A Hemodynamic Comparison of Essential and Renovascular Hypertension: Cardiac Output and Total Peripheral Resistance Supine and Tilted Patients
A Hemodynamic Comparison of Essential and Renovascular Hypertension: Cardiac Output and Total Peripheral Resistance Supine and Tilted Patients
复制标题
原发性高血压和肾血管性高血压的血流动力学比较：仰卧和倾斜患者的心输出量和总外周阻力
作者：
E. Frohlich;M. Ulrych;R. Tarazi;H. Dustan;I. Page
对15例正常人和30例未经治疗的高血压患者（15例原发性高血压和15例肾动脉纤维化狭窄）进行了全身血流动力学测定。原发性高血压患者是从更大的群体中选出的，其基础是将他们的平均动脉压和年龄与配对的肾动脉疾病患者的平均动脉压和年龄相匹配;肾血管性高血压患者的心脏指数始终高于原发性高血压患者。即使通过将受试者倾斜至50°头高位降低心输出量，肾动脉疾病组仍保持较高的心输出量。两组高血压患者外周总阻力均增加。在原发性高血压中发现的低心脏指数和平均左心室射血率也可能涉及这种形式的高血压的心脏。因此，总外周阻力增加，长期以来被认为是高血压的血流动力学标志，可能不是唯一的全身异常;心输出量可能增加肾动脉疾病，甚至减少原发性高血压。
Systemic hemodynamic measurements were obtained in 15 normal subjects and 30 untreated hypertensive patients (15 with essential hypertension and 15 with fibrosing stenosis of renal arteries). The essential hypertensives were selected from a larger group solely on the basis of matching their mean arterial pressures and ages with those of the patients with renal arterial disease in matched pairs; cardiac index was consistently higher in patients with renovascular hypertension than in those with essential hypertension. The higher cardiac output was maintained in the group with renal arterial disease even when reduced by tilting the subjects to a 50° head-up position. Total peripheral resistance was increased in both hypertensive groups. The low cardiac indices and mean rates of left ventricular ejection found in essential hypertension may also implicate the heart in this form of hypertension. Hence, increased total peripheral resistance, long thought to be the hemodynamic hallmark of hypertension, may not be the sole systemic abnormality; cardiac output may be increased in renal arterial disease and even reduced in essential hypertension.