不同运动强度对老老年单纯收缩期高血压患者血管功能的影响
摘要
目的探讨不同运动强度对老老年单纯收缩期高血压(ISH)患者血管功能的影响。方法 ISH患者306例随机分为低强度运动组(低强度组,n=102)、中强度运动组(中强度组,n=100),自然活动组(对照组,n=104),在血压控制达标的前提下按设定运动强度运动12 w。以踝肱指数(ABI)和脉搏波传导速度(PWV)作为血管功能的评价指标,观察不同强度的运动对老老年ISH患者血管功能的影响。结果 ABI值和PWV值均与增龄密切相关,80岁以上老老年人群,年龄每增加1岁,ABI降低0. 019,PWV则增加0. 609 m/s。运动后低、中强度组收缩压(SBP)均显著降低〔(127. 4±8. 6) vs(126. 8±7. 3) mm Hg,P<0. 05〕、〔(128. 8±7. 0) vs(127. 1±5. 7) mm Hg,P<0. 01〕,中强度组舒张压(DBP)显著降低〔(82. 4±3. 5) vs(80. 8±2. 8) mm Hg,P<0. 01〕。运动后低、中强度组ABI值均显著增高〔(0. 78±0. 08) vs (0. 79±0. 07),P <0. 01〕、〔(0. 76±0. 07) vs(0. 82±0. 08),P<0. 01〕; PWV值均显著降低〔(16. 95±2. 54) vs(15. 57±2. 16) m/s,P<0. 01〕、〔(16. 92±3. 22)比(15. 11±2. 85) m/s,P<0. 01〕。与对照组比较,低强度组、中强度组前后ABI增幅均显著大(均P <0. 01),PWV降幅均显著大(均P <0. 01);与低强度组比较,中强度组对ABI和PWV的改变显著优于低强度组(P<0. 01,P<0. 05)。结论老老年人群血管功能与增龄密切相关(其中ABI与增龄呈负相关,PWV与增龄呈正相关)。低中强度运动均能降低老老年ISH患者的血管硬化度,且中强度优于低强度。
引文
1张亚杰.老年单纯收缩期高血压[J].中国实用医药,2012;7(7):51-3.
2 Chobanian AV.Clinical practice.Isolated systolic hypertension in the elderly[J].N Engl J Med,2007;357(8):789-96.
3 Maldonado J,Pereira T,Polónia J,et al.Arterial stiffness predicts cardiovascular outcome in a low-to-moderate cardiovascular risk population:the EDIVA(Estudo de DIstensibilidade VAscular)project[J].JHypertens,2011;29(4):669-75.
4 Protogerou AD,Safar ME,Papaioannou TG,et al.The combined effect of aortic stiffness and pressure wave reflections on mortality in the very old with cardiovascular disease:the PROTEGER Study[J].Hypertens Res,2011;34(7):803-8.
5 Rabkin SW,Chan SH,Sweeney C.Ankle-brachial index as an indicator of arterial stiffness in patients without peripheral artery disease[J].Angiology,2012;63(2):150-4.
6 Sheng CS,Li Y,Li LH,et al.Brachial-ankle pulse wave velocity as a predictor of mortality in elderly Chinese[J].Hypertension,2014;64(5):1124-30.
7 Huang C,Wang J,Deng S,et al.The effects of aerobic endurance exercise on pulse wave velocity and intima media thickness in adults:a systematic review and meta-analysis[J].Scand J Med Sci Sports,2016;26(5):478-87.
8 Ohta M,Hirao N,Mori Y,et al.Effects of bench step exercise on arterial stiffness in post-menopausal women:contribution of IGF-1 bioactivity and nitric oxide production[J].Growth Horm Igf Res,2012;22(1):36-41.
9刘力生.中国高血压防治指南2010[J].中华高血压杂志,2011;19(8):701-43.
10吴雅利,雷梦觉,刘秋玲,等.单纯收缩期高血压病人年龄与血管内皮功能对大动脉僵硬度的影响[J].中华高血压杂志,2008;16(8):704-6.
11毛勇,余金明,胡大一,等.多中心研究高血压患者心血管病危险度与踝臂血压指数异常的关联性[J].中华高血压杂志,2012;20(3):300.
12 Avolio AP,Chen SG,Wang RP,et al.Effects of aging on changing arterial compliance and left ventricular load in a northern Chinese urban community[J].Circulation,1983;68(1):50-8.
13 Mc Eniery CM,Hall IR,Qasem A,et al.Normal vascular aging:differential effects on wave reflection and aortic pulse wave velocity:the Anglo-Cardiff Collaborative Trial(ACCT)[J].J Am Coll Cardiol,2005;46(9):1753-60.
14 Kulinski JP,Sanghavi M,Ayers CR,et al.Association between low ankle-brachial index and accelerometer-derived sedentary and exercise time in the asymptomatic general population[J].Vasc Med,2015;20(4):332-8.
15钟梅芳,吴国忠,杨文君,等.低强度自愿运动与强迫运动对自发性高血压大鼠血管内皮功能及炎症损伤的影响[J].中华高血压杂志,2009;17(9):825-9.
