Maeda H, Matsumoto M, Handa N, Hougaku H, Ogawa S, Itoh T, Tsukamoto Y, Kamada T
First Department of Internal Medicine, Osaka University Medical School, Japan.
J Hypertens. 1994 Feb;12(2):191-7.
To evaluate hypertensive cerebral involvement before cerebrovascular accidents.
Cerebral microvascular responses to changes in the arterial partial pressure of CO2 (pCO2; the CO2 reactivity) were compared among patients with different stages and severity of hypertensive disease.
Fifty-eight patients with hypertension, 11 with borderline hypertension, 15 hypertensives with cerebral infarction and 58 normotensive controls were studied.
The cerebrovascular CO2 reactivity was determined by measuring simultaneously the end-tidal pCO2 and the blood flow velocity in the middle cerebral artery using transcranial Doppler sonography under hypocapnic, normocapnic and hypercapnic conditions.
CO2 reactivity was impaired in the hypertensive patients compared with in the normotensive controls, but less so than in the symptomatic hemisphere of the hypertensive patients with cerebral infarction. The CO2 reactivity in the borderline hypertensive patients was greater than that in both the symptomatic and asymptomatic hemispheres of the hypertensive patients with cerebral infarction. In the subjects without cerebral infarction, two risk factors for cerebral atherosclerosis (age and hypertension) were negatively correlated with cerebrovascular CO2 reactivity. In the hypertensive patients age and the estimated duration of hypertension were negatively correlated with cerebrovascular CO2 reactivity. CO2 reactivity in the patients with hypertensive or arteriosclerotic retinopathy or ST-T changes on their electrocardiogram was impaired compared with that in the patients without such changes.
Hypertension affected the microvascular reactivity of the brain before the development of cerebrovascular accidents, and its effect varied dependently on the extent of involvement of other target organs.
评估脑血管意外发生前高血压对脑部的影响。
比较不同阶段和严重程度的高血压病患者大脑微血管对二氧化碳动脉分压（pCO2；二氧化碳反应性）变化的反应。
研究了58例高血压患者、11例临界高血压患者、15例患有脑梗死的高血压患者和58例血压正常的对照者。
在低碳酸血症、正常碳酸血症和高碳酸血症条件下，使用经颅多普勒超声同时测量呼气末pCO2和大脑中动脉的血流速度，以确定脑血管二氧化碳反应性。
与血压正常的对照者相比，高血压患者的二氧化碳反应性受损，但低于患有脑梗死的高血压患者有症状半球的受损程度。临界高血压患者的二氧化碳反应性高于患有脑梗死的高血压患者有症状和无症状半球的反应性。在没有脑梗死的受试者中，脑动脉粥样硬化的两个危险因素（年龄和高血压）与脑血管二氧化碳反应性呈负相关。在高血压患者中，年龄和估计的高血压病程与脑血管二氧化碳反应性呈负相关。与没有高血压性或动脉硬化性视网膜病变或心电图ST-T改变的患者相比，有这些改变的患者的二氧化碳反应性受损。
高血压在脑血管意外发生前就影响了大脑的微血管反应性，其影响因其他靶器官受累程度的不同而有所差异。
