Shargorodsky Marina, Leibovitz Eyal, Lubimov Leonid, Gavish Dov, Zimlichman Reuven
Department of Endocrinology, Wolfson Medical Center, Holon, Israel.
Am J Hypertens. 2002 Dec;15(12):1087-91. doi: 10.1016/s0895-7061(02)03134-5.
Decreased arterial compliance (AC) is considered an early marker of vascular wall damage. Hypertension gradually decreases arterial compliance. We studied whether treatment with the angiotensin type 1 (AT(1)) antagonist valsartan will affect AC in patients with essential hypertension (EH).
Twenty-two patients with EH, 6 men and 16 women, mean age 58.7 +/- 4.1 years, without overt target organ damage were included. Antihypertensive medications were withdrawn for 3 weeks, Valsartan was given at 80- and 160-mg doses. The AC, blood pressure (BP), blood, and urine were measured monthly. Large (C1) and small (C2) AC were derived from radial artery waveforms, obtained using a calibrated tonometer (model CR-2000, HDI Inc., Eagan, MN).
After 3 months, systolic BP decreased from 172 +/- 17 to 142 +/- 13 mm Hg (P <.0001) and diastolic BP from 95 +/- 9 to 82 +/- 8 mm Hg (P <.0001). The decrease in BP was significant within 1 month and improved further on. The C1 increased by 22%, from 8.0 +/- 3.1 to 9.7 +/- 2.3 mL/mm Hg x 10 (P <.01). The C2 increased by 35%, from 2.9 +/- 1.3 to 3.9 +/- 1.9 mL/mm Hg x 100 (P <.01). Both C1 and C2 reached statistical significance only after 3 months. Systemic vascular resistance (SVR) decreased by 15% from 2,140 +/- 376 to 1,817 +/- 262 dynes/sec/cm(-5) (P <.0001).
Treatment with valsartan in patients with EH improves small and large AC. The improvement in AC was significant only after 3 months of treatment, whereas systolic BP, diastolic BP, and SVR decreased earlier. The AT(1) receptor blockade with valsartan seems to be an effective means of not only lowering BP but of reversal of vascular wall damage, which predisposes to cardiovascular events.
动脉顺应性（AC）降低被认为是血管壁损伤的早期标志。高血压会逐渐降低动脉顺应性。我们研究了血管紧张素1型（AT(1)）拮抗剂缬沙坦治疗是否会影响原发性高血压（EH）患者的动脉顺应性。
纳入22例原发性高血压患者，其中男性6例，女性16例，平均年龄58.7±4.1岁，无明显靶器官损害。停用抗高血压药物3周，给予80毫克和160毫克剂量的缬沙坦。每月测量动脉顺应性、血压（BP）、血液和尿液。大（C1）和小（C2）动脉顺应性由桡动脉波形得出，使用校准眼压计（CR-2000型，HDI公司，伊根，明尼苏达州）获取。
3个月后，收缩压从172±17毫米汞柱降至142±13毫米汞柱（P<.0001），舒张压从95±9毫米汞柱降至82±8毫米汞柱（P<.0001）。血压在1个月内显著下降，并进一步改善。C1增加了22%，从8.0±3.1增加到9.7±2.3毫升/毫米汞柱×10（P<.01）。C2增加了35%，从2.9±1.3增加到3.9±1.9毫升/毫米汞柱×100（P<.01）。C1和C2仅在3个月后达到统计学显著性。全身血管阻力（SVR）从2140±376降至1817±262达因/秒/厘米（-5），下降了15%（P<.0001）。
缬沙坦治疗原发性高血压患者可改善大小动脉顺应性。动脉顺应性的改善仅在治疗3个月后显著，而收缩压、舒张压和全身血管阻力下降更早。缬沙坦的AT(1)受体阻断似乎不仅是降低血压的有效手段，而且是逆转易导致心血管事件的血管壁损伤的有效手段。
