Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Université de Lorraine, Inserm DCAC Department, Nancy, France.
Am J Hypertens. 2020 Apr 1;33(4):291-296. doi: 10.1093/ajh/hpz193.
Arterial stiffness-typically assessed from non-invasive measurement of pulse wave velocity along a straight portion of the vascular tree between the right common carotid and femoral arteries-is a reliable predictor of cardiovascular risk in patients with essential hypertension.
We reviewed how carotid-femoral pulse wave velocity increases with age and is significantly higher in hypertension (than in age- and gender-matched individuals without hypertension), particularly when hypertension is associated with diabetes mellitus.
From the elastic aorta to the muscular peripheral arteries of young healthy individuals, there is a gradual but significant increase in stiffness, with a specific gradient. This moderates the transmission of pulsatile pressure towards the periphery, thus protecting the microcirculatory network. The heterogeneity of stiffness between the elastic and muscular arteries causes the gradient to disappear or be inversed with aging, particularly in long-standing hypertension.
In hypertension therefore, pulsatile pressure transmission to the microcirculation is augmented, increasing the potential risk of damage to the brain, the heart, and the kidney. Furthermore, elevated pulse pressure exacerbates end-stage renal disease, particularly in older hypertensive individuals. With increasing age, the elastin content of vessel walls declines throughout the arterial network, and arterial stiffening increases further due to the presence of rigid wall material such as collagen, but also fibronectin, proteoglycans, and vascular calcification. Certain genes, mainly related to angiotensin and/or aldosterone, affect this aging process and contribute to the extent of arterial stiffness, which can independently affect both forward and reflected pressure waves.
动脉僵硬度通常通过测量右侧颈总动脉和股动脉之间的血管树直段的脉搏波速度来评估，它是原发性高血压患者心血管风险的可靠预测指标。
我们回顾了颈动脉-股动脉脉搏波速度随年龄的增加而增加，并且在高血压（与年龄和性别匹配的无高血压个体相比）中显著升高，尤其是在高血压伴发糖尿病时。
从弹性主动脉到年轻健康个体的肌肉外周动脉，僵硬度逐渐但显著增加，具有特定的梯度。这会缓和脉动压力向周围的传递，从而保护微循环网络。弹性和肌肉动脉之间的僵硬度异质性导致梯度随着年龄的增长而消失或反转，尤其是在长期高血压中。
因此，在高血压中，脉动压力向微循环的传递增强，增加了对大脑、心脏和肾脏的损伤风险。此外，脉压升高会加重终末期肾病，尤其是在老年高血压患者中。随着年龄的增长，血管壁的弹性蛋白含量在整个动脉网络中下降，由于刚性壁材料（如胶原）的存在，动脉僵硬度进一步增加，但也有纤维连接蛋白、蛋白聚糖和血管钙化。某些基因，主要与血管紧张素和/或醛固酮有关，会影响这个衰老过程，并影响动脉僵硬度的程度，而动脉僵硬度可以独立影响正向和反射压力波。
