Hausberg M, Lang D, Barenbrock M, Kosch M
Medizinische Klinik und Poliklinik D, Universitätsklinikum Münster.
Dtsch Med Wochenschr. 2005 Nov 18;130(46):2657-61. doi: 10.1055/s-2005-922051.
Decisions about the management of patients with hypertension should not be based on the level of blood pressure alone but also on the presence of target organ damage. Apart of classical sites of target organ damage - kidney and heart - the assessment of functional and structural alterations of large arteries is of increasing clinical importance. Modern non-invasive procedures allow the assessment of large artery wall properties within the clinical routine. Hypertension associated large artery damage may present as structural and functional alterations. Structural alterations comprise intima-media thickening, plaque formation, stenosis of the artery and formation of aneurysms. Functional alterations comprise endothelial dysfunction and alterations of the mechanical properties of the arterial wall with increasing stiffness and loss of the Windkessel function. Loss of central artery elastic properties will ensue an early reflection of the pulse wave with a resulting increase in central systolic and central diastolic pressure. This causes an increase in left ventricular afterload and a reduction in diastolic perfusion of the myocardium. In the last decade the relevance of large artery structural alterations, endothelial dysfunction and arterial stiffness for the risk of cardiovascular morbidity and mortality in hypertensive patients could be demonstrated convincingly. Measurement of intima-media-thickness therefore is part of the standard evaluation of hypertensive patients. Because of the equal prognostic relevance of functional properties of the arterial wall, assessment of large artery functional alterations is helpful for the risk stratification of hypertensive patients. Modern antihypertensive drugs have favourable effects on arterial wall properties. Therefore, the quantification of large artery wall properties should be part of the management of hypertensive patients.
高血压患者的管理决策不应仅基于血压水平，还应考虑靶器官损害的存在。除了肾脏和心脏等经典的靶器官损害部位外，评估大动脉的功能和结构改变在临床上的重要性日益增加。现代非侵入性检查方法可在临床常规中对大动脉壁特性进行评估。高血压相关的大动脉损害可表现为结构和功能改变。结构改变包括内膜中层增厚、斑块形成、动脉狭窄和动脉瘤形成。功能改变包括内皮功能障碍以及动脉壁力学特性的改变，表现为动脉僵硬度增加和弹性贮器功能丧失。中心动脉弹性特性丧失会导致脉搏波早期反射，进而使中心收缩压和中心舒张压升高。这会导致左心室后负荷增加以及心肌舒张期灌注减少。在过去十年中，大动脉结构改变、内皮功能障碍和动脉僵硬度与高血压患者心血管发病和死亡风险的相关性已得到令人信服的证实。因此，内膜中层厚度的测量是高血压患者标准评估的一部分。由于动脉壁功能特性具有同等的预后相关性，评估大动脉功能改变有助于对高血压患者进行危险分层。现代抗高血压药物对动脉壁特性有有利影响。因此，大动脉壁特性的量化应成为高血压患者管理的一部分。
