From macro- to microcirculation: benefits in hypertension and diabetes.

Enrico Agabiti-Rosei
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Abstract

Chronic hypertension and diabetes produce both macrovascular and microvascular pathophysiological changes. Greater arterial stiffness increases central systolic and pulse pressure, which raises left ventricular afterload and reduces coronary perfusion. Resistance arteries remodelling and capillary rarefaction increase peripheral resistance, thereby contributing to hypertension and amplifying the detrimental haemodynamic effects of arterial stiffening. The result is target organ impairment, such as left ventricular hypertrophy, decreased coronary perfusion pressure, reduced coronary reserve and further vascular remodelling, culminating in coronary artery disease and stroke. Therapeutic intervention is possible and necessary to stop these vascular changes. Vasodilating antihypertensive drugs, such as the perindopril/indapamide combination, have been shown to modify both arterial and arteriolar remodelling, leading to reduced central systolic blood pressure and enhancing vascular bed perfusion. These effects probably underpin the benefits of these agents in reducing cardiovascular morbidity and mortality.

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从宏观到微循环:对高血压和糖尿病有益。
慢性高血压和糖尿病同时产生大血管和微血管病理生理变化。较大的动脉硬度增加中央收缩压和脉压,从而增加左心室后负荷并减少冠状动脉灌注。阻力动脉重构和毛细血管稀疏增加外周阻力,从而导致高血压,并放大动脉硬化的有害血流动力学效应。其结果是靶器官受损,如左心室肥厚、冠状动脉灌注压降低、冠状动脉储备减少和进一步的血管重构,最终导致冠状动脉疾病和中风。治疗干预是可能的,也是必要的,以阻止这些血管变化。血管舒张抗高血压药物,如培哚普利/吲达帕胺联合用药,已被证明可以改变动脉和小动脉重塑,导致中央收缩压降低,增强血管床灌注。这些作用可能支持了这些药物在降低心血管发病率和死亡率方面的益处。
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