Shargorodsky M, Hass E, Boaz M, Gavish D, Zimlichman R
Department of Endocrinology, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Atherosclerosis. 2008 Mar;197(1):303-10. doi: 10.1016/j.atherosclerosis.2006.12.036. Epub 2007 Jun 22.
Aggressive inhibition of renin-angiotensin-aldosterone system may provide the best cardiovascular protection. We examined the effect of different doses of angiotensin II receptor blocker, Candesartan, on arterial elasticity, inflammatory and metabolic parameters in hypertensive patients with multiple cardiovascular risk factors. 69 hypertensive patients were randomized into three groups: group 1 included patients treated with high doses of Candesartan (32 mg), group 2 included patients treated with conventional doses of Candesartan (16 mg), group 3 included patients that received antihypertensive treatment other that angiotensin II type-1 receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEIs). Patients were evaluated for lipid profile, HbA1C, insulin, C-peptide, hs-CRP, aldosterone, renin and Homeostasis model assessment-insulin resistance (HOMA-IR). Arterial elasticity was evaluated using pulse wave contour analysis method (HDI CR 2000, Eagan, Minnesota). In patients treated with high doses of Candesartan: large artery elasticity index (LAEI) increased from 8.6+/-2.8 to 16.6+/-5.1 ml/mm Hg x 100 after 6 months of treatment (p<0.0001). Small artery elasticity index (SAEI) increased from 2.7+/-1.3 to 5.9+/-2.8 ml/mm Hg x 100 (p<0.0001). Systemic vascular resistance (SVR) decreased from 1881.5+/-527.5 to 1520.9+/-271.8 (p<0.0006). In patients treated with conventional doses of Candesartan: LAEI index increased from 11.0+/-3.5 to 14.4+/-3.2 ml/mm Hg x 100 (p<0.0001). SAEI increased during the study from 3.7+/-1.4 to 5.4+/-2.1 ml/mm Hg x 100 (p<0.0001). SVR decreased from 1699.8+/-327.6 to 1400.7+/-241 (p<0.0001). In the control group: neither LAE nor SAE improved during the treatment period. Although similar reduction in blood pressure was observed in all three groups, both LAE and SAE improved only in patients treated by ARBs. Treatment with high doses of Candesartan improves arterial stiffness to a greater extent than conventional doses of Candesartan, despite comparable changes in blood pressure.
积极抑制肾素-血管紧张素-醛固酮系统可能提供最佳的心血管保护作用。我们研究了不同剂量的血管紧张素II受体阻滞剂坎地沙坦对具有多种心血管危险因素的高血压患者动脉弹性、炎症和代谢参数的影响。69例高血压患者被随机分为三组：第1组包括接受高剂量坎地沙坦（32毫克）治疗的患者，第2组包括接受常规剂量坎地沙坦（16毫克）治疗的患者，第3组包括接受除1型血管紧张素II受体阻滞剂（ARBs）或血管紧张素转换酶抑制剂（ACEIs）以外的抗高血压治疗的患者。对患者进行血脂谱、糖化血红蛋白、胰岛素、C肽、高敏C反应蛋白、醛固酮、肾素和稳态模型评估-胰岛素抵抗（HOMA-IR）评估。使用脉搏波轮廓分析方法（HDI CR 2000，明尼苏达州伊根）评估动脉弹性。在接受高剂量坎地沙坦治疗的患者中：治疗6个月后，大动脉弹性指数（LAEI）从8.6±2.8增加到16.6±5.1毫升/毫米汞柱×100（p<0.0001）。小动脉弹性指数（SAEI）从2.7±1.3增加到5.9±2.8毫升/毫米汞柱×100（p<0.0001）。全身血管阻力（SVR）从1881.5±527.5降至1520.9±271.8（p<0.0006）。在接受常规剂量坎地沙坦治疗的患者中：LAEI指数从11.0±3.5增加到14.4±3.2毫升/毫米汞柱×100（p<0.0001）。在研究期间，SAEI从3.7±1.4增加到5.4±2.1毫升/毫米汞柱×100（p<0.0001）。SVR从1699.8±327.6降至1400.7±241（p<0.0001）。在对照组中：治疗期间LAE和SAE均未改善。尽管在所有三组中观察到相似的血压降低，但仅在接受ARBs治疗的患者中LAE和SAE有所改善。尽管血压变化相当，但高剂量坎地沙坦治疗比常规剂量坎地沙坦在更大程度上改善了动脉僵硬度。
