The macrocirculation and microcirculation of hypertension
The macrocirculation and microcirculation of hypertension
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DOI：
10.1007/s11906-009-0033-6
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发表时间：
2009-06-01
影响因子：
5.6
通讯作者：
Waeber, Bernard
中科院分区：
文献类型：
--
作者：
Feihl, Francois;Liaudet, Lucas;Waeber, Bernard
伴随高血压的血管结构改变可能导致高血压终末器官损害。应考虑大血管和微血管水平，因为它们之间的相互作用被认为是至关重要的。关于大循环，文章首先回顾了血管生物力学的基本概念，如动脉顺应性，动脉扩张性和动脉壁材料的应力-应变关系，然后回顾高血压如何影响管道动脉的特性，特别是检查证据表明，它加速了通常随着年龄的增长而发生的进行性硬化。高动脉僵硬度可能通过两种不同的机制增加中心收缩压和脉压：1）异常高的脉搏波速度可能导致收缩期外周反射的压力波到达中央主动脉，从而增加收缩压; 2）在老年人中，向前压力波的相互作用与高动脉僵硬度是导致异常高脉压的主要原因。在微血管水平，高血压疾病的特征是向内的微动脉的肥大或肥厚的重塑和毛细血管稀疏。这些异常可能部分取决于高脉动血压向微血管网络的异常传输，特别是在具有低血管阻力的高灌注器官中，如肾脏、心脏和大脑，在那里它有助于高血压终末器官损伤。
Changes in vascular structure that accompany hypertension may contribute to hypertensive end-organ damage. Both the macrovascular and microvascular levels should be considered, as interactions between them are believed to be critically important. Regarding the macrocirculation, the article first reviews basic concepts of vascular biomechanics, such as arterial compliance, arterial distensibility, and stress-strain relationships of arterial wall material, and then reviews how hypertension affects the properties of conduit arteries, particularly examining evidence that it accelerates the progressive stiffening that normally occurs with advancing age. High arterial stiffness may increase central systolic and pulse pressure by two different mechanisms: 1) Abnormally high pulse wave velocity may cause pressure waves reflected in the periphery to reach the central aorta in systole, thus augmenting systolic pressure; 2) In the elderly, the interaction of the forward pressure wave with high arterial stiffness is mostly responsible for abnormally high pulse pressure. At the microvascular level, hypertensive disease is characterized by inward eutrophic or hypertrophic arteriolar remodeling and capillary rarefaction. These abnormalities may depend in part on the abnormal transmission of highly pulsatile blood pressure into microvascular networks, especially in highly perfused organs with low vascular resistance, such as the kidney, heart, and brain, where it contributes to hypertensive end-organ damage.