Arterial stiffness and hypertension.
Arterial stiffness and hypertension.
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DOI：
10.1161/hypertensionaha.114.00921
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发表时间：
2014-07
期刊：
影响因子：
--
通讯作者：
Mitchell GF
中科院分区：
文献类型：
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作者：
Mitchell GF
在过去十年中，主动脉僵硬度增加已成为靶器官损伤和心血管疾病事件的重要风险因素。主动脉僵硬度可以通过脉搏波速度（PWV）和脉压（PP）进行评估，PWV是主动脉壁僵硬度的量度，PP受壁僵硬度以及流量和直径之间的相互作用的影响。由于这些刚度度量对几何形状和其他因素的敏感性不同，因此它们仅适度相关，并在风险预测中发挥补充作用。动脉硬化长期以来一直被视为高血压的并发症，它综合了血压升高和其他危险因素的长期不良影响。然而，PWV仅与年龄和血压以外的风险因素适度相关，这可能解释了PWV添加到标准风险预测模型并以临床相关方式重新分类风险的能力。最近的研究表明，僵硬可以提前和有助于高血压的发病机制，提高了动脉僵硬度的早期评估可能提供洞察并发症，包括高血压，发展多年后的可能性。僵硬在高血压和心血管疾病的发病机制中所起的作用已经引起了人们对定义覆盖主动脉壁、增加PP和促进靶器官损伤的基本机制的极大兴趣，希望阐明这些机制将允许开发更有效的治疗方法。
Over the past decade, increased aortic stiffness has emerged as an important risk factor for target organ damage and cardiovascular disease events. Aortic stiffness can be assessed as pulse wave velocity (PWV), which is a measure of aortic wall stiffness, and pulse pressure (PP), which is affected by wall stiffness and the interaction between flow and diameter. Because these stiffness measures have different sensitivities to geometry and other factors, they are only moderately correlated and play a complementary role in risk prediction. Arterial stiffness has long been viewed as a complication of hypertension that integrates long-term adverse effects of elevated blood pressure and other risk factors. However, PWV is only modestly correlated with risk factors other than age and blood pressure, which likely explains the ability of PWV to add to standard risk prediction models and reclassify risk in a clinically relevant manner. Recent studies have demonstrated that stiffness can antedate and contribute to the pathogenesis of hypertension, raising the possibility that early assessment of arterial stiffness may provide insight into complications including hypertension that develop years later. The role that stiffness plays in the pathogenesis of hypertension and cardiovascular disease has sparked considerable interest in defining basic mechanisms that stiffen the aortic wall, increase PP and contribute to target organ damage with a hope that elucidation of these mechanisms will allow for development of more effective treatments.