收缩压与高血压左室重构的关联

目的探讨动态血压参数变化与高血压左心室重构之间的关系。方法对105例原发性高血压患者进行超声心动图检查;24小时动态血压监测获取动态血压参数。采用多元回归方法对左心室质量（LVM）与动态血压各参数作逐步回归分析。结果24 h平均收缩血压和白天收缩血压均值与左心室重构有关。结论收缩血压是影响左心室重构的主要危险因素。     

Relationship between exercise systolic blood pressure and left ventricular geometry in overweight, mildly hypertensive patients

OBJECTIVE: To examine the association between the graded exercise systolic blood pressure (SBP) response and left ventricular (LV) geometric structure in patients with untreated mild hypertension. PARTICIPANTS: The study included 80 sedentary, overweight patients (43 female and 37 male) with unmedicated high normal blood pressure or stage 1-2 hypertension. METHODS: An echocardiogram was used to determine LV mass and the relative wall thickness (RWT) in relation to the chamber dimension. Participants performed a maximal graded exercise test, and the SBP was recorded at workloads of 2, 4 and 6 metabolic equivalents and at peak exercise. Separate statistical models were used to determine the influence of LV mass indexed for height(2.7) (LVMIh) and RWT on submaximal exercise SBP and peak exercise SBP, controlling for resting SBP, age, gender, ethnicity and body mass index. RESULTS: A greater RWT was associated with a higher submaximal SBP level (P = 0.038). Neither LVMIh (P = 0.989) nor the interaction of RWT and LVMIh (P = 0.787) were related to the submaximal SBP. None of the main or interaction effects of RWT and LVMIh were associated with the peak exercise SBP level. CONCLUSION: Increases in RWT were associated with higher submaximal exercise SBP responses in a sample of overweight, unmedicated hypertensives. These results suggest that RWT is an important determinant of the association between cardiac mass and exercise SBP response.     

Effects of arterial dilator agents on central aortic systolic pressure and on left ventricular hydraulic load

Recordings of pressure in the brachial or peripheral arteries fail to disclose the marked increase in systolic pressure that occurs in the proximal aorta and central arteries with increasing age and with hypertension. This systolic pressure boost is caused by wave reflection returning from the periphery of the body while the ventricle is still contracting. Such early wave reflection is caused in turn by increased pulse-wave velocity, attributable to stiffening of the aorta and major conduit arteries. Drugs have little effect on arterial stiffening, whereas wave reflection can be markedly reduced by agents that dilate peripheral arteries. Such reduction in wave reflection causes substantial decrease of systolic pressure in central arteries. Because of differential timing of wave reflection, however, such reduction is not apparent from pressure recordings taken in the brachial or other peripheral arteries. The sphygmomanometer, therefore, fails to show the favorable effects of reduced wave reflection in the proximal aorta and central arteries. Noninvasive tonometric pressure wave recordings can supplement the sphygmomanometer to assess the magnitude of beneficial effect.     

Method for noninvasive measurement of central aortic systolic pressure

A method for noninvasive generation of central aortic systolic pressure curves is presented. The method is based on plotting the occlusive pressure values applied at the brachial artery level against the time intervals needed for the aortic pressure wave to equalize and break through the occlusive pressure at the brachial artery level. These time intervals were obtained by measuring the time from the beginning of depolarization (the QRS complex) to the detection of the pressure wave at the temporarily occluded brachial artery. The validity of the method was documented by 3 different approaches. The pressure values measured by a device developed by us were superimposed on the simultaneously measured central intra-aortic pressure waves and all values were within one standard deviation from the central aortic recordings in 8 of the 10 patients studied. At the same time, the noninvasively recorded pressure waves were completely different from the peripheral artery pressure recorded simultaneously at the femoral artery site. The DP/DT values derived from the central aortic recordings and the noninvasive device correlated (r = 0.83). These results indicate that the noninvasive device measures the central aortic pressure or a close approximation of it. By combining noninvasive pressure measurements with volume measurements obtained by radionuclide angiography, noninvasive pressure-volume curves were generated in 10 subjects. Possible clinical application of the systolic noninvasive pressure-volume curves is suggested.     

