Puato Massimo, Boschetti Giovanni, Rattazzi Marcello, Zanon Marta, Pesavento Raffaele, Faggin Elisabetta, Fania Claudio, Benetti Elisabetta, Palatini Paolo, Pauletto Paolo
a Department of Medicine , University of Padova , Padova , Italy.
b Medicina I, Ospedale Ca' Foncello , Treviso , Italy.
Blood Press. 2017 Feb;26(1):48-53. doi: 10.1080/08037051.2016.1184964. Epub 2016 May 24.
Aim of this study was to evaluate in a long follow-up the carotid artery remodelling in a cohort of young hypertensive subjects having good blood pressure (BP) control. We studied 20 grade I hypertensives (HT) by assessing the B-mode ultrasound of mean carotid intima-media thickness (mean-IMT) and maximum IMT (M-MAX) in each carotid artery segment (common, bulb, internal), bilaterally. We compared their ultrasound measurements with those recorded 5 and 10 years earlier. While the first 5-year follow-up was observational, in the second 5-year follow-up, lifestyle modifications and/or pharmacological therapy were started to obtain well-controlled BP levels. Office BP was measured at the time of the ultrasound studies and every 6 months during the follow-up. BP levels were: 10 years 144/91 mmHg, 5 years 143/90 mmHg and 129 ± 79 mmHg at the time of the study. In the first 5-year observational follow-up, both mean-IMT and M-MAX increased (Δ 0.116 and Δ 0.165 mm, respectively, p < 0.0005). In the 5-year intervention follow-up, characterized by well-controlled BP, mean-IMT slightly but significantly increased (Δ 0.084 mm, p = 0.004), whereas M-MAX remained stable (Δ 0.026 mm). In our HT, well-controlled BP levels were able to prevent pro-atherogenic remodelling (expressed by M-MAX). Conversely, good BP control slightly decreased but did not stop the progression in mean-IMT, which is likely to reflect some hypertrophy of the arterial media layer.
本研究的目的是在长期随访中评估一组血压控制良好的年轻高血压患者的颈动脉重塑情况。我们通过双侧评估每个颈动脉段（颈总动脉、颈动脉球部、颈内动脉）的平均颈动脉内膜中层厚度（mean-IMT）和最大内膜中层厚度（M-MAX）的B型超声，对20例I级高血压患者（HT）进行了研究。我们将他们的超声测量结果与5年和10年前记录的结果进行了比较。前5年的随访是观察性的，在第二个5年的随访中，开始进行生活方式改变和/或药物治疗以实现血压的良好控制。在超声研究时以及随访期间每6个月测量一次诊室血压。血压水平分别为：研究时129±79mmHg、5年时143/90mmHg、10年时144/91mmHg。在第一个5年观察性随访中，mean-IMT和M-MAX均增加（分别增加0.116和0.165mm，p<0.0005）。在以血压良好控制为特征的5年干预随访中，mean-IMT略有但显著增加（增加0.084mm，p=0.004），而M-MAX保持稳定（增加0.026mm）。在我们的高血压患者中，良好的血压控制能够预防动脉粥样硬化前期重塑（以M-MAX表示）。相反，良好的血压控制使mean-IMT略有下降但并未阻止其进展，这可能反映了动脉中层的一些肥厚。
