Pini Riccardo, Cavallini M Chiara, Staglianò Loredana, Tarantini Francesca, 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 the Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
J Hypertens. 2006 May;24(5):973-9. doi: 10.1097/01.hjh.0000222769.22724.ed.
While many studies have examined the relation between antihypertensive treatment and ventricular hypertrophy, relatively few data are available regarding changes in arterial structure due to blood pressure reduction. Therefore, we compared normotensive to untreated hypertensive subjects to uncontrolled (treated with elevated blood pressure values) or controlled (treated with normal blood pressure values) hypertensive older subjects.
Community-dwellers (age >or= 65 years) of a small town in Italy (Dicomano) underwent extensive clinical examination, echocardiography, carotid ultrasonography, and applanation tonometry. Of the 614 participants, 173 subjects were normotensive; among the hypertensive subjects, 225 were untreated (51%), 177 (40%) were uncontrolled, and only 39 (9%) were controlled.
The majority of treated hypertensive subjects were on monotherapy (82%). Subjects with a history of coronary artery disease or stroke were more frequently treated. Controlled hypertensives had left ventricular mass index similar to normotensives but lower than uncontrolled and untreated hypertensives. There were no differences among the three hypertensive groups in carotid artery structure. Only the pressure-independent stiffness index was reduced in the treated hypertensive subjects compared to untreated hypertensives, with no difference between controlled and uncontrolled subjects.
In our community-based, older population, antihypertensive treatment was associated with a normal left ventricular mass only when blood pressure was well controlled. In contrast, carotid artery remodeling and atherosclerosis were independent of antihypertensive treatment as well as of achievement of satisfactory blood pressure control. However, antihypertensive treatment was associated with significantly higher carotid compliance even in the absence of detectable changes in carotid structure.
尽管许多研究已探讨了降压治疗与心室肥厚之间的关系，但关于血压降低导致的动脉结构变化的数据相对较少。因此，我们将血压正常者与未治疗的高血压患者进行比较，同时也与血压未得到控制（血压值仍较高）或得到控制（血压值正常）的老年高血压患者进行比较。
意大利一个小镇（迪科马诺）的社区居民（年龄≥65岁）接受了全面的临床检查、超声心动图检查、颈动脉超声检查和平板测压法。在614名参与者中，173名受试者血压正常；在高血压患者中，225名未接受治疗（51%），177名（40%）血压未得到控制，只有39名（9%）血压得到控制。
大多数接受治疗的高血压患者采用单一疗法（82%）。有冠状动脉疾病或中风病史的患者接受治疗的频率更高。血压得到控制的高血压患者的左心室质量指数与血压正常者相似，但低于血压未得到控制和未接受治疗的高血压患者。三组高血压患者的颈动脉结构没有差异。与未接受治疗的高血压患者相比，仅接受治疗的高血压患者中与压力无关的硬度指数降低，血压得到控制和未得到控制的患者之间没有差异。
在我们基于社区的老年人群中，只有在血压得到良好控制时，降压治疗才与正常的左心室质量相关。相比之下，颈动脉重塑和动脉粥样硬化与降压治疗以及血压是否得到满意控制无关。然而，即使在颈动脉结构没有可检测到的变化的情况下，降压治疗也与显著更高的颈动脉顺应性相关。
