原发性高血压及糖尿病患者桡动脉增强指数的变化及相关性研究
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摘要
背景:最新的国内外研究发现,血管壁结构和功能的异常是心血管疾病及急性心脑血管事件发病的根本原因,已经证实,原发性高血压(essential hypertension, EH)在早期就可以发现动脉(包括大动脉和小动脉)结构和功能改变。动脉弹性又称动脉顺应性,是在一定压力作用下的动脉可扩张性,是动脉的重要功能之一,它不仅是收缩压、舒张压和脉压的重要决定因素,而且在相当程度上反映了动脉内皮的功能状态,弹性功能减退已经成为评价心血管疾病的重要危险指标之一。评价动脉弹性功能的指标较多,其中增强指数(Augment index, AI)是一项较为经典的指标,AI增加提示动脉硬化。AI既可以从中央动脉获得,也可以从外周动脉获得,如桡动脉增强指数(Radial Augment index, AIR)。当前对于EH患者与AIR的相关性研究较多,而高血糖也通过许多共同的途径加速动脉硬化。糖尿病人群合并冠心病的危险是健康人群的2～3倍,EH的发病率也比健康人群大2～4倍,如果糖尿病合并EH,则糖尿病人群具有发生心、脑血管疾病的更高的危险,这些并发症的发生与血管病变有关[1]。但关于糖尿病及EH患者的AIR水平的变化及相关性鲜有报道。本研究旨在应用无创的平面压力波测定技术检测AIR值,了解EH、2型糖尿病患者(type 2 diabetes mellitus ,T2DM)及EH合并T2DM患者血管僵硬程度的改变及相关情况。
目的:研究原发性高血压、二型糖尿病及原发性高血压合并二型糖尿病患者AIR的变化及相关性。
方法:选择大连医科大学第一附属医院2007年7月～2007年11月门诊确诊及住院治疗的EH患者73例,男性36例,女性37例,年龄23～81岁,平均年龄(57.7±14.9)岁;T2DM患者59例,男性33例,女性26例,年龄21～81岁,平均年龄(56.8±14.3)岁;EH+T2DM患者54例,男性27例,女性27例,年龄23～83岁,平均年龄(62.3±12.78)岁。所有患者均符合世界卫生组织(world healthy organization, WHO)与国际高血压学会1999年高血压相应诊断标准及1999年WHO糖尿病诊断标准。所有患者经相关临床检查排除继发性高血压、冠心病、心律失常、心脏瓣膜病、心衰、外周血管疾病或其他系统严重疾病等。另在我院进行健康体检的人群中选取与上述患者匹配的对照组72例,男性35例,女性37例,年龄25～82岁,平均年龄(55.4±14.04)岁。上述对象均未经抗高血压、糖尿病治疗或停止抗高血压、糖尿病治疗至少2周以上,均未服用他汀类药物、阿司匹林及其他抗血小板聚集药物、硝酸酯类等药物。运用无创的HEM-9000AI型(日本欧姆龙公司)脉搏波检测装置检测校正心率为75次/分的桡动脉增强指数记作AIRP75。
结果:EH、T2DM、EH+T2DM组与对照组在年龄、性别、吸烟指数、体重指数、腰围臀围比值等方面比较差异无统计学意义(P>0.05),总胆固醇、甘油三脂,低密度脂蛋白、血肌酐等方面较对照组增高(P<0.05)。EH、EH+T2DM组的收缩压(SBP)、舒张压(DBP)、脉压(PP)均较对照组增高(P<0.05),但EH、EH+T2DM组间无显著性差异(P>0.05);T2DM组和EH+T2DM组的空腹血糖较其他组显著增高(P<0.01)。应用单因素方差分析得出结论:EH组及EH+T2DM组的AIRP75较对照组增高且有统计学意义(P<0.05),但EH组与T2DM组,EH组与EH+T2DM组、T2DM组与EH+T2DM组、T2DM组与对照组间无统计学差异( P> 0.05)。进一步行析因设计的方差分析结论为: EH、EH+T2DM组的AIRP75高于对照组;EH与T2DM不存在交互作用;T2DM组与对照组AIRP75差异无统计学意义;EH组、T2DM组及EH+T2DM组的AIRP75组间比较差异无统计学意义。相关分析显示所有检测对象的AIRP75与年龄(r=0.257,P<0.01)、SBP(r=0.222,P<0.01)、PP(r=0.22,P<0.01)显著正相关,与吸烟指数(r=0.242,P<0.05)正相关;与身高(r=-0.381,P<0.01)、体重指数(r=0.2,P<0.01)显著负相关;EH组患者的高血压病史与AIRP75正相关(r=0.251,P<0.05)。多元线性回归分析表明AIRP75与吸烟指数、腰臀比、SBP、胆固醇、血肌酐等指标正相关;与身高,体重指数等负相关。
结论:EH患者中存在血管壁结构、动脉弹性功能受损,AIRP75较与之匹配的健康人增大。T2DM的AIRP75与对照组无差异,故AIRP75是否可作为评价糖尿病患者动脉弹性功能的指标仍需进一步探讨。
Background and purpose:Structure and function of vascular wall are abnormal existing in patients with hypertension and diabetes, and they will make arterial stiffness increase. The conclusion was drawn in latest domestic and international study that abnormal of vascular wall was the root cause of cardiovascular disease and acute cardiovascular cerebral-vascular events incidence. Arterial elasticity function is one of important ability of artery, which is not only the important determinant of systolic blood pressure and diastolic blood pressure but also to a large extent reflection of the artery endothelial function, flexibility dysfunction has become an important cardiovascular disease risk indicator. Radial augmentation index (AIR), which was measured by the technology applanationtonometry, has become one of the key indicators to evaluate the arterial elasticity. Now days, there are a lot of reach about the relevant between hypertension and AIR. To we all know that high blood sugar through many common ways to accelerate atherosclerosis, but reports about relationships between patients with hypertension and diabetes and AIR are absent. This study was designed to use the noninvasive technique to detect radial augmentation index, through which we can learn artery stiffness change situation in patients with hypertension and/or diabetes.
