Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark.
Am J Hypertens. 2012 Sep;25(9):1017-23. doi: 10.1038/ajh.2012.81. Epub 2012 Jun 14.
Pharmaceutical differences in central hemodynamics might influence cardiac response to antihypertensive treatment despite similar lowering of brachial blood pressure (BP).
Data from all patients with at least two echocardiographic examinations in the Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) echocardiographic substudy (n = 801); high-risk patients on losartan- vs. atenolol-based antihypertensive therapy. Echocardiography was performed annually for 4 years to measure stroke index (SI), heart rate, cardiac index (CI), conduit artery stiffness assessed as pulse pressure/stroke index (PP/SI) and total peripheral resistance index (TPRI).
Atenolol- and losartan-based therapy reduced BP similarly (cumulative difference in mean brachial blood pressure 0.3 mm Hg, P = 0.65). After 4 years the cumulative means of SI and heart rate were 1.8 ml/m(2) higher and 5.7 beats/min lower on atenolol-based treatment, respectively (both P < 0.001). This kept CI below baseline in atenolol-treated patients, whereas in the losartan group CI was unchanged from baseline throughout the study. TPRI was decreased more and remained lower in the losartan group (cumulative difference in mean TPRI 287 dynes/sec(-5)/cm/m(2), P < 0.001). These findings partly explained univariate differences in systolic- and diastolic function indices between the two treatments; fully adjusted losartan was only associated with a smaller left atrial diameter (cumulative mean difference 0.07 cm; 95% confidence intervals, -0.13 to -0.01, P = 0.03).
Contrasting hemodynamics impacted cardiac response to similar reductions in brachial BP on losartan- vs. atenolol-based therapy. The similar reduction of PP/SI suggests that the antihypertensive regimens used in the LIFE study had comparable effects on arterial stiffness (LIFE study; NCT00338260)
尽管肱动脉血压（BP）降低相似，但药物引起的中心血液动力学差异可能影响降压治疗后的心脏反应。
来自洛沙坦干预终点减少高血压（LIFE）超声心动图子研究中至少进行了两次超声心动图检查的所有患者的数据（n=801）；接受洛沙坦-与阿替洛尔为基础的降压治疗的高危患者。在 4 年内每年进行超声心动图检查，以测量卒中指数（SI）、心率、心输出量（CI）、脉搏压/卒中指数（PP/SI）评估的导管动脉僵硬度和外周总阻力指数（TPRI）。
阿替洛尔和洛沙坦的治疗降低血压相似（平均肱动脉血压的累积差异为 0.3mmHg，P=0.65）。4 年后，阿替洛尔治疗组的 SI 和心率的累积平均值分别高出 1.8ml/m2和 5.7 次/分（均 P<0.001）。这使得阿替洛尔治疗患者的 CI 低于基线，而在洛沙坦组中，CI 在整个研究期间均保持与基线一致。TPRI 降低更多且一直低于洛沙坦组（TPRI 的平均累积差异为 287 dynes/sec(-5)/cm/m2，P<0.001）。这些发现部分解释了两种治疗方法之间的收缩期和舒张功能指数的单变量差异；经完全调整后，洛沙坦仅与较小的左心房直径相关（累积平均差异 0.07cm；95%置信区间，-0.13 至 -0.01，P=0.03）。
对比血液动力学影响了洛沙坦与阿替洛尔治疗时相似的肱动脉 BP 降低对心脏反应的影响。PP/SI 的相似降低表明，LIFE 研究中使用的降压方案对动脉僵硬度有相似的影响（LIFE 研究；NCT00338260）。
