Central Clinical Laboratory, Nara Medical University, 634-8522, 840 Shijo, Kashihara, Nara, Japan.
Hypertension. 2012 Aug;60(2):326-32. doi: 10.1161/HYPERTENSIONAHA.111.189209. Epub 2012 Jul 2.
Recently, coronary microvascular function was documented to be impaired even in patients with prehypertension. However, the impact of antihypertensive level on improvement of coronary microvascular dysfunction in hypertensive patients remains to be established. We investigated the optimal blood pressure achieved with treatment of antihypertensive agents for improvement of coronary microvascular dysfunction in hypertensive patients. We prospectively studied 108 untreated hypertensive patients. All patients were treated with antihypertensive agents for approximately 12 months. Coronary flow reserve (CFR) was measured before and after treatment. The patients were divided into hypertensive, prehypertensive, and normal groups based on their average blood pressure during the treatment period. Pretreatment CFR was similar among all groups. CFR increased significantly in the normal group during the treatment period, but decreased significantly in the prehypertensive and hypertensive groups. This decrease was significantly greater in the hypertensive group than in the prehypertensive group. Multivariate analysis showed lowering blood pressure to normal level to be an independent determinant of improvement in CFR. The normal group was divided into normal-higher and normal-lower subgroups based on their average diastolic blood pressure during the treatment period. Increase in CFR was significantly greater in the normal-higher group than in the normal-lower group. These findings indicate that lowering blood pressure to a normal level is necessary to improve coronary microvascular dysfunction in hypertensive patients. Furthermore, raising diastolic blood pressure to a higher level within normal range has the most beneficial effect. However, as this study is based on observational design, it may have several limitations.
最近，即使在患有高血压前期的患者中，也发现冠状动脉微血管功能受损。然而，降压水平对高血压患者冠状动脉微血管功能障碍改善的影响仍有待确定。我们研究了降压药物治疗改善高血压患者冠状动脉微血管功能障碍的最佳血压。我们前瞻性研究了 108 例未经治疗的高血压患者。所有患者均接受降压药物治疗约 12 个月。在治疗前后测量了冠状动脉血流储备（CFR）。根据治疗期间的平均血压，将患者分为高血压、高血压前期和正常血压组。治疗前，所有组的 CFR 相似。在治疗期间，正常组的 CFR 显著增加，但高血压前期和高血压组的 CFR 显著降低。高血压组的降低幅度明显大于高血压前期组。多变量分析显示，将血压降至正常水平是 CFR 改善的独立决定因素。根据治疗期间的平均舒张压，将正常组分为正常高值组和正常低值组。正常高值组的 CFR 增加幅度明显大于正常低值组。这些发现表明，将血压降至正常水平是改善高血压患者冠状动脉微血管功能障碍所必需的。此外，将舒张压升高至正常范围内的较高水平具有最有益的效果。然而，由于本研究基于观察性设计，可能存在一些局限性。
