Celik Turgay, Iyisoy Atila, Acikel Cengizhan, Yuksel Cagdas, Celik Murat, Yaman Halil, Baysan Oben, Isik Ersoy
Department of Cardiology, Gulhane Military Medical Academy, School of Medicine, Etlik-Ankara, Turkey.
Blood Press Monit. 2008 Jun;13(3):169-76. doi: 10.1097/MBP.0b013e3282fed786.
It has been recently demonstrated that aortic elasticity is impaired in young patients with prehypertension compared with healthy controls. Accordingly, the purpose of the current study was to analyze the comparative effects of metoprolol and perindopril on aortic elasticity in young patients with prehypertension after 6 months of therapy.
Fifty newly diagnosed patients with hypertension, who were in the prehypertension category according to the Joint National Committee seventh report, were enrolled in this blind, randomized, prospective study. After baseline clinical assessment, patients were randomly assigned to 4 mg daily dose of perindopril (group I, n=27, 18 male, median age=35 years) or 100 mg daily dose of metoprolol succinate (group II, n=28, 16 male, median age=33 years) for 6 months. Aortic strain, distensibility, and stiffness indexes were calculated from aortic diameters measured by echocardiography and blood pressures simultaneously measured by sphygmomanometry before and after treatment.
When the median aortic distensibility and strain indexes after 6 months of therapy were analyzed, aortic distensibility and strain indexes of both treatment arms were found to be significantly higher than those of the pretreatment period. In contrast, the posttreatment aortic stiffness indexes of both groups were significantly lower compared with those of pretreatment period. No statistical difference was found between pretreatment and posttreatment aortic elasticity parameters of both groups. Importantly, no statistically significant difference was found between the percentage change from baseline of metoprolol and perindopril groups regarding aortic elasticity parameters (aortic distensibility: 38.1 vs. 37.9%, respectively, P=0.86; aortic strain: 37.7 vs. 37.9%, respectively, P=0.44; stiffness index: -20.0 vs. -23.9%).
The current study revealed that early pharmacological intervention had strong beneficial effects on aortic elasticity in patients with prehypertension despite the fact that neither metoprolol nor perindopril was superior to the other.
最近有研究表明，与健康对照者相比，年轻的高血压前期患者的主动脉弹性受损。因此，本研究的目的是分析美托洛尔和培哚普利在治疗6个月后对年轻高血压前期患者主动脉弹性的比较效果。
根据美国国家联合委员会第七次报告，选取50例新诊断的高血压前期患者，纳入这项盲法、随机、前瞻性研究。在进行基线临床评估后，患者被随机分配至每日服用4 mg培哚普利组（第一组，n = 27，男性18例，中位年龄 = 35岁）或每日服用100 mg琥珀酸美托洛尔组（第二组，n = 28，男性16例，中位年龄 = 33岁），治疗6个月。根据超声心动图测量的主动脉直径和同时用血压计测量的血压，计算治疗前后的主动脉应变、扩张性和僵硬度指数。
分析治疗6个月后的主动脉扩张性和应变指数中位数时发现，两个治疗组的主动脉扩张性和应变指数均显著高于治疗前期。相反，两组治疗后的主动脉僵硬度指数均显著低于治疗前期。两组治疗前后的主动脉弹性参数之间未发现统计学差异。重要的是，美托洛尔组和培哚普利组主动脉弹性参数相对于基线的变化百分比之间未发现统计学显著差异（主动脉扩张性：分别为38.1%对37.9%，P = 0.86；主动脉应变：分别为37.7%对37.9%，P = 0.44；僵硬度指数：-20.0%对-23.9%）。
本研究表明，尽管美托洛尔和培哚普利对主动脉弹性的改善效果并无优劣之分，但早期药物干预对高血压前期患者的主动脉弹性具有显著的有益作用。
