Department of Medicine and Feinberg School of Medicine of Northwestern University, Chicago, Illinois 60611, USA.
Can J Cardiol. 2009 Dec;25(12):e406-12. doi: 10.1016/s0828-282x(09)70534-3.
There is controversy regarding whether blood pressure (BP) medications have relevant therapeutic benefits beyond those due to lowering of BP.
To show that rapid successful treatment of hypertension leads to improvement in cardiac morphology and function regardless of the pharmacological agents used.
Hypertension was defined as an average 24 h ambulatory BP of higher than 135/85 mmHg in 38 subjects with a mean (+/- SD) age of 54+/-7 years. Patients were randomly assigned to treatment with a diuretic based (n=20) or a calcium channel blocker (CCB)-based (n=18) medication. All subjects were followed every two weeks, and similar additional medications were added until the BP was lower than 125/80 mmHg, then followed monthly for a total of six months. Echocardiography with tissue Doppler imaging was performed, and was repeated after six months of aggressive pharmacotherapy and lifestyle management.
Baseline ambulatory BP monitoring and echocardiographic measures of diastolic function were similar between both treatment groups. Subjects received 3.5+/-1 pills and 11+/-2 follow-up visits. The average 24 h BP was reduced from 145/91 mmHg to 124/75 mmHg (P<0.001) in the CCB group. A greater lowering from 143/91 mmHg to 117/72 mmHg occurred in the diuretic group (P=0.02 for the difference between groups) at six months. There was significant improvement in tissue Doppler imaging diastolic function parameters in both groups, with a trend toward greater improvement in the diuretic group. The left ventricular mass/ height(2.7) index decreased from 40 g/m(2.7) to 37 g/m(2.7) in the diuretic group (P=0.02), whereas a nonsignificant change (41 g/m(2.7) to 42 g/m(2.7)) occurred in the CCB group.
Aggressive BP lowering is associated with improved left ventricular diastolic function and mass proportional to the extent of BP normalization.
关于血压（BP）药物是否除了降低血压之外还有相关的治疗益处存在争议。
表明迅速成功治疗高血压可改善心脏形态和功能，而与所使用的药物无关。
将平均年龄为 54+/-7 岁的 38 例平均 24 小时动态血压高于 135/85mmHg 的患者定义为高血压。将患者随机分配至利尿剂治疗组（n=20）或钙通道阻滞剂（CCB）治疗组（n=18）。所有患者每两周随访一次，并添加类似的附加药物，直至血压低于 125/80mmHg，然后每月随访一次，共随访 6 个月。进行超声心动图检查和组织多普勒成像，并在积极药物治疗和生活方式管理 6 个月后重复该检查。
两组患者的基线动态血压监测和超声心动图舒张功能测量值相似。患者共接受了 3.5+/-1 种药物治疗，随访了 11+/-2 次。CCB 组患者的平均 24 小时血压从 145/91mmHg 降至 124/75mmHg（P<0.001）。利尿剂组患者的血压降幅更大，从 143/91mmHg 降至 117/72mmHg（P=0.02 表示两组间的差异）。两组患者的组织多普勒成像舒张功能参数均有显著改善，利尿剂组患者的改善程度有更大的趋势。利尿剂组左心室质量/高度（2.7）指数从 40g/m（2.7）降至 37g/m（2.7）（P=0.02），而 CCB 组无显著变化（从 41g/m（2.7）降至 42g/m（2.7））。
积极降低血压与改善左心室舒张功能和质量有关，且与血压正常化的程度成正比。
