EFFECT OF TREATMENT ON ENDOTHELIUM-DEPENDENT VASCULAR RELAXATION IN HYPERTENSION

我们已经证明，内皮依赖性血管舒张是异常的， 在高血压患者中。 为了进一步研究这个 在原发性高血压中，我们研究了前臂 血管系统对动脉内输注 内皮依赖性血管扩张剂乙酰胆碱，和直接平滑 肌扩张剂硝普钠15例（年龄54 ± 12岁）。 研究对象血压正常（平均血压93/-+9 mmHg，一半接受治疗，一半接受药物治疗，5个半衰期前停止 研究），而高血压（平均血压118+/-7 mmHg， 停药后至少2周）。 结果 与一组年龄和性别匹配的正常志愿者进行比较。 的 增加血流量和降低血管阻力， 高血压患者的乙酰胆碱显著降低， 与正常对照组相比，他们停止了药物治疗。 但没有 两组之间的血管差异有显著性 对硝普钠的反应 有效的药物治疗 使每个高血压患者的血压正常化。 没有 在血液中的增加方面观察到显著差异， 乙酰胆碱可降低血管阻力， 两项研究之间的高血压患者。 同样，血管 对硝普钠的反应在两项研究中没有差异。 因此，观察到的异常内皮依赖性血管舒张， 原发性高血压患者血压没有改善时， 通过治疗恢复正常。 这一发现表明， 内皮功能障碍或者在血管内皮细胞损伤中起主要的因果作用， 高血压过程，或者，如果是继发性的，一旦这一过程变得不可逆， 过程已经建立。

We have shown that endothelium dependent vascular relaxation is abnormal in hypertensive patients. To further investigate the role of this endothelial dysfunction in essential hypertension, we studied the forearm vasculature response to intra-arterial infusion of the endothelium-dependent vasodilator acetylcholine, and the direct smooth muscle dilator sodium nitroprusside in 15 patients (age 54+/-12 yrs). Patients were studied while normotensive (mean blood pressure 93/-+9 mmHg, half on treatment and half with drugs stopped 5 half lives before the study), and while hypertensive (mean blood pressure 118+/-7 mmHg, after withdrawal of medications for at least 2 weeks). The results were compared to a group of normal volunteers, matched for age and sex. The increase in blood flow and the decrease in vascular resistance with acetylcholine was significantly reduced in hypertensive patients while they were off medications compared to normal controls. However, no significant differences were found between the two groups in the vascular responses to sodium nitroprusside. Medical therapy effectively normalized the blood pressure in each hypertensive patient. No significant differences were observed with regard to increase in blood flow and decrease in vascular resistance with acetylcholine in hypertensive patients between the two studies. Similarly, the vascular response to sodium nitroprusside did not differ between the two studies. Thus, the abnormal endothelium-dependent vascular relaxation observed in patients with essential hypertension is not improved when blood pressure is normalized with treatment. This finding suggests that such endothelial dysfunction either plays a primary causal role in the hypertensive process or, if secondary, becomes irreversible once this process is established.