Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
Atherosclerosis. 2011 Mar;215(1):184-8. doi: 10.1016/j.atherosclerosis.2010.12.022. Epub 2010 Dec 30.
Excess aldosterone has a detrimental effect on large artery stiffness. We aimed to investigate the association of the change in plasma aldosterone concentration (PAC) by antihypertensive medication with the change in aortic pulse wave velocity (aPWV).
We conducted a prospective, randomized, open-label, blinded end-point study in 207 hypertensive patients. Patients received olmesartan monotherapy for 12 weeks, followed by add-on use of hydrochlorothiazide (HCTZ; n=104) or azelnidipine (n=103) for 24 weeks after randomization. The aPWV, which was determined by measuring the carotid to femoral PWV, and laboratory data were assessed at baseline and 24 weeks later.
PAC in the HCTZ group increased more than that in the azelnidipine group, while aPWV and mean arterial pressure in the azelnidipine group decreased more than those in the HCTZ group. In univariable analyses, the change in PAC was significantly and positively correlated with the change in aPWV in the total population (r=0.26, P<0.001) and the HCTZ group (r=0.28, P=0.004), but not in the azelnidipine group (r=0.17, P=0.09). In multivariable analyses, a positive association of the change in PAC with the change in aPWV was observed in the total population (standardized regression coefficient β=0.18, P<0.001) and the HCTZ group (β=0.23, P=0.004), independently of the changes in covariates, but not in the azelnidipine group (β=0.13, P=0.06).
The change in PAC was significantly and positively associated with the change in aPWV in patients treated with HCTZ. These findings may partly explain why thiazide diuretics have little effect on large artery stiffness.
过量的醛固酮对大动脉僵硬度有不利影响。我们旨在研究降压药物治疗后血浆醛固酮浓度（PAC）的变化与主动脉脉搏波速度（aPWV）的变化之间的关系。
我们在 207 名高血压患者中进行了一项前瞻性、随机、开放标签、盲终点研究。患者接受奥美沙坦单药治疗 12 周，随后在随机分组后 24 周加用氢氯噻嗪（HCTZ；n=104）或阿折地平（n=103）。通过测量颈动脉-股动脉脉搏波速度来确定 aPWV，并在基线和 24 周后评估实验室数据。
HCTZ 组的 PAC 增加多于阿折地平组，而阿折地平组的 aPWV 和平均动脉压下降多于 HCTZ 组。在单变量分析中，总人群（r=0.26，P<0.001）和 HCTZ 组（r=0.28，P=0.004）中 PAC 的变化与 aPWV 的变化呈显著正相关，但在阿折地平组中无相关性（r=0.17，P=0.09）。在多变量分析中，总人群（标准化回归系数β=0.18，P<0.001）和 HCTZ 组（β=0.23，P=0.004）中 PAC 变化与 aPWV 变化呈正相关，与协变量变化独立，但在阿折地平组中无相关性（β=0.13，P=0.06）。
在接受 HCTZ 治疗的患者中，PAC 的变化与 aPWV 的变化显著正相关。这些发现可能部分解释了噻嗪类利尿剂对大动脉僵硬度影响较小的原因。
