中青年高血压PPT参考幻灯片.ppt

* 摘要：高血压和糖尿病与动脉僵硬度增加有关。ACEI独立于血压之外的直接改善动脉僵硬度的作用尚未被明确地证实。在这项研究中，入选患者经雅施达治疗1个月后如对治疗有反应(SBP下降10mmHg且血钾未升高，如仍5.2mmol/L)，随机双盲接受雅施达4mg或8mg再治疗6个月（总共治疗7个月）。采用血管回声跟踪技术和平面压力波测定法，检测57例高血压合并2型糖尿病患者基线时和治疗7个月后的颈动脉扩张性。基线和治疗后进行动态血压监测。治疗7个月后，两治疗组24小时动态血压均显著下降，但组间无显著性差异（雅施达4mg组24小时平均血压从103降至99mmHg，8mg组从100降至93mmHg）。雅施达8mg颈动脉扩张性较4mg显著增加(8mg：从13.1±5.9增至16.0±6.7kPa-1×10-3；4mg: 从13.2±5.2降至12.7±5.9 kPa-1×10-3；方差分析P0.05)。雅施达8mg较4mg显著降低颈动脉内径和弹性系数，独立于降压之外。该研究结果表明ACEI具有剂量依赖的和独立于降压作用之外的改善颈动脉僵硬度的作用。动脉扩张性的增加是由于发生向心性重构，这会引起动脉壁切应力的降低，并因此降低弹性系数。该研究结果也表明高血压合并2型糖尿病患者需要大剂量(8mg)雅施达长期治疗以改善颈动脉结构和功能。 Abstract—Hypertension and diabetes are associated with an increased arterial stiffness. A direct blood pressure–independent effect of angiotensin-converting enzyme inhibitors on arterial stiffness has never been unequivocally demonstrated. In this mechanistic study, we used an experimental design in which patients responding to 1 month treatment with 4 mg perindopril were randomized double-blind to either 4 mg perindopril or 8 mg perindopril for 6 months. We determined carotid distensibility with echotracking and applanation tonometry at baseline and after the 7-month treatment period in 57 essential hypertensive patients with type 2 diabetes (age 637 years). We monitored ambulatory blood pressure at baseline and after treatment. After 7 months treatment, 24-hour ambulatory blood pressure significantly decreased, with no significant difference between 4 mg and 8 mg perindopril. Carotid distensibility increased more after 8 mg perindopril compared with 4 mg perindopril (8 mg: from 13.1±5.9 to 16.0±6.7kPa-1×10-3; 4 mg: from 13.2±5.2 to 12.7±5.9 kPa-1×10-3; ANOVA, dose-period interaction, P0.05). Carotid internal diameter and elastic modulus were significantly lower after 8 mg perindopril compared with 4 mg perindopril, independent of blood pressure