updateonarterialstiffness大動(dòng)脈僵硬研究進(jìn)展-閱讀頁
2024-09-21 14:25本頁面
【正文】 23 25 27 29 31 33 35 37 Body mass index (kg/cm178。 PWV in obese and nonobese hypertensive patients. PWV is related to glucose intolerance and diabetes (Adapted from Amar et al) 0 2 4 6 8 10 12 14 Controls Glucose intolerants Diabetics Carotidfemoral PWV (m/s) ** * 16 13 14 15 No Unilateral Bilateral 13 14 15 1 2 3 4 5 PWV is related to ATHEROSCLEROSIS Indicators Quintiles of carotid wall thickness Plaques in carotid artery Carotidfemoral PWV (m/s) Carotidfemoral PWV (m/s) p p = Values are adjusted for age, sex, mean BP and pulse rate ARTERIAL STIFFNESS amp。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。Rourke3, W Q Jin2, L S Liu1, C W Li2, P C Tai2, X C Zhang2 and S Z Liu2 ? 1 Hypertension Division, Fu Wai Hospital, Chinese Academy of Medical Sciences, ? Peking Union Medical College, PR China 2 Ren Ming Hospital, Weifang, Samdong, PR China 3 St Vincent39。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)測量結(jié)果對照 。 一、 用藥前后傳統(tǒng)觀察指標(biāo)的變化 肱動(dòng)脈收縮壓1510505100 1 2 3 4 5 6 7壓力變化（mmHg）肱動(dòng)脈平均壓 (DP + 1/3PP)864202460 1 2 3 4 5 6 7壓力變化（mmHg）肱動(dòng)脈舒張壓64202460 1 2 3 4 5 6 7壓力變化（mmHg）心率43210123450 1 2 3 4 5 6 7時(shí)間（小時(shí)）心率變化（次/分）0mg/hr二、用藥前后中心動(dòng)脈脈搏波指標(biāo)變化 中心動(dòng)脈收縮壓201510505100 1 2 3 4 5 6 7壓力變化(mmHg)中心動(dòng)脈反射波增壓121086420240 1 2 3 4 5 6 7壓力變化 (mmHg)積分平均壓（按波形計(jì)算）12108642024680 1 2 3 4 5 6 7壓力變化(mmHg)射血時(shí)間3025201510505100 1 2 3 4 5 6 7時(shí)間(小時(shí))射血時(shí)間變化（毫秒）0mg/hrChange of Carotid distensibility after 6 months of treatment (diuretics Vs. ACEI) Unequal effect on distensibility for the same BP reduction HCTZ + amiloride 15 10 5 P perindopril 20 Improvement % 0 Kool M et al, J hypertes. 1995 1 16% improvement *P versus baseline 通過脈搏波分析比較咪達(dá)普利對中心和外周動(dòng)脈壓的影響 中國循環(huán)雜志 2020； 19（ 2）： 120122 蔣雄京 1 張宇清 1 王茹 2 張承宗 2 段兵 1 劉力生 1 中國醫(yī)學(xué)科學(xué)院 阜外心血管病醫(yī)院高血壓診治中心 。 177。 177。 177。 結(jié)論 咪達(dá)普利降低外周動(dòng)脈壓和中心動(dòng)脈壓均有效，且降低收縮壓和脈壓在中心動(dòng)脈比外周動(dòng)脈顯著，其差異可能系波反射降低所致。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。 Cardiovascular Institute, Peking Union Medical College, Beijing, CHINA。113 :121325 Systolic pressure Pulse pressure arm aorta arm aorta 臨 床 問 題 ASCOT的 CAF201。 ACEI治療方案由于有額外的降低中心動(dòng)脈壓作用，優(yōu)于 β阻滯劑 177。 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.
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