.     

Regression of Radial Artery Wall Hypertrophy and Improvement of Carotid Artery Compliance After Long-Term Antihypertensive Treatment in Elderly Patients

Objectives. The present study was designed to assess whether a diuretic- or an angiotensin-converting enzyme inhibitor–based treatment can reduce arterial wall hypertrophy of a distal muscular medium-sized artery—the radial artery—and the stiffness of a proximal large elastic artery—the common carotid artery.Background. Large-artery wall thickness and stiffness are increased during sustained essential hypertension and contribute to the increased risk of complications. Whether antihypertensive treatment can normalize the wall hypertrophy of conducting arteries has not yet been determined.Methods. Seventy-seven elderly hypertensive patients were randomized to receive 9 months of double-blind treatment with perindopril (2 to 8 mg/day) or the diuretic combination of hydrochlorothiazide (12.5 to 50 mg/day) plus amiloride (1.25 to 5 mg/day) after a 1-month placebo washout period. If systolic blood pressure remained at >160 mm Hg after 5 months, chlorthalidone or atenolol was added, respectively. Arterial variables, including radial artery mass and common carotid artery compliance, were calculated from noninvasive measurements of internal diameter and wall thickness with the use of high resolution echo-tracking systems at baseline and after 5 and 9 months.Results. During treatment, blood pressure and arterial variables changed to the same extent in both groups. After a 9-month treatment, systolic, diastolic and pulse pressures and radial artery wall thickness, mass and thickness/radius ratio decreased significantly (p < 0.01), whereas carotid compliance increased (p < 0.001). The decrease in radial artery thickness/radius ratio after a 9-month treatment was significantly related to the reduction in pulse pressure (p < 0.01), whereas the improvement in carotid compliance was related to the reduction in mean arterial pressure (p < 0.01). In healthy subjects and untreated hypertensive patients, radial artery diameter, wall thickness and thickness/radius ratio and carotid artery compliance did not change significantly during a 9-month observation period.Conclusions. These results indicate that in elderly hypertensive patients, both angiotensin-converting enzyme inhibitor– and diuretic combination–based treatments can reduce radial artery wall hypertrophy and improve carotid artery compliance.     

Echographic assessment of carotid and femoral arterial structure in men with essential hypertension

Extracoronary in vivo structural arterial changes were studied in asymptomatic essential hypertension. Carotid and femoral arteries were examined with B-mode echography for the presence or absence of plaque (the whole vascular segments of each vessel in the both sides) and for automated measurement of the far wall intima-media thickness (the vascular segment of each vessel proximal to the bifurcation in the right side) in 53 never treated hypertensive men and 133 normotensive men similar with regard to age, serum cholesterol levels, and smoking history. In the hypertensive group carotid plaque was more frequent (P < .05) and carotid and femoral intima-media thicknesses were greater (P < .001) than in the normotensive group. In the overall normotensive and hypertensive population intima-media thickness was independently associated with age and systolic pressure in both arteries (P < .001) and with cholesterol in the femoral artery (P < .05) while plaque was associated with systolic pressure (P < .01), and cholesterol (P < .01) in the carotid arteries and with age (P < .01), cholesterol (P < .05), and smoking (P < .001) in the femoral arteries. No significant difference in intima-media thickness in both arteries existed between hypertensive subjects with plaque and those without.Wall thickening and plaque were more frequent in hypertensive patients. Thickening was distributed homogeneously to both arteries, while plaque affected preferentially the femoral bed. The influence of age and pressure was more marked on intima-media thickness than on plaque. The lack of association between wall thickening and plaque suggested that vascular hypertrophy and early atherosis might be two different structural changes.     

原发性高血压患者无创检测大动脉重构的临床意义

目的 :研究原发性高血压 (EH)对大动脉结构和功能的影响 ,选择能反映EH患者预后的敏感指标。方法 :对 6 4例EH患者和 36例正常人在二维超声下分别检测主动脉及股动脉内膜、收缩期及舒张期内径 ,并计算血管壁 /腔径比、血管壁 /腔径面积比等反映血管结构改变的指标 ,并利用彩色多普勒超声仪测量主 股动脉脉搏波速度 ,并计算动脉扩张性和顺应性等反映动脉功能的指标。结果 :反映血管结构的内膜中层厚度、血管腔径、血管腔径面积及血管壁 /腔径比及血管壁 /腔径面积比 ,EH组显著高于正常组 ,而反映大动脉缓冲功能的主动脉 股动脉脉搏波速度EH组也显著高于正常组 ,甚至在校正了年龄、性别、体重指数、心率、吸烟等影响因素后 ,差异依然存在。结论 :高血压所致大动脉重构表现为动脉结构和功能的改变 ,早期发现这些改变对预防和治疗高血压有积极的作用 ,而主动脉 股动脉脉搏波速度可以较早并准确的反映大动脉功能的减退 ,为临床提供了一个重要的无创性指标     

Vascular remodeling of the carotid artery in patients with untreated essential hypertension increases with age.

We examined whether hypertrophy of the carotid artery in patients with untreated essential hypertension is associated with compensatory carotid artery enlargement as these patients age. Carotid ultrasonography was evaluated in 163 patients with untreated essential hypertension (74 males and 89 females) and in 76 normotensive subjects. Intima-media end-diastolic thickness (IMT) and outer vessel diameter (VD) were measured, and relative wall thickness (IMT/R, R=VD/2) and vascular mass (VM) were calculated. Determinants of vascular hypertrophy in patients with untreated essential hypertension were also investigated. VD, VM, and IMT were significantly correlated with age in both the normotensive and hypertensive groups. Additionally, IMT was significantly correlated with VD in both groups. There was no correlation between increasing age and IMT/R in either group. IMT, VD and VM were significantly higher in the hypertensive group >50 years than in age-matched normotensive controls. However, IMT/R was significantly higher in the 50-59 years hypertensive group than in normotensive controls of the same age group. In addition to age, VM was related to systolic blood pressure, pulse pressure, fasting blood sugar, IMT, VD, and IMT/R in the hypertensive group. Multivariate regression analysis in the hypertensive group indicated that IMT/R was the strongest predictor of carotid vascular mass. Age and pulse pressure were also independently related to vascular mass. These results indicate that, as patients with untreated hypertension age, carotid arteries undergo remodeling. This should add further impetus to the implementation of appropriate hypertension treatment for such patients.     

Ultrasonographic measurement of the common carotid artery wall thickness in hypercholesterolemic patients A new model for the quantitation and follow-up of preclinical atherosclerosis in living human subjects

Ultrasound high resolution B-mode imaging of human arteries allows in vivo an accurate and non-invasive determination of the thickness of the intimal-medial complex. A computer assisted procedure to measure this parameter at the level of common carotid arteries was developed. The average difference between duplicate thickness determinations was 4.6%. The thickness of the intimal medial complex of common carotid arteries was then measured in a group of hypercholesterolemic patients. This parameter was significantly greater in these patients as compared to controls (P < 0.001). The prevalence of small plaques in the carotid arterial tree was also significantly increased in patients. Analysis of data showed that in controls, but not in patients, the thickness of the intimal medial complex increases with age (r = 0.46, P < 0.05). Within the hypercholesterolemic group, intimal-medial complex values were greater in male patients and in smokers.

It is concluded that the common carotid arteries of hypercholesterolemic patients show thickening of the intimal-medial complex. Cigarette smoking, male sex and age increase the extent of this modification. The determination of this parameter using a non-invasive technique may represent an important tool to monitor in vivo the progression and/or the regression of early atherosclerosis in man.