Zizek B, Poredos P
Department of Angiology, University Medical Centre, Ljubljana, Slovenia.
J Intern Med. 2001 Feb;249(2):189-97. doi: 10.1046/j.1365-2796.2001.00794.x.
To evaluate whether endothelium-dependent (nitric oxide-mediated) dilation of the brachial artery (BA) is impaired in patients being treated for essential hypertension (EH), and whether this abnormality can be detected in normotensive offspring of subjects with EH (familial trait, FT); and to investigate the interrelationship between flow-mediated vasodilation (FMD) and hyperinsulinaemia/insulin resistance.
Cross-sectional study.
Angiology department at a teaching hospital.
The study encompassed 172 subjects, of whom 46 were treated hypertonics aged 40-55 (49) years, and 44 age-matched, normotensive volunteers as controls. We also investigated 41 normotonics with FT aged 20-30 (25) years and 41 age-and sex-matched controls without FT.
Using high-resolution ultrasound, BA diameters at rest, during reactive hyperaemia (endothelium-dependent dilation) and after sublingual glyceryl trinitrate (GTN) application (endothelium-independent dilation) were measured.
In hypertonics FMD was significantly lower than in controls [2.4 (2.9) vs. 7.4 (2.5)%; P < 0.00005], as was GTN-induced dilation [12.1 (4.3) vs. 16.1 (4.6)%; P=0.0007]. In subjects with FT, FMD was also decreased compared with the control group [5.8 (4.1) vs. 10.0 (3.0)%; P < 0.00005]. The response to GTN was comparable in both groups of young subjects. FMD was negatively related to insulin concentration in all subjects studied (P < 0.00005).
In treated patients with EH, flow-mediated dilation of the BA as well as endothelium-independent dilation are decreased. In individuals with FT the endothelial function of the peripheral arteries is also altered in the absence of elevated blood pressure. Endothelial dysfunction is related to hyperinsulinaemia/insulin resistance, which could be one of the pathogenetic determinants of EH and its complications.
评估接受原发性高血压（EH）治疗的患者肱动脉（BA）的内皮依赖性（一氧化氮介导）舒张功能是否受损，以及在EH患者的血压正常后代（家族性特征，FT）中是否能检测到这种异常；并研究血流介导的血管舒张（FMD）与高胰岛素血症/胰岛素抵抗之间的相互关系。
横断面研究。
一家教学医院的血管病科。
该研究纳入了172名受试者，其中46名是年龄在40 - 55（49）岁的高血压患者，44名年龄匹配的血压正常志愿者作为对照。我们还研究了41名年龄在20 - 30（25）岁有家族性特征的血压正常者和41名年龄及性别匹配、无家族性特征的对照者。
使用高分辨率超声测量静息时、反应性充血期间（内皮依赖性舒张）和舌下含服硝酸甘油（GTN）后（内皮非依赖性舒张）的BA直径。
高血压患者的FMD显著低于对照组[2.4（2.9）%对7.4（2.5）%；P < 0.00005]，GTN诱导的舒张也较低[12.1（4.3）%对16.1（4.6）%；P = 0.0007]。在有家族性特征的受试者中，FMD也比对照组降低[5.8（4.1）%对10.0（3.0）%；P < 0.00005]。两组年轻受试者对GTN的反应相当。在所有研究的受试者中，FMD与胰岛素浓度呈负相关（P < 0.00005）。
在接受治疗的EH患者中，BA的血流介导舒张以及内皮非依赖性舒张均降低。在有家族性特征的个体中，即使血压未升高，外周动脉的内皮功能也会改变。内皮功能障碍与高胰岛素血症/胰岛素抵抗有关，这可能是EH及其并发症的发病机制决定因素之一。
