Vergnaud Anne Claire, Protogerou Athanase D, Blacher Jacques, Safar Michel E
U557 INSERM (UMR INSERM/INRA/CNAM), CRNH Ile-de-France, Paris, France.
J Hypertens. 2008 Jan;26(1):138-44. doi: 10.1097/HJH.0b013e3282efd1ad.
The ESH2003 report (J Hypertens 2003, 21:1011-1053) has classified brachial blood pressure into six groups reflecting the consistently increasing cardiovascular risk caused by high blood pressure. Chronically treated hypertensive individuals with well-controlled blood pressure retain higher cardiovascular risk than normotensive untreated individuals. Differences between these groups in arterial stiffness, pressure wave reflections and central blood pressure, which are all predictors of cardiovascular risk independently of peripheral blood pressure, have never been studied.
A cohort of 216 treated subjects with controlled hypertension was compared with 105 never-treated normotensive controls, according to the ESH2003 blood pressure groups. Aortic stiffness (pulse wave velocity; PWV), carotid wave reflections (augmentation index; AI) and carotid pressures were measured non-invasively, by pulse wave analysis. Systolic blood pressure (SBP) and pulse pressure (PP) amplification between brachial and carotid arteries were estimated.
The distribution of subjects in each subgroup of the untreated and treated populations was: 'optimal', 21 versus 43; 'normal', 44 versus 77; 'borderline', 40 versus 96. Brachial blood pressure, carotid SBP and PP did not differ between the two populations, but a constant interaction between blood pressure classification and treatment effect on PWV, AI and blood pressure amplification was found. Compared with untreated subjects, treated subjects had higher AI and lower blood pressure amplification (in the optimal group) and higher PWV (in the borderline group).
'Optimal' to 'borderline' blood pressure control in chronically treated hypertensive individuals is associated with impaired properties of the large and small arteries. These results suggest that antihypertensive treatment strategies with more beneficial effects on arterial properties are needed.
ESH2003报告（《高血压杂志》2003年，21卷：1011 - 1053页）已将肱动脉血压分为六组，以反映高血压导致的心血管风险持续增加的情况。血压得到良好控制的慢性高血压患者，其心血管风险仍高于未接受治疗的正常血压个体。这些组在动脉僵硬度、压力波反射和中心血压方面的差异从未被研究过，而这些因素都是独立于外周血压的心血管风险预测指标。
根据ESH2003血压分组，将216例血压得到控制的高血压治疗患者队列与105例未接受治疗的正常血压对照者进行比较。通过脉搏波分析，无创测量主动脉僵硬度（脉搏波速度；PWV）、颈动脉波反射（增强指数；AI）和颈动脉压力。估计肱动脉和颈动脉之间的收缩压（SBP）和脉压（PP）放大情况。
未治疗和治疗人群各亚组中受试者的分布情况为：“理想”，分别为21例和43例；“正常”，分别为44例和77例；“临界”，分别为40例和96例。两组人群的肱动脉血压、颈动脉SBP和PP无差异，但发现血压分类与治疗对PWV、AI和血压放大的影响之间存在持续的相互作用。与未治疗的受试者相比，治疗后的受试者AI较高，血压放大较低（在理想组），PWV较高（在临界组）。
慢性高血压患者“理想”至“临界”血压控制与大、小动脉特性受损有关。这些结果表明，需要采用对动脉特性有更有益影响的抗高血压治疗策略。
