Department of Pharmacology, INSERM U970, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.
Hypertension. 2010 Jun;55(6):1314-22. doi: 10.1161/HYPERTENSIONAHA.109.148999. Epub 2010 Apr 19.
The beta-blocker atenolol is less effective than angiotensin-receptor blockers and calcium-channel blockers for reducing central blood pressure (BP). The trial was designed to determine whether the advantages of angiotensin-receptor blockers over atenolol remained significant when both were combined with the calcium-channel blocker amlodipine. A prospective, randomized, blinded endpoint (PROBE design) parallel group, multicenter trial including 393 patients with essential hypertension resistant to 4 weeks of 5 mg of amlodipine was set out. Central systolic BP, augmentation index (AIx; either rough or adjusted on heart rate), and carotid-to-femoral pulse wave velocity were measured with applanation tonometry (SphygmoCor) at inclusion and after 8 and 24 weeks of active treatment with an amlodipine-valsartan combination (5/80 mg and then 10/160 mg) or an amlodipine-atenolol combination (5/50 mg and then 10/100 mg). From baseline to week 24, central systolic BP decreased significantly more in the amlodipine-valsartan group (-13.70+/-1.15 mm Hg; P<0.0001) than in the amlodipine-atenolol group (-9.70+/-1.10 mm Hg; P<0.0001; difference: -4.00 mm Hg [95% CI: -7.10 to -0.90]; P=0.013), despite similar changes in brachial systolic BP. The difference in rough AIx reduction was -6.5% (95% CI: -8.3 to -4.7; P<0.0001) in favor of amlodipine-valsartan. AIx adjusted on heart rate was significantly reduced in favor of amlodipine-valsartan (-2.8% [95% CI: -4.92 to -0.68]; P<0.01). Heart rate decreased significantly more with amlodipine-atenolol (difference: -11 bpm [95% CI: -14 to -8 bpm]; P<0.001). Pulse wave velocity decreased by 0.95 m/s in both groups with no significant difference. Differences in central systolic BP and rough AIx remained significant after adjustment to the changes in heart rate. The amlodipine-valsartan combination decreased central (systolic and pulse) pressure and AIx more than the amlodipine-atenolol combination.
美托洛尔的β受体阻滞剂不如血管紧张素受体阻滞剂和钙通道阻滞剂有效，用于降低中心血压（BP）。该试验旨在确定当血管紧张素受体阻滞剂与钙通道阻滞剂氨氯地平联合使用时，血管紧张素受体阻滞剂相对于美托洛尔的优势是否仍然显著。一项前瞻性、随机、盲终点（PROBE 设计）平行组、多中心试验，包括 393 名对 4 周 5mg 氨氯地平治疗有抵抗的原发性高血压患者。通过平板测压法（SphygmoCor）在纳入时和主动治疗 8 周和 24 周后测量中心收缩压、增强指数（AIx；心率粗糙或调整）和颈动脉-股动脉脉搏波速度，用氨氯地平-缬沙坦联合治疗（5/80mg，然后 10/160mg）或氨氯地平-阿替洛尔联合治疗（5/50mg，然后 10/100mg）。从基线到 24 周，与氨氯地平-阿替洛尔组（-9.70+/-1.10mm Hg；P<0.0001）相比，氨氯地平-缬沙坦组的中心收缩压明显下降更多（-13.70+/-1.15mm Hg；P<0.0001；差异：-4.00mm Hg [95%CI：-7.10 至-0.90]；P=0.013），尽管肱动脉收缩压的变化相似。粗糙 AIx 降低的差异为-6.5%（95%CI：-8.3 至-4.7；P<0.0001），有利于氨氯地平-缬沙坦。心率调整后的 AIx 明显降低，有利于氨氯地平-缬沙坦（-2.8% [95%CI：-4.92 至-0.68]；P<0.01）。与氨氯地平-阿替洛尔相比，氨氯地平-阿替洛尔的心率明显下降更多（差异：-11bpm [95%CI：-14 至-8bpm]；P<0.001）。两组脉搏波速度均下降 0.95m/s，无显著差异。心率变化调整后，中心收缩压和粗糙 AIx 的差异仍然显著。与氨氯地平-阿替洛尔联合治疗相比，氨氯地平-缬沙坦联合治疗降低了中心（收缩压和脉搏）压力和 AIx。
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