1、內(nèi)內(nèi) 容容內(nèi)內(nèi) 容容動脈壓動脈壓相關(guān)因素相關(guān)因素心搏量心搏量末梢阻力末梢阻力血管壁硬度血管壁硬度反射波反射波中心動脈壓中心動脈壓主動脈順應(yīng)性（大血管硬度）主動脈順應(yīng)性（大血管硬度）反射波反射波 時間時間 幅度幅度london and guerin. am heart j 1999;138:220-224normaldecreased aortic compliancesystolediastole40%60%60%50%50%50%aortic compliance and pulse pressuresystolediastolewindkessel function 大動脈順應(yīng)性降低，彈性

2、降低，收縮壓力在動脈內(nèi)不能得到緩沖，使收縮壓升高。 舒張期大血管彈性回縮減低，使舒張壓降低。結(jié)果：脈壓增大主動脈順應(yīng)性下降augmentation and reflection waveincident wavereflection wavemcdonalds fourth editionsystolic bpaugmentationindex diastolic bparrival of reflection wavearterial pressure waveform and reflection wave反射波機制對中心動脈壓的影響反射波機制對中心動脈壓的影響 脈搏波傳導(dǎo)速度脈搏波傳導(dǎo)速

3、度(pwv) -(pwv) -反射波速度反射波速度 阻力微、小動脈阻力微、小動脈反射位點反射位點 動脈彈性動脈彈性-反射波幅度反射波幅度 心率心率-反射波在收縮期疊加的幅度反射波在收縮期疊加的幅度 ai與主動脈壓、脈壓的測量與主動脈壓、脈壓的測量內(nèi)內(nèi) 容容attenuation of peripheral augmentation effect by arterial stiffnessperipheral bp and central bpnichols ww et al. 199368 years old24 years old50100150(mmhg)50100150(mmhg)020

4、406080100120140160-4950-5960-6970-31493231(mmhg)reflection component ageestimated aortic blood pressurekohara k et al. j am geriatr soc, 1999incident component aortic diastolic bpage and central blood pressureradial bp was matched as 150 mmhg in all age groupssystolic hypertensionwide pulse pressure

5、central hypertensionaugmentation by reflection pressure wavearterial stiffnessreduced complianceimpaired windkessel functionmean pressurepulse pressurethe strong heart studycentral blood pressure better predicts cardiovascular events than does peripheral blood pressure2662 patients, 63yrs, follow-up

6、 3.4yroman mj, et al. aha sept. 2005reflection of pressure wave as risk factoresrd patientsblacher et al. circulation, 19991.00.750.500.25003570105140survival rate for cardiovascular deathtime (month)pwv9.4m/s9.4pwv12.0m/s12.0m/s pwv1.00.750.500.25003570105140even free rate for cardiovascular accide

7、ntstime (month)augmentation index 1 群 augmentation index 2 群 augmentation index 3 群 augmentation index 4 群 london gm et al. hypertension, 2001中心動脈壓和脈壓升高對中心動脈壓和脈壓升高對心血管系統(tǒng)影響心血管系統(tǒng)影響 左室后負荷增加，左室重構(gòu)左室后負荷增加，左室重構(gòu) 冠狀動脈灌注下降，儲備功能下降，冠狀動脈灌注下降，儲備功能下降， 心肌缺血心肌缺血 內(nèi)皮損傷和功能紊亂，動脈硬化性疾病內(nèi)皮損傷和功能紊亂，動脈硬化性疾病 進展進展circulation 200

8、4;109:184-189no lesions1211109876543augmented pressure mmhgonevesseltwovesselsthree vesselsai and coronary heart diseaseassociation between aortic ai and coronary arteriogram1601401201008060smulyan h et al. ann intern med 20001601208016012016012080adolescencemiddle ageelderly500500500000015001500150

9、ascending aortic bp (mmhg)ascending aortic blood flow (ml/s)coronary blood flow (ml/min)80mcdonalds fourth editionblood pressure (mmhg)吸煙對中心動脈壓和周圍動脈壓的影響吸煙對中心動脈壓和周圍動脈壓的影響5060708090100110120130140-8-7-6-5-4-3-2-1012aortic ai (%)*brachial bpaortic bp* p0.05non-smoker (n=116)smokers (n=41)hypertension.

