Left ventricular remodeling and arterial afterload in older women with uncontrolled and controlled hypertension.
Left ventricular remodeling and arterial afterload in older women with uncontrolled and controlled hypertension.
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DOI：
10.1097/gme.0000000000001046
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发表时间：
2018-05
期刊：
影响因子：
--
通讯作者：
Fu Q
中科院分区：
文献类型：
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作者：
Yoo JK;Okada Y;Best SA;Parker RS;Hieda M;Levine BD;Fu Q
妇女的高血压患病率随着年龄的增长而增加。老年妇女的血压控制更难实现，尽管血压控制良好，但心血管死亡率仍然很高。然而，根本的机制还不清楚。招募了19名接受药物治疗的未控制高血压女性（70±2 [SE]岁，动态清醒血压; 152±2/84±2 mmHg），19名控制高血压女性（68±1岁，128±2/71±2 mmHg）和31名健康血压正常女性（68±1岁，127±1/73±1 mmHg）。受试者停用抗高血压药物，并在进行心血管评估之前进行3周的导入。用心脏MRI评价左心室形态。动脉负荷和血管硬度通过超声和压平眼压测量。经体表面积标准化的左心室质量在高血压组之间没有差异（未控制与控制：50.0±1.7与51.8±2.3 g/m2），但血压正常组较低（41.7±0.9 g/m2，单因素方差分析P=0.004）。同样，高血压组之间的中心脉搏波速度无差异（11.5±0.6 vs 11.1±0.5 m/s），血压正常组较低（9.1± 0.3 m/s，单因素方差分析P=0.0001）。与血压正常组相比，未控制HTN的总外周阻力更大（2051±323 vs. 1719±380 dyn·sec·cm−5），而控制HTN组（1925±527 dyn·sec·cm−5）与两组无差异。无论目前的血压控制，高血压老年妇女表现出增加心脏质量和动脉僵硬度相比，血压正常。未来的大规模纵向研究是必要的，以直接调查的机制，高血压的老年妇女血压控制良好的心血管疾病的死亡率高。
The prevalence of hypertension increases with advancing age in women. Blood pressure control is more difficult to achieve in older women and despite well-controlled blood pressure, the cardiovascular mortality remains high. However, the underlying mechanisms are not understood. 19 women with uncontrolled hypertension on drug treatment (70±2 [SE] yrs, ambulatory awake blood pressure; 152±2/84±2 mmHg), 19 with controlled hypertension (68±1 yrs, 128±2/71±2 mmHg), and 31 healthy normotensive women (68±1 yrs, 127±1/73±1 mmHg) were recruited. Participants were weaned from antihypertensive drugs and underwent 3 weeks of run-in prior to cardiac-vascular assessments. Left ventricular morphology was evaluated with cardiac MRI. Arterial load and vascular stiffness were measured via ultrasound and applanation tonometry. Left ventricular mass normalized by body surface area was not different between hypertension groups (uncontrolled vs. controlled: 50.0±1.7 vs. 51.8±2.3 g/m2), but it was lower in the normotensive group (41.7±0.9 g/m2, one-way ANOVA P=0.004). Likewise, central pulse wave velocity was not different between hypertension groups (11.5±0.6 vs 11.1±0.5 m/s), lower in the normotensive group (9.1±0.3m/s, one-way ANOVA P=0.0001). Total peripheral resistance was greater in uncontrolled HTN compared to normotensive group (2051±323 vs. 1719±380 dyn•sec•cm−5), while controlled HTN group (1925±527 dyn•sec•cm−5) was not different to either groups. Regardless of current blood pressure control, hypertensive older women exhibited increased cardiac mass and arterial stiffness compared to normotensives. Future large-scale longitudinal studies are warranted to directly investigate the mechanisms for the high cardiovascular mortality among older hypertensive women with well-controlled blood pressure.