临床实践中,大多数患者我会测定PWV和脉搏波分析(PWA)。需要特别指出的是,所有初次诊断的高血压患者我都会评价血管功能,同时每年进行随访,采用PWV和PWA来计算心血管风险。
International Circulation: It has been reported that some antihypertensive drugs reduce the PWV more than others. Can predict the effect of the drug?
Park: this is important thing. We have been treated patients on basis of brachial artery, but which is not culprit site of vascular damage. Central artery and central hemodynamics are much more important in evaluation of patient’s risk and treatment effect. Now it is accepted that ACE inhibitor or ARB is best in reducing PWV and augmentation index, and CCB is following after RAS blockade and diuretic is neutral and beta-blocker is worse. These effects are demonstrated in large clincial trials such as ASCOT and CAFE, REASON studies....
《国际循环》:有学者报道,一些降压药物较其他降压药物能够更有效地降低PWV。降低PWV的作用能否预测药物的效应?
Park教授:这是个重要的事情。我们根据肱动脉血压治疗患者,但是肱动脉并不是血管损伤的罪犯血管。中心动脉及其血液动力学在评价患者的心血管风险和治疗效应方面更为重要。当前,大家公认的是ACEI或ARB降低PWV和增强指数的作用最强,其次是CCB,利尿剂对其没有影响,而β阻滞剂有不良影响。这是被ASCOT、CAFE和REASON等大型试验所证实的。