Abstract

BACKGROUND: Ambulatory blood pressure monitoring can sensitively and objectively reflect blood pressure level, which is closely related to target organ damage and disease prognosis. In hypertension, vascular endothelial damage is the most common lesion to target organs. There is little known about how ambulatory pulse pressure correlates to large artery elasticity and vascular endothelial function.

OBJECTIVE: To investigate changes of large artery elasticity and of vascular endothelial function in patients with primary hypertension using an automatic pulse wave velocity determinator and ultrasound techniques, and to analyze the correlation of ambulatory pulse pressure to large artery elasticity and vascular endothelial function.

DESIGN: A non-randomized concurrent control clinical observation.

SETTING: Diagnosis and Treatment Center for Coronary Heart Disease, the 305 Hospital of Chinese PLA.

PARTICIPANTS: A total of 156 inpatients and/or outpatients, who were recently confirmed with primary hypertension, were recruited for this study between June 2005 and April 2007. Patients consisted of 114 males and 42 females. All patients averaged 56 ± 4 years of age (range: 40-75). Inclusive criteria: Corresponding to diagnostic standards for preventing and treating hypertension instituted in 2004 by Chinese scholars. Confirmed as primary hypertension within 1 month. Not receiving any blood pressure lowering, hypolipidemic or nitrate-like drug treatments. Written informed consents for laboratory measurements were obtained from all subjects. The study was approved by the hospital's Ethics Committee.

METHODS: According to the mean pulse pressure over 24 hours, all patients were assigned into 3 groups: Group A (mean pulse pressure < 40 mm Hg, n=92), group B (40 mm Hg ≤ mean pulse pressure < 60 mm Hg, n=39) and group C (mean pulse pressure > 60 mm Hg, n=25). In each group, daytime pulse pressure and night-time pulse pressure, as well as 24-hour mean pulse pressure were measured using a non-invasive portable ambulatory blood pressure monitor (ABPM-04, Meditech Inc, USA). Carotid-femoral and carotid-radial arterial pulse wave velocities were measured using an automatic pulse wave velocity determinator to evaluate large artery dilation. Blood flow mediated and nitroglycerin-dependent dilatation of the brachial artery was determined using a high-resolution ultrasound technique to evaluate vascular endothelial function.

MAIN OUTCOME MEASURES: Correlations of ambulatory pulse pressure to large artery dilation and arterial endothelial function.

RESULTS: All 156 patients were included in the final analysis. Correlation of ambulatory pulse pressure to large artery dilation: Carotid-femoral arterial pulse wave velocity was significantly positively correlated to daytime pulse pressure, night-time pulse pressure and 24-hour mean pulse pressure, with coefficient of partial correlation being 0.310, 0.281 and 0.303, respectively, P < 0.01). There were no significant correlations of carotid-radial arterial pulse wave velocity to daytime pulse pressure, night-time pulse pressure or 24-hour pulse pressure (P > 0.05). Correlation of ambulatory pulse pressure to arterial endothelial function: There was a linear relationship between ambulatory pulse pressure and blood flow-mediated blood vessel dilatation values. Linear correlation analysis was performed, taking ambulatory pulse pressure as an independent variable, and endothelial-dependent dilatation as a dependent variable. Results demonstrated that blood flow-mediated blood vessel dilatation was significantly negatively correlated to daytime pulse pressure, night-time pulse pressure and 24- hour mean pulse pressure (r = -0.684, -0.597, -0.668, P < 0.01). There was no correlation of ambulatory pulse pressure to non-endothelial-dependent blood vessel dilatation.

CONCLUSION: Ambulatory pulse pressure increase is closely related to large artery elasticity decrease and injury to endothelial function in patients with primary hypertension.

1Diagnosis and Treatment Center for Coronary Heart Disease, the 305 Hospital of Chinese PLA, Beijing 100013, China; 2Department of Cardiology, People's Hospital of Peking University, Beijing 100044, China

Du Da-yong★, Master, Attending physician, Diagnosis and Treatment Center for Coronary Heart Disease, the 305 Hospital of Chinese PLA, Beijing 100013, China sxtyddy@yahoo.
com.cn

Correspondence to: Li Yun-tian, Diagnosis and Treatment Center for Coronary Heart Disease, the 305 Hospital of Chinese PLA, Beijing 100013, China

Supported by: the Grant from the Eleventh Five-Year High-Tech Research and Development Program, No. 06G145*

