Relationship Of Pulse Pressure With Atherosclerosis, Remodeling, Endothelial Function And Related Factors In Patients With Essential Hypertension

Hypertension is one of the risk factors for cardiovascular events. In the past years, rapid progress has been made in the study and treatment of hypertension, however, clinical research discover that it was not perfect to hold merely systolic blood pressure (SBP) and diastolic blood pressure (DBP) as evaluating markers. Some clinical trials indicated that pulse pressure (PP) was a more effective predictor of cardiovascular events. The bigger the PP of patients with essential hypertension, the higher the rate of cardiovascular events. Impairment of edothelium-dependent vasodilation is a marker for early atherosclerosis in patients with hypertension. Increase in intima-media thickness (IMT) of carotid arteries is a noninvasive index to reflect the degree of atherosclerosis. The IMT of carotid arteries has close relativity to atherosclerosis of coronary arteries. The lower distensibility of large arteries is related to increasing arterial stiffness, and these patients may be prone to get more cardiovascular complications. The substances, such as TNFa, IL-6, CRP and ET-1, playing important roles in injuring arteries and atherosclerosis, can also mark the state of arterial damage. The study on the relationship between PP and above mentioned substances is important to make clear the relation between PP and injury to arteries andatherosclerosis. B-mode ultrasound was used to scan carotid, brachial arteries of the patients in order to measure IMT and diameter of brachial arteries at rest and during reactive hyperemia, take count of the number of carotid arteries plaques. TNFa, IL-6, CRP and ET-1 in blood were determined with immunological method. Our study revealed that PP had a closer relation to IMT and plaque of carotid arteries than SBP and DBP did. The increasing PP was related to wide diameter and low distensibility of large arteries. There was a strong relativity between increasing PP and dysfunction of endothelium-dependent vasodilation. The bigger the PP, the higher the blood concentration of TNFa, IL-6, CRP and ET-1. In summary, there was a close relation between the augmentation of PP and endothelial dysfunction, decreasing large arterial distensibility, atherosclerosis, high concentration of TNFa, IL-6, CRP, ET-1 in patients with essential hypertension. It showed there was close relationship between increasing PP and arterial injury and PP was a more effective index to evaluate and forecast atherosclerosis than SBP and DBP in patients with essential hypertension.