Aznaouridis K A, Stamatelopoulos K S, Karatzis E N, Protogerou A D, Papamichael C M, Lekakis J P
Vascular Laboratory, Department of Clinical Therapeutics, Athens Medical School, Alexandra Hospital, Athens, Greece.
J Hum Hypertens. 2007 Aug;21(8):654-63. doi: 10.1038/sj.jhh.1002211. Epub 2007 Apr 26.
The acute effects of the renin-angiotensin system (RAS) blockers may be important in some clinical settings. To assess the acute impact of such drugs on arterial function, we studied the effects of captopril 25 mg, quinapril 20 mg and telmisartan 80 mg on 100 hypertensive patients, according to a randomized, double-blind, placebo-controlled study. Central (aortic) blood pressure (BP) and augmentation index (AIx, a measure of wave reflections), as well as flow-mediated dilatation (FMD) of the brachial artery and forearm blood flow (FBF) (measures of conduit and resistance artery endothelial function, respectively), were evaluated before and 2 h after oral drug administration. Compared to placebo, captopril and quinapril decreased central systolic (by 7.5 mm Hg, P<0.05 and by 12.3 mm Hg, P<0.001) and diastolic BP (by 4.9 mm Hg, P<0.01 and by 8.4 mm Hg, P<0.001), whereas telmisartan had no significant effect (P=NS). Additionally, AIx was reduced after quinapril (absolute decrease of 7.2%, P<0.01) and marginally after captopril (decrease of 4.7%, P=0.07). Only quinapril led to a beneficial change of FMD (absolute increase of 2.7%, P<0.001). No treatment was related to significant changes of peak hyperaemic or 3-min hyperaemic FBF. In adjusted analyses, all the favourable alterations induced by quinapril were independent of potential confounding haemodynamic factors. Our data show that acute RAS inhibition with quinapril (20 mg) may be more beneficial in terms of arterial function and central haemodynamics compared to captopril (25 mg) or telmisartan (80 mg). Further studies are needed to investigate whether these acute arterial effects of quinapril are clinically significant.
肾素-血管紧张素系统（RAS）阻滞剂的急性效应在某些临床情况下可能很重要。为评估此类药物对动脉功能的急性影响，我们根据一项随机、双盲、安慰剂对照研究，研究了25毫克卡托普利、20毫克喹那普利和80毫克替米沙坦对100例高血压患者的影响。在口服药物前及服药后2小时，评估中心（主动脉）血压（BP）和增强指数（AIx，一种反映波反射的指标），以及肱动脉的血流介导的血管舒张（FMD）和前臂血流量（FBF）（分别为传导动脉和阻力动脉内皮功能的指标）。与安慰剂相比，卡托普利和喹那普利降低了中心收缩压（分别降低7.5毫米汞柱，P<0.05；降低12.3毫米汞柱，P<0.001）和舒张压（分别降低4.9毫米汞柱，P<0.01；降低8.4毫米汞柱，P<0.001），而替米沙坦无显著影响（P=无显著性差异）。此外，喹那普利后AIx降低（绝对降低7.2%，P<0.01），卡托普利后略有降低（降低4.7%，P=0.07）。只有喹那普利导致FMD有有益变化（绝对增加2.7%，P<0.001）。没有治疗与高峰充血或3分钟充血性FBF的显著变化相关。在调整分析中，喹那普利引起的所有有利改变均独立于潜在的混杂血流动力学因素。我们的数据表明，与卡托普利（25毫克）或替米沙坦（80毫克）相比，急性使用20毫克喹那普利抑制RAS在动脉功能和中心血流动力学方面可能更有益。需要进一步研究以调查喹那普利的这些急性动脉效应是否具有临床意义。
