中心动脉压和血管功能.ppt

* * * * * * * * * * * * * * * 这些方法评价的动脉功能在各种高危人群中和终点事件关系如何来看机组流行病学调查数据 * * * * * 探讨各种药物作用机制，更合理地选择药物。 * * * * * * * * * * * * * * * * * 近几年来，随着流行病学和循证医学证据的积累，血管在以高血压为代表的多种心血管疾病中的重要地位日益受到重视。 * Hypertension 43:176–181, 2004 Glucose intolerance and arterial stiffness The Hoorn Study 1.2 1.0 0.8 0.6 243 129 256 60 55 50 45 40 120 74 125 34 33 32 31 30 261 170 188 Total arterial compliance (SV/carotid PP, ml/mmHg) Transmission time from carotid artery to femoral artery (msec) Augmentation index (%) * * * * Control Impaired glucose tolerance Type 2 DM Change in HR (bpm) -10 -8 -6 -4 -2 0 Change in AI (%) -1.2 -1 -0.8 -0.6 -0.4 -0.2 0 Change in PWV (m/sec) -5 -4 -3 -2 -1 0 1 2 3 4 Asmar RG, et al. Hypertension. 2001;38:922 * ** Mean±SD. *p0.05, ** p0.001 vs atenolol. Effect of antihypertensive drugs on brachial BP and central BP Diastolic BP on brachial artery was matched for 1 year Perindopril / indapamide (n=204) atenolol (n=202) Am J Hypertens 17:118–123, 2004 70 80 90 100 110 120 130 140 150 160 170 Placebo * * * * * * * * * * * * Blood pressure (mmHg) peripheral central 32 elderly hypertensive patients (age 65-80) were treated for 4 weeks each drugs in double blind and cross-over fashion. Effect of antihypertensive drugs double blind and cross-over study ACE inhibitor b-blocker Ca channel blocker diuretics Effect of antihypertensive drugs on AI and central BP AI Central BP diuretics ↓→ ↓ b-blocker ↑→ ↓→ ACE inhibitor/ARB ↓ ↓↓ Ca channel blocker ↓ ↓↓ CAFé: 肱动脉和中心动脉收缩压 肱动脉收缩压 平均差异(AUC)=0.7mmHg 133.9 133.2 氨氯地平 阿替洛尔 P=.07 125.5 121.2 P.0001 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 AUC 115 140 135 130 125 120 mm Hg 中心动脉收缩压 平均差异(AUC)=4.3mmHg 时间(年) 阿替洛尔 86 243 324 356 445 372 462 270 339 128 85 1031 氨氯地平 88 248 329 369 475 406 508 278 390 126 101 1042 CAFé: 血压对终点事件的影响（未校正的多因素分析） X2 P值 HR CI 肱