Puato M, Rattazzi M, Zanon M, Benetti E, Faggin E, Palatini P, Pauletto P
Department of Medicine, DMED, University of Padova, Padova, Italy.
1] Department of Medicine, DMED, University of Padova, Padova, Italy [2] Medicina I, Ospedale Ca' Foncello, Treviso, Italy.
J Hum Hypertens. 2015 Sep;29(9):561-5. doi: 10.1038/jhh.2014.121. Epub 2014 Dec 18.
We evaluated the structural/functional characteristics of the arterial wall in a cohort of hypertensives with well-controlled blood pressure (BP) levels. We studied 40 hypertensives with well-controlled BP. We assessed by B-mode ultrasound the mean intima-media thickness (mean-IMT) and maximum-IMT (M-MAX) of carotid artery (common, bulb, internal) bilaterally. Endothelial function was evaluated by post-occlusion flow-mediated dilation (FMD) of the brachial artery. Along with traditional risk factors, we studied the impact of serum high-sensitivity C-reactive protein (hs-CRP) and osteoprotegerin (OPG). Forty normotensive subjects served as controls. In the hypertensives, the BP levels were well controlled (office BP: 129/79 mm Hg, ambulatory BP monitoring: 121/75 mm Hg). Compared with controls, higher BP levels and body mass index were present in hypertensives, whereas age and metabolic parameters were similar. In hypertensives, the IMT (mean-IMT 0.68 mm, M-MAX 0.81 mm) was significantly higher than in controls (mean-IMT 0.60 mm, M-MAX 0.71 mm). FMD was impaired in hypertensives (5.9%) compared with controls (9.2%). In multivariate analyses, it turned out that in hypertensives IMT parameters were related to age, hs-CRP and OPG. Low-density lipoprotein (LDL) cholesterol was the only factor related to FMD. IMT and FMD had no relationship with BP levels. In conclusion, in hypertensives with well-controlled BP, the pro-atherogenic remodelling (IMT) is mainly dependent on age and the inflammatory cytokines, OPG in particular. The functional impairment of the arterial wall (FMD) was related to the levels of LDL cholesterol. Under these conditions, when the impact of BP is minimized, the role of inflammatory cytokines and lipids on structural/functional remodelling becomes predominant.
我们评估了一组血压得到良好控制的高血压患者动脉壁的结构/功能特征。我们研究了40例血压得到良好控制的高血压患者。我们通过B型超声双侧评估颈动脉（颈总动脉、颈动脉球部、颈内动脉）的平均内膜中层厚度（mean-IMT）和最大内膜中层厚度（M-MAX）。通过肱动脉闭塞后血流介导的血管舒张（FMD）评估内皮功能。除了传统危险因素外，我们还研究了血清高敏C反应蛋白（hs-CRP）和骨保护素（OPG）的影响。40名血压正常的受试者作为对照。在高血压患者中，血压水平得到良好控制（诊室血压：129/79 mmHg，动态血压监测：121/75 mmHg）。与对照组相比，高血压患者的血压水平和体重指数更高，而年龄和代谢参数相似。在高血压患者中，内膜中层厚度（mean-IMT 0.68 mm，M-MAX 0.81 mm）显著高于对照组（mean-IMT 0.60 mm，M-MAX 0.71 mm）。与对照组（9.2%）相比，高血压患者的FMD受损（5.9%）。在多变量分析中，结果表明在高血压患者中，内膜中层厚度参数与年龄、hs-CRP和OPG有关。低密度脂蛋白（LDL）胆固醇是与FMD相关的唯一因素。内膜中层厚度和FMD与血压水平无关。总之，在血压得到良好控制的高血压患者中，促动脉粥样硬化重塑（内膜中层厚度）主要取决于年龄和炎性细胞因子，尤其是OPG。动脉壁的功能损害（FMD）与LDL胆固醇水平有关。在这些情况下，当血压的影响最小化时，炎性细胞因子和脂质对结构/功能重塑的作用变得占主导地位。