Methods:73 patients (male:36;female:37;age:23~81 years old; average age 57.7±14.9 years old) with essential hypertension;59 patients (male:33;female:26;age:21~81 years old; average age 56.8±14.3 years old) with type 2 diabetes mellitus; 54 patients (male:27;female:27;age:23~83 years old; average 62.3±12.78 years old) combined with EH and T2DM(EH+T2DM) were enrolled. Secondary hypertension, coronary heart disease, arrhythmias, heart valve disease, heart failure, peripheral vascular disease, connective tissue disease, infection, liver and kidney dysfunction, other systems serious illness were excluded. And 72 healthy people as the normal control (matched with age, sex, smoking index, and body mass index) were chosen. All the objects never received antihypertension and the control of blood glucose treatment or stop the treatment over two weeks, and statin lipid-lowering drugs, aspirin and other antiplatelet aggregation drugs, nitrates drugs and so on were not taken. HEM-9000AI type (Japan Omron Corporation) pulse wave detection device was used to detect the radial augmentation index which heart rate correction is 75 times per minute that recorded as AIRP75.
Results:There were no significant difference in age, sex, smoking index, body mass index, waist-hip ratio among the four groups (P>0.05). The level of cholesterol, triglyceride, low-density lipoprotein, serum creatinine in EH, T2DM and EH+T2DM groups were higher than those in control group (P<0.05).The systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP) in EH, EH+T2DM groups were higher than the control group (P<0.05), no significant difference was found between EH and EH+T2DM groups (P>0.05). The fasting blood glucose both in patients with T2DM and T2DM+EH groups were higher than other two groups (P<0.01); the AIRP75 was higher in patients with EH and EH+T2DM groups than that in control group (P<0.05), but the significant difference was not found between other groups. Further factorial design for the analysis of variance conclusion: Hypertension and diabetes had not actual interaction; there had no statistics difference of AIRP75 in EH, T2DM and EH+T2DM groups. AIRP75 positively correlated with age (r=0.257, P<0.01),systolic blood pressure (r=0.222,P<0.01),pulse pressure( r=0.22,P<0.01)and smoking index(r=0.242,P<0.05);AIRP75 negatively correlated with height (r=0.381,P<0.01), body weight index (r=0.2,P<0.01); AIRP75 of hypertension group correlated positively with the hypertension history (r=0.251, P<0.05). Multilinear regression analysis indicated that AIRP75 correlated positively smoking index, waist-hip ratio, SBP, cholesterol, creatinine and correlated negatively with height, body mass index.
Conclusion:The vessel wall structure and the arterial elasticity were impaired in patients with essential hypertension. The AIRP75 in patients with essential hypertension was increased. There was no difference between type 2 diabetes mellitus patients’AIRP75 and the control group’s, so whether AIRP75 could be used as the indicator to evaluate artery elasticity needed to further explore.
