Agabiti-Rosei Enrico, Rizzoni Damiano
aClinica Medica, Department of Clinical and Experimental Sciences, University of BresciabDivision of Medicine, Istituto Clinico Città di Brescia, Brescia, Italy.
J Hypertens. 2017 May;35(5):914-921. doi: 10.1097/HJH.0000000000001259.
Remodelling of subcutaneous small resistance arteries, as indicated by an increased media-to-lumen ratio, is frequently present in hypertensive, obese, or diabetic patients. The increased media-to-lumen ratio may impair organ flow reserve. This may be important in the maintenance and, probably, also in the progressive worsening of hypertensive disease. The presence of structural alterations represents a prognostically relevant factor, in terms of development of target organ damage or cardiovascular events, thus allowing us a prediction of complications in hypertension. In fact, media-to-lumen ratio of small arteries at baseline, and possibly their changes during treatment may have a strong prognostic significance. However, new, non-invasive techniques are needed before suggesting extensive application of the evaluation of remodelling of small arteries for the cardiovascular risk stratification in hypertensive patients. Some new techniques for the evaluation of microvascular morphology in the retina, currently under clinical investigation, seem to represent a promising and interesting future perspective. The evaluation of microvascular structure is progressively moving from bench to bedside, and it could represent, in the near future, an evaluation to be performed in all hypertensive patients, to obtain a better stratification of cardiovascular risk, and, possibly, it might be considered as an intermediate endpoint in the evaluation of the effects of antihypertensive therapy, provided that a demonstration of a prognostic value of non-invasive measures of microvascular structure is made available.
皮下小阻力动脉重塑，表现为中膜与管腔比值增加，常见于高血压、肥胖或糖尿病患者。中膜与管腔比值增加可能损害器官血流储备。这在高血压疾病的维持以及可能的病情进展恶化中可能很重要。结构改变的存在代表了一个与预后相关的因素，就靶器官损害或心血管事件的发生而言，从而使我们能够预测高血压的并发症。事实上，小动脉的基线中膜与管腔比值以及治疗期间可能的变化可能具有很强的预后意义。然而，在建议广泛应用小动脉重塑评估进行高血压患者心血管风险分层之前，需要新的非侵入性技术。目前正在临床研究的一些评估视网膜微血管形态的新技术，似乎代表了一个有前景且有趣的未来方向。微血管结构评估正逐渐从实验室走向临床，在不久的将来，它可能成为所有高血压患者都要进行的评估，以更好地分层心血管风险，并且，如果能够证明微血管结构的非侵入性测量具有预后价值，那么它可能被视为评估降压治疗效果的一个中间终点。