广州市中老年人群血压水平与血尿酸和尿素氮的关系

目的探讨广州市中老年人群收缩压(systolic blood pressure,SBP)、舒张压(diastolic bloodpressure,DBP)与血尿酸(uric acid,UA)、血尿素氮(blood urea nitrogen,BUN)浓度的相关性及两组指标间典型相关特征。方法采集广州市中老年人群242例的血标本检测血UA、BUN浓度等,应用柱式水银血压计测量上臂血压3次,取平均血压值。各研究指标间相关性采用Pearson相关分析,应用多元相关分析进一步分析SBP、DBP与血UA、BUN浓度两组指标间的典型相关性,应用逐步回归分析估计因变量为SBP、DBP,解释变量为UA、BUN的回归系数和标准回归系数。结果Pearson相关分析显示广州市中老年人群242例的SBP与血UA浓度呈正相关(r=0.16023,P=0.0126);SBP与血BUN浓度呈正相关(r=0.16424,P=0.0105);DBP与血UA浓度呈正相关(r=0.16562,P=0.0099);DBP与血BUN浓度呈正相关(r=0.13506,P=0.0358)。本组SBP、DBP与血清UA、BUN浓度两组指标间的典型相关系数R...     

Noninvasive determination of systolic,diastolic and end-systolic blood pressure in neonates,infants and young children: Comparison with central aortic pressure measurements

Noninvasive determinations of systolic and diastolic blood pressure using the oscillometric method for pressure measurement were combined with externally recorded axillary pulse tracings to estimate end-systolic pressure in 32 neonates, infants and young children. Results were compared with central aortic pressure measurements made at the time of central aortic catheter placement. Studies were performed in patients aged 1 day to 48 months who weighed 0.9 to 18.1 kg. A wide range of systolic (41 to 141 mm Hg), diastolic (22 to 73 mm Hg) and end-systolic (30 to 111 mm Hg) pressure values were found. The mean absolute pressure differences and percent errors (pressure difference divided by central aortic pressure) were 1.8 mm Hg and 2.5% for systolic, 0.8 mm Hg and 0.8% for diastolic and 1.4 mm Hg and 2.1% for end-systolic pressure. No correlation was noted between percent error and age, weight, heart rate, cardiac index or systemic vascular resistance. The ability to perform reliable noninvasive pressure measurements should prove invaluable for clinical and research purposes. In addition, this method of end-systolic blood pressure determination enables sensitive indexes of left ventricular contractility to be measured noninvasively in small children.     

Increased aortic stiffness and blood pressure in non-classic Pompe disease

Vascular abnormalities and glycogen accumulation in vascular smooth muscle fibres have been described in Pompe disease. Using carotid-femoral pulse wave velocity (cfPWV), the gold standard methodology for determining aortic stiffness, we studied whether aortic stiffness is increased in patients with Pompe disease. Eighty-four adult Pompe patients and 179 age- and gender-matched volunteers participated in this cross-sectional case-controlled study. Intima media thickness and the distensibility of the right common carotid artery were measured using a Duplex scanner. Aortic augmentation index, central pulse pressure, aortic reflexion time and cfPWV were assessed using the SphygmoCor® system. CfPWV was higher in patients than in volunteers (8.8 versus 7.4 m/s, p?<?0.001). This difference was still present after adjustment for age, gender, mean arterial blood pressure (MAP), heart rate and diabetes mellitus (p?=?0.001), and was shown by subgroup analysis to apply to the 40-59 years age group (p?=?0.004) and 60+ years age group (p?=?0.01), but not to younger age groups (p?=?0.99). Except for a shorter aortic reflexion time (p?=?0.02), indirect indicators of arterial stiffness did not differ between patients and volunteers. Relative to volunteers (20 %), more Pompe patients had a history of hypertension (36 %, p?=?0.005), and the MAP was higher than in volunteers (100 versus 92 mmHg, p?<?0.001). This study shows that patients with non-classic Pompe disease have increased aortic stiffness and blood pressure. Whether this is due to glycogen accumulation requires further investigation. To reduce the potential risk of cardiovascular diseases, we recommend that blood pressure and other common cardiovascular risk factors are monitored regularly.     

