Pini Riccardo, Cavallini M Chiara, Bencini Francesca, Silvestrini Gabriella, Tonon Elisabetta, De Alfieri Walter, Marchionni Niccolò, Di Bari Mauro, Devereux Richard B, Masotti Giulio, Roman Mary J
Department of Critical Care Medicine and Surgery-Unit of Gerontology and Geriatrics, University of Firenze and Azienda Ospedaliera Careggi, Firenze, Italy.
J Am Coll Cardiol. 2002 Oct 2;40(7):1283-9. doi: 10.1016/s0735-1097(02)02159-9.
We investigated cardiac and vascular remodeling in an unselected older population with either diastolic hypertension (HTN) or isolated systolic hypertension (ISH).
Isolated systolic hypertension accounts for a substantial proportion of hypertension in individuals older than 65 years and is strongly associated with an increased risk of cardiac and cerebrovascular events. The exact mechanisms underlying the increased risk associated with ISH and elevated pulse pressure (PP), in comparison with HTN, have not been extensively investigated.
Community-dwelling residents age >/=65 years in a small town in Italy (Dicomano) were enrolled. Untreated subjects considered in this study included 173 normotensive subjects (blood pressure [BP] <140/90 mm Hg), 95 subjects with HTN (diastolic BP >/=90 mm Hg), and 43 subjects with ISH (BP >/=160/<90 mm Hg). All subjects underwent extensive clinical examination, echocardiography, carotid ultrasonography, and carotid applanation tonometry.
Subjects with ISH had higher left ventricular (LV) mass, which was independently related to PP but not to systolic or mean pressures. Both carotid wall cross-sectional area and vascular stiffness were greater in ISH patients than in HTN and normal subjects and were independently related to PP but not to systolic BP. In addition, ISH was associated with a higher prevalence of carotid plaque and more extensive carotid atherosclerosis.
In our community-based elderly population, individuals with ISH had higher prevalences of LV hypertrophy and carotid atherosclerosis than subjects with HTN despite lower mean BP. These findings provide potential pathophysiologic mechanisms underlying the associations of ISH and PP with increased risk of cardiovascular morbidity and mortality.
我们在未经过筛选的老年人群中研究了舒张期高血压（HTN）或单纯收缩期高血压（ISH）患者的心脏和血管重塑情况。
单纯收缩期高血压在65岁以上个体的高血压中占很大比例，并且与心血管和脑血管事件风险增加密切相关。与HTN相比，ISH及脉压（PP）升高相关风险增加的确切机制尚未得到广泛研究。
纳入了意大利一个小镇（迪科马诺）年龄≥65岁的社区居民。本研究中未经治疗的受试者包括173名血压正常者（血压[BP]<140/90 mmHg）、95名HTN患者（舒张压BP≥90 mmHg）和43名ISH患者（BP≥160/<90 mmHg）。所有受试者均接受了全面的临床检查、超声心动图检查、颈动脉超声检查和颈动脉压平式眼压测量。
ISH患者的左心室（LV）质量更高，这与PP独立相关，而与收缩压或平均压无关。ISH患者的颈动脉壁横截面积和血管僵硬度均高于HTN患者和正常受试者，且与PP独立相关，与收缩压无关。此外，ISH与颈动脉斑块患病率更高及更广泛的颈动脉粥样硬化相关。
在我们基于社区的老年人群中，尽管平均血压较低，但ISH患者的LV肥厚和颈动脉粥样硬化患病率高于HTN患者。这些发现为ISH和PP与心血管疾病发病率和死亡率增加之间的关联提供了潜在的病理生理机制。
