（PPT）UpdateonArterialStiffness大动脉僵硬研究进展课件.ppt

Update on Arterial Stiffness大动脉僵硬研究进展 中国医学科学院 阜外心血管病医院 高血压诊治中心 蒋 雄 京 Definition of Blood Pressure In clinical practice, blood pressure is defined in terms of systolic and diastolic blood pressure, which represent the extremes of the blood pressure oscillation around a mean value, the MBP. In fact, the blood pressure curve may be considered as the summation of a steady component, MBP, and a pulsatile component, the pulse pressure (PP). From: ? O’ Rourke The pulsatile component, PP Determinants: 1. pattern of left ventricular ejection 2. cushioning capacity of aorta 3. the timing and intensity of wave reflections. arterial stiffness PP in subjects 50 years of age, ventricular ejection tends to be reduced, so that arterial stiffness and amplitude and timing of wave reflections become the main determinants of increased SBP and PP. Question: Is arterial stiffness a marker of cardiovascular disease and mortality in the elderly? PWV PROBABILITIES OF OVERALL AND EVENT-FREE SURVIVAL IN HEMODIALYSIS PATIENTS 2.年轻人在生理条件下脉搏波速度（PWV）较慢，反射波落在升主动脉压力波的舒张期（上图）。由于衰老动脉硬度不断增加，PWV加快，反射波提前产生，落在中心动脉压力波的收缩期而而主动脉舒张期压力下降（下图） 。 Determinants of Arterial Stiffness 1.Arterial pressure 2.Arterial wall structure: vascular smooth muscle(VSM) cells, collagen fibers, and ground substance. Collagen greatly modifies arterial rigidity and the transit of wave reflections. Neurohumoral factors(RAS systems), may modulate collagen accumulation. Chemical modifications of collagen, such as breakdown, cross-linking, or glycation, result in marked changes in stiffness. 3. The function of endothelium Changes in VSM tone are modulated by nitric oxide (NO) and vasoconstrictive (norepinephrine, angiotensin, endothelin) compounds, which mainly depend on the function of endothelium. Amplitude of Earlier Wave Reflections mainly based on the geometry, number, structure, and function of smaller muscular arteries and arterioles which serve as major reflec