Diagnosis Center, Hôpital Hôtel-Dieu, 1 Place du Parvis Notre-Dame, 75181 Paris Cedex 04, France
Nat Rev Cardiol. 2010 Aug;7(8):442-9. doi: 10.1038/nrcardio.2010.96.
Arterial aging can be attributed to two different pathophysiological changes--increase in arterial stiffness and disturbed wave reflections. The capacity of the aorta to absorb the force exerted by the left ventricular ejection and dampen pulsatile flow becomes diminished with advancing age, owing to the progressive hardening of the arterial wall. These changes contribute to increase blood pressure, mainly systolic blood pressure and pulse pressure, which can trigger cardiovascular events. Understanding the pulsatile arterial hemodynamics that elevate cardiovascular risk has led to the use of pharmacological therapies, which prevent arterial stiffness and reduce wave reflections, and improve cardiovascular morbidity and mortality. Antifibrotic agents, such as those that block the renin-angiotensin-aldosterone pathway, are often given in association with diuretics, calcium-channel blockers, or both, but not with standard beta-blockers. Consistent reductions in cardiovascular outcomes obtained using these agents can be predicted through noninvasive measurements of central systolic blood pressure and pulse pressure.
动脉老化可归因于两种不同的病理生理变化——动脉僵硬度增加和波反射紊乱。随着年龄的增长，由于动脉壁逐渐变硬，主动脉吸收左心室射血产生的力并缓冲脉动流的能力下降。这些变化会导致血压升高，主要是收缩压和脉压升高，从而引发心血管事件。了解导致心血管风险增加的脉动动脉血液动力学，导致使用药物治疗，这些治疗可以预防动脉僵硬和减少波反射，并改善心血管发病率和死亡率。抗纤维化药物，如阻断肾素-血管紧张素-醛固酮途径的药物，通常与利尿剂、钙通道阻滞剂或两者联合使用，但不与标准的β受体阻滞剂联合使用。通过对中心收缩压和脉压进行非侵入性测量，可以预测这些药物治疗对心血管结局的一致降低。
