updateonarterialstiffness大動(dòng)脈僵硬研究進(jìn)展-預(yù)覽頁(yè)
【正文】 Left ventricle ejection, which taking blood into the aorta, generates a pressure wave that is propagated to other arteries throughout the body. Propagation occurs along the arterial wall Systole . Blood = inpressible fluid Artery = elastic conduit } Radial waveform Ascending aortic waveform Female 18 years Female 48 years Female 97 years O’Rourke amp。 ALLCAUSE MORTALITY IN 1980 HYPERTENSIVES 0 5 10 15 20 Followup (years) Survival Low PWV tertile Medium PWV tertile High PWV tertile KaplanMeier P Laurent et al., Hypertension 2020 PWV amp。 Determinants of Arterial Stiffness pressure wall structure: vascular smooth muscle(VSM) cells, collagen fibers, and ground substance. Collagen greatly modifies arterial rigidity and the transit of wave reflections. Neurohumoral factors(RAS systems), may modulate collagen accumulation. Chemical modifications of collagen, such as breakdown, crosslinking, or glycation, result in marked changes in stiffness. 3. The function of endothelium Changes in VSM tone are modulated by nitric oxide (NO) and vasoconstrictive (norepinephrine, angiotensin, endothelin) pounds, which mainly depend on the function of endothelium. Amplitude of Earlier Wave Reflections mainly based on the geometry, number, structure, and function of smaller muscular arteries and arterioles which serve as major reflection sites ? or remodeling of small arteries and arterioles ? and branching angles of arterioles ? of the microenvironment (in particular sodium and other cations), ? endotheliummediated vasodilation, ? in matrix position of small arteries and arterioles, ? mediated alterations of vasomotor tone, arising from smooth muscle or endothelial cells. 動(dòng)脈硬度與心血管危險(xiǎn) 動(dòng)脈硬度 ↑ 反射波強(qiáng)度 ↑ amp。Pulse Wave Analysis A simple method to assess arterial stiffness and distensibility. Widely used. Noninvasive and reproducible. Simultaneous assessment shows modest correlation (r=). Yasmin Brown MJ. QJM. 1999。 BODY MASS INDEX PWV is related to BMI (Adapted from TotoMoukouo et al., 1986) 19 21 23 25 27 29 31 33 35 37 Body mass index (kg/cm178。SBP To decrease SBP with maintenance of or even increase in DBP, the target mechanisms are the decrease in ventricular ejection, the active decrease in arterial stiffness, and the change in wave reflections. Drugs with potential direct effects on arterial stiffness or wave reflection ? Nitroglycerin, nitrate derivatives ? NO donors, enhancers of NO production and/or release ? CCB ? ACEIamp。88:143148 方法 ? 46名志愿者 ， 禁食 、 臥床 ， 隨機(jī)給予安慰劑或不同劑量的緩釋 GTN貼劑 （ 毫克 /小時(shí) ， /小時(shí) ， /小時(shí)及 /小 時(shí) ） ， 記錄橈動(dòng)脈脈搏波并與傳統(tǒng)的袖帶血壓計(jì)測(cè)量結(jié)果對(duì)照 。 177。 177。25(5):10959. ? XiongJing Jiang, Michael F. O’Rourke, YuQing Zhang, XinYe He, LiSheng Liu ? of Hypertension,Fu Wai Hospital, Chinese Academy of Medical Sciences,amp。113 :121325 Systolic pressure Pulse pressure arm aorta arm aorta 臨 床 問(wèn) 題 ASCOT的 CAF201。 Future ? Novel therapeutic approaches reduce the increase in PP and arterial stiffness with age should be developed further. Therapeutic trials using such medications will be necessary to demonstrate an improvement in morbidity and mortality on the basis of influencing vascular stiffness and increased PP.
教學(xué)課件相關(guān)推薦
鄂ICP備17016276號(hào)-1