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Mean IMTSD
Mean DiameterSD
Number of points
System I 2.0 - IdP, Paris, France
Estructura de la Pared Arterial
*
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CAROTID-FEMORAL PWV AND CAROTID COMPLIANCE
h
T
d
PWV (m/s) =L/T
L = Carotid-Femoral distance (m). T = Time (sec)
Dm:Mean diameter, d : blood density, Pm:Mean pressure, Piso: 110
mmHg
1
L
2
P
2
2
1334
PWV
D
C
m
m
=
d
P
C
C
m
m
=
P
iso
iso
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0.00
1.00
2.00
3.00
4.00
5.00
60
80
100
120
140
160
PAM (mmHg)
10-4 cm/mmHg
NT
HTpost
HTpre
Compliance Isobrica
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Relacin PA con Funcin Arterial
*
12.unknown
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IMT:
Compliance and Viscosity Relationship
R = 0.60
p < 0.05
0
2
4
6
8
10
0.4
0.6
0.8
1.0
1.2
IMT [mm]
Viscosity index
[mmHg.s/mm]
R = 0.57
p < 0.05
0
5
10
15
20
25
0.5
0.7
0.9
1.1
IMT [mm]
Compliance
[10
-4
cm/mmHg
]
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Indice de Desadaptacin e IMVI
*
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IMVI y PA
*
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IMVI y PA
*
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Dependencia del IMVI del la variabilidad de la PA pero no de los
valores medios de PA.
In HT subjects, the relationship between LVMI and BP variability
is independent of the BP values.
This is shown by the fact that in either group in which BP was
separed in groups of 10mmHg, the higher the standard deviation the
higher the LVMI.
*
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Rin e Hipertensin Arterial
Drawn from Laragh, JAMA, 1960
Renina
Angiotensina II
Angiotensina I
ECA
Atgeno Plasmatico
CORTEZA
ADRENAL
Aldosterona
ACTH
K+
Na+ retencin
K+ Prdida
PA
Vasoconstriccin
Vasculotoxicidad
Cerebro (ACV)
Retina (desprendimiento)
Corazn (IAM, IC, Arritmias)
Rin (IR)
Estrs Oxidativo
*
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Mecanismo de accin de los Bloqueantes de los Receptores de la
Angiotensina II (BRA)
CIMASAS
ANGIOTENSINA I
ANGIOTENSINOGENO
ANGIOTENSINA II
BRA
INHIBIDOR
DE RENINA
BRADIKININA
PEPTIDOS
IECA
NO
AT1
AT2
*
Valsartan is a highly selective antagonists at the AT1 receptor,
thereby selectively inhibiting only the deleterious effects of Ang
II
ACE inhibitors have many substrates including bradykinin,
substance P, neurotensin, enkephalin, LHRH,
N-acetyl-Ser-Asp-Lys-Pro
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*
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Relacin entre el SRA y la formacin de xido Ntrico
Angiotensina II
Angiotensina I
Angiotensina (1-7)
Endopeptidasas
Receptor AT2
Receptor AT (1-7)
Bradiquinina
Receptor BK II
ON
Accin antiproliferativaDiferenciacin celularReparacin
tisularVasodilatacinNatriuresisDiuresisAccin anti-remodelacin
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*
17.unknown
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*
18.unknown
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Obesidad
Reduccin
De
Peso
*
19.unknown
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*
20.unknown
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*
21.unknown
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HTA, Dao de Organo Blanco y
Riesgo Cardiovascular
Adapted from Willenheimer R et al Eur Heart J 1999; 20(14):
9971008, Dahlf B J Hum Hypertens 1995; 9(suppl 5): S37S44,
Daugherty A et al J Clin Invest 2000; 105(11): 16051612, Fyhrquist
F et al J Hum Hypertens 1995; 9(suppl 5): S19S24, Booz GW, Baker KM
Heart Fail Rev 1998; 3: 125130, Beers MH, Berkow R, eds. The Merck
Manual of Diagnosis and Therapy. 17th ed. Whitehouse Station, NJ:
Merck Research Laboratories 1999: 16821704, Anderson S Exp Nephrol
1996; 4(suppl 1): 3440, Fogo AB Am J Kidney Dis 2000;
35(2):179188
*preclinical data. LV = left ventricular; MI = myocardial
infarction; GFR = glomerular filtration rate
GFR
Proteinuria
Aldosterone release
Glomerular sclerosis
Atherosclerosis*
Vasoconstriction
Vascular hypertrophy
Endothelial dysfunction
LV hypertrophy
Fibrosis
Remodeling
Apoptosis
Stroke
DEATH
Hypertension
Heart failure
MI
Renal failure
*
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Gracias Por Vuestra Atencin
LUCES POR FAVOR
*
mmHg
50
75
100
125
150
bpm
50
60
70
80
bursts/min
20
30
40
50
60
bursts/100bpm
20
35
50
65
80
*
*
*
*
*
*
NT
Essential
Secondary
NT
Essential
Secondary
MBP
HR
MSNA
MSNA
Blood Pressure and HR Beat Series
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
200
180
160
140
120
100
80
60
40
20
0
480
400
320
240
160
80
0
Frecuencia de Distribucin
(135 Pts)
PAS (mmHg)
105
115
125
135
145
155
165
175
185
195
205
n=
0
5
10
15
20
25
30
35
Promedio
- DS
+ DS
Test de Fenilefrine
BRS (msec/mmHg)
5
6
7
8
9
10
11
12
13
14
Variabilidad de la PAM (mmHg)
2
4
6
8
10
Test Nitroglicerina
SBR (mseg/mmHg)
6
7
8
9
10
11
12
13
2
4
6
8
10
r=0.617; n=35; p