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Arterial stiffness as a risk factor for clinical hypertension
Nature Reviews Cardiology ( IF 49.6 ) Pub Date : 2017-10-12 , DOI: 10.1038/nrcardio.2017.155
Michel E. Safar

In patients with uncomplicated essential hypertension, cardiac output remains within normal ranges and intravascular volume is normal or low, assuming the presence of a sufficient Windkessel effect and usual resistance and compliance calculations. However, mean circulatory pressure is elevated in these patients. In addition, vascular resistance is augmented, and most importantly, the viscoelasticity of the cardiovascular system is substantially impaired. Such considerations are essential to understanding the mechanisms behind carotid–femoral arterial stiffness, a major risk factor in individuals with hypertension. Arterial stiffness, measured from pulse wave velocity, is substantially increased in hypertension even independently of blood pressure levels. Structural vascular changes and endothelial dysfunction are consistently associated with vessel impairments in animal models of hypertension. Increased arterial stiffness has a major effect on pulse pressure (the difference between systolic and diastolic blood pressure), wave reflections, kidney function, and above all, cardiovascular risk. This increased cardiovascular risk is particularly deleterious in patients with hypertension and/or type 2 diabetes mellitus, who are at risk of both renal and cardiovascular events. In this Review, we discuss the importance of arterial stiffness in the diagnosis and management of hypertension and the need for new approaches for the treatment of hypertension in patients with or without diabetes and/or renal impairment.



中文翻译:

动脉僵硬是临床高血压的危险因素

对于没有并发症的原发性高血压患者,假设存在足够的Windkessel效应并进行常规抵抗力和依从性计算,则心输出量保持在正常范围内,血管内容积正常或较低。但是,这些患者的平均循环压升高。另外,血管阻力增加,最重要的是,心血管系统的粘弹性显着受损。这些考虑因素对于理解颈动脉-股动脉僵硬背后的机制至关重要,颈动脉-股动脉僵硬是高血压患者的主要危险因素。从脉搏波速度测量的动脉僵硬度在高血压中显着增加,甚至与血压水平无关。在高血压动物模型中,结构性血管变化和内皮功能障碍与血管损伤始终相关。动脉僵硬度的增加对脉压(收缩压与舒张压之差),波反射,肾功能以及最重要的心血管风险有重大影响。在患有肾和心血管事件的风险的高血压和/或2型糖尿病患者中,这种增加的心血管风险特别有害。在这篇综述中,我们讨论了动脉僵硬在高血压的诊断和管理中的重要性,以及对患有或不患有糖尿病和/或肾功能不全的患者进行高血压治疗的新方法的需求。动脉僵硬度的增加对脉压(收缩压与舒张压之差),波反射,肾功能以及最重要的心血管风险有重大影响。在患有肾和心血管事件的风险的高血压和/或2型糖尿病患者中,这种增加的心血管风险特别有害。在这篇综述中,我们讨论了动脉僵硬在高血压的诊断和管理中的重要性,以及对患有或不患有糖尿病和/或肾功能不全的患者进行高血压治疗的新方法的需求。动脉僵硬度的增加对脉压(收缩压与舒张压之差),波反射,肾功能以及最重要的心血管风险有重大影响。在患有肾和心血管事件的风险的高血压和/或2型糖尿病患者中,这种增加的心血管风险特别有害。在这篇综述中,我们讨论了动脉僵硬在高血压的诊断和管理中的重要性,以及对患有或不患有糖尿病和/或肾功能不全的患者进行高血压治疗的新方法的需求。在患有肾和心血管事件的风险的高血压和/或2型糖尿病患者中,这种增加的心血管风险特别有害。在这篇综述中,我们讨论了动脉僵硬在高血压的诊断和管理中的重要性,以及对患有或不患有糖尿病和/或肾功能不全的患者进行高血压治疗的新方法的需求。在患有肾和心血管事件的风险的高血压和/或2型糖尿病患者中,这种增加的心血管风险特别有害。在这篇综述中,我们讨论了动脉僵硬在高血压的诊断和管理中的重要性,以及对患有或不患有糖尿病和/或肾功能不全的患者进行高血压治疗的新方法的需求。

更新日期:2017-10-12
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