Munakata Masanori, Aihara Akiko, Nunokawa Tohru, Ito Nobuhiko, Imai Yutaka, Ito Sadayoshi, Yoshinaga Kaoru
Division of Hypertension and Cardiology, Tohoku Rosai Hospital, Sendai, Japan.
Clin Exp Hypertens. 2003 Apr;25(3):169-81. doi: 10.1081/ceh-120019149.
Both baroreflex sensitivity and flow-mediated vasodilator function have been recognized to have prognostic significance in cardiovascular diseases. Long-term antihypertensive treatment effects on these parameters, however, remain unclear.
We examined the effects of long-term treatment by angiotensin converting enzyme inhibitors (ACEI) orcalcium channel blockers (CCB) on baroreflex and flow-mediated vasodilator function in patients with essential hypertension (EH). We recruited 36 patients aged 56 +/- 11 years, with systolic blood pressure > or = 160 mmHg and/or diastolic blood pressure > or = 95 mmHg. Patients were assigned either to treatment by long-acting ACEI (n = 12) or CCB (n = 24). All patients were followed for 12 months. Optimal BP was achieved by two optional increases in treatment: dose-doubling of the primary drug during the first three months and the addition of diuretics or beta-blockers thereafter. Target blood pressure was 140/90 mmHg or a fall > or = 20/10 mmHg. Baroreflex sensitivity was examined by spectral analysis of blood pressure and RR interval variabilities before treatment and after 3 and 12 months of treatment. The flow-mediated vasodilator function was determined before and 12 months after treatment by measuring the change in brachial artery diameter during increases in flow induced by reactive hyperemia.
Baseline blood pressures were similar between the ACEI and CCB groups (172 +/- 5/103 +/- 2 vs. 172 +/- 4/101 +/- 3 mmHg). Blood pressures after 3 and 12 months of treatment also did not differ between the ACEI and CCB groups (149 +/- 4/91 +/- 2 vs. 145 +/- 2/85 +/- 2 mmHg, and 133 +/- 5/84 +/- 2 vs. 133 +/- 2/81 +/- 2 mmHg, respectively). Baseline baroreflex sensitivity was similar between the groups (6.7 +/- 0.8 vs. 5.9 +/- 0.6 msec/mmHg). This parameter remained unchanged at three months but increased after 12 months of treatment in both the ACEI (9.5 +/- 1.6 msec/mmHg, p = 0.05) and CCB (9.1 +/- 1.2 msec/mmHg, p = 0.006) groups. Percent increases in brachial arterial diameter and flow during reactive hyperemia increased in the group treated with ACEI (12.4 +/- 3.5 vs. 25.8 +/- 6.3% and 618 +/- 72 vs. 953 +/- 166, p < 0.05 for both) but both parameters remained unchanged in the group treated with CCB.
These data suggest that long-term blood pressure control with modem antihypertensive drugs improves baroreflex function. Treatment with ACEI may be more favorable for flow-mediated vasodilator function than treatment with CCB.
压力反射敏感性和血流介导的血管舒张功能在心血管疾病中均具有预后意义。然而，长期抗高血压治疗对这些参数的影响仍不明确。
我们研究了血管紧张素转换酶抑制剂（ACEI）或钙通道阻滞剂（CCB）长期治疗对原发性高血压（EH）患者压力反射和血流介导的血管舒张功能的影响。我们招募了36例年龄为56±11岁、收缩压≥160 mmHg和/或舒张压≥95 mmHg的患者。患者被分配接受长效ACEI治疗（n = 12）或CCB治疗（n = 24）。所有患者随访12个月。通过两次可选的治疗增加来实现最佳血压：在前三个月将主要药物剂量加倍，此后添加利尿剂或β受体阻滞剂。目标血压为140/90 mmHg或下降≥20/10 mmHg。在治疗前以及治疗3个月和12个月后，通过对血压和RR间期变异性进行频谱分析来检测压力反射敏感性。通过测量反应性充血引起的血流增加期间肱动脉直径的变化来确定治疗前和治疗12个月后的血流介导的血管舒张功能。
ACEI组和CCB组的基线血压相似（172±5/103±2与172±4/101±3 mmHg）。治疗3个月和12个月后，ACEI组和CCB组的血压也无差异（分别为149±4/91±2与145±2/85±2 mmHg，以及133±5/84±2与133±2/81±2 mmHg）。两组的基线压力反射敏感性相似（6.7±0.8与5.9±0.6 msec/mmHg）。该参数在3个月时保持不变，但在ACEI组（从6.7±0.8至9.5±1.6 msec/mmHg，p = 0.05）和CCB组（从5.9±0.6至9.1±1.2 msec/mmHg，p = 0.006）治疗12个月后均增加。ACEI治疗组在反应性充血期间肱动脉直径和血流的百分比增加（分别为12.4±3.5%与25.8±6.3%以及618±72与953±166，两者p均<0.05），但CCB治疗组的这两个参数均保持不变。
这些数据表明，使用现代抗高血压药物进行长期血压控制可改善压力反射功能。与CCB治疗相比，ACEI治疗可能对血流介导的血管舒张功能更有利。
