Giannattasio Cristina, Failla Monica, Hennig Michael, Hollweck Regina, Laurent Stephan, Mallion Jean Michel, Reid John, Safar Michel, Bond Gene, Zanchetti Alberto, Mancia Giuseppe
Clinica Medica, University of Milan-Bicocca, San Gerardo Hospital, Monza (Milan), Italy.
J Hypertens. 2005 Mar;23(3):557-62. doi: 10.1097/01.hjh.0000160212.33232.3e.
The European Lacidipine Study on Atherosclerosis (ELSA) has been planned to investigate the effect of reduction in office and ambulatory blood pressure by lacidipine versus atenolol on carotid artery wall thickness in mild to moderate essential hypertensive patients with no metabolic abnormalities. One prespecified sub-study of ELSA focused on measurements of arterial distensibility in the carotid as well as in the radial artery to determine the relationship of functional arterial properties with office versus ambulatory blood pressure (BP) values as well as the correspondence between functional and structural arterial alterations.
The sub-study was conducted on 124 patients recruited in four centres (Monza-Milan, Paris, Grenoble and Glasgow). BP was measured both by a mercury sphygmomanometer and by 24-h ambulatory monitoring. Common carotid artery wall thickness was measured by certified sonographers as described in the main study. Common carotid and radial artery distensibility were obtained by echotracking techniques, which allowed to relate changes in arterial diameter with systo-diastolic BP changes.
Carotid artery wall distensibility showed (1) a negative correlation with office and more so 24-h average systolic BP (r = -0.45 and -0.58, P < 0.008 and 0.001) but not with office or 24-h diastolic BP) and (2) a negative correlation with the corresponding wall thickness (r = -0.47, P < 0.005). In contrast, at the radial artery level distensibility and thickness showed no correlation with each other and with BP. Carotid (but not radial) artery distensibility also correlated with ambulatory systolic BP variability but the correlation was lost after adjustment for age and mean BP values.
These data suggest that stiffening of large elastic artery is reflected more by ambulatory than office BP elevations, systolic BP being much more important than diastolic. Alterations of large elastic arteries function is related to structural wall changes. Functional and structural properties of middle-size muscle arteries are independent of BP.
欧洲拉西地平动脉粥样硬化研究（ELSA）旨在调查在无代谢异常的轻至中度原发性高血压患者中，拉西地平与阿替洛尔降低诊室血压和动态血压对颈动脉壁厚度的影响。ELSA的一项预先设定的子研究聚焦于测量颈动脉和桡动脉的动脉扩张性，以确定动脉功能特性与诊室血压和动态血压值之间的关系，以及动脉功能和结构改变之间的对应关系。
该子研究在四个中心（蒙扎 - 米兰、巴黎、格勒诺布尔和格拉斯哥）招募的124名患者中进行。通过汞柱式血压计和24小时动态监测测量血压。如主要研究中所述，由经过认证的超声检查人员测量颈总动脉壁厚度。通过回声跟踪技术获得颈总动脉和桡动脉的扩张性，该技术可将动脉直径变化与收缩 - 舒张压变化相关联。
颈动脉壁扩张性显示：（1）与诊室血压呈负相关，与24小时平均收缩压的负相关性更强（r = -0.45和 -0.58，P < 0.008和0.001），但与诊室舒张压或24小时舒张压无相关性；（2）与相应的壁厚度呈负相关（r = -0.47，P < 0.005）。相比之下，在桡动脉水平，扩张性和厚度彼此之间以及与血压均无相关性。颈动脉（而非桡动脉）扩张性也与动态收缩压变异性相关，但在调整年龄和平均血压值后相关性消失。
这些数据表明，大型弹性动脉的硬化更多地反映在动态血压升高而非诊室血压升高上，收缩压比舒张压重要得多。大型弹性动脉功能的改变与壁结构变化有关。中尺寸肌性动脉（译者注：此处原文表述可能有误，推测应为中型肌性动脉）的功能和结构特性与血压无关。
