Toyama Takuji, Sato Chizuru, Koyama Keiko, Kasama Shu, Murakami Jun, Yamashita Eiji, Kawaguchi Ren, Adachi Hitoshi, Hoshizaki Hiroshi, Oshima Shigeru
Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
Cardiology. 2012;122(4):230-6. doi: 10.1159/000339762. Epub 2012 Aug 14.
Hypertension impairs coronary endothelial cell function, coronary microvascular function and the coronary flow (CF) reserve (CFR). Angiotensin II receptor blockers (ARBs) have been reported to possibly improve coronary endothelial function and coronary microvascular function. The purpose of this study was to determine whether treatment with the ARB olmesartan was more effective for improving CFR than the calcium channel blocker amlodipine.
Twenty patients with untreated essential hypertension (M/F = 13/7, aged 55.6 ± 11.6 years) were randomly assigned to treatment with either olmesartan (n = 10) or amlodipine (n = 10) for 6 months. CF was measured in the proximal left anterior descending artery by magnetic resonance imaging before and during intravenous infusion of adenosine. CFR was calculated as the ratio of the hyperemic to baseline diastolic peak flow before and after 6 months of treatment.
The extent of systolic blood pressure reduction was similar in both groups (-40.0 ± 19.1 vs. -48.8 ± 14.7 mm Hg, p = 0.26). The olmesartan group showed significant improvement of CFR (from 1.9 ± 1.0 to 3.1 ± 1.1, p = 0.005), but this did not occur in the amlodipine group.
Olmesartan, but not amlodipine, improves CFR in hypertensive patients.
高血压会损害冠状动脉内皮细胞功能、冠状动脉微血管功能以及冠状动脉血流（CF）储备（CFR）。据报道，血管紧张素II受体阻滞剂（ARB）可能改善冠状动脉内皮功能和冠状动脉微血管功能。本研究的目的是确定使用ARB奥美沙坦治疗在改善CFR方面是否比钙通道阻滞剂氨氯地平更有效。
20例未经治疗的原发性高血压患者（男/女 = 13/7，年龄55.6±11.6岁）被随机分为两组，分别接受奥美沙坦（n = 10）或氨氯地平（n = 10）治疗6个月。在静脉输注腺苷之前和期间，通过磁共振成像测量左前降支近端的CF。CFR计算为治疗6个月前后充血期与基线舒张期峰值血流的比值。
两组收缩压降低程度相似（-40.0±19.1 vs. -48.8±14.7 mmHg，p = 0.26）。奥美沙坦组CFR有显著改善（从1.9±1.0提高到3.1±1.1，p = 0.005），但氨氯地平组未出现这种情况。
奥美沙坦可改善高血压患者的CFR，而氨氯地平则不能。
