Hlubocká Z, Umnerová V, Heller S, Peleska J, Jindra A, Jáchymová M, Kvasnicka J, Aschermann M, Horký K
II. interní klinika kardiovaskulárních chorob 1. lékarské fakulty UK a VFN, Praha.
Vnitr Lek. 2002 Aug;48(8):718-23.
The objective of the investigation was to assess whether circulating adhesion molecules, von Willebrand factor (vWf) and endothelin-1 are elevated in patients with mild uncomplicated essential hypertension without further risk factors of atherosclerosis and whether they could serve as indicators of endothelial dysfunction in this form of hypertension. Furthermore the authors investigated the effect of ACE inhibitor treatment (ACEI), quinapril, on the level of these markers of endothelial dysfunction. The level of adhesion molecules [intercellular cytoadhesion molecule-1 (ICAM-1), E-selectin, P-selectin], von Willebrand s factor (vWf) and endothelin-1 were assessed in patients with mild essential hypertension without further cardiovascular risk factors or clinical manifestations of atherosclerosis before and after quinapril treatment (n = 25) and compared with normotensive controls (n = 29). The results of the examinations provided evidence that contrary to controls the hypertensive subjects had significantly higher ICAM-1 levels (237.8 vs. 207.8 ng/ml, P = 0.02) vWf (118 vs. 106 IU/dl, p < 0.05) and endothelin-1 (5.81 vs. 5.15 fmol/ml, p < 0.05). Three-month treatment of hypertensive patients with ACEI led to a significant drop of endothelin-1 levels (5.81 vs. 5.26 fmol/ml, p = 0.01). The authors proved also an unequivocal declining trend of other cytoadhesion molecules and vWf after ACEI treatment, the changes however were not statistically significant. From the investigation it may be concluded that also patients with uncomplicated essential hypertension without other cardiovascular risk factors or clinical manifestations of atherosclerosis have significantly elevated plasma levels of ICAM-1, vWf and endothelin-1. Higher concentrations of these factors suggest endothelial dysfunction already in mild forms of essential hypertension without further risk factors or cardiovascular complications. A significant drop of endothelin-1 and declining trend of the other investigated indicators suggest that ACEI treatment can favourably influence endothelial dysfunction in hypertensive patients also independently on reduction of the BP.
该研究的目的是评估在无动脉粥样硬化进一步危险因素的轻度单纯原发性高血压患者中，循环黏附分子、血管性血友病因子（vWf）和内皮素-1是否升高，以及它们是否可作为这种高血压形式下内皮功能障碍的指标。此外，作者研究了血管紧张素转换酶抑制剂（ACEI）喹那普利治疗对这些内皮功能障碍标志物水平的影响。在喹那普利治疗前后，对无其他心血管危险因素或动脉粥样硬化临床表现的轻度原发性高血压患者（n = 25）的黏附分子[细胞间细胞黏附分子-1（ICAM-1）、E-选择素、P-选择素]、血管性血友病因子（vWf）和内皮素-1水平进行了评估，并与血压正常的对照组（n = 29）进行比较。检查结果表明，与对照组相比，高血压患者的ICAM-1水平显著更高（237.8对207.8 ng/ml，P = 0.02），vWf（118对106 IU/dl，p < 0.05）和内皮素-1（5.81对5.15 fmol/ml，p < 0.05）。高血压患者接受ACEI治疗三个月后，内皮素-1水平显著下降（5.81对5.26 fmol/ml，p = 0.01）。作者还证明，ACEI治疗后其他细胞黏附分子和vWf有明确的下降趋势，然而这些变化无统计学意义。从该研究可以得出结论，即使是无其他心血管危险因素或动脉粥样硬化临床表现的单纯原发性高血压患者，其血浆ICAM-1、vWf和内皮素-1水平也显著升高。这些因子浓度较高表明，在无进一步危险因素或心血管并发症的轻度原发性高血压形式中已经存在内皮功能障碍。内皮素-1的显著下降以及其他研究指标的下降趋势表明，ACEI治疗也可独立于血压降低而对高血压患者的内皮功能障碍产生有利影响。
