updateonarterialstiffness大動(dòng)脈僵硬研究進(jìn)展(完整版)
【正文】 070809010011012013014015015 20 25 30 35 40 45 50 55 60 65 70 75 80Age(yr)BP(mmHg)menwomenbothThe change of PP with age in China BP Survey in 1990 (n=950,000)354045505560657015 25 35 45 55 65 75Age(yr)Pulse Pressure(mmHg)menwomenbothNichols WW, O’Rourke MF. McDonald’s Blood Flow in Arteries. 5th ed. London。99:2434 ≤ PWV ≤ m/s ≤ PWV ≤ m/s （ PWV）較慢，反射波落在升主動(dòng)脈壓力波的舒張期（上圖）。 PP in subjects 50 years of age, ventricular ejection tends to be reduced, so that arterial stiffness and amplitude and timing of wave reflections bee the main determinants of increased SBP and PP. Question: Is arterial stiffness a marker of cardiovascular disease and mortality in the elderly? PWV amp。46:200204 血流 血流 Evaluation of arterial stiffness Surrogate Measures of arterial stiffness Pulse Wave Velocityamp。 THERAPY Therapy for Arterial Stiffness Any antihypertensive drug that reduces mean arterial pressure results in passive decrease in arterial stiffness 從病理生理上已經(jīng)注意到動(dòng)脈僵硬是心血管事件重要的中心環(huán)節(jié)，那么動(dòng)脈僵硬度的降低是否比血壓降低更重要，能獨(dú)立預(yù)測(cè)心血管危險(xiǎn)的降低？ The goal of treatment for a selective increase in PP amp。 咪達(dá)普利治療 6周后肱動(dòng)脈血壓變化與中心動(dòng)脈血壓變化的比較 肱動(dòng)脈 中心動(dòng)脈 P 收縮壓變化 (mmHg) 177。 SUPERIOR EFFECT OF AN ANGIOTENSIN CONVERTING ENZYME INHIBITOR OVER A DIURETIC FOR REDUCING AORTIC SYSTOLIC PRESSURE J Hypertens. 2020 May。 利尿劑治療方案 多數(shù)大規(guī)模臨床試驗(yàn)發(fā)現(xiàn) CCB、噻嗪類利尿劑與 ACEI在降壓一致的情況下，降低高血壓患者心血管危險(xiǎn)方面一樣有效 .假如降壓一致的情況下出現(xiàn)終點(diǎn)事件顯著差異，如何解釋？動(dòng)脈僵硬度的變化是否為切入點(diǎn)？ 普通高血壓目標(biāo)血壓 140/90 mmHg 糖尿病，腎病 130/80 mmHg 老年人 SBP150mmHg +T40mg +T80mg 加其它降壓藥 導(dǎo)入期 +D1/2片 +D1片 加其它降壓藥 A5mgg+D1片 A5mg+T80mg 2W 0 2W 4W 2M 3M 6M 9M 48M A：氨氯地平； D：復(fù)方阿米洛利； T：替米沙坦 CHIEF主課題研究方案 CASTI研究目的 下降低脈搏波增壓指數(shù) (AI)和脈搏波速度(PWV)是否有差異？ AI和 PWV下降是否與心血管危險(xiǎn)下降顯著相關(guān) ？ 2. 探討 AI和 PWV對(duì)心腦血管事件的預(yù)測(cè)作用 。 ? Peking Union Medical College, Beijing 100037, China. ? b. Medical Professorial Unit, St. Vincent’s Hospital, New South Wales University, NSW ? 2020, Australia. Change from baseline to the end of treatment in Imdapamide(n=51) and Enalapril (n=50)group 8090100110120130140150160t i m AORTA8090100110120130140150160t im epressure (mmHg)b a s e l i n e e n d o f s t u d yRADIALss8090100110120130140150160t i m eAORTA8090100110120130140150160t im epressure (mmHg)b a s e l i n e e n d o f s t u d yNO DIFFERENTIAL EFFECT OF FELODIPINE ON CENTRAL AORTIC . BRACHIAL SYSTOLIC PRESSURE IN TONOMETER SUBSTUDY OF FEVER TRIAL XJ Jiang?, MF O’Rourke?, LS Liu?, YQ Zhang?, XY He?, QC Cheng?, H Lou? ? Division of Hypertension, Fuwai Hospital amp。 舒張壓變化 (mmHg) 177。ARB ? Diuretics ? Spironolactone ? Agents acting on collagen crosslinking ? Vasopeptidase inhibitors The effect of nitroglycerin on wave reflection. From O’Rourke et al Quantification of glyceryl trinitrate effect through analysis of the synthesised ascending aortic pressure waveform ? X J Jiang1, M F O39。 92: 595–600. Arterial pulse and pulse wave velocity(PWV)
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