Ferguson Joanne M, Minas Jack, Siapantas Siky, Komesaroff Paul A, Sudhir Krishnankutty
Hormones and Vasculature Laboratory, Baker Medical Research Institute, Melbourne, Victoria, Australia.
J Cardiovasc Pharmacol. 2008 Jun;51(6):590-5. doi: 10.1097/FJC.0b013e31817a8316.
The ideal therapy for patients with isolated systolic hypertension remains unclear; diuretics, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors are all used in clinical practice. The aim of this study was to determine whether a fixed-dose ACE inhibitor/diuretic combination would reduce ambulatory blood pressures (BP) and arterial stiffness in isolated systolic hypertension more than antihypertensive monotherapy. In this randomized, double-blind study, 8 weeks of fosinopril/hydrochlorothiazide combination (10/12.5 mg titrated up to 20/12.5 mg) was compared with the calcium channel blocker (amlodipine, 5 mg titrated up to 10 mg) and diuretic (indapamide, 2.5 mg) monotherapy in 28 patients with isolated systolic hypertension. Each patient received all 3 therapies. Assessments included 24-hour ambulatory BP, clinic BP, and applanation tonometry-derived augmentation index. At 8 weeks, the fall in average 24-hour systolic BP and night time systolic BP were significantly greater in the fosinopril-hydrochlorothiazide group, compared to amlodipine and indapamide. The decrease in augmentation index and central aortic systolic BP was also greater in the fosinopril-hydrochlorothiazide group, compared to either amlodipine or indapamide. There was no difference between therapies in decrease in clinic systolic or diastolic BP, or diastolic ABP (average 24-h, diurnal, or nocturnal). Compared with either calcium channel blocker or diuretic therapy, a fixed-dose ACE inhibitor-diuretic combination induces greater reductions in systolic ABP, particularly at night, favorable effects that may be related to a decrease in the intensity of or delay in arterial wave reflections. ACE inhibitor-diuretic combination therapy is a useful approach to cardiovascular risk reduction in isolated systolic hypertension.
单纯收缩期高血压患者的理想治疗方法仍不明确；利尿剂、钙通道阻滞剂和血管紧张素转换酶（ACE）抑制剂在临床实践中均有应用。本研究的目的是确定固定剂量的ACE抑制剂/利尿剂联合用药在降低单纯收缩期高血压患者的动态血压（BP）和动脉僵硬度方面是否比抗高血压单药治疗更有效。在这项随机、双盲研究中，将28例单纯收缩期高血压患者的福辛普利/氢氯噻嗪联合用药（10/12.5mg滴定至20/12.5mg）治疗8周与钙通道阻滞剂（氨氯地平，5mg滴定至10mg）和利尿剂（吲达帕胺，2.5mg）单药治疗进行了比较。每位患者均接受了所有三种治疗。评估包括24小时动态血压、诊室血压以及应用压平式眼压计得出的增强指数。8周时，与氨氯地平和吲达帕胺相比，福辛普利-氢氯噻嗪组的平均24小时收缩压和夜间收缩压下降幅度明显更大。与氨氯地平或吲达帕胺相比，福辛普利-氢氯噻嗪组的增强指数和中心主动脉收缩压下降幅度也更大。在诊室收缩压或舒张压以及动态舒张压（平均24小时、日间或夜间）的下降方面，各治疗组之间没有差异。与钙通道阻滞剂或利尿剂治疗相比，固定剂量的ACE抑制剂-利尿剂联合用药可使收缩期动态血压有更大幅度的降低，尤其是在夜间，这些有益效果可能与动脉波反射强度的降低或延迟有关。ACE抑制剂-利尿剂联合治疗是降低单纯收缩期高血压患者心血管风险的一种有效方法。
