解读《中国高血压防治指南(2005年修订版)》(四)高血压治疗中收缩压与脉压的意义

高血压是心血管疾病(cardiovascular disease,CVD)重要的危险因素,而50岁以上的成年人,收缩压(svstolic blood pressure,SBP)≥140mmHg(1 mm Hg=0.133 kPa)是比舒张压(diastolic blood pressure,DBP)更重要和更难控制的CVD危险因素[1].脉压(pulse pressure,PP)是指收缩压和舒张压的差值,是血压的脉动部分,反映了动脉血压的波动情况,当收缩压恒定时,舒张压越低,脉压越大,对靶器官损害越大.

解读2005年《中国高血压防治指南(修订版)》(四)(续)高血压治疗中收缩压与脉压的意义

3收缩压及脉压增高对靶器官的损害3.1左心室肥厚高血压引起的左心室肥厚(left ventricular hypertrophy,LVH)是左室壁为平衡动脉血压的升高而发生的适应性改变过程,多种血液动力学和非血液动力学因素参与了LVH的形成.前者主要是压力负荷和容量负荷,后者包括遗传因素、交感神经张力、肾素-血管紧张素系统的活性、肥胖以及血液黏稠度等.无论对于总死亡率,还是对于心血管事件的发病率和死亡率,经超声心动图诊断的LVH都是一个很强的、独立的危险因素.

高血压治疗中收缩压与脉压的意义(中)

2脉压升高的病理生理有关高血压病的诊断、治疗以及相关心血管疾病危险程度的判断,都是以收缩压和/或舒张压的升高水平作为依据的.然而,越来越多的证据表明,脉压增大也是心血管疾病(尤其是冠心病)的独立危险因素.脉压的高低主要受左心室射血、大动脉的僵硬度、早期脉搏波的反射以及心率等因素的影响.研究表明,大动脉顺应性减退35%,可使收缩压升高25%,舒张压下降12%,从而导致脉压增大.

高血压治疗中收缩压与脉压的意义(下)

3收缩压及脉压增高对靶器官的损害3.1左心室肥厚:高血压引起的左心室肥厚(left ventricular hypeitrophy,LVH)是左室壁为平衡动脉血压的升高而发生的适应性改变过程.多种血液动力学和非血液动力学因素参与了LVH的形成,前者主要是压力负荷和容量负荷,后者包括遗传因素、交感神经张力、肾素一血管紧张素系统的活性、肥胖以及血液黏稠度等.

高血压治疗中收缩压与脉压的意义(上)

高血压是心血管疾病(Cardiovascular Disease,CVD)重要的危险因素,而50岁以上的成年人,收缩压(Systolic Blood Pressure,SBP)≥1 40mmHg是比舒张压(Diastolic Blood Pressure,DBP)更重要和更难控制的CVD危险因素.

老年高血压患者平均脉压与冠状动脉病变严重程度的相关性研究

高血压是冠心病的独立危险因素.近年已证实,动脉僵硬性增加、顺应性降低可能参与动脉粥样硬化的形成[1].脉压升高是冠心病危险因素的重要组成部分[2].我国的流行病学研究也发现,脉压与冠心病成正相关,在中老年人中其预测冠心病危险性方面优于收缩压或舒张压.

绝经后女性骨密度与中心脉压关系的探讨

骨质疏校症是一种全身性的骨骼疾病,随着年龄的增大而日渐严重,特别在约经后女性人群中,这种骨代谢异常表现得尤为显著.

Objective: To determine the relationship between pulse pressure and mortality from all the causes: CVD and CVA. Methods: The cohort consisted of the beneficiaries from Korea Medical Insurance Corporation (KMIC) aged 40 and older who had taken health examination and completed the questionnaire inquiring of health habits and past medical history in 1992 or 1993. The number of cohort members was 698,796, and they were followed up from 1st January, 1994 until 31st December, 2000. The primary sources of the data used in this study were the death benefit record and health examination file of KMIC. In the case that the information about the cause of death was unknown in the death benefit record, it was checked from the death registry of National statistical Office and the inpatient data of KMIC. There were 37439 deaths during the follow-up period. Results: A linear relationship between pulse pressure and mortality from all the causes, cardiovascular disease and cerebrovascular disease, was determined in both genders, the whole population and age groups, in the hypertensive and normotensive ( P＜ 0. 01). Pulse pressure and mortality from all the causes, CVD and CVA increased ( P ＜0.01). Pulse pressure was significantly associated with a relatively high risk of mortality from all the causes, CVD and CVA in the whole population, both genders, all age groups, the hypertensive and normotensive after adjusted to age, gender, body mass index, blood sugar, serum total cholesterol, AST, ALT, urine protein, urine glucose, alcohol drinking and cigarette smoking ( P＜ 0.01). Conclusion: Pulse pressure shows linear relationship with the mortality from all the causes,CVD and CVA. Pulse pressure appears to be a single measure of blood pressure in predicting mortality from all the causes,CVD and CVA, even in the hypertensive and normotensive.

CAPD患者低白蛋白血症与脉压的关系

大量研究显示低白蛋白血症是透析患者心血管疾病发生率和病死率的独立预测因子[1].但是,低白蛋白血症引起心血管疾病的机制尚不明确.另外,无论正常人或透析患者脉压增加都标志着动脉硬化程度的加重[2].本研究旨在探讨低白蛋白血症是否是通过动脉硬化程度加重导致心血管疾病的.