16 Vogel T,Lepretre PM,Brechat PH,et al.Effect of a short-term intermittent exercise-training programme on the pulse wave velocity and arterial pressure:a prospective study among 71 healthy older subjects[J].Int J Clin Pract,2013;67(5):420-6.
17 Ramos JS,Dalleck LC,Tjonna AE,et al.The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function:a systematic review and meta-analysis[J].Sports Med,2015;45(5):679-92.
18 Hallmark R,Patrie JT,Liu Z,et al.The effect of exercise intensity on endothelial function in physically inactive lean and obese adults[J].PLoS One,2014;9(1):e85450.
19吴寿岭,黄卫,戚长春,等.单纯收缩期高血压对老年人群心脑血管事件的影响[J].中华高血压杂志,2012;20(1):67-71.
20 Nocon M,Hiemann T,Muller-Riemenschneider F,et al.Association of physical activity with all-cause and cardiovascular mortality:a systematic review and meta-analysis[J].Eur J Cardiovasc Prev Rehabil,2008;15(3):239-46.
21 Ashor AW,Lara J,Siervo M,et al.Effects of exercise modalities on arterial stiffness and wave reflection:a systematic review and meta-analysis of randomized controlled trials[J].Plos One,2014;9(10):e110034.
22 Heikkila A,Venermo M,Kautiainen H,et al.Physical activity improves borderline ankle-brachial index values in a cardiovascular risk population[J].Ann Vasc Surg,2016;32(4):50-6.
23 Faselis C,Doumas M,Pittaras A,et al.Exercise capacity and allcause mortality in male veterans with hypertension aged>/=70 years[J].Hypertension,2014;64(1):30-5.
24 Woodcock J,Franco OH,Orsini N,et al.Non-vigorous physical activity and all-cause mortality:systematic review and meta-analysis of cohort studies[J].Int J Epidemiol,2011;40(1):121-38.
25 Barengo NC,Antikainen R,Borodulin K,et al.Leisure-time physical activity reduces total and cardiovascular mortality and cardiovascular disease incidence in older adults[J].J Am Geriatr Soc,2017;65(3):504-10.
26 Gkaliagkousi E,Gavriilaki E,Nikolaidou B,et al.Exercise-induced pulse wave velocity changes in untreated patients with essential hypertension:the effect of an angiotensin receptor antagonist[J].J Clin Hypertens(Greenwich),2014;16(7):482-7.
27 Gielen S,Schuler G,Adams V.Cardiovascular effects of exercise training:molecular mechanisms[J].Circulation,2010;122(12):1221-38.
28 Roque FR,Briones AM,Garcia-Redondo AB,et al.Aerobic exercise reduces oxidative stress and improves vascular changes of small mesenteric and coronary arteries in hypertension[J].Br J Pharmacol,2013;168(3):686-703.
29 Seals DR,Walker AE,Pierce GL,et al.Habitual exercise and vascular ageing[J].J Physiol,2009;587(Pt 23):5541-9.
30 Kojda G,Hambrecht R.Molecular mechanisms of vascular adaptations to exercise.Physical activity as an effective antioxidant therapy[J]?Cardiovasc Res,2005;67(2):187-97.
31 Teixeira-Lemos E,Nunes S,Teixeira F,et al.Regular physical exercise training assists in preventing type 2 diabetes development:focus on its antioxidant and anti-inflammatory properties[J].Cardiovasc Diabetol,2011;28(10):12.
32 Steppan J,Sikka G,Jandu S,et al.Exercise,vascular stiffness,and tissue transglutaminase[J].J Am Heart Assoc,2014;3(2):e599.
2 Chobanian AV.Clinical practice.Isolated systolic hypertension in the elderly[J].N Engl J Med,2007;357(8):789-96.
3 Maldonado J,Pereira T,Polónia J,et al.Arterial stiffness predicts cardiovascular outcome in a low-to-moderate cardiovascular risk population:the EDIVA(Estudo de DIstensibilidade VAscular)project[J].JHypertens,2011;29(4):669-75.
4 Protogerou AD,Safar ME,Papaioannou TG,et al.The combined effect of aortic stiffness and pressure wave reflections on mortality in the very old with cardiovascular disease:the PROTEGER Study[J].Hypertens Res,2011;34(7):803-8.
5 Rabkin SW,Chan SH,Sweeney C.Ankle-brachial index as an indicator of arterial stiffness in patients without peripheral artery disease[J].Angiology,2012;63(2):150-4.
6 Sheng CS,Li Y,Li LH,et al.Brachial-ankle pulse wave velocity as a predictor of mortality in elderly Chinese[J].Hypertension,2014;64(5):1124-30.
7 Huang C,Wang J,Deng S,et al.The effects of aerobic endurance exercise on pulse wave velocity and intima media thickness in adults:a systematic review and meta-analysis[J].Scand J Med Sci Sports,2016;26(5):478-87.
8 Ohta M,Hirao N,Mori Y,et al.Effects of bench step exercise on arterial stiffness in post-menopausal women:contribution of IGF-1 bioactivity and nitric oxide production[J].Growth Horm Igf Res,2012;22(1):36-41.
