Adji Audrey, Hirata Kozo, Hoegler Sonja, O'Rourke Michael F
St. Vincent's Clinic, University of New South Wales, MPU/VCCRI Department, Sydney, New South Wales, Australia.
Am J Hypertens. 2007 Aug;20(8):917-22. doi: 10.1016/j.amjhyper.2007.03.006.
Concerns persist about the validity of generalized transfer function-derived, aortic blood-pressure measurements during the administration of vasoactive agents in clinical trials. Hence, we compared this transfer-function method with another, which estimates aortic systolic pressure directly from the late systolic shoulder of the radial pressure wave, after administration of placebo, ramipril, or atenolol.
We recorded radial pressure pulse waveforms, using a commercially available system, in 30 subjects with >or=1 coronary risk factor in an acute study of ramipril at 10 mg and atenolol at 100 mg. Directly recorded radial and derived aortic pressure pulse waveforms were examined individually and were ensemble-averaged, and the difference between radial and aortic pressure responses was examined.
The late systolic shoulder response from radial waveforms was reduced by 15.8 mm Hg (SD, 12.2 mm Hg) more with ramipril than with atenolol. This was similar to a difference of 14.6 mm Hg (SD, 11.2 mm Hg) calculated for the aortic systolic pressure response using the transfer-function technique. Ramipril caused a greater reduction in the aortic systolic pressure response (22.2 mm Hg), whereas with atenolol, there was a modest decrease (7.6 mm Hg). The mean difference between aortic systolic pressures measured from direct radial waveforms and from derived aortic pressure between 3 and 5 h after dosing under all circumstances was 1.6 mm Hg (SD, 8.9 mm Hg).
Central pressure derived from radial pressure waveforms using a generalized transfer function gave similar results for central pressure measured directly from radial waveforms. The hemodynamic benefits of angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, and calcium channel blocker over beta-blocker antihypertensive therapy in recent trials were confirmed by this study.
在临床试验中，使用血管活性药物期间，通过广义传递函数得出的主动脉血压测量值的有效性一直受到关注。因此，我们将这种传递函数方法与另一种方法进行了比较，后者是在给予安慰剂、雷米普利或阿替洛尔后，直接从桡动脉压力波的收缩期末肩部估计主动脉收缩压。
在一项关于10 mg雷米普利和100 mg阿替洛尔的急性研究中，我们使用市售系统记录了30名具有≥1个冠心病危险因素的受试者的桡动脉压力脉搏波形。分别检查直接记录的桡动脉和推导的主动脉压力脉搏波形，并进行总体平均，然后检查桡动脉和主动脉压力反应之间的差异。
与阿替洛尔相比，雷米普利使桡动脉波形的收缩期末肩部反应降低了15.8 mmHg（标准差12.2 mmHg）。这与使用传递函数技术计算的主动脉收缩压反应的14.6 mmHg（标准差11.2 mmHg）的差异相似。雷米普利使主动脉收缩压反应的降低幅度更大（22.2 mmHg），而阿替洛尔则使主动脉收缩压有适度降低（7.6 mmHg）。在所有情况下，给药后3至5小时，直接从桡动脉波形测量的主动脉收缩压与推导的主动脉压力之间的平均差异为1.6 mmHg（标准差8.9 mmHg）。
使用广义传递函数从桡动脉压力波形得出的中心压力与直接从桡动脉波形测量的中心压力结果相似。本研究证实了近期试验中血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂和钙通道阻滞剂相对于β受体阻滞剂降压治疗的血流动力学益处。
