Atherosclerosis and Blood Pressure Variability.
Atherosclerosis and Blood Pressure Variability.
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动脉粥样硬化和血压变异。
DOI：
10.1161/hypertensionaha.117.10481
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发表时间：
2018
期刊：
影响因子：
8.3
通讯作者：
M. Ziegler
中科院分区：
文献类型：
--
作者：
M. Ziegler
请参阅相关文章，第 465–472 页
在本期中，Johansson 等人发现动脉粥样硬化和炎症标志物（存在于动脉粥样硬化斑块中）与体位性低血压有关。当我们站立时，超过 500 毫升的血液会流入腿部，从而降低血压。压力反射是稳定血压的最初机制。颈动脉和主动脉弓中的压力感受器感知血压变化，并向脑干发出信号，从而引发单次心跳中心率的增加。然后交感神经导致血管收缩，使血压在站立后约 20 秒内恢复到基线水平。当该系统出现故障时，就会发生体位性低血压。体位性低血压不仅会导致跌倒，还与中风和心肌梗死的发病率增加有关。2
随着年龄的增长，压力感受反射对血压的控制会慢慢恶化，从而减弱交感神经和副交感神经对高血压和低血压的反应。高血压和动脉粥样硬化会加速压力感受反射功能的丧失。因此，体位性低血压和阵发性高血压的发生率也会随着年龄和血管疾病的增加而增加。患有颈动脉斑块和冠状动脉粥样硬化的受试者的压力感受反射受损。5 心率变异性降低是压力感受反射丧失的标志，与心血管死亡率和总死亡率过高相关6，并可预测冠状动脉疾病。心肌梗死后，压力感受性反射敏感性降低可导致心脏死亡率增加 280%。7 Johansson 等人1 报告称，与动脉粥样硬化相关的蛋白质也与血压控制受损有关。为什么会这样呢？
压力感受器是……
See related article, pp 465–472
In this issue, Johansson et al1 find that markers of atherosclerosis and inflammation (which is present in atherosclerotic plaques) are associated with postural hypotension. When we stand, >500 mL of blood descend into the legs, decreasing blood pressure. The baroreflex is the initial mechanism called into play to stabilize blood pressure. Blood pressure changes are sensed by the baroreceptors in the carotids and aortic arch and signaled to the brain stem, which initiates an increase in heart rate in a single heartbeat. Sympathetic nerves then lead to vasoconstriction so that blood pressure returns toward baseline levels in ≈20 seconds after standing. When this system fails, postural hypotension ensues. Postural hypotension is not just a risk for falls, it is also associated with an increased incidence of stroke and myocardial infarction.2
Baroreflex control of blood pressure slowly deteriorates with advancing age, diminishing both sympathetic3 and parasympathetic4 nervous responses to hypertension and hypotension. Loss of baroreflex function is accelerated in hypertension and atherosclerosis. Consequently, the incidence of postural hypotension and episodic hypertension also increases with age and vascular disease. The baroreflex is impaired in subjects with carotid plaque and coronary atherosclerosis.5 Diminished heart rate variability is a sign of baroreflex loss and is associated with excess cardiovascular mortality and total mortality6 and predicts coronary artery disease. After a myocardial infarction, depressed baroreflex sensitivity predicted a 280% increase in cardiac mortality.7 Johansson et al1 report that proteins associated with atherosclerosis are also associated with impaired blood pressure control. Why should this be so?
Baroreceptors are …
一位患有难以控制的高血压的 91 岁女性：临床回顾。
DOI：
10.1001/jama.2013.277027
发表时间：
2013
期刊：
JAMA
影响因子：
--
作者：
Lipsitz,LewisA
通讯作者：
Lipsitz,LewisA