Versari D, Virdis A, Ghiadoni L, Daghini E, Duranti E, Masi S, Magagna A, Taddei S
Department of Internal Medicine, University of Pisa, Pisa, Italy.
Atherosclerosis. 2009 Jul;205(1):214-20. doi: 10.1016/j.atherosclerosis.2008.11.023. Epub 2008 Dec 3.
The aim of the present study is to evaluate the effect of treatment with verapamil, trandolapril and their combination on peripheral microcirculation vasoreactivity.
Twenty hypertensive patients were randomized to receive oral trandolapril (4 mg oid; TRA) or verapamil (240 mg oid; VER) for 6 months and then the combination of the two drugs for additional 6 months. At baseline, 6 months and 12 months, peripheral microcirculation vasoreactivity was evaluated by forearm blood flow technique (venous plethysmography), as vasodilation to an endothelium-dependent (acetylcholine) and an endothelium-independent stimulus (sodium nitroprusside, SNP); minimal forearm vascular resistances (MFVR) were also evaluated.
Blood pressure decreased similarly and progressively in both groups throughout the study period. In VER, 6-month verapamil treatment significantly increased vasodilation to acetylcholine, but not to SNP. The superimposition of trandolapril increased the response to SNP, and less to acetylcholine. In TRA group, 6-month treatment with trandolapril improved the response to SNP, but not to acetylcholine. In this group, the superimposition of verapamil caused a significant improvement in the response to acetylcholine, but not to SNP. At the end of the study, MFVR were significantly reduced in both groups, but to a greater extent in TRA.
The present study demonstrates that chronic treatment with verapamil ameliorates endothelial function in the forearm microcirculation of essential hypertensive patients, while trandolapril protects microcirculation from structural alterations. The combination of the two drugs is potentially a powerful tool to counteract hypertension-related microvascular dysfunction and damage.
本研究旨在评估维拉帕米、群多普利及其联合用药对外周微循环血管反应性的影响。
20例高血压患者被随机分为两组，分别口服群多普利（4mg，每日一次；TRA）或维拉帕米（240mg，每日一次；VER），疗程6个月，之后联合使用这两种药物再治疗6个月。在基线期、6个月和12个月时，采用前臂血流技术（静脉体积描记法）评估外周微循环血管反应性，包括对内皮依赖性刺激（乙酰胆碱）和内皮非依赖性刺激（硝普钠，SNP）的血管舒张反应；同时评估最小前臂血管阻力（MFVR）。
在整个研究期间，两组患者的血压均以相似的幅度逐渐下降。在VER组，维拉帕米治疗6个月显著增加了对乙酰胆碱的血管舒张反应，但对SNP无此作用。加用群多普利后增加了对SNP的反应，而对乙酰胆碱的反应增加较少。在TRA组，群多普利治疗6个月改善了对SNP的反应，但对乙酰胆碱无此作用。在该组中，加用维拉帕米后对乙酰胆碱的反应显著改善，但对SNP无此作用。研究结束时，两组的MFVR均显著降低，但TRA组降低的幅度更大。
本研究表明，维拉帕米长期治疗可改善原发性高血压患者前臂微循环的内皮功能，而群多普利可保护微循环免受结构改变的影响。两种药物联合使用可能是对抗高血压相关微血管功能障碍和损伤的有力工具。
