Mörtsell D, Malmqvist K, Held C, Kahan T
Division of Cardiology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
J Intern Med. 2007 May;261(5):472-9. doi: 10.1111/j.1365-2796.2007.01775.x.
Angiotensin II promotes cell growth and has been implicated in the development and maintenance of left ventricular (LV) hypertrophy and of structural vascular changes. We wished to examine whether an angiotensin receptor blocker (ARB) would influence structural vascular changes beyond the effects of blood pressure reduction.
Hypertensive patients with LV hypertrophy (age 55 +/- 9 years, blood pressure 162 +/- 19/104 +/- 8 mmHg, LV mass index 148 +/- 31 g m(-2); mean +/- SD) were randomized double-blind to the ARB irbesartan (n=52) or the beta(1) receptor blocker atenolol (n=56) for 48 weeks. Ultrasonography of the left and right common carotid artery (CCA) and echocardiography were performed at week 0 and 48.
With similar reductions in blood pressure, CCA intima-media thickness (IMT) was reduced by irbesartan (from 0.92 +/- 0.14 by 0.01 +/- 0.10 mm, NS), whereas it was increased by atenolol (from 0.94 +/- 0.21 by 0.03 +/- 0.12 mm, P=0.018; P=0.002 between groups). CCA lumen diameter was less reduced by irbesartan than by atenolol. Thus, CCA intima-media area was reduced by irbesartan (from 21.3 +/- 5.0 by 0.90 +/- 2.45 mm(2), P=0.034) but not by atenolol (from 21.3 +/- 6.1 by 0.18 +/- 2.71 mm(2), NS; P=0.037 between groups). Changes in CCA IMT or area did not relate to changes in LV mass.
The favourable effects by irbesartan on CCA IMT with an outward vascular remodelling suggest that angiotensin II mediates structural vascular changes, beyond the effects of blood pressure. This may be important in the prevention of cerebrovascular events.
血管紧张素II可促进细胞生长，并与左心室（LV）肥厚以及血管结构改变的发生和维持有关。我们希望研究血管紧张素受体阻滞剂（ARB）是否会在降低血压的作用之外，对血管结构改变产生影响。
将患有LV肥厚的高血压患者（年龄55±9岁，血压162±19/104±8 mmHg，LV质量指数148±31 g m⁻²；均值±标准差）随机双盲分为ARB厄贝沙坦组（n = 52）或β₁受体阻滞剂阿替洛尔组（n = 56），治疗48周。在第0周和第48周进行左右颈总动脉（CCA）超声检查和超声心动图检查。
在血压降低程度相似的情况下，厄贝沙坦使CCA内膜中层厚度（IMT）降低（从0.92±0.14降至0.01±0.10 mm，无显著性差异），而阿替洛尔使其增加（从0.94±0.21增至0.03±0.12 mm，P = 0.018；两组间P = 0.002）。厄贝沙坦使CCA管腔直径减小的程度小于阿替洛尔。因此，厄贝沙坦使CCA内膜中层面积减小（从21.3±5.0降至0.90±2.45 mm²，P = 0.034），而阿替洛尔未使其减小（从21.3±6.1降至0.18±2.71 mm²，无显著性差异；两组间P = 0.037）。CCA IMT或面积的变化与LV质量的变化无关。
厄贝沙坦对CCA IMT具有有利影响并伴有血管向外重塑，这表明血管紧张素II在血压作用之外介导了血管结构改变。这在预防脑血管事件中可能很重要。
