Arterial Stiffness, Pulse Pressure, and the Kidney
Arterial Stiffness, Pulse Pressure, and the Kidney
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DOI：
10.1093/ajh/hpu206
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发表时间：
2015-05-01
影响因子：
3.2
通讯作者：
Mimran, Albert
中科院分区：
文献类型：
--
作者：
Safar, Michel E.;Plante, Gerard E.;Mimran, Albert
经典研究表明，肾脏对高血压的贡献几乎完全与平均动脉压（MAP）和血管阻力之间的关联有关。最近的报告，包括肾小球滤过率（GFR）的估计表明，脉压（PP）和脉搏波速度，动脉硬度的2个主要指标，现在成为心血管风险和年龄相关的GFR下降的重要预测因子。这些发现主要见于高血压和肾衰竭患者以及接受冠状动脉造影术的动脉粥样硬化受试者。在这些患者中，肾部位升主动脉和终末主动脉之间的PP扩增持续增加超过10 mm Hg（P < 0.001），而MAP水平保持持续不变。这种PP扩增与蛋白尿的存在显著相关。此外，在横断面和纵向研究中，血浆肌酐和主动脉僵硬度的增加是独立和正相关的（P < 0.001）。所有这些与PP、动脉硬度和肾功能相关的关系主要在60岁或以上的患者中观察到。此外，在肾移植患者及其供体中，招募受试者评价动脉僵硬度和移植后GFR下降。移植后1年和9年评估GFR下降的决定因素。第一年GFR下降与吸烟和急性排斥反应有关，而后者与供体年龄和主动脉僵硬度显著相关。因此，在高血压人群中，观察到的PP和GFR之间的相关性表明，这两个参数基本上是由动脉僵硬度介导的，而不仅仅是由血管阻力介导的。
Classical studies indicate that the contribution of kidneys to hypertension is almost exclusively related to the association between mean arterial pressure (MAP) and vascular resistance. Recent reports including estimates of glomerular filtration rate (GFR) have shown that pulse pressure (PP) and pulse wave velocity, 2 major indices of arterial stiffness, now emerge as significant predictors of cardiovascular risk and age-associated decline in GFR. Such findings are mainly observed in patients with hypertension and renal failure and in atherosclerotic subjects undergoing coronary angiography. In such patients, amplification of PP between ascending and terminal aorta at the renal site is constantly increased over 10 mm Hg (P < 0.001), whereas MAP level remains continuously unmodified. This PP amplification is significantly associated with presence of proteinuria. Furthermore, increases in plasma creatinine and aortic stiffness are independently and positively correlated (P < 0.001) both in cross-sectional and longitudinal studies. All these relationships associating PP, arterial stiffness, and renal function are mainly observed in patients 60 years of age or older. Furthermore, in renal transplant patients and their donors, subjects have been recruited for evaluations of arterial stiffness and posttransplant decline in GFR. Determinants of GFR decline were evaluated 1 and 9 years after transplantation. The first year GFR decline was related to smoking and acute rejection, whereas the later was significantly and exclusively associated with donor age and aortic stiffness. Thus, in hypertensive humans, the observed association between PP and GFR suggests that the 2 parameters are substantially mediated by arterial stiffness, not exclusively by vascular resistance.