Pulse wave reflection in children: amplification through the lifecourse.
Pulse wave reflection in children: amplification through the lifecourse.
复制标题
儿童脉搏波反射：生命历程中的放大。
DOI：
10.1097/hjh.0000000000001357
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发表时间：
2017
影响因子：
4.9
通讯作者：
Zachariah,JustinP
中科院分区：
文献类型：
--
作者：
Zachariah,JustinP
确定早期血压（BP）的组成部分至关重要，因为有证据表明BP在预测未来动脉粥样硬化性心血管疾病（ASCVD）中的作用。经典文献已经证明，历史BP能够预测因事故和战争等不幸死亡的年轻人中动脉粥样硬化斑块的存在[2-5]。最近的数据显示，青少年男性血压（分为SBP、DBP、脉压（PP）、平均动脉压（MAP）等各种指标）与最终成人ASCVD事件之间存在连续关系[6]。来自美洲原住民的类似数据显示，医生诊断的儿童高血压是早期死亡的风险因素[7]。一项针对青少年男性的研究表明，即使在调整中年BP后，青少年BP也可预测未来的ASCVD，这强调了早期BP的附加效用[8]。越来越多的证据进一步证明了血压升高在临床前动脉粥样硬化变化（包括左心室肥大和血管变化）中的特定作用[9，10]。有趣的纵向数据甚至表明，从儿童期到成年期血压升高的正常化改善了这些临床前动脉粥样硬化变化[11]。现在有多条证据将早期生命BP与临床前体内动脉粥样硬化、动脉粥样硬化斑块的病理学证据、实际ASCVD事件和死亡率以及甚至动脉粥样硬化变化与BP衰减的逆转联系起来。转向生理分类，BP可以使用每个血压计的传统SBP和DBP进行分类。另一种描述通过PP（大动脉特性的指标）和MAP（小动脉功能的指标）对BP进行分类。这两种组合都可以预测未来的ASCVD [12，13]，但PP和MAP有助于更多的机制研究
Identifying the components of early-life blood pressure (BP) is of critical importance as evidence builds on the role of BP in predicting future atherosclerotic cardiovascular disease (ASCVD). Classic literature has demonstrated the ability for historical BP to predict presence of atherosclerotic plaque in younger persons victim to unfortunate mortality like accident and war [2–5]. Recent data show a continuous relation between adolescent male BP separated into various indices including SBP, DBP, pulse pressure (PP), mean arterial pressure (MAP), and eventual adult ASCVD events [6]. Similar data from Native American populations show physician diagnosed hypertension in childhood as a risk factor for early mortality [7]. One study of adolescent men suggests that adolescent BP predicts future ASCVD even after adjustment for middle-aged BP, underscoring the additive utility of early-life BP [8]. Mounting evidence further demonstrates the specific role of elevated BP in preclinical atherosclerotic changes including left ventricular hypertrophy and vascular change [9, 10]. Intriguing longitudinal data even suggest that normalization of elevated BP from childhood into adulthood ameliorates these preclinical atherosclerotic changes [11]. There are now multiple threads of evidence linking early-life BP to preclinical in-vivo atherosclerosis, pathological evidence of atherosclerotic plaque, actual ASCVD events and mortality, and even reversal of atherosclerotic change with attenuation in BP.Turning to physiologic classification, BP may be classified using traditional SBP and DBP per sphygmomanometer. An alternate description classifies BP by PP, an index of large artery properties, and MAP, an index of small artery function. Both combinations predict future ASCVD [12, 13], but PP and MAP lend themselves to more mechanistic study