Central pressure: Variability and impact of cardiovascular risk factors - The Anglo-Cardiff Collaborative Trial II
Central pressure: Variability and impact of cardiovascular risk factors - The Anglo-Cardiff Collaborative Trial II
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DOI：
10.1161/hypertensionaha.107.105445
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发表时间：
2008-06-01
期刊：
影响因子：
8.3
通讯作者：
Wilkinson, Ian B.
中科院分区：
文献类型：
--
作者：
McEniery, Carmel M.;McDonnell, Barry;Wilkinson, Ian B.
脉压在整个动脉树上变化，导致中心和外周压力之间的梯度。年龄、心率和身高等因素会影响这种梯度。然而，心血管危险因素和动脉粥样硬化性疾病对中心压的相对影响以及健康个体中心压的正常变化尚不清楚。对健康人、糖尿病患者、心血管疾病患者和仅有高血压、高胆固醇血症或吸烟的患者进行坐位外周(臂动脉)和中心(主动脉)血压的评估，并计算主动脉和臂部脉压之比(即脉压比，即1/放大)。年龄范围从18岁到101岁，分析了10613人的数据。与健康人相比，有危险因素或疾病的人的脉压比显著升高(即中心收缩压相对较高)(P0.01)。尽管年龄增长与脉压比增加有关，但在80岁的男性和女性中，臂动脉和主动脉收缩压之间的平均+/-SD差分别为11+/-4和8+/-3毫米汞柱。最后，根据臂压对个体进行分层显示，主动脉压有相当大的重叠，因此，70%的正常臂压偏高的个体的主动脉压与1期高血压的个体相似。这些数据表明，心血管危险因素影响脉压比，中心压不能可靠地从外周压力推断出来。然而，对中心压的评估可能会改善心血管风险升高患者的识别和管理。
Pulse pressure varies throughout the arterial tree, resulting in a gradient between central and peripheral pressure. Factors such as age, heart rate, and height influence this gradient. However, the relative impact of cardiovascular risk factors and atheromatous disease on central pressure and the normal variation in central pressure in healthy individuals are unclear. Seated peripheral (brachial) and central (aortic) blood pressures were assessed, and the ratio between aortic and brachial pulse pressure (pulse pressure ratio, ie, 1/amplification) was calculated in healthy individuals, diabetic subjects, patients with cardiovascular disease, and in individuals with only 1 of the following: hypertension, hypercholesterolemia, or smoking. The age range was 18 to 101 years, and data from 10 613 individuals were analyzed. Compared with healthy individuals, pulse pressure ratio was significantly increased (ie, central systolic pressure was relatively higher) in individuals with risk factors or disease (P 0.01 for all of the comparisons). Although aging was associated with an increased pulse pressure ratio, there was still an average+/-SD difference between brachial and aortic systolic pressure of 11+/-4 and 8+/-3 mm Hg for men and women aged >80 years, respectively. Finally, stratifying individuals by brachial pressure revealed considerable overlap in aortic pressure, such that >70% of individuals with high-normal brachial pressure had similar aortic pressures as those with stage 1 hypertension. These data demonstrate that cardiovascular risk factors affect the pulse pressure ratio, and that central pressure cannot be reliably inferred from peripheral pressure. However, assessment of central pressure may improve the identification and management of patients with elevated cardiovascular risk.