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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24h平均脉压水平将患者分为3组:24h脉压<40mmHg组(n=92),40mmHg≤24h脉压<60mmHg组(n=39)及24h脉压≥60mmHg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24h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24h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24h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。
Background: Ambulatory blood pressure monitoring can be more sensitive and objective to reflect the actual blood pressure level, and target organ damage and prognosis are closely related. Hypertensive target organ damage in the most common vascular endothelial damage. Is there any correlation between ambulatory blood pressure and arterial elasticity and vascular endothelial function? Objective: To evaluate the changes of aortic elasticity and endothelial function in patients with essential hypertension by using automatic pulse wave velocity analyzer and ultrasound technique. , The relationship between endothelial function. Design: Non-randomized concurrent controlled clinical observation. Unit: The 305th People’s Liberation Army Coronary Heart Disease Clinic. PARTICIPANTS: A total of 156 patients with newly diagnosed essential hypertension were enrolled in the outpatient and inpatient department of the 305 Hospital of Chinese PLA from 2005-06 to 2007-04. There were 114 males and 42 females, aged 40-75 years, with an average of (56 ± 4) years old. Inclusion criteria: ① in line with the 2004 guidelines for the prevention and treatment of hypertension in China diagnostic criteria. ② nearly 1 month in outpatient or inpatient diagnosis of primary hypertension. ③ did not take any antihypertensive, lipid-lowering and nitric acid drug treatment. Patients were informed consent to the test, the experiment approved by the hospital ethics committee. Methods: ①Experimental grouping: The patients were divided into 3 groups according to 24h average pulse pressure: 24h pulse pressure <40mmHg group (n = 92), 40mmHg≤24h pulse pressure <60mmHg group (n = 39) and 24h pulse pressure≥60mmHg Group (n = 25). ② project testing: the United States Medscapech company ABPM-04 non-invasive ambulatory blood pressure monitor venous pressure during the day and night and 24h mean pulse pressure; use of automatic pulse wave velocity measuring instrument neck-femoral artery pulse wave velocity and Evaluation of aortic dilatation using a cervical-radial arterial pulse wave velocity; Evaluation of endothelial function by high-resolution extravascular ultrasound using flow-mediated vasodilation and nitroglycerin-dependent vasodilation in the brachial artery. MAIN OUTCOME MEASURES: Correlation between ambulatory pulse pressure and aortic dilatation and arterial endothelial function. Results: 156 patients were included in the analysis of the results. (1) Correlation analysis between dynamic pulse pressure and aortic dilatation: The pulse wave velocity of the carotid-radial artery was positively correlated with the pulse pressure at daytime, pulse pressure at night and 24h mean pulse pressure with partial correlation coefficients of 0.310, 0.281 and 0.303 (P (All P <0.01). There was no significant correlation between pulse wave velocity of carotid artery and radial artery and pulse pressure at daytime, pulse pressure at night and pulse pressure at 24 hours (P> 0.05). ② Dynamic pulse pressure and arterial endothelial function correlation analysis: dynamic pulse pressure and blood flow-mediated vasodilation of two variables in a linear relationship. Dynamic pulse pressure as an independent variable, endothelium-dependent vasodilation as a dependent variable linear correlation analysis showed that blood flow-mediated vasodilation and daytime pulse pressure, night pulse pressure and mean pulse pressure was significantly negatively correlated (r = -0.684, -0.597, -0.668, P <0.01). Dynamic pulse pressure was not associated with non-endothelium-dependent vasodilation. Conclusion: The increase of dynamic pulse pressure is closely related to the reduction of aortic elasticity and endothelial dysfunction in patients with essential hypertension.