Schiffrin E L, Deng L Y
MRC Multidisciplinary Research Group on Hypertension, Clinical Research Institute of Montreal, Québec, Canada.
J Hypertens. 1999 Mar;17(3):381-7. doi: 10.1097/00004872-199917030-00011.
Studies of cerebral arterioles have suggested that pulse pressure may be a more important determinant of small-artery structure than systolic, diastolic or mean blood pressure in stroke-prone spontaneously hypertensive rats and in rats with an arterio-venous shunt. A study of small arteries has suggested that this is not the case in human essential hypertension. We therefore investigated the role of hemodynamic determinants on small-artery structure in hypertensive patients.
To determine whether pulse pressure contributes to structural alterations in human essential hypertension, small arteries (lumen < 300 microns) were obtained from gluteal subcutaneous biopsies of 40 normotensive subjects aged 40.7 +/- 1.2 years and 45 untreated essential hypertensive humans aged 46.5 +/- 1.3 years. The relationship between the media: lumen ratio of the small arteries and levels of systolic, diastolic and mean blood pressure and pulse pressure was investigated.
The media: lumen ratio (5.33 +/- 0.001%) of small gluteal subcutaneous arteries of normotensive subjects was significantly smaller and the lumen diameter (306 +/- 13 microns) significantly larger than in untreated hypertensive patients (7.42 +/- 0.001% and 244 +/- 9.7 microns respectively, P < 0.001). The media: lumen ratio of both groups examined together correlated with systolic blood pressure (r = 0.45, P < 0.001), diastolic blood pressure (r = 0.56, P < 0.001) and mean arterial pressure (r = 0.55, P < 0.001). The media: lumen ratio of vessels from hypertensive patients correlated with diastolic blood pressure (r = 0.22, P < 0.01) but not with systolic or mean blood pressure. There was no correlation between the media: lumen ratio of small gluteal subcutaneous arteries and pulse pressure in this population of normotensive and hypertensive subjects, examined together or separately.
These results suggest that in 30- to 65-year-old humans with systolodiastolic essential hypertension, pulse pressure does not appear to be an important determinant of small-artery structure.
对脑小动脉的研究表明，在易发生中风的自发性高血压大鼠和动静脉分流大鼠中，脉压可能比收缩压、舒张压或平均血压更能决定小动脉结构。一项对小动脉的研究表明，在人类原发性高血压中情况并非如此。因此，我们研究了血流动力学决定因素在高血压患者小动脉结构中的作用。
为了确定脉压是否会导致人类原发性高血压患者的结构改变，从40名年龄为40.7±1.2岁的血压正常受试者和45名年龄为46.5±1.3岁的未经治疗的原发性高血压患者的臀皮下组织活检中获取小动脉（管腔<300微米）。研究了小动脉的中膜与管腔比值与收缩压、舒张压、平均血压和脉压水平之间的关系。
血压正常受试者的臀皮下小动脉中膜与管腔比值（5.33±0.001%）显著小于未经治疗的高血压患者（分别为7.42±0.001%和244±9.7微米，P<0.001），管腔直径（306±13微米）显著大于高血压患者。两组一起检查时，中膜与管腔比值与收缩压（r = 0.45，P<0.001）、舒张压（r = 0.56，P<0.001）和平均动脉压（r = 0.55，P<0.001）相关。高血压患者血管的中膜与管腔比值与舒张压（r = 0.22，P<0.01）相关，但与收缩压或平均血压无关。在该组血压正常和高血压受试者中，一起或分别检查时，臀皮下小动脉的中膜与管腔比值与脉压之间均无相关性。
这些结果表明，在30至65岁的收缩期舒张期原发性高血压患者中，脉压似乎不是小动脉结构的重要决定因素。
