Safar Michel E, Plante Gérard E, Mimran Albert
Faculty of Medicine, Paris Descartes University, Hôtel-Dieu Hospital, AP-HP, Diagnosis and Therapeutic Center, Paris, France;
Department of Internal Medicine, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.
Am J Hypertens. 2015 May;28(5):561-9. doi: 10.1093/ajh/hpu206. Epub 2014 Dec 4.
Classical studies indicate that the contribution of kidneys to hypertension is almost exclusively related to the association between mean arterial pressure (MAP) and vascular resistance. Recent reports including estimates of glomerular filtration rate (GFR) have shown that pulse pressure (PP) and pulse wave velocity, 2 major indices of arterial stiffness, now emerge as significant predictors of cardiovascular risk and age-associated decline in GFR. Such findings are mainly observed in patients with hypertension and renal failure and in atherosclerotic subjects undergoing coronary angiography. In such patients, amplification of PP between ascending and terminal aorta at the renal site is constantly increased over 10mm Hg (P < 0.001), whereas MAP level remains continuously unmodified. This PP amplification is significantly associated with presence of proteinuria. Furthermore, increases in plasma creatinine and aortic stiffness are independently and positively correlated (P < 0.001) both in cross-sectional and longitudinal studies. All these relationships associating PP, arterial stiffness, and renal function are mainly observed in patients 60 years of age or older. Furthermore, in renal transplant patients and their donors, subjects have been recruited for evaluations of arterial stiffness and posttransplant decline in GFR. Determinants of GFR decline were evaluated 1 and 9 years after transplantation. The first year GFR decline was related to smoking and acute rejection, whereas the later was significantly and exclusively associated with donor age and aortic stiffness. Thus, in hypertensive humans, the observed association between PP and GFR suggests that the 2 parameters are substantially mediated by arterial stiffness, not exclusively by vascular resistance.
经典研究表明，肾脏对高血压的影响几乎完全与平均动脉压（MAP）和血管阻力之间的关联有关。最近包括肾小球滤过率（GFR）估算值在内的报告显示，脉压（PP）和脉搏波速度这两个主要的动脉僵硬度指标，如今已成为心血管风险和与年龄相关的GFR下降的重要预测指标。这些发现主要在高血压和肾衰竭患者以及接受冠状动脉造影的动脉粥样硬化患者中观察到。在这些患者中，肾部位升主动脉和终末主动脉之间的PP增幅持续超过10mmHg（P<0.001），而MAP水平则持续不变。这种PP增幅与蛋白尿的存在显著相关。此外，在横断面和纵向研究中，血浆肌酐升高与主动脉僵硬度增加均呈独立正相关（P<0.001）。所有这些将PP、动脉僵硬度和肾功能联系起来的关系主要在60岁及以上的患者中观察到。此外，在肾移植患者及其供体中，已招募受试者评估动脉僵硬度和移植后GFR的下降情况。在移植后1年和9年评估GFR下降的决定因素。第一年GFR下降与吸烟和急性排斥反应有关，而后期则显著且仅与供体年龄和主动脉僵硬度有关。因此，在高血压患者中，观察到的PP与GFR之间的关联表明，这两个参数主要由动脉僵硬度介导，而非仅由血管阻力介导。
