Department of Non-Invasive Investigations, PARCC Inserm U, Inserm U, Lariboisière Hospital, AP-HP, University Paris Diderot, France.
Am J Hypertens. 2010 Oct;23(10):1136-43. doi: 10.1038/ajh.2010.115. Epub 2010 May 27.
Microvascular rarefaction and endothelium dysfunction are hallmarks of hypertension. We assessed whether antihypertensive treatments affect the microcirculation and whether the fixed-dose combination perindopril/indapamide (per/ind) modifies the microcirculation of hypertensive patients independently of blood pressure reduction.
One hundred ninety-three consecutive patients were enrolled into one of four groups depending on their blood pressure and existing treatment: (i) controlled hypertensive patients treated with per/ind (controlled-per/ind), (ii) controlled hypertensive patients treated with agents other than angiotensin-converting enzyme (ACE) inhibitors or diuretics (controlled-other), (iii) uncontrolled hypertensive patients treated with agents other than ACE inhibitors or diuretics (uncontrolled-other), (iv) untreated normotensive subjects. Macro- and microcirculation parameters were evaluated once in every patient. We used intravital video microscopy to measure dermal capillary density in the dorsum of the fingers. Microvascular endothelial function was assessed by measuring the perfusion increases after pilocarpine iontophoresis and central hemodynamic parameters by tonometry.
Capillary density was significantly higher in controlled-per/ind patients (99 ± 12 capillaries/mm(2)) than in all other groups (P < 0.05). Controlled-per/ind patients had a significantly greater endothelial response to pilocarpine than patients from all other groups (P < 0.05). Central hemodynamic parameters were similarly improved in both controlled groups compared with the uncontrolled-other group (P < 0.05).
Thus, hypertensive patients with blood pressure controlled with the combination per/ind had normalized capillary density and endothelial function, whereas other antihypertensive treatments, excluding ACE inhibitors or diuretics, had less effect despite similar blood pressure control.
微血管稀疏和内皮功能障碍是高血压的标志。我们评估了抗高血压治疗是否会影响微循环，以及固定剂量联合制剂培哚普利/吲达帕胺（培哚普利/吲达帕胺）是否会独立于血压降低而改变高血压患者的微循环。
根据血压和现有治疗情况，193 例连续患者被分为四组之一：（i）接受培哚普利/吲达帕胺（控制培哚普利/吲达帕胺）治疗的血压控制的高血压患者；（ii）接受血管紧张素转换酶（ACE）抑制剂或利尿剂以外的药物治疗的血压控制的高血压患者（控制其他药物）；（iii）接受 ACE 抑制剂或利尿剂以外的药物治疗的血压未控制的高血压患者（未控制其他药物）；（iv）未接受治疗的正常血压受试者。每位患者均评估宏观和微循环参数。我们使用活体视频显微镜测量手指背部的皮肤毛细血管密度。通过测量毛果芸香碱离子电渗后的灌注增加来评估微血管内皮功能，通过张力测量中心血液动力学参数。
与所有其他组（P < 0.05）相比，控制培哚普利/吲达帕胺患者的毛细血管密度明显更高（99 ± 12 个毛细血管/mm2）。与所有其他组相比，控制培哚普利/吲达帕胺患者对毛果芸香碱的内皮反应明显更大（P < 0.05）。与未控制的其他组相比，两组控制组的中心血液动力学参数均得到了类似的改善（P < 0.05）。
因此，血压控制在培哚普利/吲达帕胺联合治疗的高血压患者中，毛细血管密度和内皮功能正常，而其他降压治疗，除 ACE 抑制剂或利尿剂外，尽管血压控制相似，但效果较差。
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