Early Atherosclerotic Clinic (Bene Essere Donna & Cardiometabolic Center) of Policlinico Hospital, Institute of Cardiology, University of Modena and Reggio Emilia, Italy.
J Renin Angiotensin Aldosterone Syst. 2011 Dec;12(4):446-55. doi: 10.1177/1470320311415134. Epub 2011 Jul 20.
Endothelial dysfunction is a well-demonstrated independent predictor of cardiovascular events in hypertensive postmenopausal women. Accordingly, it is plausible that improving endothelial function could represent an adjunctive target for antihypertensive treatment. The aim of our study was to evaluate the effect of pharmacologic treatment on endothelial function in the specific population of hypertensive postmenopausal women.
A total of 320 consecutive hypertensive postmenopausal women underwent a high-resolution ultrasound study of the brachial artery at baseline and after six months, while 'optimal' control of blood pressure (maintenance of blood pressure values below 140/90 mmHg at all follow-up visits) was achieved using antihypertensive therapy. Endothelial function was measured as flow-mediated dilation, using ultrasound method.
After six months of treatment, flow-mediated dilatation (FMD) had significantly improved in the majority of patients (n = 257 [80.3% of the entire population]; FMD = 8.1 ± 1.0% at baseline vs. 10.6 ± 1.5% after follow-up; p < 0.001), but it had not changed or worsened in others (n = 63 [19.7%]; FMD = 8.2 ± 1.2% at baseline vs. 7.6 ± 1.0% after six months; p = ns). Improvement of endothelial function, at multivariate analysis, resulted independently associated with the use of aldosterone inhibitors (odds ratio = 2.15; 95% confidence interval: 1.55-2.75; p = 0.001).
This study demonstrates that a significant improvement in endothelial function may be obtained after six months of an optimal antihypertensive therapy. Among all hypertensive postmenopausal women that achieved an optimal control of blood pressure during follow-up, the use of drugs that inhibit aldosterone receptors was associated with an improvement of endothelial function, beyond the 'optimal' blood pressure control.
内皮功能障碍是高血压绝经后女性心血管事件的一个公认的独立预测因子。因此，改善内皮功能可能是降压治疗的一个附加目标。本研究旨在评估药物治疗对高血压绝经后女性特定人群内皮功能的影响。
共 320 例连续的高血压绝经后女性在基线和 6 个月时接受肱动脉高分辨率超声检查，同时通过降压治疗实现“最佳”血压控制（所有随访时血压值维持在 140/90mmHg 以下）。内皮功能通过超声方法测量血流介导的舒张。
在治疗 6 个月后，大多数患者（n=257[整个人群的 80.3%]）的血流介导舒张（FMD）显著改善（FMD=基线时 8.1±1.0%，随访时 10.6±1.5%；p<0.001），但其他人（n=63[19.7%]）则没有变化或恶化（FMD=基线时 8.2±1.2%，随访时 7.6±1.0%；p=ns）。多变量分析显示，内皮功能的改善与醛固酮抑制剂的使用独立相关（比值比=2.15；95%置信区间：1.55-2.75；p=0.001）。
本研究表明，经过 6 个月的最佳降压治疗，内皮功能可能显著改善。在所有随访期间血压控制达到“最佳”的高血压绝经后女性中，使用抑制醛固酮受体的药物与内皮功能的改善相关，超出了“最佳”血压控制的范围。
