Agarwal Rajiv
Indiana University School of Medicine, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana 46202, USA.
Curr Opin Nephrol Hypertens. 2007 Sep;16(5):409-15. doi: 10.1097/MNH.0b013e3282063b86.
Arterial stiffness is a sign of diffuse adventitial macrovascular disease. The purpose of the present review is to discuss, in patients with chronic kidney disease, the pathophysiology of increased arterial stiffness, the role of antihypertensive therapy on reduction of arterial stiffness, and the clinical ways by which the prognostication of cardiovascular disease in patients with chronic kidney disease can be refined using arterial stiffness monitoring.
Arterial stiffness is increased with increasing prevalence of traditional cardiovascular risk factors. In patients with chronic kidney disease some unique factors further increase the risk of arterial stiffness, and include volume overload, activation of the renin-angiotensin system, anemia, and dysregulated mineral metabolism. Arterial stiffness is increased even in patients with early-stage chronic kidney disease. Blood pressure reduction when accompanied by a reduction in arterial stiffness is associated with improved prognosis. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can preferentially improve arterial stiffness, which may be an additional mechanism of cardiovascular protection with these agents.
The impact of improvement in arterial stiffness with antihypertensive agents on cardiovascular outcomes needs well designed clinical trials.
动脉僵硬度是弥漫性外膜大血管疾病的一个标志。本综述的目的是讨论慢性肾脏病患者动脉僵硬度增加的病理生理学、降压治疗在降低动脉僵硬度方面的作用，以及通过动脉僵硬度监测来优化慢性肾脏病患者心血管疾病预后评估的临床方法。
随着传统心血管危险因素患病率的增加，动脉僵硬度也会升高。在慢性肾脏病患者中，一些独特的因素会进一步增加动脉僵硬度的风险，包括容量负荷过重、肾素-血管紧张素系统激活、贫血和矿物质代谢失调。即使在早期慢性肾脏病患者中，动脉僵硬度也会增加。血压降低且伴有动脉僵硬度降低与预后改善相关。血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂可优先改善动脉僵硬度，这可能是这些药物心血管保护的另一种机制。
降压药物改善动脉僵硬度对心血管结局的影响需要精心设计的临床试验。
