Bălan H
Carol Davila University of Medicine and Pharmacy, Bucharest Medical Clinic, Clinical Emergency Hospital, Ilfov County, Romania.
Rom J Intern Med. 2009;47(4):355-61.
The "manometric" way of considering the complex management of high blood pressure (HBP) must remain ancient history. The huge therapeutical armamentarium existing nowadays allows us to select the drug/s most appropriate for the comorbidities/particularities of each case. The BP level target, unanimously considered a very important element of HBP management, must not be the only one. The so-called pleiotropic effects of the different classes of antihypertensive drugs must always influence our way of thinking. Another important possibility to improve the therapeutical efficacy of the antihypertensive treatment is chronotherapy. The aim of the present study is to demonstrate the possibility of some benefic effects by imposing, by chronotherapy, a "normal" "dipping" status of the BP values. Among the surrogate end-points that can be used to demonstrate the benefits of this kind of HBP management we chose the structural and functional cardiac parameters, echocardiographically determined--using the criteria of the American Society of Echocardiography. We studied the evolution of these parameters of the left ventricle (LV) and we have evaluated them after 3 months of once-a-day morning (at awakening) administration, and respectively after 3 months of once-a-day administration in the evening (at bedtime) of: Prestarium (perindopril) cp 10 mg Tarka (cp 180 mg verapamil hydrochloride/2 mg trandolapril) Norvasc (amlodipine besilat) cp 10 mg as monotherapy, in 60 patients. We studied the anatomical parameters of the left ventricle (dimensions measured enddiastolically: the thickness of the interventricular septum, the thickness of the posterior wall, the internal diameter of the LV), the LV mass (which has a cutedge value for hypertrophy of the LV-LVH--of 134 g/m2 for men and 110 g/m2 for women) and the functional parameters, systolic as diastolic of the LV. We noticed a statistically significant reduction (p < 0.05) in all the 3 subgroups, of the functional parameters, these ones becoming similar to those in normotensive subjects only after the evening (at bedtime) administration of the studied drugs. The differences between the 3 subgroups for all the studied parameters, also in comparison with the normotensive subjects, have not been statistically significant after vesperal (at bedtime) administration of the studied drugs. It is, thus, possible that by an optimal treatment, chronotherapeutically "tailored", to obtain a normalisation of the anatomical and functional parameters of the LV and a significant improvement of the prognosis of these patients.
那种通过“测压法”来考虑高血压综合管理的方式必定已成为历史。如今现有的庞大治疗手段使我们能够为每个病例的合并症/特殊情况选择最合适的药物。血压水平目标，尽管一直被视为高血压管理中非常重要的一个要素，但绝不应是唯一要素。不同类别的降压药所具有的所谓多效性效应必须始终影响我们的思维方式。改善降压治疗疗效的另一个重要可能性是时间治疗法。本研究的目的是通过时间治疗法使血压值呈现“正常”的“勺型”状态，以此来证明可能存在的一些有益效果。在可用于证明这种高血压管理益处的替代终点指标中，我们选择了经超声心动图测定的心脏结构和功能参数——采用美国超声心动图学会的标准。我们研究了左心室这些参数的变化情况，并在每天早晨（醒来时）服用一次药物3个月后，以及分别在每天晚上（就寝时）服用一次药物3个月后，对以下药物进行了评估：普乐欣（培哚普利）10毫克片、达利全（180毫克盐酸维拉帕米/2毫克群多普利）、络活喜（苯磺酸氨氯地平）10毫克片，作为单一疗法，共60例患者。我们研究了左心室的解剖参数（舒张末期测量的维度：室间隔厚度、后壁厚度、左心室内径）、左心室质量（左心室肥厚——LVH的临界值，男性为134克/平方米，女性为110克/平方米）以及左心室的收缩和舒张功能参数。我们注意到，在所有3个亚组中，功能参数均有统计学意义的降低（p<0.05），这些参数仅在晚上（就寝时）服用所研究药物后才变得与血压正常者相似。在所研究药物晚上（就寝时）服用后，与血压正常者相比，所有研究参数在3个亚组之间的差异也无统计学意义。因此，通过一种经过时间治疗法“量身定制”的优化治疗，有可能使左心室的解剖和功能参数正常化，并显著改善这些患者的预后。
