接受降压治疗患者的压力波反射及中心动脉收缩压

Pressure wave reflections and central blood pressure in treated hypertensive subjects

目的探讨接受降压治疗患者不同血压分级间压力波反射和中心动脉收缩压变化及不同种类降压药物与它们之间的关系。方法从北京地区5100名自然人群中筛选出1371例接受降压治疗的高血压患者（其中男性679例，女性692例），年龄33—87（47．2±11．5）岁。采用科林HEM-9000动脉反射波增强指数（AI）检测仪，用桡动脉张力测量法测量桡动脉AI及中心动脉收缩压。结果桡动脉AI随血压水平的升高而逐渐增高（P〈0．01）。中心动脉收缩压低于相对应的肱动脉血压（P〈0．01）。多元线性回归分析显示，影响桡动脉Al的因素为：血管紧张素转换酶抑制剂（标准化β=-0．09，P〈0．05）、血管紧张素Ⅱ受体拮抗剂（标准化β=-0．07，P=0．01）、钙离子拮抗剂（标准化β=-0．12，P〈0．01）及利尿剂（标准化13=0．14，P=0．04）；而中心动脉收缩压受血管紧张素转换酶抑制剂（标准化β=-0．07，P：0．02）、血管紧张素Ⅱ受体拮抗剂（标准化β=-0．08，P=0．01）及钙离子拮抗剂（标准化β=-0．15，P〈0．05）的降压影响。结论在接受降压治疗的患者中，积极有效降压可以减少波反射对心血管系统的不良作用，降压药物的选择应更加注重对动脉血管功能的改善。

Objective To investigate the differences in pressure wave reflections and central blood pressure between brachial BP ＇classification and the effect of antihypertensive drugs. Method In 1371 chronically treated hypertensive subjects aged 33 - 87 years [ 679 males and 692 females, mean age （47. 2±11.5）years ], radial arterial augmentation index （rAI） and central systolic blood pressure were measured using an automated tonometric method. Results rAI gradually increased from the subgroup with the lower blood pressure to the higher blood pressure （ P 〈 0. 01 ）, for each given brachial value, central systolic blood pressure was lower than the corresponding bracbial pressure（P 〈 0. 01 ）. In muhivariable linear regression models analysis revealed that the application of angiotensin converting enzyme inhibitor （β = - 0. 09, P 〈 0.05 ） , AT1 receptor blockade （β = - 0. 07, P = O. 01 ） , calcium channel blocker（ β = - 0. 12, P 〈 0. 01 ） and diuretic （ β = 0. 14, P = 0. 04 ） were independent determinants of rAL Central SBP significantly correlated to the application of ACEI（β= - 0. 07, P = 0. 02 ）, ARB （ β=-0.08, P = 0. 01 ） and CCB （ β= - 0. 15, P 〈 0.05）. Conclusions In chronically treated hypertensive individuals, tight blood pressure control would be effective in reducing the reflection wave and central BP. Antihypertensive treatment strategies with more beneficial effects on arterial properties are needed.