9刘力生.中国高血压防治指南2010[J].中华高血压杂志,2011;19(8):701-43.
10吴雅利,雷梦觉,刘秋玲,等.单纯收缩期高血压病人年龄与血管内皮功能对大动脉僵硬度的影响[J].中华高血压杂志,2008;16(8):704-6.
11毛勇,余金明,胡大一,等.多中心研究高血压患者心血管病危险度与踝臂血压指数异常的关联性[J].中华高血压杂志,2012;20(3):300.
12 Avolio AP,Chen SG,Wang RP,et al.Effects of aging on changing arterial compliance and left ventricular load in a northern Chinese urban community[J].Circulation,1983;68(1):50-8.
13 Mc Eniery CM,Hall IR,Qasem A,et al.Normal vascular aging:differential effects on wave reflection and aortic pulse wave velocity:the Anglo-Cardiff Collaborative Trial(ACCT)[J].J Am Coll Cardiol,2005;46(9):1753-60.
14 Kulinski JP,Sanghavi M,Ayers CR,et al.Association between low ankle-brachial index and accelerometer-derived sedentary and exercise time in the asymptomatic general population[J].Vasc Med,2015;20(4):332-8.
15钟梅芳,吴国忠,杨文君,等.低强度自愿运动与强迫运动对自发性高血压大鼠血管内皮功能及炎症损伤的影响[J].中华高血压杂志,2009;17(9):825-9.
16 Vogel T,Lepretre PM,Brechat PH,et al.Effect of a short-term intermittent exercise-training programme on the pulse wave velocity and arterial pressure:a prospective study among 71 healthy older subjects[J].Int J Clin Pract,2013;67(5):420-6.
17 Ramos JS,Dalleck LC,Tjonna AE,et al.The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function:a systematic review and meta-analysis[J].Sports Med,2015;45(5):679-92.
18 Hallmark R,Patrie JT,Liu Z,et al.The effect of exercise intensity on endothelial function in physically inactive lean and obese adults[J].PLoS One,2014;9(1):e85450.
19吴寿岭,黄卫,戚长春,等.单纯收缩期高血压对老年人群心脑血管事件的影响[J].中华高血压杂志,2012;20(1):67-71.
20 Nocon M,Hiemann T,Muller-Riemenschneider F,et al.Association of physical activity with all-cause and cardiovascular mortality:a systematic review and meta-analysis[J].Eur J Cardiovasc Prev Rehabil,2008;15(3):239-46.
21 Ashor AW,Lara J,Siervo M,et al.Effects of exercise modalities on arterial stiffness and wave reflection:a systematic review and meta-analysis of randomized controlled trials[J].Plos One,2014;9(10):e110034.
22 Heikkila A,Venermo M,Kautiainen H,et al.Physical activity improves borderline ankle-brachial index values in a cardiovascular risk population[J].Ann Vasc Surg,2016;32(4):50-6.
23 Faselis C,Doumas M,Pittaras A,et al.Exercise capacity and allcause mortality in male veterans with hypertension aged>/=70 years[J].Hypertension,2014;64(1):30-5.
24 Woodcock J,Franco OH,Orsini N,et al.Non-vigorous physical activity and all-cause mortality:systematic review and meta-analysis of cohort studies[J].Int J Epidemiol,2011;40(1):121-38.
25 Barengo NC,Antikainen R,Borodulin K,et al.Leisure-time physical activity reduces total and cardiovascular mortality and cardiovascular disease incidence in older adults[J].J Am Geriatr Soc,2017;65(3):504-10.
26 Gkaliagkousi E,Gavriilaki E,Nikolaidou B,et al.Exercise-induced pulse wave velocity changes in untreated patients with essential hypertension:the effect of an angiotensin receptor antagonist[J].J Clin Hypertens(Greenwich),2014;16(7):482-7.
27 Gielen S,Schuler G,Adams V.Cardiovascular effects of exercise training:molecular mechanisms[J].Circulation,2010;122(12):1221-38.
28 Roque FR,Briones AM,Garcia-Redondo AB,et al.Aerobic exercise reduces oxidative stress and improves vascular changes of small mesenteric and coronary arteries in hypertension[J].Br J Pharmacol,2013;168(3):686-703.
29 Seals DR,Walker AE,Pierce GL,et al.Habitual exercise and vascular ageing[J].J Physiol,2009;587(Pt 23):5541-9.
30 Kojda G,Hambrecht R.Molecular mechanisms of vascular adaptations to exercise.Physical activity as an effective antioxidant therapy[J]?Cardiovasc Res,2005;67(2):187-97.
31 Teixeira-Lemos E,Nunes S,Teixeira F,et al.Regular physical exercise training assists in preventing type 2 diabetes development:focus on its antioxidant and anti-inflammatory properties[J].Cardiovasc Diabetol,2011;28(10):12.
32 Steppan J,Sikka G,Jandu S,et al.Exercise,vascular stiffness,and tissue transglutaminase[J].J Am Heart Assoc,2014;3(2):e599.