Cl inical Study of Arterial Buffering Function and Endothel ial Function in Patients with Essential Hypertension

Transcription

1 48 (200025) ( Pulse wave velocity PWV) - PWV(CPWV) (Distensibility) (CSC) (VD) CPWV ( P = ) CSC VD ( P = P = ) ( P = ) VD ( r = P = ) Cl inical Study of Arterial Buffering Function and Endothel ial Function in Patients with Essential Hypertension Wang Hongyu Zhang Weizhong Gong L ansheng Rui J in Hospital Shanghai Second Medical University; Sha nghai I nstit ute of Hypertension Sha nghai (200025) Abstract To evaluate the impact of hypertension in artery buffering function and endothelial function and seek sensi2 tive marker to indicate hypertensive patients risk. Automatic pulse wave velocity( PWV) measurement was applied to exam2 ine 54 hypertensive patients and 16 healthy subjects. Carotid - femoral PWV(CPWV) was parameter to reflect arterial dis2 tensibility. B2mode ultrasonography was used to detect brachial artery cross2sectional compliance(csc). Volumic distensibili2 ty(vd). Csc and VD were parameter to reflect artery buffering function. Endotheliumdependent dilation was assessed as the changes in diameter of the artery during reactive hyperemia to reflect endothelial function. CPWV was higher in hyperten2 sive group ( P = ) CSC VD were lower in hypertensive group ( P = P = ) endothelium - dependent dilatation was reduced in hypertensive group ( P = ). Mutiple factors analysis demonstrated VD had close relationship with brachial artery endothelium - dependent dilatation( r = P = ). Artery Buffering function and endothe2 lial function were damaged during hypertension. Endothelial dysfunction led to buffering dysfunction. The change of artery distensibility was early and sensitive index to reflect artery buffering function and endothelial function which would have im2 portant value in clinic. Key words :Essential hypertension ; Artery ; Distensibility ; Endothelial function [1 ]

2 kpa (140 mmhg) ( 50 mmhg) kpa(90 mmhg) 10 min D (mm) D D %(4) min 1. 5 mm (Vs ( ) 2min cm/ s) (Vd cm/ s) 1 3 (Vm cm/ s) ( Q) Q = 60VmDD 2 / 4 2. (1) (ml/ min) [ 3 ] 3. HP Image (Complior France) - Point 2. 5MHz [ 4 ] 16 2 mm 3 3 ( Pe) ( Pa) 10 (2) R T 7. 5MHz Image Point ( 3 ) ( Pulse pressure PP mmhg) 2cm = SBP - DBP ( Mean blood pressure MBP mmhg) = 2cm DBP + 1/ 3P (Body mass index BMI kg/ m 2 ) = - - / - ( Intima - Media Thickness IM T) 3 ( Systolic diameter SD) (Diastolic diameter DD) (Left ventricle mass LVM g) = (Cross - sectional Compliance CSC) CSC =. DD. AD/ 2P(10-3 mm 2 mmhg - 1 P (Volumic distensibility VD) VD = 2AD/ DD. P(10-3 mmhg - 1 ) [ 2 ] (3) cm 7. 5 MHz Image Point ( ) LVMIg/ m 2 ) = LVM/ BSA [ 4 ] 2cm 2 cm t 10 min 2 (Body surface area BSA m 2 ) = (cm) (kg) [ 5 ] 0. 8[1. 04 ( IVSD + LV IDD + L PWD) 3 - LV IDD 3 ] g IVSD LV IDD L PWD ( Left ventricle mass index ( 0. 25) P < 0. 05

3 50 ( Waist/ Hips ratio) ( = P = ) SBP DBP MB ( P = P = P = ) 1 ( Age ) ( BM I) / 1 Age (years) BMI(kg/ m 2 ) Waist/ Hips ratio SBP( mmhg) DBP(mmHg) MBP(mmHg) PP(mmHg) LVM I ( P = ) CSC VD ( P = ) Pe/ Pa ( = P = ( P = ) ) 2 3. CPWV 2 LVMI(g/ m 2 ) Pe/ Pa IMT(mm) DD(mm) CPWV (m/ s) CSC(10-3 mm 2 mmhg - 1 ) VD(10-3 mmhg - 1 ) ( P = P = P = ) (D %) 3 3 D(mm) D % Vm(ml/ min) Q R (ml/ min) Q (ml/ min) : 3Vm Q Vm Q Q R

4 VD D % ( r = P = ) 4 D % F VD Q BMI : 3 Q 0 [8 ] ( CPWV CSC VD) VD PWV [6 ] [7 ] [8 9 ] [10 ] VD [8 ] [11 ] [12 13 ] [1 ] 1 Cohn J N. Arteries myocardium blood pressure and

5 52 cardiovascular risk : towards a revised definition of hypertension.j Hypertens : Khder Y Bray DL Aliot E et al. Effects of blood pressure control on radial artery diameter and com2 pliance in hypertensive patients. Am J Hypertens : Neunteufl T Kostner K Katzenschlager R et al. Additional benefits of vitamin E supplementation to simvastatin therapy on vasoreactivity of the brachial artery of hypercholesterolemicmen. J Am Coll Cardiol : Palatini P Visentin P Mormino P et al. Structural abnormalities and not diastolic dysfunction are the earliest left ventricular changes in hypertension. Am J Hypertens : Hammond ZW Devereux RB Alderman MH et al. Relation of blood pressure and body build to left ventricular mass in normotensive and hypertensive employed adults. JACC : Enderle MD Schroeder S Ossen R et al. Compar2 sion of peripheral endothelial dysfunction and inti2 mal media thickness in patients with suspected coronary artery disease. Heart : Khder Y Briancon S Petermann R et al. Shear stress abnormalities contribute to endothelial dys2 function in hypertension but not in type dia2 betes.j Hypertens : Iiyama K Nagano M Yo Y et al. Impaired en2 dothelial function with essential hypertension as2 sessed by ultrasonography. Am Heart J : Taddei S Virdis A Ghiadoni L et al. The role of endothelium in human hypertension. Nephrol Hypertens : Curr Opin 10 Drexler H. Hypertension heart failure and en2 dothelial function. Am J Cardiol :20S 22S. 11 Celermajer DS Sorensen KE Gooch VM et al. Non - invasive detection of endothelial dysfunc2 tion in children and adults at risk of atherosclero2 sis. Lancet : Luscher TF Noll G. Endothelial function as an end - point in interventional trials : concepts methodsandcurrent data. J Hypertens (suppl 2) :S111S Taddei S Virdis A Ghiadoni L et al. Effects of angiotensin converting enzyme inhibition on en2 dothelium - dependent vasodilatation in essential hypertensive patients. J Hypertens : ( ) (China Info) (ChinaInfo) (ChinaInfo) (ChinaInfo) ( : http :/ / www. chinainfo. gov. cn/ periodical) 1000 (ChinaInfo) (ChinaInfo) (1 ) (ChinaInfo)