Chemaly E, London G, Benetos A, Darné B, Asmar R
Hôpital Broussais, Paris.
Arch Mal Coeur Vaiss. 2002 Jul-Aug;95(7-8):637-40.
Pulse pressure (PP) corresponds to the difference between arterial systolic blood pressure and diastolic blood pressure. Central PP seems to be a stronger coronary risk marker than brachial PP. Central PP can be estimated by aortic PP measured non invasively by aplanation tonometry of the carotid artery. The aim of this study was to compare 2 methods of estimation of aortic PP: estimation from Pulse Wave Velocities (PWV) and by aplanation tonometry of the carotid artery. Estimation from PWV is based on the non uniform transmission of the PP i.e. the amplification of PP from the aorta to brachial artery, through arteries of increasing impedance.
One hundred and fifty one subjects were included, 111 hemodialysis patients and 40 subjects free of cardiovascular treatment or cardiovascular organ damage, recruited in a preventive medicine setting. Central PP was measured by aplanation tonometry of the carotid artery. The following formula was used for the relationship between PP and PWV in the two arterial segments considered for pulse wave travel (waterhammer formula): [formula: see text] Where measurement of brachial PP (PPBr) and PWV at aortic (PWVAo) and brachial (PWVBr) gives an estimation of aortic PP (PPAo estimated). Carotid-femoral PWV was used for PWVAo and carotid-radial PWV was used for PWVBr. The two methods were compared by t-test and according to Bland and Altman's method.
In the hemodialysis group (73 males, 44 +/- 12 years old), brachial PP was 56 +/- 15 mm Hg and central PP as measured at the carotid level was 47 +/- 15 mmHg. In the healthy group (29 males, 46 +/- 11 years old), these values were 46 +/- 10 mmHg and 35 +/- 10 mmHg respectively. Compared to carotid artery aplanation tonometry, PPAo estimated was larger than central PP by 2.9 +/- 6.3 mmHg in hemodialysis patients and by 5.4 +/- 6.6 mmHg in the healthy group. The difference was significantly larger in healthy subjects than in hemodialysis patients (p = 0.031).
The PWV estimated PP is larger than the central PP measured at the carotid level by aplanation tonometry. The difference is larger in cardiovascular event free subjects than in patients on hemodialysis.
脉压（PP）等于动脉收缩压与舒张压之差。中心脉压似乎比肱动脉脉压更能有效反映冠状动脉风险。中心脉压可通过颈动脉平面张力测定法无创测量主动脉脉压来估算。本研究旨在比较两种主动脉脉压估算方法：基于脉搏波速度（PWV）的估算方法和颈动脉平面张力测定法。基于PWV的估算方法是依据脉压的非均匀传递，即脉压从主动脉到肱动脉，通过阻抗不断增加的动脉而放大。
共纳入151名受试者，其中111名血液透析患者和40名未接受心血管治疗或无心血管器官损伤的受试者，这些受试者均来自预防医学机构。通过颈动脉平面张力测定法测量中心脉压。在考虑脉搏波传播的两个动脉段中，脉压与PWV的关系采用以下公式（水击公式）：[公式：见正文]，其中肱动脉脉压（PPBr）以及主动脉（PWVAo）和肱动脉（PWVBr）的PWV测量值可用于估算主动脉脉压（PPAo估算值）。使用颈股PWV代表PWVAo，使用颈桡PWV代表PWVBr。采用t检验并根据布兰德和奥特曼方法对两种方法进行比较。
血液透析组（73名男性，44±12岁）中，肱动脉脉压为56±15 mmHg，颈动脉水平测量的中心脉压为47±15 mmHg。健康组（29名男性，46±11岁）中，这些值分别为46±10 mmHg和35±10 mmHg。与颈动脉平面张力测定法相比，血液透析患者中PPAo估算值比中心脉压高2.9±6.3 mmHg，健康组中高5.4±6.6 mmHg。健康受试者中的差异显著大于血液透析患者（p = 0.031）。
基于PWV估算的脉压大于通过颈动脉平面张力测定法测量的颈动脉水平中心脉压。无心血管事件的受试者中的差异大于血液透析患者。
