London Gerard, Schmieder Rolland, Calvo Carlos, Asmar Rolland
Service de Néphrologie et d'Hémodialyse, Centre Hospitalier F.H. Manhès, 8 rue Roger Clavier, Fleury Merogis, Ste Geneviève des Bois 91712, France.
Am J Hypertens. 2006 Jan;19(1):113-21. doi: 10.1016/j.amjhyper.2005.06.027.
Reducing systolic blood pressure (BP) is of major benefit to patients with isolated systolic hypertension, but lowering normal diastolic BP may be harmful in terms of cardiovascular risk. Effects of different drugs on systolic BP, diastolic BP, and pulse pressure are therefore of interest.
The NatriliX SR versus CandEsartan and amLodipine in the reduction of systoLic blood prEssure in hyperteNsive patienTs study (X-CELLENT) was a randomized, double-blind, placebo-controlled study comparing the effects of three drugs on these BP components. Patients with systolic-diastolic or isolated systolic hypertension (n = 1758) received indapamide (1.5 mg) sustained release (SR), candesartan (8 mg), amlodipine (5 mg), or placebo once daily for 12 weeks.
Compared to placebo all active treatments reduced all BP components significantly (P < .001). For the patients with isolated systolic hypertension (n = 388), the three treatments significantly reduced systolic BP, but only indapamide SR did not change diastolic BP and thus reduced pulse pressure significantly relative to placebo (P = .005). In an ancillary study using ambulatory BP monitoring (n = 576), all three treatments significantly reduced BP components during 24 h relative to placebo. Changes in systolic BP and pulse pressure were similar with the three treatments, but the reduction in diastolic BP was significantly smaller, and therefore more favorable, with indapamide SR compared with candesartan (P = .039). In patients with isolated systolic hypertension (n = 106), indapamide SR reduced 24-h systolic BP significantly more than amlodipine (P = .037), and only indapamide SR reduced 24-h pulse pressure significantly relative to placebo (P = .03). All three drugs were well tolerated.
This distinctive BP-lowering profile of indapamide SR seems highly beneficial when compared to the either of candesartan or amlodipine.
降低收缩压对单纯收缩期高血压患者大有裨益，但降低正常舒张压在心血管风险方面可能有害。因此，不同药物对收缩压、舒张压和脉压的影响备受关注。
“高血压患者中纳催离缓释片与坎地沙坦及氨氯地平降低收缩压的研究（X-CELLENT）”是一项随机、双盲、安慰剂对照研究，比较了三种药物对这些血压成分的影响。收缩期-舒张期高血压或单纯收缩期高血压患者（n = 1758）每日服用一次吲达帕胺（1.5 mg）缓释片、坎地沙坦（8 mg）、氨氯地平（5 mg）或安慰剂，持续12周。
与安慰剂相比，所有活性治疗均显著降低了所有血压成分（P <.001）。对于单纯收缩期高血压患者（n = 388），三种治疗均显著降低了收缩压，但只有吲达帕胺缓释片未改变舒张压，因此相对于安慰剂显著降低了脉压（P =.005）。在一项使用动态血压监测的辅助研究中（n = 576），相对于安慰剂，三种治疗在24小时内均显著降低了血压成分。三种治疗的收缩压和脉压变化相似，但与坎地沙坦相比，吲达帕胺缓释片降低舒张压的幅度显著更小，因此更有利（P =.039）。在单纯收缩期高血压患者（n = 106）中，吲达帕胺缓释片降低24小时收缩压的幅度显著大于氨氯地平（P =.037），并且只有吲达帕胺缓释片相对于安慰剂显著降低了24小时脉压（P =.03）。所有三种药物耐受性良好。
与坎地沙坦或氨氯地平相比，吲达帕胺缓释片这种独特的降压模式似乎非常有益。
