Malmqvist Karin, Ohman K Peter, Lind Lars, Nyström Fredrik, Kahan Thomas
Division of Internal Medicine, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden.
J Cardiovasc Pharmacol. 2003 Dec;42(6):719-26. doi: 10.1097/00005344-200312000-00005.
We examined long-term influence of the angiotensin II type 1-receptor blocker irbesartan and the beta1-adrenergic receptor blocker atenolol on some neurohormonal systems implicated in the pathophysiology of cardiac hypertrophy. Thus, 115 hypertensive patients with left ventricular hypertrophy were randomized to receive double-blind irbesartan or atenolol, with additional therapy if needed. Neurohormone measurements and echocardiography were performed at weeks 0, 12, 24, and 48. Left ventricular mass was reduced more by irbesartan than by atenolol (-26 g/m2 versus -14 g/m2, P = 0.024), despite similar reductions in blood pressure. Plasma renin activity and angiotensin II increased (P < 0.001) by irbesartan (0.9 +/- 0.7 to 3.4 +/- 4.2 ng/mL x h, and 3.0 +/- 1.6 to 13.0 +/- 17.7 pmol/L), but decreased (P < 0.01) by atenolol (1.0 +/- 0.6 to 0.7 +/- 0.6 ng/mL x h, and 3.4 +/- 1.6 to 3.2 +/- 2.2 pmol/L). Serum aldosterone decreased (P < 0.05) by both irbesartan (346 +/- 140 to 325 +/- 87 pmol/L) and atenolol (315 +/- 115 to 283 +/- 77 pmol/L). Changes in left ventricular mass by irbesartan related inversely to changes in plasma renin activity, angiotensin II, and aldosterone (all P < 0.05). Plasma levels and 24-hour urinary excretions of catecholamines, plasma leptin, proinsulin, insulin and insulin sensitivity remained largely unchanged in both groups. Thus, the renin-angiotensin aldosterone system appears to be an important non-hemodynamic factor in the regulation of left ventricular mass.
我们研究了血管紧张素II 1型受体阻滞剂厄贝沙坦和β1肾上腺素能受体阻滞剂阿替洛尔对一些与心脏肥大病理生理学相关的神经激素系统的长期影响。因此，115例左心室肥大的高血压患者被随机分为接受双盲厄贝沙坦或阿替洛尔治疗，必要时进行额外治疗。在第0、12、24和48周进行神经激素测量和超声心动图检查。尽管血压下降幅度相似，但厄贝沙坦使左心室质量的降低幅度大于阿替洛尔（-26 g/m2对-14 g/m2，P = 0.024）。厄贝沙坦使血浆肾素活性和血管紧张素II升高（P < 0.001）（从0.9 +/- 0.7至3.4 +/- 4.2 ng/mL·h，以及从3.0 +/- 1.6至13.0 +/- 17.7 pmol/L），而阿替洛尔使其降低（P < 0.01）（从1.0 +/- 0.6至0.7 +/- 0.6 ng/mL·h，以及从3.4 +/- 1.6至3.2 +/- 2.2 pmol/L）。厄贝沙坦和阿替洛尔均使血清醛固酮降低（P < 0.05）（分别从346 +/- 140至325 +/- 87 pmol/L和从315 +/- 115至283 +/- 77 pmol/L）。厄贝沙坦导致的左心室质量变化与血浆肾素活性、血管紧张素II和醛固酮的变化呈负相关（均P < 0.05）。两组中儿茶酚胺的血浆水平和24小时尿排泄量、血浆瘦素、胰岛素原、胰岛素及胰岛素敏感性基本保持不变。因此，肾素-血管紧张素-醛固酮系统似乎是调节左心室质量的一个重要非血流动力学因素。