目的:研究原发性高血压、二型糖尿病及原发性高血压合并二型糖尿病患者AIR的变化及相关性。
方法:选择大连医科大学第一附属医院2007年7月～2007年11月门诊确诊及住院治疗的EH患者73例,男性36例,女性37例,年龄23～81岁,平均年龄(57.7±14.9)岁;T2DM患者59例,男性33例,女性26例,年龄21～81岁,平均年龄(56.8±14.3)岁;EH+T2DM患者54例,男性27例,女性27例,年龄23～83岁,平均年龄(62.3±12.78)岁。所有患者均符合世界卫生组织(world healthy organization, WHO)与国际高血压学会1999年高血压相应诊断标准及1999年WHO糖尿病诊断标准。所有患者经相关临床检查排除继发性高血压、冠心病、心律失常、心脏瓣膜病、心衰、外周血管疾病或其他系统严重疾病等。另在我院进行健康体检的人群中选取与上述患者匹配的对照组72例,男性35例,女性37例,年龄25～82岁,平均年龄(55.4±14.04)岁。上述对象均未经抗高血压、糖尿病治疗或停止抗高血压、糖尿病治疗至少2周以上,均未服用他汀类药物、阿司匹林及其他抗血小板聚集药物、硝酸酯类等药物。运用无创的HEM-9000AI型(日本欧姆龙公司)脉搏波检测装置检测校正心率为75次/分的桡动脉增强指数记作AIRP75。
结果:EH、T2DM、EH+T2DM组与对照组在年龄、性别、吸烟指数、体重指数、腰围臀围比值等方面比较差异无统计学意义(P>0.05),总胆固醇、甘油三脂,低密度脂蛋白、血肌酐等方面较对照组增高(P<0.05)。EH、EH+T2DM组的收缩压(SBP)、舒张压(DBP)、脉压(PP)均较对照组增高(P<0.05),但EH、EH+T2DM组间无显著性差异(P>0.05);T2DM组和EH+T2DM组的空腹血糖较其他组显著增高(P<0.01)。应用单因素方差分析得出结论:EH组及EH+T2DM组的AIRP75较对照组增高且有统计学意义(P<0.05),但EH组与T2DM组,EH组与EH+T2DM组、T2DM组与EH+T2DM组、T2DM组与对照组间无统计学差异( P> 0.05)。进一步行析因设计的方差分析结论为: EH、EH+T2DM组的AIRP75高于对照组;EH与T2DM不存在交互作用;T2DM组与对照组AIRP75差异无统计学意义;EH组、T2DM组及EH+T2DM组的AIRP75组间比较差异无统计学意义。相关分析显示所有检测对象的AIRP75与年龄(r=0.257,P<0.01)、SBP(r=0.222,P<0.01)、PP(r=0.22,P<0.01)显著正相关,与吸烟指数(r=0.242,P<0.05)正相关;与身高(r=-0.381,P<0.01)、体重指数(r=0.2,P<0.01)显著负相关;EH组患者的高血压病史与AIRP75正相关(r=0.251,P<0.05)。多元线性回归分析表明AIRP75与吸烟指数、腰臀比、SBP、胆固醇、血肌酐等指标正相关;与身高,体重指数等负相关。
结论:EH患者中存在血管壁结构、动脉弹性功能受损,AIRP75较与之匹配的健康人增大。T2DM的AIRP75与对照组无差异,故AIRP75是否可作为评价糖尿病患者动脉弹性功能的指标仍需进一步探讨。
Background and purpose:Structure and function of vascular wall are abnormal existing in patients with hypertension and diabetes, and they will make arterial stiffness increase. The conclusion was drawn in latest domestic and international study that abnormal of vascular wall was the root cause of cardiovascular disease and acute cardiovascular cerebral-vascular events incidence. Arterial elasticity function is one of important ability of artery, which is not only the important determinant of systolic blood pressure and diastolic blood pressure but also to a large extent reflection of the artery endothelial function, flexibility dysfunction has become an important cardiovascular disease risk indicator. Radial augmentation index (AIR), which was measured by the technology applanationtonometry, has become one of the key indicators to evaluate the arterial elasticity. Now days, there are a lot of reach about the relevant between hypertension and AIR. To we all know that high blood sugar through many common ways to accelerate atherosclerosis, but reports about relationships between patients with hypertension and diabetes and AIR are absent. This study was designed to use the noninvasive technique to detect radial augmentation index, through which we can learn artery stiffness change situation in patients with hypertension and/or diabetes.
