中心动脉脉压是影响大动脉僵硬度的主要因素

目的观察高血压患者及血压正常人群中心动脉血流动力学差异；探讨哪种血压指标与动脉僵硬度及血管损害标志物更
密切相关。方法从北京地区社区人群中筛选出820名高血压患者，同时入选820名与之年龄、性别相匹配的血压正常者。采用
脉搏波传播速度(PWV)自动测量系统测定颈-股动脉PWV和颈-桡动脉PWV；应用张力测量法测量中心动脉压和中心动脉脉搏
波增强指数（AIx）。同时血浆同型半胱氨酸（HCY），高敏C反应蛋白（HsCRP）及N末端脑利钠肽前体(NT-proBNP)被测定。结
果无论是高血压患者还是血压正常人群，中心动脉收缩压和脉压显著低于相应的肱动脉收缩压和脉压，这种脉压扩增在血压
正常组9.85±6.55 mmHg明显低于高血压组12.64±6.69 mmHg，但在脉压扩增比上两组未见差异。大动脉僵硬度受血压及年龄
的影响，高血压组具有较高的颈股动脉PWV和中心动脉AIx，脉压扩增比随年龄的增长而递减。单因素分析见中心脉压相对
其它血压指标与动脉僵硬度和血管损害标志物的相关性更强；多元逐步回归分析显示颈股动脉PWV和中心动脉AIx受中心脉
压的独立影响而外周平均动脉压及脉压未进入回归方程。结论中心动脉脉压相对其它血压指标可能是中心动脉僵硬度更直
接的指示器和更好的血管老化的标志，未来的临床试验中可能更多地将中心动脉压作为治疗的靶目标值。

Central pulse pressure but not brachial blood pressure is the predominant factor affecting aortic arterial stiffness

Objective To investigate the differences in central hemodynamic indices between hypertensive and normotensive
subjects and identify the blood pressure index that the most strongly correlate with arterial stiffness and vascular damage
markers. Methods A cohort of 820 hypertensive patients and 820 normotensive individuals matched for age and gender were
enrolled in this study. We measured carotid-femoral and carotid-radial pulse wave velocity (PWV), aortic augmentation index
(AIx) and central blood pressures using pulse wave analysis and applanation tonometry. Plasma homocysteine (HCY),
high-sensitivity C-reactive protein (hsCRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were also tested in
these subjects. Results In both hypertensive and normotensive subjects, the central systolic blood pressure (SBP) and pulse
pressure (PP) were significantly lower than brachial SBP and PP; this PP amplification was significantly lower in the
normotensives (9.85±6.55 mmHg) than in the hypertensives (12.64±6.69 mmHg), but the amplification ratios were comparable
between the two groups. Blood pressure and age were closely related with aortic arterial stiffness. Compared with
normotensive subjects, hypertensive subjects had higher carotid-femoral PWV and AIx, and showed significantly lowered PP
amplification ratio with age. Central PP was more strongly related to arterial stiffness and vascular damage markers than the
other pressure indices. Multivariate analyses revealed that carotid-femoral PWV and aortic AIx were strongly influenced by
central PP but not by the mean blood pressure or brachial PP. Conclusion The central PP is a more direct indicator of central
arterial stiffness and a better marker of vascular aging than other blood pressure variables. These findings support the use of
central blood pressure as a treatment target in future trials.