Olsen Michael H, Wachtell Kristian, Tuxen Christian, Fossum Eigil, Bang Lia E, Hall Christian, Ibsen Hans, Rokkedal Jens, Devereux Richard B, Hildebrandt Per R
Glostrup University Hospital, Glostrup, Denmark.
J Hypertens. 2005 May;23(5):1083-90. doi: 10.1097/01.hjh.0000166851.18463.85.
Secretion of natriuretic peptides is related to cardiac wall stress and influenced by the renin-angiotensin system. Therefore, we investigated the influence of blood pressure (BP) reduction with losartan versus atenolol on N-terminal pro-atrial natriuretic peptide (Nt-proANP) and N-terminal pro-brain natriuretic peptide (Nt-proBNP).
In 183 patients with hypertension and electrocardiographic left ventricular (LV) hypertrophy, enrolled in the LIFE Study, we measured BP and serum Nt-proANP and Nt-proBNP by immunoassay after 2 weeks of placebo treatment and after 1, 2, 4, 6, 12, 24, 36 and 48 months of randomized treatment with losartan- or atenolol-based antihypertensive regimens.
There was no significant difference in BP at any time point between the two treatment groups. In patients treated with losartan, median Nt-proANP decreased gradually throughout the study, reaching significance after 6 months of treatment (1125-1060 pmol/l, P < 0.001), and Nt-proBNP decreased within the first month (24.7-18.7 pmol/l, P < 0.01) and stayed reduced throughout the study. During losartan-based antihypertensive treatment, Nt-proANP and Nt-proBNP as a percentage of baseline values were correlated to reductions in systolic BP (r = 0.11, P < 0.01 and r = 0.10, P = 0.01) and diastolic BP (r = 0.17, P < 0.001 and r = 0.07, P = 0.09). In atenolol-treated patients, Nt-proANP (1100-1640 pmol/l, P < 0.001) and Nt-proBNP (20.0-37.7 pmol/l, P < 0.001) increased during the first month, and remained elevated throughout the study. During atenolol-based antihypertensive treatment, changes in Nt-proANP (r = -0.16, P < 0.001) and Nt-proBNP (r = -0.07, P = 0.08) were negatively related to change in heart rate.
Nt-proANP and Nt-proBNP were reduced in parallel with BP in losartan-treated patients whereas they increased in parallel with decreased heart rate in atenolol-treated patients.
利钠肽的分泌与心脏壁压力相关，并受肾素 - 血管紧张素系统影响。因此，我们研究了氯沙坦与阿替洛尔降低血压对N末端前心房利钠肽（Nt - proANP）和N末端前脑利钠肽（Nt - proBNP）的影响。
在参加LIFE研究的183例高血压和心电图左心室肥厚患者中，我们在安慰剂治疗2周后以及随机接受基于氯沙坦或阿替洛尔的降压方案治疗1、2、4、6、12、24、36和48个月后，通过免疫测定法测量血压以及血清Nt - proANP和Nt - proBNP。
两个治疗组在任何时间点的血压均无显著差异。在接受氯沙坦治疗的患者中，整个研究期间Nt - proANP中位数逐渐下降，治疗6个月后达到显著水平（1125 - 1060 pmol/l，P < 0.001），Nt - proBNP在第一个月内下降（24.7 - 18.7 pmol/l，P < 0.01）并在整个研究期间持续降低。在基于氯沙坦的降压治疗期间，Nt - proANP和Nt - proBNP相对于基线值的百分比与收缩压降低相关（r = 0.11，P < 0.01和r = 0.10，P = 0.01）以及舒张压降低相关（r = 0.17，P < 0.001和r = 0.07，P = 0.09）。在接受阿替洛尔治疗的患者中，Nt - proANP（1100 - 1640 pmol/l，P < 0.001）和Nt - proBNP（20.0 - 37.7 pmol/l，P < 0.001）在第一个月升高，并在整个研究期间保持升高。在基于阿替洛尔的降压治疗期间，Nt - proANP（r = -0.16，P < 0.001）和Nt - proBNP（r = -0.07，P = 0.08）的变化与心率变化呈负相关。
在氯沙坦治疗的患者中，Nt - proANP和Nt - proBNP与血压平行降低，而在阿替洛尔治疗的患者中，它们与心率降低平行升高。
