updateonarterialstiffness大动脉僵硬研究进展(编辑修改稿)

updateonarterialstiffness大动脉僵硬研究进展(编辑修改稿)内容摘要：

0,000)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。 Arnold Hodder 2020 PWV with age Reproduced from Avalio,et al. Change in contour and amplitude of pressure waves recorded in the radial artery and carotid in normal subjects between the first and eighth decade of life Disorders with great effects on arterial stiffness  Hypertension  Arteriosclerosisgeneralized degeneration of medial elements in elastic arteries  Atherosclerosis  Diabetes mellitus  Premature aortic degeneration  Obesity  All these disorders result in artery stiffening. However, to some extent, the increased arterial stiffness are reversible by treatment. Pressure/diameter relationships show schematically for an elastic artery of a normal subject(left) and an agematched patient with hypertension(right) ARTERIAL STIFFNESS amp。 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。 x10 4 ) 21 19 17 15 13 11 9 7 Pulse wave velocity (m/s) Nonobese Obese r = p BMI amp。 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。 THERAPY Therapy for Arterial Stiffness Any antihypertensive drug that reduces mean arterial pressure results in passive decrease in arterial stiffness 从病理生理上已经注意到动脉僵硬是心血管事件重要的中心环节，那么动脉僵硬度的降低是否比血压降低更重要，能独立预测心血管危险的降低。 The goal of treatment for a selective increase in PP 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。 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。 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。 s Clinic, University of New South Wales, Sydney, Australia  Heart 2020。 88:143148 方法  46名志愿者 ， 禁食 、 卧床 ， 随机给予安慰剂或不同剂量的缓释 GTN贴剂 （ 毫克 /小时 ， /小时 ， /小时及 /小 时 ） ， 记录桡动脉脉搏波并与传统的袖带血压计测量结果对照。 中心动脉 脉搏波通过已验证的转换。