Opie Lionel H, Haus Matthias, Commerford Patrick J, Levetan Basil, Moore Karen, Brink Johan
Hypertension Clinic, Department of Medicine, Groote Schuur Hospital and Cape Heart Centre, University of Cape Town, Observatory, South Africa.
Am J Hypertens. 2002 Oct;15(10 Pt 1):911-6. doi: 10.1016/s0895-7061(02)02992-8.
It is not known whether strict control of blood pressure (BP) in mild post-transplant hypertension gives any benefit. Our primary objective was to test the antihypertensive effects of lisinopril added to standard therapy on ambulatory BP (ABP) of post-transplant patients. The secondary objective was to monitor echocardiographic and hemodynamic end points.
Post-transplant patients with an abnormality of the 24-h ABP recording were recruited to this double-blind randomized prospective study that started 2 to 3 months after transplantation. Patients were then evaluated at 6, 12, 18, and 24 months after transplantation.
Lisinopril decreased the clinic BP and ABP, the latter from 134/85 to 126/82 mm Hg at 6 months (P =.01 v placebo) and 121/79 mm Hg after 2 years (P =.03 v placebo). Fewer patients in the lisinopril group required added amlodipine to control the BP (P =.01). Data on left ventricular (LV) mass are difficult to interpret because by coincidence in this small study, the lisinopril group had lower initial values than placebo. However, in the lisinopril group mean LV mass decreased by 10% (P =.02) and mass index by 13% (P =.01), whereas placebo LV mass and index did not change. The LV end-diastolic diameter increased only in the placebo group (P =.008). There were no significant changes in any of the other secondary outcomes, including the cardiac index and systemic vascular resistance.
Thus, in these post-transplant patients, stricter BP control to normal levels by the addition of lisinopril to existing therapy, reduced BP and modestly decreased LV mass without altering cardiac hemodynamic function.
对于移植后轻度高血压患者进行严格的血压控制是否有益尚不清楚。我们的主要目的是测试在标准治疗基础上加用赖诺普利对移植后患者动态血压（ABP）的降压效果。次要目的是监测超声心动图和血流动力学终点指标。
将24小时ABP记录异常的移植后患者纳入这项双盲随机前瞻性研究，该研究在移植后2至3个月开始。然后在移植后6、12、18和24个月对患者进行评估。
赖诺普利降低了诊室血压和ABP，6个月时ABP从134/85 mmHg降至126/82 mmHg（与安慰剂相比，P = 0.01），2年后降至121/79 mmHg（与安慰剂相比，P = 0.03）。赖诺普利组中需要加用氨氯地平来控制血压的患者较少（P = 0.01）。左心室（LV）质量的数据难以解释，因为在这项小型研究中巧合的是，赖诺普利组的初始值低于安慰剂组。然而，在赖诺普利组中，平均LV质量下降了10%（P = 0.02），质量指数下降了13%（P = 0.01），而安慰剂组的LV质量和指数没有变化。仅在安慰剂组中左心室舒张末期直径增加（P = 0.008）。其他任何次要结局指标，包括心脏指数和全身血管阻力，均无显著变化。
因此，在这些移植后患者中，通过在现有治疗基础上加用赖诺普利将血压更严格地控制在正常水平，可降低血压并适度减少LV质量，而不改变心脏血流动力学功能。