Methods:73 patients (male:36;female:37;age:23~81 years old; average age 57.7±14.9 years old) with essential hypertension;59 patients (male:33;female:26;age:21~81 years old; average age 56.8±14.3 years old) with type 2 diabetes mellitus; 54 patients (male:27;female:27;age:23~83 years old; average 62.3±12.78 years old) combined with EH and T2DM(EH+T2DM) were enrolled. Secondary hypertension, coronary heart disease, arrhythmias, heart valve disease, heart failure, peripheral vascular disease, connective tissue disease, infection, liver and kidney dysfunction, other systems serious illness were excluded. And 72 healthy people as the normal control (matched with age, sex, smoking index, and body mass index) were chosen. All the objects never received antihypertension and the control of blood glucose treatment or stop the treatment over two weeks, and statin lipid-lowering drugs, aspirin and other antiplatelet aggregation drugs, nitrates drugs and so on were not taken. HEM-9000AI type (Japan Omron Corporation) pulse wave detection device was used to detect the radial augmentation index which heart rate correction is 75 times per minute that recorded as AIRP75.
Results:There were no significant difference in age, sex, smoking index, body mass index, waist-hip ratio among the four groups (P>0.05). The level of cholesterol, triglyceride, low-density lipoprotein, serum creatinine in EH, T2DM and EH+T2DM groups were higher than those in control group (P<0.05).The systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP) in EH, EH+T2DM groups were higher than the control group (P<0.05), no significant difference was found between EH and EH+T2DM groups (P>0.05). The fasting blood glucose both in patients with T2DM and T2DM+EH groups were higher than other two groups (P<0.01); the AIRP75 was higher in patients with EH and EH+T2DM groups than that in control group (P<0.05), but the significant difference was not found between other groups. Further factorial design for the analysis of variance conclusion: Hypertension and diabetes had not actual interaction; there had no statistics difference of AIRP75 in EH, T2DM and EH+T2DM groups. AIRP75 positively correlated with age (r=0.257, P<0.01),systolic blood pressure (r=0.222,P<0.01),pulse pressure( r=0.22,P<0.01)and smoking index(r=0.242,P<0.05);AIRP75 negatively correlated with height (r=0.381,P<0.01), body weight index (r=0.2,P<0.01); AIRP75 of hypertension group correlated positively with the hypertension history (r=0.251, P<0.05). Multilinear regression analysis indicated that AIRP75 correlated positively smoking index, waist-hip ratio, SBP, cholesterol, creatinine and correlated negatively with height, body mass index.
Conclusion:The vessel wall structure and the arterial elasticity were impaired in patients with essential hypertension. The AIRP75 in patients with essential hypertension was increased. There was no difference between type 2 diabetes mellitus patients’AIRP75 and the control group’s, so whether AIRP75 could be used as the indicator to evaluate artery elasticity needed to further explore.
引文
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2.龚兰生,王宏宇,张维忠等.中国血管病变早期检测技术应用指南[J].中国民康医学杂志,2006,18(5): 323-331.
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5. Kohara K, Tabara Y, et al. Radial Augmentation index: A useful and easily obtainable parameter for vascular aging [J]. American Journal of Hypertension, 2005, 18:115-145.
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9. Oliver JJ, Webb DJ. Noninvaxive assessment of arterial stiffness and risk of atherosclerotic events [J].Arterioscler Thromb Vase Biol, 2003, 23(4):554-566.
10. Chen CH, Nevo E, Fetics B, et al. Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure: validation of generalized transfer function [J].Circulation,1997,95:1827-1836.
11. Pauca AL, O’Rourke MF, Kon ND,et al. Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform [J].Hyertension, 2001, 38:932-937.
12. O’Rourke MF. Wave travel and reflection in the arterial system [J].J Hypertens, 1999, 17(Suppl 5):S45-47.
13. Liang YL, Teede H, Kotsopoulos D, et al. Non-invasive measurements of arterial structure and function: repeatability, interrelationships and trial sample size [J].Clin Sci (Lond), 1998, 95(6):669-679.
14. Nichols WW, O’Rourke MF, Avolio AP,et al. Effects of age on ventricularvascular coupling[J].Am J Cardiol,1985,15(55):1179-1184.
