Department of Neurology and Neurorehabilitation.
Department of Radiology, Luzerner Kantonsspital, Spitalstrasse, Luzern.
J Hypertens. 2019 Feb;37(2):372-379. doi: 10.1097/HJH.0000000000001854.
Whether cerebrovascular regulation is different in patients with controlled high blood pressure (HBP) with and without small vessel disease (SVD).
Sixty-seven healthy controls (mean age ± SD, 45 ± 16 years; 30 women, 37 men) and 40 patients (mean age, 64 ± 13 years; 14 women, 26 men) with HBP and different stages of SVD, underwent simultaneous recordings of the spontaneous fluctuations of BP, blood flow velocity (CBFV) in both middle cerebral arteries (MCA), and of end-tidal CO2 (ETCO2). Coherence and transfer function gain and phase between BP and CBFV were assessed in the frequency ranges of VLF (0.02-0.07 Hz), low frequency (0.07-0.15), and high frequency (>0.15). BP SD indicated BP variability (BPV).
In controls (BP, 86 ± 13 mmHg; ETCO2, 39 ± 4 mmHg; BPV, 15 ± 6 mmHg), gain, phase and coherence were not age-dependent in simple or a multiple regression models. BPV correlated significantly in both MCAs with gain in low frequency and high frequency, and with phase in VLF and high frequency. In patients (BP, 91 ± 16 mmHg, ETCO2, 39 ± 4 mmHg, BPV 18 ± 5 mmHg), only gain showed some differences between different SVD groups. Comparing all patients with 25 controls of similar age and sex, patients exhibited significantly (P < 0.05-P < 0.005): increased coherence and gain in VLF, decreased phase in VLF and low frequency, correlations between BPV with phase in low frequency (left) and with gain in VLF (left) and in high frequency (left and right).
Phase seems an age independent autoregulatory index. In controlled HBP, CBF regulation is degraded at longlasting CBF changes; BPV effects lose their physiological bilateral distribution.
探讨血压控制良好的高血压（HBP）伴和不伴小血管疾病（SVD）患者的脑血管调节是否存在差异。
共纳入 67 名健康对照者（平均年龄±标准差，45±16 岁；女性 30 名，男性 37 名）和 40 名 HBP 伴不同阶段 SVD 患者（平均年龄 64±13 岁；女性 14 名，男性 26 名），同步记录双侧大脑中动脉（MCA）的血压波动、血流速度（CBFV）和呼气末二氧化碳（ETCO2）。评估血压和 CBFV 在 VLF（0.02-0.07 Hz）、低频（0.07-0.15 Hz）和高频（>0.15 Hz）频率范围内的相干性和传递函数增益及相位。血压标准差（BPV）表示血压变异性（BPV）。
在对照组（血压 86±13mmHg；ETCO2 39±4mmHg；BPV 15±6mmHg）中，在简单或多元回归模型中，增益、相位和相干性均与年龄无关。在双侧 MCA 中，BPV 与低频和高频的增益以及 VLF 和高频的相位均呈显著相关。在患者组（血压 91±16mmHg，ETCO2 39±4mmHg，BPV 18±5mmHg）中，仅增益在不同 SVD 组之间存在差异。将所有患者与 25 名年龄和性别相似的对照组进行比较，患者的 VLF 相干性和增益显著增加（P<0.05-P<0.005），VLF 和低频的相位降低，BPV 与低频（左侧）和 VLF（左侧和右侧）以及高频（左侧和右侧）的增益之间存在相关性。
相位似乎是一个与年龄无关的自动调节指数。在血压控制良好的 HBP 中，当 CBF 发生持久变化时，CBF 调节受损；BPV 的影响失去了其生理上的双侧分布。