Received: 2007-10-11 Accepted: 2007-11-19 (07-50-10-5505/YWY)

Du DY, Li YT, Wang HY, Ding K, Li Y. Correlations of ambulatory pulse pressure to large artery elasticity and vascular endothelial function in patients with primary hypertension.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(7): 1363-1367(China)

[www.zglckf.com/
zglckf/ejournal/
upfiles/08-7/
7k-1363(ps).pdf]

摘要
背景：动态血压监测能较敏感、客观的反映实际血压水平, 与靶器官损害及预后的关系密切。高血压靶器官损害中以血管内皮损害最常见。动态血压与大动脉弹性及血管内皮功能变化是否有一定相关性？
目的：应用自动脉搏波速度测定仪和超声技术评价原发高血压患者大动脉弹性和内皮功能的变化，分析患者动态脉压与大动脉弹性、内皮功能的关系。
设计：非随机化同期对照临床观察。
单位：解放军第三○五医院冠心病诊疗中心。
对象：选择2005-06/2007-04在解放军第三○五医院冠心病诊疗中心门诊和住院156例新近诊断原发性高血压患者,男114例,女42例，年龄40~75岁，平均(56±4)岁。纳入标准：①符合2004年中国高血压防治指南诊断标准。②近1月内在门诊或住院诊断原发高血压。③未服任何降压、降脂以及硝酸酯类药物治疗。患者均对检测知情同意，实验经过医院伦理委员会批准。
方法：①实验分组：根据24 h平均脉压水平将患者分为3组: 24 h脉压< 40 mm Hg组(n=92), 40 mm Hg≤24 h脉压< 60 mm Hg组(n=39)及24 h脉压≥60 mm Hg组 (n=25)。②项目检测：采用美国Meditech公司ABPM-04无创性携带式动态血压监护仪检测各组患者白昼及夜间脉压及24 h平均脉压；应用自动脉搏波速度测定仪测定颈-股动脉脉搏波速度和颈-桡动脉脉搏波速度评价大动脉扩张性；应用高分辨率血管外超声分别通过对肱动脉进行血流介导的血管扩张和硝酸甘油依赖性的血管扩张测定来评价内皮功能。
主要观察指标：患者动态脉压与大动脉扩张性及动脉内皮功能的相关性。
结果：纳入患者156例均进入结果分析。① 动态脉压与大动脉扩张性的相关分析：颈-桡动脉脉搏波速度与白昼脉压、夜间脉压及24 h平均脉压均呈显著正相关,偏相关系数分别为0.310、0.281和0.303 (P均< 0.01), 颈-桡动脉脉搏波速度与白昼脉压、夜间脉压及24 h平均脉压均无显著相关（P > 0.05）。②动态脉压与动脉内皮功能的相关分析：动态脉压与血流介导的血管扩张两变量在数值上呈直线关系。以动态脉压为自变量,以内皮依赖性血管扩张为因变量进行直线相关分析显示, 血流介导的血管扩张与白昼脉压、夜间脉压及平均脉压呈显著性负相关(r=-0.684，-0.597，-0.668，P < 0.01)。动态脉压与非内皮性依赖性血管扩张无相关性。
结论：动态脉压升高与原发高血压患者大动脉弹性降低和内皮功能受损密切相关。
关键词：高血压; 脉压; 大动脉弹性; 内皮功能；组织构建

1解放军第三○五医院冠心病诊疗中心， 北京市 100013；2北京大学人民医院心内科, 北京市 100044
杜大勇★,男，1972年生，山西省定襄县人，汉族，1996年山西医科大学毕业，硕士，主治医师，主要从事冠心病基础与临床、冠心病介入治疗的研究。
通讯作者：李运田，解放军第三○五医院冠心病诊疗中心, 北京市100044
全军“十一五”科技攻关项目支助（06G145）*


中图分类号: R544.1 文献标识码: A 文章编号: 1673-8225(2008)07-01363-05
杜大勇,李运田,王红宇,丁康,李艳. 原发高血压患者动态脉压与大动脉弹性及血管内皮功能的关系[J].中国组织工程研究与临床康复, 2008,12(7):1363-1367
[www.zglckf.com/zglckf/ejournal/upfiles/08-7/7k-1363(ps).pdf]
(Edited by Akman B/Vernaglione L/Song LP/Wang L)