Schmieder R E, Weihprecht H, Schobel H, John S, Weidinger G, Gatzka C, Veelken R
Department of Internal Medicine IV, University Erlangen-Nürnberg, Germany.
Am J Hypertens. 1997 Mar;10(3):323-31. doi: 10.1016/s0895-7061(96)00414-1.
There is controversy over whether endothelial function is impaired in human essential hypertension. All studies to date have used measurements of forearm blood flow by plethysmography to assess endothelium-dependent vasodilation and endothelial function. In contrast to these studies, which have focused on resistance vessels, we have determined what effects the endothelium has on underlying smooth muscle cells in conduit arteries by measuring arterial compliance of the radial arteries (change in diameter of radial artery over pressure for each arterial pulse). In 13 normotensive healthy subjects and 11 young patients with essential hypertension, arterial compliance of the radial artery was assessed directly with a new high-precision ultrasonic device (NIUS 02) after infusion of acetylcholine (endothelium-dependent response) or sodium nitroprusside (endothelium-independent response). Arterial compliance of the radial artery was similar at baseline and with increasing doses of acetylcholine and sodium nitroprusside in normotensive and in hypertensive subjects. The increase in arterial compliance from baseline at each individual concentration of acetylcholine and sodium nitroprusside was the same in both normotensive and hypertensive subjects. However, after a single oral dose of a combination of the angiotensin converting enzyme inhibitor spirapril and the calcium entry blocker isradipine, the increase in arterial compliance in response to the maximum dose of intraarterial acetylcholine was enhanced in normotensives (0.38 +/- 1.23 to 0.76 +/- 1.01 mm2/mm Hg x 10(-3), P < .05), but not in hypertensives (+0.41 +/- 1.26 to 0.36 +/- 1.31 mm2/mm Hg x 10(-3), not significant), and differed significantly between normotensive and hypertensive subjects (P < .05). Thus, pharmacologic stimulation disclosed a blunted response of endothelium-dependent action in the arterial compliance of the conduit arteries in hypertensive subjects. This suggests an impaired endothelial function reserve in persons with essential hypertension.
人类原发性高血压患者的内皮功能是否受损存在争议。迄今为止，所有研究均通过体积描记法测量前臂血流量来评估内皮依赖性血管舒张和内皮功能。与这些专注于阻力血管的研究不同，我们通过测量桡动脉的动脉顺应性（每个动脉搏动时桡动脉直径随压力的变化），确定了内皮对传导动脉中潜在平滑肌细胞的影响。在13名血压正常的健康受试者和11名年轻原发性高血压患者中，在输注乙酰胆碱（内皮依赖性反应）或硝普钠（非内皮依赖性反应）后，使用新型高精度超声设备（NIUS 02）直接评估桡动脉的动脉顺应性。在血压正常和高血压受试者中，桡动脉的动脉顺应性在基线时以及随着乙酰胆碱和硝普钠剂量增加时相似。在每个乙酰胆碱和硝普钠个体浓度下，血压正常和高血压受试者从基线开始的动脉顺应性增加是相同的。然而，在单次口服血管紧张素转换酶抑制剂螺普利和钙通道阻滞剂伊拉地平的组合后，血压正常者对动脉内最大剂量乙酰胆碱的反应中动脉顺应性的增加增强（从0.38±1.23增加到0.76±1.01 mm2/mm Hg×10(-3)，P<.05），但高血压患者中未增强（从+0.41±1.26增加到0.36±1.31 mm2/mm Hg×10(-3)，无显著性差异），且血压正常和高血压受试者之间差异显著（P<.05）。因此，药物刺激揭示了高血压受试者传导动脉的动脉顺应性中内皮依赖性作用的反应减弱。这表明原发性高血压患者的内皮功能储备受损。
