Palombo C, Kozakova M, Magagna A, Bigalli G, Morizzo C, Ghiadoni L, Virdis A, Emdin M, Taddei S, L'Abbate A, Salvetti A
CNR Institute of Clinical Physiology and Department of Internal Medicine, Univeristy of Pisa, Italy.
J Hypertens. 2000 Apr;18(4):453-9. doi: 10.1097/00004872-200018040-00015.
To evaluate relations between coronary flow velocity and myocardial oxygen demand at rest, as well as coronary vasodilator capacity and flow reserve, in asymptomatic subjects with borderline hypertension as compared to normotensive controls and patients with sustained high blood pressure (HBP) and without left ventricular hypertrophy (LVH).
Forty-two asymptomatic males were studied: 13 healthy normotensive volunteers; 12 subjects with borderline HBP and 17 asymptomatic subjects with sustained systemic hypertension. Coronary flow velocity in left anterior descending artery and coronary flow reserve were assessed by transesophageal echo-doppler at baseline and during intravenous adenosine infusion. Left ventricular mass, peak systolic wall stress (PSWS; Pa), and midwall fractional shortening (MFS; %) were obtained from M-mode images of the left ventricle in transthoracic long-axis view and in transesophageal transgastric view.
Coronary flow velocity at baseline was not significantly different in the three groups, despite significantly higher rate-pressure product (RPP) in the hypertensive groups as compared with controls. Only in control subjects, was resting coronary flow velocity significantly correlated with RPP (y = 4279 + 200x, r = + 0.58, P < 0.05) and PSWS (y = 17.2 + 5.1 x, r = + 0.62, P < 0.05). Coronary reserve was 3.5 +/- 0.65 in controls and significantly lower (P < 0.05) in borderline hypertensive (2.87 +/- 0.46) and in sustained hypertensive subjects (2.66 +/- 0.56). Minimum coronary resistance was significantly increased in both hypertensive groups (1.30 +/- 0.29 and 1.39 +/- 0.48 mmHg/s per cm) as compared to normotensive controls (0.93 +/- 0.20 mmHg/s per cm, P < 0.01).
In asymptomatic subjects with borderline hypertension and without LVH, a significant reduction in coronary flow reserve is already detectable and appears almost entirely related to an impaired coronary vasodilator capacity rather than to an increased myocardial oxygen demand.
评估临界高血压无症状受试者与血压正常的对照组以及持续性高血压（HBP）且无左心室肥厚（LVH）患者相比，静息时冠状动脉血流速度与心肌需氧量之间的关系，以及冠状动脉血管舒张能力和血流储备。
对42名无症状男性进行研究：13名健康血压正常的志愿者；12名临界HBP受试者和17名无症状持续性系统性高血压受试者。通过经食管超声多普勒在基线及静脉注射腺苷期间评估左前降支冠状动脉血流速度和冠状动脉血流储备。从经胸长轴视图和经食管胃视图的左心室M型图像中获取左心室质量、收缩期峰值壁应力（PSWS；Pa）和室壁中层缩短分数（MFS；%）。
尽管高血压组的心率 - 血压乘积（RPP）显著高于对照组，但三组的基线冠状动脉血流速度无显著差异。仅在对照组中，静息冠状动脉血流速度与RPP（y = 4279 + 200x，r = + 0.58，P < 0.05）和PSWS（y = 17.2 + 5.1x，r = + 0.62，P < 0.05）显著相关。对照组的冠状动脉储备为3.5±0.65，临界高血压组（2.87±0.46）和持续性高血压组（2.66±0.56）显著降低（P < 0.05）。与血压正常的对照组（0.93±0.20 mmHg/s per cm，P < 0.01）相比，两个高血压组的最小冠状动脉阻力均显著增加（1.30±0.29和1.39±0.48 mmHg/s per cm）。
在临界高血压且无LVH的无症状受试者中，已可检测到冠状动脉血流储备显著降低，且几乎完全与冠状动脉血管舒张能力受损有关，而非与心肌需氧量增加有关。
