Higuchi Takahiro, Abletshauser Claudia, Nekolla Stephan G, Schwaiger Markus, Bengel Frank M
Nuklearmedizinische Klinik und Poliklinik der Technischen Universität München, Klinikum rechts der Isar, Munich, Germany.
Microcirculation. 2007 Nov-Dec;14(8):805-12. doi: 10.1080/10739680701410827.
To noninvasively investigate the effects of the angiotensin receptor blocker (ARB) Valsartan. on myocardial microcirculation in moderately hypertensive patients with stable coronary artery disease (CAD).
In this prospective open-label study, patients with mild stable CAD and moderate systolic and/or diastolic hypertension were treated with 160 mg Valsartan daily. Myocardial blood flow was quantified noninvasively using positron emission tomography (PET) with N-13 ammonia at baseline, after one week and after 16 weeks. Mean blood pressure at rest improved significantly from baseline to week 16 (105 +/- 10 vs. 98 +/- 9 mm Hg: p = 0.017, n = 12), but no significant change was observed after one week (103 +/- 11 vs. 100 +/- 11, p = 0.43, n = 13). PET analysis revealed that flow increase during endothelial-dependent, sympathetic stimulation by cold pressor testing (CPT) and in response to pharmacologic vasodilation with adenosine improved from baseline after 1 week (CPT: 1.10 +/- 0.3 vs. 1.37 +/- 0.3; p = 0.017, adenosine: 2.34 +/- 0.52 vs. 2.91 +/- 0.81; p = 0.048) and at week 16 (CPT: 1.15 +/- 0.4 vs 1.39 +/- 0.2; p = 0.10, adenosine: 2.34 +/- 0.52 vs 2.81 +/- 0.91; p = 0.039).
In patients with stable coronary disease, ARB results in improved PET-determined microvascular flow reserve. Improvements in microcirculation preceded the reduction of blood pressure, suggesting direct beneficial effects on microvascular function.
以非侵入性方式研究血管紧张素受体阻滞剂（ARB）缬沙坦对中度高血压合并稳定型冠状动脉疾病（CAD）患者心肌微循环的影响。
在这项前瞻性开放标签研究中，轻度稳定型CAD且伴有中度收缩期和/或舒张期高血压的患者每日服用160mg缬沙坦。在基线、1周后和16周后，使用正电子发射断层扫描（PET）结合N-13氨对心肌血流进行非侵入性定量分析。静息平均血压从基线到第16周显著改善（105±10 vs. 98±9 mmHg：p = 0.017，n = 12），但1周后未观察到显著变化（103±11 vs. 100±11，p = 0.43，n = 13）。PET分析显示，在冷加压试验（CPT）引起的内皮依赖性交感神经刺激期间以及对腺苷进行药物性血管舒张反应时，血流增加在1周后（CPT：1.10±0.3 vs. 1.37±0.3；p = 0.017，腺苷：2.34±0.52 vs. 2.91±0.81；p = 0.048）和第16周（CPT：1.15±0.4 vs 1.39±0.2；p = 0.10，腺苷：2.34±0.52 vs 2.81±0.91；p = 0.039）均较基线有所改善。
在稳定型冠心病患者中，ARB可改善PET测定的微血管血流储备。微循环的改善先于血压降低，提示对微血管功能有直接有益作用。
