Hashimoto Junichiro
Department of Blood Pressure Research, Tohoku University Graduate School of Medicine.
Tohoku J Exp Med. 2014 May;233(1):1-8. doi: 10.1620/tjem.233.1.
Recent advances in technology have enabled the noninvasive evaluation of pulsatile hemodynamics in the central aorta; namely, central pressure and flow measurements. The central blood pressure represents the true load imposed on the heart, kidney and brain, and the central blood flow influences the local flow into these vital organs. An elevation of the central blood pressure has a direct, adverse impact on the target organ and, thus, the cardiovascular prognosis in patients with hypertension. A decrease in the central blood flow can cause organ dysfunction and failure. The central pressure and flow dynamics were conventionally regarded as unidirectional from the heart to the periphery. However, current evidence suggests that it should be recognized as a bidirectional interplay between the central and peripheral arteries. Specifically, the pressure pulse wave is not only transmitted forward to the periphery but also reflected backward to the central aorta. The flow pulse wave is also composed of the forward and reverse components. Aortic stiffening and arteriolar remodeling due to hypertension not only augment the central pressure by increasing the wave reflection but also may alter the central bidirectional flow, inducing hemodynamic damage/dysfunction in susceptible organs. Therefore, central hemodynamic monitoring has the potential to provide a diagnostic and therapeutic basis for preventing systemic target organ damage and for offering personalized therapy suitable for the arterial properties in each patient with hypertension. This brief review will summarize hypothetical mechanisms for the association between the central hemodynamics and hypertensive organ damage in the heart, kidney and brain.
技术的最新进展使得对主动脉中心的搏动性血流动力学进行无创评估成为可能；即中心压力和血流测量。中心血压代表施加于心脏、肾脏和大脑的实际负荷，而中心血流影响进入这些重要器官的局部血流。中心血压升高对靶器官有直接的不利影响，进而影响高血压患者的心血管预后。中心血流减少会导致器官功能障碍和衰竭。传统上，中心压力和血流动力学被认为是从心脏到外周的单向过程。然而，目前的证据表明，应将其视为中心动脉和外周动脉之间的双向相互作用。具体而言，压力脉搏波不仅向前传播到外周，还会向后反射回主动脉中心。血流脉搏波也由正向和反向成分组成。高血压导致的主动脉硬化和小动脉重塑不仅通过增加波反射来升高中心压力，还可能改变中心双向血流，在易感器官中引发血流动力学损伤/功能障碍。因此，中心血流动力学监测有可能为预防全身性靶器官损伤以及为每位高血压患者提供适合其动脉特性的个性化治疗提供诊断和治疗依据。本简要综述将总结中心血流动力学与心脏、肾脏和大脑中高血压器官损伤之间关联的假设机制。