15. Weber T, Auer J, O’Rourke MF, et al. Arterial stiffness ,wave reflections and the risk of coronary artery disease[J].Circulation.2004,109:184-189.
16. Hirai T, Sasayama S, Kawasaki T, et al. Stiffness of systemic arteries in patient’s wi-th myocardial infarction. A noninvasive method to predict severity of coronary atherosclerosis [J]. Circulation, 1989, 80:78-86.
17. Nichols WW, Pepine CJ. Ventricular/vascular interaction in health and heart failure [J].Compr Ther, 1992, 18:12-19.
18. Laurent S, Boutouyrie P, Asmar R, et al. Aortic stiffness is an independent predictor of all-case and cardiovascular mortality in hypertensive patients [J].Hypertension, 2001, 37:1236-1241.
19. Safar ME, Blacher J, Pannier B, et al. Central pulse pressure and mortality in end-stage renal disease [J]. Hypertension, 2002, 39:735-738.
20. Dart AM. Pulse pressure a review of mechanism and clinical relevance [J].Am J Coll Cardiol, 2001, 37:975-984.
21. Domanski M,Norman J,Wolz M, et al. Cardiovascular risk assessment using pulse pressure in the first national health and nutrition examination survey [J].Hypertension, 2001, 38:739-797.
22.张维忠.脉压与弹性功能[J].高血压杂志,2003,38:932-937.
23. Mitchell GF, Moye LA, Braunwald E, et al. Sphygmomanmetrically-determined pulse pressure is a powerful independent predictor of recurrent events following mypcardial infarction in patients with impaired left ventricular function[J].Circulation,1997,96(12):4254-4260.
24. Nichol WW, Edwards DG. Augmentation index as a measure of peripheral vascular disease state [J].Curr Opin Cardiol, 2002, 6:5-21.
25. Safar ME, Levy BI, Struijker BH,et al. Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular disease[J].Circulation,2003,107:2864-2869.
26. Asmar RG, London GM, O’Rourke ME,et al. Improvement in blood pressure ,arterial stiffness and wave reflections with a very low-dose perindopril/indapamide combination in hypertensive patient :a comparison with atenolol[J].Hypertension,2001,38:922-926.
27. Suzuki H, Nakamoto H, Okada R, et al. A selective angiotensin receptor antagonist. valsartan, produced regression of left ventricular hypertrophy associated with a reduction of arterial stiffness[J].Adv Perit Dial 2003,19:59-66.
28. Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevenrion Evaluation Study Investigators [J].N Engl J Med, 2000, 342:145-153.
29. Chobanian AV, Bakris GL, Black HR, et al. National heart, lung and blood institute joint national committee on prevention, detection. Evaluation, and treatment of high blood pressure: National high blood pressure education program coordinating committee: The seventh report of the joint national committee on prevention detection evaluation and treatment of high blood pressure: the JNC 7 report [J].J AM Med Assoc 2003, 289:2560-2572.
30. Lawes CM ,Bennett DA, Feigin VL,et al. Blood pressure and stroke: an overview of published reviews [J].Stroke, 2004, 35:1024-1033.
31. O’Rourke MF. Wave travel and reflection in the arterial system [J].J Hypertens, 1999, 17(Suppl 5):S45-47.
32. London GM, Asmar RG, O’Rourk MF, et al. Mechanism(s) of selective systolic blood pressure reduction after a low-dose combination of perindopril/indapamide in hypertensive subjects: comparison with ateolol [J].J Am Coll Cardiol, 2004,43:92-99.
33. Nichol WW, Edwards DG. Arterial elastance and wave reflection augmentation of systolic blood pressure:deleterious effects and implications for therapy[J].J Cardio-vase Pharmacol Ther,2001,6:5-21.
34. Nichols WW, Singh BM. Augmentation index as a measure of peripheral vascular disease state [J].Curr Opin Cardiol, 2002, 17:543-551.
35. Suzuki H, Nakamoyo H, Okada H, et al. A selective angiotensin receptor antagonist,valsartan produced regression of left ventricular hypertrophy associated with a reduction of arterial stiffness[J].Adv Perit Dial,2003,19:59-66.
36. Lonn E, Shaikholeslami R, Yi Q, et al. Effects of ramipril on left ventricular mass and function in cardiovascular patients with controlled blood pressure and with preserved left ventricular eject fraction: a sub-study of the Heart Outcomes Prevention Evaluation (HOPE) Trial [J]. J Am Coll Cardiol, 2004, 43:2200-2206.
