Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan.
Int J Cardiol. 2018 Feb 15;253:161-166. doi: 10.1016/j.ijcard.2017.11.022. Epub 2017 Nov 12.
To examine the longitudinal mutual association between endothelial dysfunction and arterial stiffness, and also to determine which of the two variables was more closely associated with the progression of subclinical organ damage.
The brachial-ankle pulse wave velocity (baPWV), carotid intima-media thickness (CIMT), estimated glomerular filtration rate, microalbuminuria and flow-mediated vasodilatation of the brachial artery (FMD) were measured three times at 1.5-year intervals in 674 Japanese patients receiving antihypertensive treatment.
The change of the baPWV during the study period was larger in the subjects with baseline FMD values in the lowest tertile as compared to those with baseline FMD values in the highest tertile. The change of the CIMT was smaller in the subjects with baseline baPWV values in the lowest tertile than in those with baseline baPWV values in the highest tertile. After the adjustment, the FMD value at the baseline was inversely associated with the baPWV at the end of the study period (beta=-0.07, p=0.01), although, the reverse association was not significant. The baPWV, but not the FMD value, at the baseline was associated with the CIMT (beta=0.06, p=0.04) measured at the end of the study period.
In hypertension, endothelial dysfunction was associated with the progression of arterial stiffness, although the reverse association was not confirmed. The increased arterial stiffness rather than endothelial dysfunction may be more closely associated with the progression of atherosclerotic vascular damage, and the endothelial dysfunction-arterial stiffness-atherosclerosis continuum may be important in hypertension.
探讨血管内皮功能障碍与动脉僵硬度的纵向相互关系，并确定两者中哪一个与亚临床器官损害的进展更为密切相关。
对 674 例接受降压治疗的日本患者，在 1.5 年的时间间隔内，3 次测量肱踝脉搏波速度（baPWV）、颈动脉内膜中层厚度（CIMT）、估算肾小球滤过率、微量白蛋白尿和肱动脉血流介导的血管舒张功能（FMD）。
与基线 FMD 值最高三分位的受试者相比，基线 FMD 值最低三分位的受试者在研究期间的 baPWV 变化更大。与基线 baPWV 值最高三分位的受试者相比，基线 baPWV 值最低三分位的受试者的 CIMT 变化更小。调整后，基线 FMD 值与研究期末的 baPWV 值呈负相关（β=-0.07，p=0.01），尽管反向关联不显著。基线时的 baPWV 与研究期末的 CIMT（β=0.06，p=0.04）呈正相关，而 FMD 值与 CIMT 无相关性。
在高血压中，内皮功能障碍与动脉僵硬度的进展有关，但反向关联未得到证实。动脉僵硬度的增加而不是内皮功能障碍可能与动脉粥样硬化血管损害的进展更为密切相关，内皮功能障碍-动脉僵硬度-动脉粥样硬化连续体在高血压中可能很重要。
