高血压患者血压急性非药物降低后持续的血管功能障碍。

Persistent vascular dysfunction following an acute nonpharmacological reduction in blood pressure in hypertensive patients.

机构信息

Geriatric Research, Education, and Clinical Center, George E. Whalen VA Medical Center.

Division of Geriatrics, Department of Internal Medicine.

出版信息

J Hypertens. 2022 Jun 1;40(6):1115-1125. doi: 10.1097/HJH.0000000000003104.

DOI:10.1097/HJH.0000000000003104

PMID:35703879

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9204754/

Abstract

BACKGROUND

Vascular dysfunction, an independent risk factor for cardiovascular disease, often persists in patients with hypertension, despite improvements in blood pressure control induced by antihypertensive medications.

METHODS

As some of these medications may directly affect vascular function, this study sought to comprehensively examine the impact of reducing blood pressure, by a nonpharmacological approach (5 days of sodium restriction), on vascular function in 22 hypertensive individuals (14 men/8 women, 50 ± 10 years). Following a 2-week withdrawal of antihypertensive medications, two 5-day dietary phases, liberal sodium (liberal sodium, 200 mmol/day) followed by restricted sodium (restricted sodium, 10 mmol/day), were completed. Resting blood pressure was assessed and vascular function, at both the conduit and microvascular levels, was evaluated by brachial artery flow-mediated dilation (FMD), reactive hyperemia, progressive handgrip exercise, and passive leg movement (PLM).

RESULTS

Despite a sodium restriction-induced fall in blood pressure (liberal sodium: 141 ± 14/85 ± 9; restricted sodium 124 ± 12/79 ± 9 mmHg, P < 0.01 for both SBP and DBP), FMD (liberal sodium: 4.6 ± 1.8%; restricted sodium: 5.1 ± 2.1%, P = 0.27), and reactive hyperemia (liberal sodium: 548 ± 201; restricted sodium: 615 ± 206 ml, P = 0.08) were not altered. Similarly, brachial artery vasodilation during handgrip exercise was not different between conditions (liberal sodium: Δ0.36 ± 0.19 mm; restricted sodium: Δ0.42 ± 0.18 mm, P = 0.16). Lastly, PLM-induced changes in peak blood flow (liberal sodium: 5.3 ± 2.5; restricted sodium: 5.8 ± 3.6 ml/min per mmHg, P = 0.30) and the total vasodilatory response [liberal sodium: 2 (0.9-2.5) vs. restricted sodium: 1.7 (1.1-2.6) ml/min per mmHg; P = 0.5] were also not different between conditions.

CONCLUSION

Thus vascular dysfunction, at both the conduit and microvascular levels, persists in patients with hypertension even when blood pressure is acutely reduced by a nonpharmacological approach.

摘要

背景

血管功能障碍是心血管疾病的一个独立危险因素，尽管降压药物可改善血压控制，但高血压患者的血管功能障碍仍常持续存在。

方法

由于这些药物中的一些可能直接影响血管功能，因此本研究旨在通过非药物手段（5 天限钠）全面评估降压对 22 名高血压患者（14 名男性/8 名女性，50±10 岁）血管功能的影响。在停用降压药物 2 周后，完成了两个为期 5 天的饮食阶段，即高钠（高钠，200mmol/天）和限钠（限钠，10mmol/天）。评估静息血压，并通过肱动脉血流介导的扩张（FMD）、反应性充血、渐进性握力运动和被动腿部运动（PLM）评估大、小血管水平的血管功能。

结果

尽管限钠可降低血压（高钠：141±14/85±9mmHg；限钠：124±12/79±9mmHg，SBP 和 DBP 均 P＜0.01），但 FMD（高钠：4.6±1.8%；限钠：5.1±2.1%，P=0.27）和反应性充血（高钠：548±201ml；限钠：615±206ml，P=0.08）均无变化。同样，握力运动时肱动脉血管扩张在两种情况下也无差异（高钠：Δ0.36±0.19mm；限钠：Δ0.42±0.18mm，P=0.16）。最后，PLM 引起的峰值血流变化（高钠：5.3±2.5ml/min/mmHg；限钠：5.8±3.6ml/min/mmHg，P=0.30）和总血管舒张反应[高钠：2（0.9-2.5）vs.限钠：1.7（1.1-2.6）ml/min/mmHg；P=0.5]在两种情况下也无差异。