Stiffness of carotid artery wall material and blood pressure in humans - Application to antihypertensive therapy and stroke prevention
Stiffness of carotid artery wall material and blood pressure in humans - Application to antihypertensive therapy and stroke prevention
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DOI：
10.1161/01.str.31.3.782
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发表时间：
2000-03-01
期刊：
影响因子：
8.3
通讯作者：
London, GM
中科院分区：
文献类型：
--
作者：
Safar, ME;Blacher, J;London, GM
背景和目的——流行病学研究表明，脉压升高和颈动脉壁物质僵硬度是心血管死亡率的预测因素，与年龄、动脉粥样硬化和传统危险因素无关，因此颈动脉壁硬度和血压之间的关系对于优化心血管预防非常重要。综述总结——中年高血压患者的平均压和脉压升高，收缩压和舒张压升高至与平均压相同的程度。颈动脉肥大与正常的壁应力相关，但没有报道壁材料的硬度增加。随着年龄的增长，正常的壁应力与颈动脉的直径增大和材质变硬相关，但与外周动脉无关。较硬的壁涉及钙化、大量胶原蛋白以及弹性组织的碎裂和破裂，这导致脉搏波速度增加以及波反射的幅度和时间的改变，从而导致收缩压和脉压不成比例的增加。在此期间，老年受试者急性服用硝酸盐能够选择性地降低收缩压和脉压，而不改变舒张压和平均血压以及颈动脉壁的组成。结论-需要主要作用于大动脉壁的新治疗方法来治疗老年患者的高血压并预防中风和心肌梗塞。这些药物可以通过改变波反射（如硝酸盐）选择性地降低脉压，或通过改变材料成分（例如作用于胶原交联的化合物）来降低动脉壁硬度。
Background and Purpose-Because epidemiological studies show that increased pulse pressure and carotid wall-material stiffness are predictors of cardiovascular mortality independent of age, atherosclerosis, and conventional risk factors, the relationships between carotid wall stiffness and blood pressure are important to the optimization of cardiovascular prevention.Summary of Review-In middle-aged hypertensive patients, mean and pulse pressures are increased, and systolic and diastolic pressures are increased to the same degree as mean pressure. Carotid hypertrophy is associated with normal wall stress, but no increased stiffness of wall material has been reported. With age, the normal wall stress is associated with a larger diameter and a stiffer material of carotid but not peripheral arteries. The stiffer wall involves calcifications, large amounts of collagen, and fragmentation and rupture of elastic tissue, which results in increased pulse-wave velocity and alterations of amplitude and timing of wave reflections and thus causes a disproportionate increase in systolic and pulse pressure. During this period, acutely administered nitrates in elderly subjects are able to reduce selectively systolic and pulse pressures without altering diastolic and mean blood pressure and composition of the carotid wall.Conclusions-New therapeutic approaches acting mainly on the wall of large arteries are needed to treat hypertension in elderly patients and prevent stroke and myocardial infarction. These drugs could either selectively lower pulse pressure through changes in wave reflections (as nitrates do) or decrease arterial wall stiffness through modification of the composition of material (such as compounds that act on collagen cross-linking).