第三代β受体阻滞剂抗高血压治疗对内皮功能和血栓前状态的影响：吸烟的作用

The impact of third-generation beta-blocker antihypertensive treatment on endothelial function and the prothrombotic state: effects of smoking.

作者信息

Vyssoulis Gregory P, Marinakis Andreas G, Aznaouridis Konstantinos A, Karpanou Eva A, Arapogianni Athina N, Cokkinos Dennis V, Stefanadis Christodoulos I

机构信息

First Cardiology Department of Athens University, Hippokration Hospital, Athens, Greece.

出版信息

Am J Hypertens. 2004 Jul;17(7):582-9. doi: 10.1016/j.amjhyper.2004.03.668.

DOI:10.1016/j.amjhyper.2004.03.668

PMID:15233977

Abstract

BACKGROUND

The significance of beta-blockers in the treatment of cardiovascular diseases is well established. The effect of vasodilating beta-blockers on endothelial function and prothrombotic state has not been investigated.

METHODS

The study comprised 550 consecutive patients with uncomplicated essential hypertension. They were treated with celiprolol, carvedilol or nebivolol monotherapy (171, 179, and 200 patients, respectively), achieving comparable blood pressure reduction. Plasma levels of fibrinogen and homocystine and serum levels of plasminogen activator inhibitor-1 (PAI-1) were obtained before and 6 months after initiation of treatment.

RESULTS

The three drugs differentiated in regard to homocystine (P <.00001) and fibrinogen level changes (P =.00003), but not (P = NS) in PAI-1 change. In smokers, differentiation was found in all three parameters (P =.0002, P =.001, and P =.006 for fibrinogen, PAI-1, and homocystine, respectively), but in nonsmokers differentiation was found only in homocystine change (P =.00003). In smokers, fibrinogen, PAI-1, and homocystine were reduced more (P =.002, P =.0009, and P <.0001, respectively) than in nonsmokers in the whole study cohort. The effect of nebivolol was more prominent in smokers than nonsmokers in reducing all three parameters (P =.0001,.003, and.003, respectively), whereas in celiprolol and carvedilol-treated groups, differentiation between smokers and nonsmokers was significant (P =.00003 and.01, respectively) only in homocystine level change.

CONCLUSIONS

In hypertensive smokers, nebivolol resulted in a significant decrease of plasma PAI-1, fibrinogen and homocystine. Celiprolol also significantly affected these parameters but to a lesser degree, whereas carvedilol had no significant favorable action. In nonsmokers, homocystine was reduced significantly by nebivolol. We conclude that smoking status should be a determinant of antihypertensive treatment choice.

摘要

背景

β受体阻滞剂在心血管疾病治疗中的重要性已得到充分证实。血管舒张性β受体阻滞剂对内皮功能和血栓前状态的影响尚未得到研究。

方法

该研究纳入了550例无并发症的原发性高血压连续患者。他们分别接受塞利洛尔、卡维地洛或奈必洛尔单药治疗（分别为171例、179例和200例患者），血压降低程度相当。在治疗开始前及治疗6个月后检测血浆纤维蛋白原和同型半胱氨酸水平以及血清纤溶酶原激活物抑制剂-1（PAI-1）水平。

结果

三种药物在同型半胱氨酸（P <.00001）和纤维蛋白原水平变化（P =.00003）方面存在差异，但在PAI-1变化方面无差异（P =无统计学意义）。在吸烟者中，所有三个参数均存在差异（纤维蛋白原、PAI-1和同型半胱氨酸的P值分别为.0002、.001和.006），但在非吸烟者中，仅同型半胱氨酸变化存在差异（P =.00003）。在整个研究队列中，吸烟者的纤维蛋白原、PAI-1和同型半胱氨酸降低幅度比非吸烟者更大（分别为P =.002、P =.0009和P <.0001）。奈必洛尔在降低所有三个参数方面对吸烟者的作用比非吸烟者更显著（分别为P =.0001、.003和.003），而在塞利洛尔和卡维地洛治疗组中，吸烟者和非吸烟者之间仅在同型半胱氨酸水平变化方面存在显著差异（分别为P =.00003和.01）。