临界高血压青年男性的冠状动脉血流储备早期受损。

Early impairment of coronary flow reserve in young men with borderline hypertension.

作者信息

Laine H, Raitakari O T, Niinikoski H, Pitkänen O P, Iida H, Viikari J, Nuutila P, Knuuti J

机构信息

Department of Medicine, Turku Positron Emission Tomography Centre, Turku University, Finland.

出版信息

J Am Coll Cardiol. 1998 Jul;32(1):147-53. doi: 10.1016/s0735-1097(98)00222-8.

DOI:10.1016/s0735-1097(98)00222-8

PMID:9669263

Abstract

OBJECTIVES

The purpose of this study was to investigate whether functional abnormalities in coronary vasomotion are present in young healthy asymptomatic men fulfilling the World Health Organization (WHO) criteria for borderline hypertension.

BACKGROUND

Previous studies have reported reduced coronary flow reserve in middle-aged subjects with sustained hypertension and hypertension-induced microvascular heart disease or left ventricular hypertrophy.

METHODS

Myocardial blood flow was measured at baseline and during dipyridamole-induced hyperemia by means of positron emission tomography and oxygen-15-labeled water in asymptomatic young men with borderline hypertension (group 1: n = 16, mean +/- SD age 37 +/- 4 years, 24-h ambulatory blood pressure 135 +/- 10/81 +/- 9 mm Hg) and matched healthy control subjects (group 2: n = 19, age 35 +/- 3 years, 24-h ambulatory blood pressure 119 +/- 8/69 +/- 8 mm Hg, p < 0.001). Left ventricular (LV) mass, dimensions and function were measured by echocardiography.

RESULTS

LV mass, dimensions and diastolic function were similar in the study groups. Baseline myocardial blood flow was similar (0.83 +/- 0.21 vs. 0.80 +/- 0.22 ml/g per min, group 1 vs. group 2, respectively, p = NS), and a significant increase in flow was detected after dipyridamole infusion (0.56 mg/kg body weight in 4 min intravenously) in both groups. However, the flow response to dipyridamole was significantly lower in group 1, leading to lower hyperemic flow in group 1 than in group 2 (2.85 +/- 1.20 vs. 3.80 +/- 1.44 ml/g per min, respectively). Consequently, the coronary flow response was lower in hypertensive than in normotensive men (3.46 +/- 1.23 vs. 4.99 +/- 2.5 ml/g per min, group 1 vs. group 2, respectively, p < 0.05).

CONCLUSIONS

These results demonstrate reduced coronary reactivity present in young asymptomatic men with borderline hypertension and no signs of hypertension-induced angina or left ventricular hypertrophy. Because baseline basal myocardial blood flow was unchanged, the reduction in coronary flow reserve depends on an impaired maximal vasodilator capacity.

摘要

目的

本研究旨在调查符合世界卫生组织（WHO）临界高血压标准的年轻健康无症状男性是否存在冠状动脉血管运动功能异常。

背景

先前的研究报道，患有持续性高血压、高血压性微血管心脏病或左心室肥厚的中年受试者冠状动脉血流储备降低。

方法

通过正电子发射断层扫描和氧-15标记水，在临界高血压无症状年轻男性（第1组：n = 16，平均±标准差年龄37±4岁，24小时动态血压135±10/81±9 mmHg）和匹配的健康对照受试者（第2组：n = 19，年龄35±3岁，24小时动态血压119±8/69±8 mmHg，p < 0.001）中，于基线和双嘧达莫诱发充血期间测量心肌血流量。通过超声心动图测量左心室（LV）质量、尺寸和功能。

结果

研究组之间的左心室质量、尺寸和舒张功能相似。基线心肌血流量相似（第1组与第2组分别为0.83±0.21 vs. 0.80±0.22 ml/g每分钟，p = 无显著差异），两组在静脉注射双嘧达莫（4分钟内0.56 mg/kg体重）后均检测到血流量显著增加。然而，第1组对双嘧达莫的血流反应显著较低，导致第1组的充血血流量低于第2组（分别为2.85±1.20 vs. 3.80±1.44 ml/g每分钟）。因此，高血压男性的冠状动脉血流反应低于正常血压男性（第1组与第2组分别为3.46±1.23 vs. 4.99±2.5 ml/g每分钟，p < 0.05）。