Muiesan Maria Lorenza, Salvetti Massimo, Belotti Eugenia, Paini Anna, Rosei Claudia Agabiti, Aggiusti Carlo, Scotti Aurelio, de Ciuceis Carolina, Rizzoni Damiano, Rosei Enrico Agabiti
Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, Italy.
Blood Press. 2011 Aug;20(4):244-51. doi: 10.3109/08037051.2011.561072. Epub 2011 Feb 21.
BACKGROUND. In hypertensive patients, endothelial dysfunction is associated with an increased incidence of cardiovascular events. Calcium-channel antagonists can reverse impaired endothelium-dependent vasodilation in different vascular districts, while conflicting results are found in the brachial artery. Aim. To investigate the effect of barnidipine in comparison with hydrochlorothiazide on endothelial function of hypertensives, as assessed by flow-mediated vasodilation (FMD) of the brachial artery. METHODS. Patients with mild to moderate hypertension (age range 26-67 years) were randomized to receive barnidipine or hydrochlorothiazide. A thorough clinical examination, including blood pressure (BP) measurement, was performed at randomization as well as after 6, 12 and 24 weeks. FMD and 24-h BP monitoring was performed at randomization, after 12 and 24 weeks. RESULTS. After 12 and 24 weeks of treatment, a significant reduction in clinic BP was observed in both groups. Furthermore, a significant reduction in 24-h SBP and DBP was observed in patients receiving barnidipine but not in those receiving diuretic. The percentage change in FMD was different between the two groups of patients treated with barnidipine (at 12 weeks +1.2 ± 2.2%, p = 0.023 and at 24 weeks +1.25 ± 3.15%, p = 0.16 from baseline) or with hydrochlorothiazide (at 12 weeks -1.0 ± 3.0. p = 0.09 and at 24 weeks -1.78 ± 2.9%, p = 0.015 from baseline). A significant difference in FMD changes between the two groups was confirmed by analysis of covariance (p = 0.031). CONCLUSIONS. In presence of a similar clinic BP reduction, an improvement of endothelial function was observed during treatment with barnidipine but not with hydrochlorothiazide, suggesting that the barnidipine may exert a favourable effect on endothelial dysfunction in hypertensive patients.
背景。在高血压患者中，内皮功能障碍与心血管事件发生率增加相关。钙通道拮抗剂可逆转不同血管区域内皮依赖性血管舒张功能受损，而肱动脉的研究结果则相互矛盾。目的。通过肱动脉血流介导的血管舒张功能（FMD）评估，比较巴尼地平与氢氯噻嗪对高血压患者内皮功能的影响。方法。轻度至中度高血压患者（年龄范围26 - 67岁）被随机分为接受巴尼地平或氢氯噻嗪治疗组。在随机分组时以及6、12和24周后进行全面的临床检查，包括测量血压（BP）。在随机分组时、12周和24周后进行FMD和24小时血压监测。结果。治疗12周和24周后，两组患者的诊室血压均显著降低。此外，接受巴尼地平治疗的患者24小时收缩压和舒张压显著降低，而接受利尿剂治疗的患者则未出现此现象。两组接受巴尼地平（12周时+1.2±2.2%，p = 0.023；24周时+1.25±3.15%，与基线相比p = 0.16）或氢氯噻嗪（12周时 -1.0±3.0，p = 0.09；24周时 -1.78±2.9%，与基线相比p = 0.015）治疗的患者FMD的百分比变化不同。协方差分析证实两组之间FMD变化存在显著差异（p = 0.031）。结论。在诊室血压降低程度相似的情况下，巴尼地平治疗期间观察到内皮功能改善，而氢氯噻嗪治疗则未出现此现象，这表明巴尼地平可能对高血压患者的内皮功能障碍发挥有益作用。