37. Kohara K, Tabara Y, Oshiumi A,et al. Radial Augmentation index: A useful and easily obtainable parameter for vascular aging [J]. American Journal of Hypertension, 2005, 18:11S-14S.
38. Lehmann ED. Where is the evidence that radial arterial artery tonometry can beused to accurare and noninvasive predict central aortic blood pressure in patients with diabetes [J].Diabetes care, 2000, 23(6):869-871.
39. Hope SA, Tay DB, Meredith IT, et al. Comparison of generalized and gender-specific transfer function for the derivation of aortic waveforms[J].Am J Physiol Heart Circ Physiol,2002,283(3):1150-1156.
40. Hope SA, Tay DB, Meredith IT, et al. Use of arterial transfer functions for the derivation of central aortic waveform characteristics in subjects with type 2 diabetes and cardiovascular disease[J].Diabetes Care,2004,27(3):746-751.
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1. Cohn JN. Vascular wall function as a risk marker for cardiovascular disease[J]. Hypertens Suppl. 1999 Dec; 17(5):S41-4.
2.龚兰生,王宏宇,张维忠等.中国血管病变早期检测技术应用指南[J].中国民康医学杂志,2006,18(5): 323-331.
3.张维忠.动脉弹性功能检测的理论与实践[J].心脑血管病防治,2003,8(3)1-2.
4. Hashimoto J, Watabe D, Hatanaka R, et al. Enhanced radial late systolic pressure augmentation in hypertensive patients with left ventricular hypertrophy.Am J Hypertens. 2006 19(1):27-32.
5. Kohara K, Tabara Y, et al. Radial Augmentation index: A useful and easily obtainable parameter for vascular aging [J]. American Journal of Hypertension, 2005, 18:115-145.
6. Roman MJ, Kizer JR, Ali T, et al. Central blood pressure better predicts cardiovasvula-r events than dose peripheral blood pressure:the Strong Heart Study[J].Circulation,2005,112 Suppl :II-778.
7. Murgo JP, Westerhof N, Giolma JP et al. Aortic input impedance in normal man: relationship to pressure wave forms [J].Circulation. 1980 Jul; 62(1):105-16.
8. Kelly R Hayward C, Avolio A, et al: Noninvasive determination of age-related changes in the human arterial pulse[J].Circulation,1989, 80(6):1652-1659.
9. Oliver JJ, Webb DJ. Noninvaxive assessment of arterial stiffness and risk of atherosclerotic events [J].Arterioscler Thromb Vase Biol, 2003, 23(4):554-566.
10. Chen CH, Nevo E, Fetics B, et al. Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure: validation of generalized transfer function [J].Circulation,1997,95:1827-1836.
11. Pauca AL, O’Rourke MF, Kon ND,et al. Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform [J].Hyertension, 2001, 38:932-937.
12. O’Rourke MF. Wave travel and reflection in the arterial system [J].J Hypertens, 1999, 17(Suppl 5):S45-47.
13. Liang YL, Teede H, Kotsopoulos D, et al. Non-invasive measurements of arterial structure and function: repeatability, interrelationships and trial sample size [J].Clin Sci (Lond), 1998, 95(6):669-679.
14. Nichols WW, O’Rourke MF, Avolio AP,et al. Effects of age on ventricularvascular coupling[J].Am J Cardiol,1985,15(55):1179-1184.
15. Weber T, Auer J, O’Rourke MF, et al. Arterial stiffness ,wave reflections and the risk of coronary artery disease[J].Circulation.2004,109:184-189.
16. Hirai T, Sasayama S, Kawasaki T, et al. Stiffness of systemic arteries in patient’s wi-th myocardial infarction. A noninvasive method to predict severity of coronary atherosclerosis [J]. Circulation, 1989, 80:78-86.
17. Nichols WW, Pepine CJ. Ventricular/vascular interaction in health and heart failure [J].Compr Ther, 1992, 18:12-19.
18. Laurent S, Boutouyrie P, Asmar R, et al. Aortic stiffness is an independent predictor of all-case and cardiovascular mortality in hypertensive patients [J].Hypertension, 2001, 37:1236-1241.
19. Safar ME, Blacher J, Pannier B, et al. Central pulse pressure and mortality in end-stage renal disease [J]. Hypertension, 2002, 39:735-738.
