Mackenzie Isla S, McEniery Carmel M, Dhakam Zahid, Brown Morris J, Cockcroft John R, Wilkinson Ian B
Clinical Pharmacology Unit, Addenbrooke's Hospital Box 110, Cambridge, CB2 0QQ United Kingdom.
Hypertension. 2009 Aug;54(2):409-13. doi: 10.1161/HYPERTENSIONAHA.109.133801. Epub 2009 Jun 1.
Isolated systolic hypertension is an important risk factor for cardiovascular disease and results primarily from elastic artery stiffening. Although various drug therapies are used to lower peripheral blood pressure (BP) in patients with isolated systolic hypertension, the effects of the 4 major classes of antihypertensive agents on central BP, pulse pressure (PP) amplification, and arterial stiffness in this condition are not clear. Fifty-nine patients over the age of 60 years with untreated isolated systolic hypertension (systolic BP > or =140 mm Hg and diastolic BP <or =90 mm Hg) were randomly assigned to receive 1 of the following 4 antihypertensive agents: perindopril, atenolol, lercanidipine, or bendrofluazide. BP was measured using a mercury sphygmomanometer, and augmentation index and carotid-femoral (aortic) pulse wave velocity were measured at baseline, after 2 weeks of placebo therapy, and at the end of 10 weeks of active therapy. Peripheral systolic BP and peripheral PP were reduced similarly after treatment with all 4 classes of drug. However, central PP was only reduced significantly by perindopril, lercanidipine, and bendrofluazide, whereas atenolol had no effect. Lercanidipine reduced the augmentation index, whereas atenolol increased it. Aortic pulse wave velocity was not changed by any of the drugs. In summary, despite similar reductions in peripheral systolic and PPs with the 4 classes of drug, changes in central pressure and augmentation index varied. Because central PP and increased wave reflections are considered important risk factors in patients with isolated systolic hypertension, the choice of therapy may be influenced by these findings in the future.
单纯收缩期高血压是心血管疾病的重要危险因素，主要源于弹性动脉僵硬。尽管在单纯收缩期高血压患者中使用了各种药物疗法来降低外周血压（BP），但这四种主要抗高血压药物类别对这种情况下的中心血压、脉压（PP）放大以及动脉僵硬度的影响尚不清楚。59名60岁以上未经治疗的单纯收缩期高血压患者（收缩压≥140 mmHg且舒张压≤90 mmHg）被随机分配接受以下四种抗高血压药物中的一种：培哚普利、阿替洛尔、乐卡地平或苄氟噻嗪。使用汞柱式血压计测量血压，并在基线、安慰剂治疗2周后以及积极治疗10周结束时测量增强指数和颈股（主动脉）脉搏波速度。用所有四类药物治疗后，外周收缩压和外周脉压均有相似程度的降低。然而，仅培哚普利、乐卡地平和苄氟噻嗪能显著降低中心脉压，而阿替洛尔无此作用。乐卡地平降低了增强指数，而阿替洛尔使其升高。所有药物均未改变主动脉脉搏波速度。总之，尽管四类药物对外周收缩压和脉压的降低程度相似，但中心压力和增强指数的变化各不相同。由于中心脉压和波反射增加被认为是单纯收缩期高血压患者的重要危险因素，这些发现未来可能会影响治疗的选择。
