Cunha R S, Benetos A, Laurent S, Safar M E, Asmar R G
Department of Internal Medicine, Broussais Hospital, Paris, France.
Am J Hypertens. 1995 Apr;8(4 Pt 1):343-52. doi: 10.1016/0895-7061(94)00249-b.
In hypertension, the principal components of the mechanical stress acting on the arterial wall may be evaluated not only from the level of peak systolic and end-diastolic blood pressure but also by the level of pulse pressure and variability of blood pressure measured by ambulatory monitoring. The purpose of the present study was, in a population of 51 subjects with essential hypertension, to determine the influence of these parameters and of heart rate on the distension capacity of the common carotid artery, measured noninvasively by high-resolution echo-tracking techniques. The pulsatile change in diameter of the carotid artery diameter, estimated either in absolute or relative values, was shown to be significantly and independently correlated with four mechanical parameters deduced from daytime ambulatory blood pressure measurements: baseline diastolic blood pressure (the lower the diastolic blood pressure, the higher the distension capacity; r = -0.44; P < .001); pulse pressure (the higher the pulse pressure, the higher the distension capacity; r = 0.32; P < .024); variability of diastolic blood pressure (the higher the variability, the higher the distension capacity; r = 0.37; P < .008); and mean heart rate (the higher the heart rate, the more reduced the distension capacity; r = -0.28; P < .05). Multiple regression analysis indicated that mean diastolic blood pressure and its variability, mean heart rate, and pulse pressure acted independently on carotid artery distension, even after adjustment for age. The present study suggests for the first time that, in humans, hypertension may act on the arterial wall not only through the amplitude of peak systolic and end-diastolic blood pressure but also through several other mechanical factors involving the level of pulse pressure and heart rate and also blood pressure variability. Thus, in addition to the level of blood pressure, carotid artery distension is specifically influenced by two factors independently implicated in the epidemiologic cardiovascular risk: pulse pressure and heart rate.
在高血压患者中，作用于动脉壁的机械应力的主要成分不仅可以根据收缩压峰值和舒张压末期血压水平来评估，还可以通过脉压水平以及动态血压监测所测量的血压变异性来评估。本研究的目的是，在51名原发性高血压患者群体中，确定这些参数以及心率对颈总动脉扩张能力的影响，该扩张能力通过高分辨率回声跟踪技术进行无创测量。颈动脉直径的脉动变化，无论是以绝对值还是相对值来估计，均显示与从日间动态血压测量得出的四个机械参数显著且独立相关：基线舒张压（舒张压越低，扩张能力越高；r = -0.44；P <.001）；脉压（脉压越高，扩张能力越高；r = 0.32；P <.024）；舒张压变异性（变异性越高，扩张能力越高；r = 0.37；P <.008）；以及平均心率（心率越高，扩张能力降低得越多；r = -0.28；P <.05）。多元回归分析表明，即使在对年龄进行调整后，平均舒张压及其变异性、平均心率和脉压对颈动脉扩张均有独立作用。本研究首次表明，在人类中，高血压可能不仅通过收缩压峰值和舒张压末期血压的幅度作用于动脉壁，还通过其他几个机械因素，包括脉压水平、心率以及血压变异性。因此，除了血压水平外，颈动脉扩张还受到两个独立与心血管流行病学风险相关的因素的特异性影响：脉压和心率。
