Laurent S, Juillerat L, London G, Nussberger J, Brunner H, Safar M
Centre de Diagnostic, Hôpital Broussais, Paris.
Arch Mal Coeur Vaiss. 1987 Jun;80(6):826-31.
The hyperresponsiveness of small arteries to norepinephrine is well documented in essential hypertensive patients. Our objective was to investigate in situ the reactivity to norepinephrine of the diameter of large arteries which are involved in the arterial disease of hypertension as well as small arteries. Brachial artery diameter, blood flow velocity, local volumic blood flow and local vascular resistances were determined non invasively using a pulsed Doppler system in 19 patients with essential hypertension and 9 normotensive subjects, before and after placebo (glucose) or increasing doses of norepinephrine (10, 20 and 40 ng/kg/min; i.v.) given in a single blind fashion. In hypertensive patients, norepinephrine (40 ng/kg/min) induced (i) a significant decrease in brachial artery diameter, local blood velocity, volumic flow and conductance and (ii) a small increase in mean arterial pressure. These hemodynamic changes did not occurred in the placebo group and were significantly greater in hypertensive patients than in normotensive subjects although plasma norepinephrine increased to the same extent in both groups. We conclude that in hypertensive patients, the increase in vascular reactivity to norepinephrine involves not only the resistive vessels, but also the large arteries thus decreasing their conducting and buffering function.
原发性高血压患者小动脉对去甲肾上腺素的高反应性已有充分记录。我们的目的是在原位研究参与高血压动脉疾病的大动脉以及小动脉直径对去甲肾上腺素的反应性。使用脉冲多普勒系统，以单盲方式在19例原发性高血压患者和9例血压正常的受试者中，于安慰剂（葡萄糖）或递增剂量的去甲肾上腺素（10、20和40 ng/kg/min；静脉注射）给药前后，无创测定肱动脉直径、血流速度、局部容积血流和局部血管阻力。在高血压患者中，去甲肾上腺素（40 ng/kg/min）导致：（i）肱动脉直径、局部血流速度、容积血流和传导率显著降低；（ii）平均动脉压略有升高。这些血流动力学变化在安慰剂组未出现，且在高血压患者中显著大于血压正常的受试者，尽管两组血浆去甲肾上腺素升高程度相同。我们得出结论，在高血压患者中，血管对去甲肾上腺素反应性的增加不仅涉及阻力血管，还涉及大动脉，从而降低其传导和缓冲功能。