20. Dart AM. Pulse pressure a review of mechanism and clinical relevance [J].Am J Coll Cardiol, 2001, 37:975-984.
21. Domanski M,Norman J,Wolz M, et al. Cardiovascular risk assessment using pulse pressure in the first national health and nutrition examination survey [J].Hypertension, 2001, 38:739-797.
22.张维忠.脉压与弹性功能[J].高血压杂志,2003,38:932-937.
23. Mitchell GF, Moye LA, Braunwald E, et al. Sphygmomanmetrically-determined pulse pressure is a powerful independent predictor of recurrent events following mypcardial infarction in patients with impaired left ventricular function[J].Circulation,1997,96(12):4254-4260.
24. Nichol WW, Edwards DG. Augmentation index as a measure of peripheral vascular disease state [J].Curr Opin Cardiol, 2002, 6:5-21.
25. Safar ME, Levy BI, Struijker BH,et al. Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular disease[J].Circulation,2003,107:2864-2869.
26. Asmar RG, London GM, O’Rourke ME,et al. Improvement in blood pressure ,arterial stiffness and wave reflections with a very low-dose perindopril/indapamide combination in hypertensive patient :a comparison with atenolol[J].Hypertension,2001,38:922-926.
27. Suzuki H, Nakamoto H, Okada R, et al. A selective angiotensin receptor antagonist. valsartan, produced regression of left ventricular hypertrophy associated with a reduction of arterial stiffness[J].Adv Perit Dial 2003,19:59-66.
28. Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevenrion Evaluation Study Investigators [J].N Engl J Med, 2000, 342:145-153.
29. Chobanian AV, Bakris GL, Black HR, et al. National heart, lung and blood institute joint national committee on prevention, detection. Evaluation, and treatment of high blood pressure: National high blood pressure education program coordinating committee: The seventh report of the joint national committee on prevention detection evaluation and treatment of high blood pressure: the JNC 7 report [J].J AM Med Assoc 2003, 289:2560-2572.
30. Lawes CM ,Bennett DA, Feigin VL,et al. Blood pressure and stroke: an overview of published reviews [J].Stroke, 2004, 35:1024-1033.
31. O’Rourke MF. Wave travel and reflection in the arterial system [J].J Hypertens, 1999, 17(Suppl 5):S45-47.
32. London GM, Asmar RG, O’Rourk MF, et al. Mechanism(s) of selective systolic blood pressure reduction after a low-dose combination of perindopril/indapamide in hypertensive subjects: comparison with ateolol [J].J Am Coll Cardiol, 2004,43:92-99.
33. Nichol WW, Edwards DG. Arterial elastance and wave reflection augmentation of systolic blood pressure:deleterious effects and implications for therapy[J].J Cardio-vase Pharmacol Ther,2001,6:5-21.
34. Nichols WW, Singh BM. Augmentation index as a measure of peripheral vascular disease state [J].Curr Opin Cardiol, 2002, 17:543-551.
35. Suzuki H, Nakamoyo H, Okada H, et al. A selective angiotensin receptor antagonist,valsartan produced regression of left ventricular hypertrophy associated with a reduction of arterial stiffness[J].Adv Perit Dial,2003,19:59-66.
36. Lonn E, Shaikholeslami R, Yi Q, et al. Effects of ramipril on left ventricular mass and function in cardiovascular patients with controlled blood pressure and with preserved left ventricular eject fraction: a sub-study of the Heart Outcomes Prevention Evaluation (HOPE) Trial [J]. J Am Coll Cardiol, 2004, 43:2200-2206.
37. Kohara K, Tabara Y, Oshiumi A,et al. Radial Augmentation index: A useful and easily obtainable parameter for vascular aging [J]. American Journal of Hypertension, 2005, 18:11S-14S.
38. Lehmann ED. Where is the evidence that radial arterial artery tonometry can beused to accurare and noninvasive predict central aortic blood pressure in patients with diabetes [J].Diabetes care, 2000, 23(6):869-871.
39. Hope SA, Tay DB, Meredith IT, et al. Comparison of generalized and gender-specific transfer function for the derivation of aortic waveforms[J].Am J Physiol Heart Circ Physiol,2002,283(3):1150-1156.
40. Hope SA, Tay DB, Meredith IT, et al. Use of arterial transfer functions for the derivation of central aortic waveform characteristics in subjects with type 2 diabetes and cardiovascular disease[J].Diabetes Care,2004,27(3):746-751.