Persistent remodeling of resistance arteries in type 2 diabetic patients on antihypertensive treatment
Persistent remodeling of resistance arteries in type 2 diabetic patients on antihypertensive treatment
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DOI：
10.1161/01.hyp.0000112029.03691.e7
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发表时间：
2004-02-01
期刊：
影响因子：
8.3
通讯作者：
Schiffrin, EL
中科院分区：
文献类型：
--
作者：
Endemann, DH;Pu, Q;Schiffrin, EL
我们假设高血压控制的糖尿病患者的抵抗动脉比未治疗的高血压患者的血管重构更少。研究对象为8例血压正常者（年龄44 +/- 3岁，3名男性，平均值为+/- SEM）， 19例未治疗高血压患者（46 +/- 2岁，9名男性），23例合并2型糖尿病并接受降压治疗的高血压患者（58 +/- 1岁，15名男性）。在加压肌图上评估从臀皮下组织剥离的阻力动脉。大多数糖尿病患者（70%）接受血管紧张素转换酶抑制剂治疗。尽管这些患者的收缩压仍高于正常血压范围（高血压患者144 +/- 2，高血压患者150 +/- 3 mm Hg，正常高血压患者114 +/- 4 mm Hg），舒张压控制良好（83 +/- 2 mm Hg），与未治疗的高血压患者（100 +/- 1 mm Hg, P < 0.001）相比明显降低，但高于正常高血压患者（76 +/- 3 mm Hg, P < 0.05）。糖尿病患者脉压增高（P < 0.05）。高血压患者的中腔动脉与管腔动脉之比（0.083 +/- 0.002）高于正常血压对照组（0.059 +/- 0.003,P < 0.05），糖尿病高血压患者的中腔动脉与管腔动脉之比甚至更高（0.105 +/- 0.004,P < 0.001）。与正常对照组相比，糖尿病和高血压患者的内侧横截面积更大（P < 0.001）。高血压患者和糖尿病合并高血压患者的血管乙酰胆碱诱导的舒张功能受损（与正常对照组相比P < 0.05），而内皮非依赖性血管舒张功能在所有组中相似。尽管进行了有效的降压治疗，但高血压糖尿病患者的抵抗动脉仍表现出明显的重构，其重构程度高于未治疗的非糖尿病高血压患者，这与糖尿病和高血压患者的心血管风险较高一致。
We hypothesized that resistance arteries from diabetic patients with controlled hypertension have less remodeling than vessels from untreated hypertensive subjects. Eight normotensive subjects ( aged 44 +/- 3 years, 3 men; values are mean +/- SEM), 19 untreated hypertensive subjects ( 46 +/- 2 years, 9 men), and 23 hypertensive subjects with type 2 diabetes mellitus under antihypertensive treatment ( 58 +/- 1 years, 15 men) were studied. Resistance arteries dissected from gluteal subcutaneous tissue were assessed on a pressurized myograph. Most diabetic patients (70%) were being treated with angiotensin-converting enzyme inhibitors. Although systolic blood pressure was still above the normotensive range in these patients ( 144 +/- 2 versus 150 +/- 3 mm Hg in hypertensive and 114 +/- 4 mm Hg in normotensive subjects), diastolic blood pressure was well controlled ( 83 +/- 2 mm Hg) and significantly lower compared with that in untreated hypertensives ( 100 +/- 1 mm Hg; P < 0.001) but higher than in normotensives ( 76 +/- 3 mm Hg; P < 0.05). Thus, pulse pressure was higher in diabetic patients ( P < 0.05). The media-to-lumen ratio of resistance arteries was greater in hypertensives ( 0.083 +/- 0.002) compared with normotensive controls ( 0.059 +/- 0.003; P < 0.05) and was even higher in diabetic hypertensive subjects ( 0.105 +/- 0.004; P < 0.001 versus normotensive controls). The medial cross-sectional area was greater in diabetic and hypertensive patients compared with normotensive controls ( P < 0.001). Acetylcholine-induced relaxation was impaired in vessels from hypertensive patients and from patients with both diabetes mellitus and hypertension ( P < 0.05 versus normotensive controls), whereas endothelium-independent vasorelaxation was similar in all groups. Despite effective antihypertensive treatment, resistance arteries from hypertensive diabetic patients showed marked remodeling, greater than that of vessels from untreated, nondiabetic, hypertensive subjects, in agreement with the high cardiovascular risk of subjects suffering from both diabetes and hypertension.