Naya Masanao, Tsukamoto Takahiro, Morita Koichi, Katoh Chietsugu, Furumoto Tomoo, Fujii Satoshi, Tamaki Nagara, Tsutsui Hiroyuki
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
J Am Coll Cardiol. 2007 Sep 18;50(12):1144-9. doi: 10.1016/j.jacc.2007.06.013. Epub 2007 Sep 4.
We aimed to compare the effects of the angiotensin II receptor blocker (ARB) olmesartan versus the calcium channel blocker (CCB) amlodipine on coronary endothelial dysfunction in patients with hypertension.
Angiotensin II receptor blockers are thought to have greater beneficial effects than CCBs on coronary vasomotion by directly blocking action of angiotensin II.
Twenty-six patients with untreated essential hypertension were prospectively assigned to treatment with either olmesartan (27.7 +/- 12.4 mg/day, n = 13) or amlodipine (5.6 +/- 1.5 mg/day, n = 13) for 12 weeks. Changes of corrected myocardial blood flow (DeltaMBF) and coronary vascular resistance (DeltaCVR) from rest to cold pressor were measured by using 15O-water and positron emission tomography before and after treatment. Blood biomarkers including lipids, glucose, insulin, high-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-alpha, and superoxide dismutase (SOD) were also measured.
Olmesartan and amlodipine reduced blood pressure (BP) to the same extent (-28.7 +/- 16.2 mm Hg vs. -26.7 +/- 10.8 mm Hg). In the olmesartan group, DeltaMBF tended to be greater (-0.15 +/- 0.19 ml/g/min vs. 0.03 +/- 0.17 ml/g/min, p = 0.09 by 2-way analysis of variance), and DeltaCVR was significantly decreased (7.9 +/- 23.5 mm Hg/[ml/g/min] vs. -16.6 +/- 18.0 mm Hg/[ml/g/min], p < 0.05) after treatment, whereas these parameters did not change in the amlodipine group (DeltaMBF: -0.15 +/- 0.12 ml/g/min vs. -0.12 +/- 0.20 ml/g/min; DeltaCVR: 6.5 +/- 18.2 mm Hg/[ml/g/min] vs. 4.8 +/- 23.4 mm Hg/[ml/g/min]). Serum SOD activity tended to increase (4.74 +/- 4.77 U/ml vs. 5.57 +/- 4.74 U/ml, p = 0.07 by 2-way analysis of variance) only in the olmesartan group.
Olmesartan, but not amlodipine, improved endothelium-dependent coronary dilation in hypertensive patients independent of BP reduction. These beneficial effects on coronary vasomotion might be via an antioxidant property of ARBs.
我们旨在比较血管紧张素II受体阻滞剂（ARB）奥美沙坦与钙通道阻滞剂（CCB）氨氯地平对高血压患者冠状动脉内皮功能障碍的影响。
血管紧张素II受体阻滞剂被认为通过直接阻断血管紧张素II的作用，在冠状动脉血管运动方面比CCB具有更大的有益作用。
26例未经治疗的原发性高血压患者被前瞻性地分配接受奥美沙坦（27.7±12.4毫克/天，n = 13）或氨氯地平（5.6±1.5毫克/天，n = 13）治疗12周。在治疗前后，使用15O-水和正电子发射断层扫描测量从静息状态到冷加压试验时校正心肌血流量（ΔMBF）和冠状动脉血管阻力（ΔCVR）的变化。还测量了包括血脂、血糖、胰岛素、高敏C反应蛋白、白细胞介素-6、肿瘤坏死因子-α和超氧化物歧化酶（SOD）在内的血液生物标志物。
奥美沙坦和氨氯地平在相同程度上降低了血压（-28.7±16.2毫米汞柱对-26.7±10.8毫米汞柱）。在奥美沙坦组中，治疗后ΔMBF有增加趋势（-0.15±0.19毫升/克/分钟对0.03±0.17毫升/克/分钟，双向方差分析p = 0.09），并且ΔCVR显著降低（7.9±23.5毫米汞柱/[毫升/克/分钟]对-16.6±18.0毫米汞柱/[毫升/克/分钟]，p < 0.05），而在氨氯地平组中这些参数没有变化（ΔMBF：-0.15±0.12毫升/克/分钟对-0.12±0.20毫升/克/分钟；ΔCVR：6.5±18.2毫米汞柱/[毫升/克/分钟]对4.8±23.4毫米汞柱/[毫升/克/分钟]）。仅在奥美沙坦组中血清SOD活性有增加趋势（4.74±4.77单位/毫升对5.57±4.74单位/毫升，双向方差分析p = 0.07）。
奥美沙坦而非氨氯地平，在高血压患者中改善了内皮依赖性冠状动脉扩张，且独立于血压降低。这些对冠状动脉血管运动的有益作用可能是通过ARB的抗氧化特性实现的。
