Department of Tracer Kinetics and Nuclear Medicine, Osaka University Graduate School of Medicine, Suita City, Osaka, Japan.
J Stroke Cerebrovasc Dis. 2010 Mar;19(2):85-91. doi: 10.1016/j.jstrokecerebrovasdis.2009.03.010.
The purpose of this study was to determine the effect of systemic blood pressure-lowering treatment with an angiotensin II receptor blocker, valsartan, on cerebral hemodynamics in patients with hypertension and evidence of cerebral small vessel disease.
We used positron emission tomography and acetazolamide challenge tests to measure cerebral blood flow (CBF) and cerebrovascular reserve (CVR) in 8 patients with hypertension (mean age 70.8 years) with lacunar infarcts and white matter lesions before and after valsartan therapy.
Systemic blood pressure was significantly decreased from baseline after treatment with valsartan. The baseline global CBFs before and after treatment were 38.2 +/- 5.6 mL/min/100 g and 39.9 +/- 9.0 mL/min/100 g, respectively. The CVRs before and after treatment were 52.2 +/- 18.4% and 39.7 +/- 18.9%, respectively. Differences in these parameters were not significant. Both regional CBF and CVR in the corona radiata with moderate or severe white matter lesions were also preserved after valsartan therapy compared with those before treatment.
Cerebral hemodynamics were preserved after blood pressure lowering with valsartan therapy. Valsartan could be a feasible antihypertensive regimen in terms of cerebral circulation in patients with cerebral small vessel disease.
本研究旨在探讨血管紧张素Ⅱ受体阻滞剂缬沙坦降压治疗对高血压伴脑小血管病患者脑血流动力学的影响。
我们使用正电子发射断层扫描和乙酰唑胺挑战试验来测量 8 例高血压患者（平均年龄 70.8 岁）在接受缬沙坦治疗前后的脑血流（CBF）和脑血管储备（CVR）。这些患者均有腔隙性梗死和脑白质病变。
缬沙坦治疗后，患者的全身血压明显降低。治疗前后的全球 CBF 分别为 38.2±5.6 mL/min/100 g 和 39.9±9.0 mL/min/100 g，CVR 分别为 52.2±18.4%和 39.7±18.9%。这些参数的差异无统计学意义。与治疗前相比，伴有中重度脑白质病变的放射冠区域的局部 CBF 和 CVR 在缬沙坦治疗后也得到了保留。
缬沙坦降压治疗后脑血流动力学得到了保留。在脑小血管病患者中，缬沙坦可能是一种可行的降压方案。
