Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu, 1, Place du Parvis Notre-Dame, 75181 Paris Cedex 04, France.
Hypertension. 2011 Aug;58(2):155-60. doi: 10.1161/HYPERTENSIONAHA.111.174383. Epub 2011 Jul 11.
To investigate the effect of different antihypertensive agents on blood pressure (BP) variability (BPV) and the underlying mechanism, we analyzed the ambulatory BP monitoring data of 577 patients before and after 3-month antihypertensive treatment, in the Natrilix SR Versus Candesartan and Amlodipine in the Reduction of Systolic Blood Pressure in Hypertensive Patients (X-CELLENT) Study, a multicenter, multinational, randomized, double-blind, placebo-controlled study with 4 parallel treatment arms (placebo, candesartan, indapamide sustained release, and amlodipine). Within-subject mean and SD of 24-hour BP, weighted by time interval between consecutive readings, were calculated in 3 time frames (daytime, nighttime, and 24 hours) to evaluate BP and BPV. The mean 24-hour heart rate (HR) and HR variability were calculated with the same algorithms. We found that the 3 antihypertensive drugs had a similar BP-lowering effect (P<0.001 for all), but amlodipine (P<0.007) and indapamide sustained release (P<0.04) were the only agents associated with a significantly decreased BPV after 3-month treatment. On the other hand, the major determinants of BPV at baseline were age, mean BP, and the corresponding HR variability. However, the reduction in BPV by amlodipine was significantly associated with the reduction in BP (P<0.006) and the reduction in HR variability (P<0.02), whereas the corresponding reduction by indapamide sustained release was only associated with the reduction in HR variability at night (P=0.004). In summary, 3-month amlodipine or indapamide sustained release treatment was associated with a significant reduction in BPV, and the mechanism of those reductions was possibly attributable to lowering BP or ameliorating the autonomic nervous system regulation or both. The combination of the 2 agents might help to optimize such properties.
为了研究不同降压药物对血压变异性（BPV）的影响及其潜在机制，我们分析了 Natrilix SR 与坎地沙坦和氨氯地平在高血压患者收缩压降低中的比较（XCELLENT）研究中 577 例患者 3 个月降压治疗前后的动态血压监测数据。这是一项多中心、多国、随机、双盲、安慰剂对照研究，有 4 个平行治疗组（安慰剂、坎地沙坦、吲达帕胺缓释片和氨氯地平）。采用时间加权间隔法计算 3 个时间窗（白天、夜间和 24 小时）内 24 小时 BP 平均值和标准差（BPV），并对 BP 和 BPV 进行评估。采用相同算法计算平均 24 小时心率（HR）和 HRV。我们发现，3 种降压药的降压效果相似（所有 P<0.001），但氨氯地平（P<0.007）和吲达帕胺缓释片（P<0.04）是仅有的 3 种在 3 个月治疗后显著降低 BPV 的药物。另一方面，BPV 的基线主要决定因素为年龄、平均 BP 和相应的 HRV。然而，氨氯地平降低 BPV 与降低 BP（P<0.006）和降低 HRV（P<0.02）显著相关，而吲达帕胺缓释片的对应降低仅与夜间 HRV 降低相关（P=0.004）。总之，3 个月氨氯地平或吲达帕胺缓释片治疗与 BPV 显著降低相关，这些降低的机制可能归因于降低 BP 或改善自主神经系统调节或两者兼而有之。这两种药物的联合可能有助于优化这些特性。
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