10、2003;41:183-187j am coll cardiol 2002;39:1005160150140130120110100908070control subjects(n=68)hyperlipidemia(n=68)0.01*blood pressure (mmhg)peripheral bpcentral bphyperlipidemia and central bphypertension 43:176181, 2004glucose intolerance and arterial stiffnessthe hoorn study1.21.00.80.624312925660

11、55504540120741253433323130261170188total arterial compliance (sv/carotid pp, ml/mmhg)transmission time from carotid artery to femoral artery (msec)augmentation index (%)*controlimpaired glucose tolerancetype 2 dmchange in hr (bpm)-10-8-6-4-20change in ai (%)-1.2-1-0.8-0.6-0.4-0.20change in pwv (m/se

12、c)-5-4-3-2-101234asmar rg, et al. hypertension. 2001;38:922*meansd. *p0.05, * p0.001 vs atenolol.effect of antihypertensive drugs on brachial bp and central bpdiastolic bp on brachial artery was matched for 1 yearperindopril / indapamide (n=204)atenolol (n=202)am j hypertens 17:118123, 2004708090100

13、110120130140150160170placebo*blood pressure (mmhg)peripheralcentral32 elderly hypertensive patients (age 65-80) were treated for 4 weeks each drugs in double blind and cross-over fashion.effect of antihypertensive drugsdouble blind and cross-over studyace inhibitorb-blockerca channelblockerdiuretics

14、effect of antihypertensive drugs on ai and central bpaicentral bpdiureticsb-blockerace inhibitor/arbca channel blockercaf: 肱動脈和中心動脈肱動脈和中心動脈收縮壓收縮壓肱動脈收縮壓肱動脈收縮壓平均差異平均差異(auc)=0.7mmhg(auc)=0.7mmhg133.9133.2氨氯地平氨氯地平阿替洛爾阿替洛爾p=.07125.5121.2p.0001 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 auc115140135130125120mm

15、 hg中心動脈收縮壓中心動脈收縮壓平均差異平均差異(auc)=4.3mmhg(auc)=4.3mmhg時間時間( (年年) )阿替洛爾阿替洛爾 86 243 324 356 445 372 462 270 339 128 85 1031氨氯地平氨氯地平 88 248 329 369 475 406 508 278 390 126 101 1042（經(jīng)校正的多因素分析）（經(jīng)校正的多因素分析）內(nèi)內(nèi) 容容動脈血管功能改變動脈血管功能改變n中、大動脈順應(yīng)性下降n舒縮功能下降n小動脈阻力增加,順應(yīng)性下降n儲備能力下降n動脈血管痙攣methods for detecting vessel diseasen

16、pulse contour analysis (c1，c2)npulse wave velocity (pwv)naortic pressure augmentation (reflected waves), pulse pressurenflow-mediated vasodilationnflow reservenbiopsynurinary protein excretion乙酰膽堿乙酰膽堿試驗試驗在基線期無嚴重的梗阻性缺損在基線期無嚴重的梗阻性缺損給予乙酰膽堿后出現(xiàn)反常的血管收縮反應(yīng)給予乙酰膽堿后出現(xiàn)反常的血管收縮反應(yīng)血流介導(dǎo)的血流介導(dǎo)的血管血管擴張擴張（fmd）測量測量surviva

17、l without ischemic heart disease in hypertensive patients with ma or normoalbuminuria (monica study)012345678910years(jensen et al: hypertension, 2000)758085909510070proportion without ischemic heart disease (%)p30mg/24h30mg/24h內(nèi)內(nèi) 容容fmd(flow mediated-dilation) 024681012“非杓型”組“杓型”組fmd（%）注：“杓型”和“非杓型”兩

18、組fmd比較，p0.001“杓型杓型”和和“非杓型非杓型”兩組兩組fmd比較比較fmd與與24hsbp的相關(guān)性的相關(guān)性r=-0.438r=-0.438fmdfmd與年齡的相關(guān)性與年齡的相關(guān)性r=-0.409r=-0.409fmd051015202530ator10mgator20mgnormalfmd/eid(%)0周fmd4周后fmd0周eid4周后eidp0.05p0.01血管的重要性血管的重要性vhp概念概念 將血管疾病(vascular disease)、高血壓(hypertension)和預(yù)防(prevention)三者 作為一個整體來對待rceuniversitynih, militaryd.h.swhoforeignassessgrantscontractscorporateprivatevc$businessproducts services r.o.i. jobs technology