Stokes Gordon S
Curr Hypertens Rep. 2006 Apr;8(1):60-8. doi: 10.1007/s11906-006-0042-7.
Isolated systolic hypertension (ISH) is an important cause of strokes and heart failure among the elderly, but it is difficult to control in some elderly patients, even with combination antihypertensive therapy. The presence of a prominent reflection wave in the arterial pulse-wave profile of such patients signifies that adjuvant nitrate therapy may prove effective in lowering pulse pressure. This reflection arises in the muscular arteries and is caused by arterial stiffness associated with hypertension and other cardiovascular risk factors, probably including endothelial dysfunction. By acting directly on the arterial wall, nitrates produce endothelium-independent vasorelaxation. The reflection wave and the contribution this makes to pulse pressure are thereby ablated. Controlled trials of the use of isosorbide mononitrate and isosorbide dinitrate in ISH have shown that these agents decrease systolic blood pressure as well as pulse pressure, and with the mononitrate, efficacy appears to be unimpaired by nitrate tolerance.
单纯收缩期高血压（ISH）是老年人中风和心力衰竭的重要原因，但即使采用联合降压治疗，一些老年患者的血压仍难以控制。这类患者动脉脉搏波轮廓中存在明显的反射波，这表明辅助使用硝酸盐治疗可能有效降低脉压。这种反射出现在肌性动脉中，是由与高血压及其他心血管危险因素（可能包括内皮功能障碍）相关的动脉僵硬引起的。通过直接作用于动脉壁，硝酸盐可产生不依赖内皮的血管舒张作用。由此，反射波及其对脉压的影响被消除。在ISH患者中使用单硝酸异山梨酯和硝酸异山梨酯的对照试验表明，这些药物可降低收缩压以及脉压，而且对于单硝酸异山梨酯而言，疗效似乎不会因硝酸盐耐受性而受损。
