Hirata Kozo, Vlachopoulos Charalambos, Adji Audrey, O'Rourke Michael F
St Vincent's Hospital and Clinic, University of New South Wales, Darlinghurst NSW, Sydney, Australia.
J Hypertens. 2005 Mar;23(3):551-6. doi: 10.1097/01.hjh.0000160211.56103.48.
The substantial benefits of ramipril over conventional therapy in high-risk patients are not always associated with clinically significant differences in brachial arterial pressure, and largely remain unexplained. We undertook this acute study to establish the magnitude of and reason for different acute effects of ramipril and atenolol on arterial pressure.
We enrolled 30 patients, who took 10 mg ramipril, 100 mg atenolol, and placebo at intervals of > or = 7 days, in a randomized, double-blind, placebo-controlled trial. After baseline, measurements were taken at 30-60 min intervals for 5 h, and comprised cuff brachial pressure, radial artery tonometry with generation of central aortic pressure, and pulse wave velocity for aorta, upper limb and lower limb arteries.
Both ramipril and atenolol reduced arterial pressure, and the diastolic pressure fall was similar in the aorta and brachial artery, but the systolic pressure fall for ramipril was greater than for atenolol (by 5.2 mmHg, P < 0.0001) in the aorta compared with the brachial artery. The aortic systolic pressure difference with ramipril in comparison with atenolol was accompanied by an absolute difference of 10.7% (P < 0.0001) in the augmentation index, denoting a reduction in peripheral wave reflection by ramipril. The aortic pulse wave velocity fell to a similar degree with ramipril in comparison with atenolol, but fell to a greater degree (1.35 and 0.44 m/s, respectively, P < 0.0001 for both) in muscular arteries of the lower and upper limbs.
A greater (average, 5.2 mmHg) decrease in aortic systolic pressure caused by ramipril may explain the greater benefit of ramipril over atenolol. The difference is attributable to decreased stiffness of peripheral arteries and a reduction in wave reflection.
雷米普利在高危患者中相较于传统疗法具有显著益处，但这些益处并不总是与肱动脉血压的临床显著差异相关，且很大程度上仍未得到解释。我们开展这项急性研究，以确定雷米普利和阿替洛尔对动脉血压不同急性作用的程度及原因。
我们纳入了30例患者，在一项随机、双盲、安慰剂对照试验中，让他们每隔≥7天分别服用10毫克雷米普利、100毫克阿替洛尔和安慰剂。在基线测量后，每隔30 - 60分钟测量5小时，测量内容包括袖带肱动脉血压、通过桡动脉张力测量法生成中心主动脉压，以及主动脉、上肢和下肢动脉的脉搏波速度。
雷米普利和阿替洛尔均降低了动脉血压，主动脉和肱动脉的舒张压下降相似，但与肱动脉相比，雷米普利在主动脉中的收缩压下降幅度大于阿替洛尔（相差5.2毫米汞柱，P < 0.0001）。与阿替洛尔相比，雷米普利使主动脉收缩压产生差异的同时，增强指数的绝对差异为10.7%（P < 0.0001），这表明雷米普利减少了外周波反射。与阿替洛尔相比，雷米普利使主动脉脉搏波速度下降程度相似，但在下肢和上肢的肌肉动脉中下降程度更大（分别为1.35米/秒和0.44米/秒，两者P均< 0.0001）。
雷米普利导致的主动脉收缩压更大幅度下降（平均5.2毫米汞柱）可能解释了雷米普利相较于阿替洛尔具有更大益处的原因。这种差异归因于外周动脉僵硬度降低和波反射减少。