Association of apolipoprotein E genotypes, blood pressure, blood lipids and ECG abnormalities in a general population aged 85+

Background  

Several studies have linked apolipoprotein E (ApoE) ε4 allele with elevated cholesterol and blood pressure levels. Data on the association of APOE genotypes with blood pressure, lipids, atrial fibrillation and ECG abnormalities in individuals aged 85 years and over is sparse.     

无创中心动脉压测量设备的比较

目的:比较目前通用的无创中心动脉压检测仪A-PULSE CASPro和SphygmoCor测量中心动脉压的相关性和稳定性。方法:450名男性志愿者,年龄19～23(22±1)岁;采集病史、记录一般情况;告知并签署知情同意;坐位休息10 min后测量右上肢肱动脉血压、分别用A-PULSE CASPro和SphygmoCor测量中心动脉压;记录数据。结果:A-PULSE CASPRO与SphygmoCor 测量的中心动脉压平均差值为1.57 mmHg(1 mmHg=0.133 kPa)和标准偏差为2.53 mmHg。采用Bland-Altman评价两种方法测量中心动脉压的偏差是在(5±8) mmHg范围之内。两种设备的线性回归方程为Y=0.9231*X+9.9341。A-PULSE CASPro和SphygmoCor测量的中心动脉压数值一致性好,R2为0.9123。结论: A-PULSE CASPro和SphygmoCor测量中心动脉压数值基本一致,相关性好,稳定性好。     

Mild hyperhomocysteinaemia is associated with increased aortic stiffness in general population

Total homocysteine (tHcy) level was identified as a strong and independent predictor of cardiovascular events. We investigated the association between tHcy and mechanical properties of large arteries in a random, general population-based sample of 251 subjects (mean age 48 years). Large artery properties, such as aortic and peripheral (lower-limb) pulse wave velocity (PWV), and augmentation index of radial artery were measured using semi-automatic Sphygmocor device. Aortic PWV (APWV) positively correlated with tHcy (r = 0.28, P<0.0001), and a significant increasing trend of APWV was found by tHcy quartiles (P = 0.0003 by ANOVA). This association remained significant after adjustment for conventional cardiovascular risk factors (age, gender, smoking, overweight, hypertension, dyslipidaemia and impaired glucose metabolism) and for usual homocysteine confounders (folate, B12, renal function). Subjects with mild hyperhomocysteinaemia (i.e. with tHcy > or = 15 micromol/l) had 2.74 times higher risk of having their APWV over 8.42 m/s (i.e. in the top quartile). No such association was found either for PWV measured at lower extremity or for radial augmentation index. In conclusion, in our series of subjects from general population, we found a strong and independent relationship between homocysteine concentration and APWV, a parameter of stiffness of central arteries.     

Determination of central aortic systolic and pulse pressure from the radial artery pressure waveform

OBJECTIVE: Measurements of central aortic systolic and pulse pressure, either gauged directly or estimated indirectly, have been shown to be superior to brachial pressure in outcome studies. While the radial pressure convolution method has proved to satisfy the criteria for 'substantial equivalence' to measure central pressure non-invasively, this study sought simpler methods to generate central systolic and pulse pressure directly from the radial artery waveform. METHODS: Two sets of data were used, in which radial artery pressure waves were measured by applanation tonometry and ascending aortic pressure was generated by the SphygmoCor process. Different approaches were applied to each dataset: firstly, using the time period from wave foot to systolic peak in central arteries; secondly, through identifying the pressure surge from the reflected wave in the radial artery; and thirdly from extrapolation and calibration of carotid systolic pressure when mean and diastolic pressure considered to be equal with radial values. RESULTS: Both datasets showed good correspondence between the central systolic and pulse pressure obtained with each of the three approaches and respective pressures generated by SphygmoCor process; all were within AAMI SP10 criteria and grade A for BSH criteria. CONCLUSION: All three approaches gave results similar substantially equivalent to those obtained with the SphygmoCor system for aortic, systolic and pulse pressure. Hence, simple inspection of the radial waveform has the potential to improve the estimation of aortic systolic and pulse pressure.