Quarti-Trevano Fosca, Cuspidi Cesare, Dell'Oro Raffaella, Ambrosino Pasquale, Grassi Guido
Clinica Medica, School of Medicine and Surgery, University Milano-Bicocca, 20052 Monza, Italy.
Department of Medicine and Surgery, University Milano-Bicocca, 20126 Milan, Italy.
J Clin Med. 2025 Mar 25;14(7):2230. doi: 10.3390/jcm14072230.
Hypertension is a clinical condition associated with structural alterations in small, medium, and large arteries, also affecting target organs due to the mechanical effects of high blood pressure and shear stress. However, these vascular changes are also influenced by various inflammatory and neurohumoral mediators originating from the endothelium, the renin-angiotensin-aldosterone system, the neuroadrenergic system, and the perivascular fat. Specifically, chronic hypertension leads to vascular stretching, which triggers complex signaling pathways that promote vascular remodeling. The endothelium plays a crucial role in this process, as its function is impaired in hypertensive patients, leading to reduced nitric oxide-mediated vasodilation, increased vascular tone, and a proinflammatory and prothrombotic state. Along with structural changes, hypertension also triggers dynamic alterations in arterial distensibility and arterial wall properties, leading to increased arterial stiffness, which is strongly linked to cardiovascular outcomes and associated disability, as well as subsequent rehabilitation needs. Several non-invasive and highly reproducible methods are currently used to assess arterial stiffness, one of which is the cardio-ankle vascular index (CAVI). This article examines the association between arterial stiffness and high blood pressure, with a particular focus on the results of the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. This study analyzes the determinants of arterial stiffness in the general population, the different hypertensive phenotypes affecting diurnal and nocturnal blood pressure profiles, and the impact of blood pressure control through antihypertensive treatment on arterial stiffness.
高血压是一种与小、中、大动脉结构改变相关的临床病症，由于高血压和剪切应力的机械作用，还会影响靶器官。然而，这些血管变化也受到源自内皮、肾素-血管紧张素-醛固酮系统、神经肾上腺素能系统和血管周围脂肪的各种炎症和神经体液介质的影响。具体而言，慢性高血压会导致血管拉伸，从而触发促进血管重塑的复杂信号通路。内皮在这一过程中起着关键作用，因为高血压患者的内皮功能受损，导致一氧化氮介导的血管舒张减少、血管张力增加以及促炎和促血栓形成状态。除了结构变化外，高血压还会引发动脉扩张性和动脉壁特性的动态改变，导致动脉僵硬度增加，这与心血管结局、相关残疾以及随后的康复需求密切相关。目前有几种非侵入性且高度可重复的方法用于评估动脉僵硬度，其中之一是心踝血管指数（CAVI）。本文探讨了动脉僵硬度与高血压之间的关联，特别关注动脉血压监测及其相关性（PAMELA）研究的结果。这项研究分析了一般人群中动脉僵硬度的决定因素、影响昼夜血压曲线的不同高血压表型，以及通过降压治疗控制血压对动脉僵硬度的影响。
