Rizzoni Damiano, Palombo Carlo, Porteri Enzo, Muiesan Maria Lorenza, Kozàkovà Michaela, La Canna Giovanni, Nardi Matilde, Guelfi Daniele, Salvetti Massimo, Morizzo Carmela, Vittone Francesca, Rosei Enrico Agabiti
Chair of Internal Medicine, Division of Cardiology, University of Brescia, c/o 2a Medicina, Spedali Civili, 25100 Brescia, Italy.
J Hypertens. 2003 Mar;21(3):625-31. doi: 10.1097/00004872-200303000-00030.
Arterial hypertension is frequently associated with the presence of structural alterations in small arteries. Moreover, a reduced coronary flow reserve and vasodilator capacity has been observed in essential hypertensive patients, possibly due, at least in part, to microangiopathy of small coronary vessels. The aim of the present study was to evaluate a possible relationship between subcutaneous small artery structure and coronary flow reserve or vasodilator capacity in patients with essential hypertension.
A total of 20 patients with mild to moderate essential hypertension were included in the study, and underwent a biopsy of the subcutaneous fat from the gluteal region. Small arteries were dissected and mounted on a micromyograph. The media thickness, the normalized internal diameter and the media:lumen ratio (M/L) were then calculated. In addition, a transesophageal Doppler echocardiographic study, which allows the measurement of coronary flow velocity before and during maximal pharmacological vasodilatation, was performed. Coronary flow reserve (CFR) was measured as the ratio of coronary flow velocity assessed during adenosine infusion and that measured in basal conditions. From blood pressure and coronary flow velocity during adenosine infusion, minimum coronary resistance was calculated. CFR as well as minimum coronary resistance were significantly correlated to both M/L and to normalized internal diameter of subcutaneous small arteries.
Our results are consistent with the hypothesis of a generalized remodelling of small arteries in the body, including the coronary circulation; this remodelling may play an important role in the reduction of coronary vasodilator capacity in patients with mild to moderate essential hypertension.
动脉高血压常与小动脉结构改变相关。此外，在原发性高血压患者中观察到冠状动脉血流储备和血管舒张能力降低，这可能至少部分归因于小冠状动脉微血管病变。本研究的目的是评估原发性高血压患者皮下小动脉结构与冠状动脉血流储备或血管舒张能力之间的可能关系。
本研究共纳入20例轻至中度原发性高血压患者，并对其臀区皮下脂肪进行活检。解剖小动脉并安装在微血管张力测定仪上。然后计算中膜厚度、标准化内径和中膜与管腔比值（M/L）。此外，进行了经食管多普勒超声心动图研究，该研究可测量最大药物血管舒张前后的冠状动脉血流速度。冠状动脉血流储备（CFR）以腺苷输注期间评估的冠状动脉血流速度与基础状态下测量的血流速度之比来衡量。根据腺苷输注期间的血压和冠状动脉血流速度，计算最小冠状动脉阻力。CFR以及最小冠状动脉阻力与皮下小动脉的M/L和标准化内径均显著相关。
我们的结果与体内小动脉（包括冠状动脉循环）普遍重塑的假设一致；这种重塑可能在轻至中度原发性高血压患者冠状动脉血管舒张能力降低中起重要作用。
