Cohn J N
Department of Medicine, University of Minnesota Medical School, Minneapolis 55455, USA.
J Hypertens Suppl. 1999 Dec;17(5):S41-4.
Elevated systolic blood pressure (SBP) and wide pulse pressure (PP) are both important risk markers for cardiovascular disease. They are indicative of a vascular abnormality, most likely located at the endothelial-vascular interface, where the balance between vasodilator and vasoconstriction determines vascular tone, structure and change in blood pressure. This abnormality makes vessel walls vulnerable to degeneration. Reducing blood pressure in patients with endothelial-vascular dysfunction has been found to reduce the rates of cardiovascular events. Preliminary data also suggest that drug therapy has successfully improved endothelial dysfunction. Endothelial release of nitric oxide has little effect on the aorta, but affects the elasticity of thinner-walled branch vessels and arterioles beneficially. Nitric oxide is normally released in response to increased blood flow and this process is often impaired by various disease states. Since blood flow can be measured, endothelial function can be assessed. Arterial compliance can be determined clinically by a technique that combines pulse wave recording and computer analysis of diastolic decay. In certain disease states, compliance seems to be reduced more in smaller vessels, a marker of early stage vascular disease. Screening for arterial elasticity with this tool can identify those patients with early stages of arterial wall disease and prevent further damage. However, further research is needed to determine whether the benefit lies in lowering blood pressure or in the actual effect of the drug in restoring the function of the arterial wall.
收缩压升高（SBP）和脉压增宽（PP）都是心血管疾病的重要风险标志物。它们表明存在血管异常，最有可能位于内皮 - 血管界面，在该界面处血管舒张和血管收缩之间的平衡决定了血管张力、结构和血压变化。这种异常使血管壁易于退化。已发现降低内皮 - 血管功能障碍患者的血压可降低心血管事件的发生率。初步数据还表明药物治疗已成功改善了内皮功能障碍。一氧化氮的内皮释放对主动脉影响不大，但对薄壁分支血管和小动脉的弹性有有益影响。一氧化氮通常会因血流增加而释放，而这一过程常常会因各种疾病状态而受损。由于血流可以测量，因此可以评估内皮功能。动脉顺应性可以通过一种结合脉搏波记录和舒张期衰减计算机分析的技术在临床上确定。在某些疾病状态下，较小血管的顺应性似乎降低得更多，这是早期血管疾病的一个标志。使用该工具筛查动脉弹性可以识别那些处于动脉壁疾病早期阶段的患者，并防止进一步损伤。然而，需要进一步研究以确定益处是在于降低血压还是在于药物恢复动脉壁功能的实际效果。
