Saul G D, Gerard H M
Med Hypotheses. 1991 Nov;36(3):228-37. doi: 10.1016/0306-9877(91)90139-p.
Medical writings on cardiovascular disease focus on intravascular pressures. Tissue pressure is assumed to be essentially atmospheric. Yet, under dynamic conditions of sitting, standing, walking, breathing, and the beating of the heart, significant pressures, both above and below atmospheric, do develop outside of important arteries. These dynamic extra-arterial pressures either decrease or increase the pressure gradients across arterial walls, i.e. the transmural pressures are changed. Physical fitness may either prevent the development of negative extra-arterial pressure or increase positive extra-arterial pressure, thereby protecting important arteries from high effective pressures. Deconditioning, old age, abdominal obesity, and other cardiovascular disease risk factors may do just the opposite, in effect, causing 'localized hypertension' in clinically important arteries. This, in turn, may lead to localized acceleration of atherosclerosis. The correlation of predictions made from this hypothesis with clinical findings is so remarkable that it suggests there is a direct cause and effect relationship between transmural arterial pressure and atherosclerosis. The concept of dynamic extra-arterial pressure seems to solve a number of puzzles and paradoxes in cardiovascular disease, it suggests key measurements that may be predictive of disease, and it offers new ideas for treatment and prevention.
关于心血管疾病的医学著作主要关注血管内压力。组织压力被认为基本与大气压相同。然而，在坐姿、站姿、行走、呼吸以及心脏跳动等动态情况下，重要动脉外部确实会产生明显高于或低于大气压的压力。这些动态的动脉外压力会降低或增加动脉壁上的压力梯度，即跨壁压力会发生变化。身体健康可能会防止动脉外负压的产生，或增加动脉外正压，从而保护重要动脉免受高效压力的影响。身体机能下降、年老、腹部肥胖以及其他心血管疾病风险因素可能会起到相反的作用，实际上，会在临床上重要的动脉中导致“局部高血压”。反过来，这可能会导致动脉粥样硬化的局部加速。根据这一假设所做的预测与临床发现的相关性非常显著，这表明跨壁动脉压力与动脉粥样硬化之间存在直接的因果关系。动态动脉外压力的概念似乎解决了心血管疾病中的一些谜题和悖论，它提出了可能预测疾病的关键测量方法，并为治疗和预防提供了新的思路。
