Paris Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France.
Am J Hypertens. 2013 Aug;26(8):1045-52. doi: 10.1093/ajh/hpt081. Epub 2013 Jun 4.
Central blood pressure (BP) is considered a better predictor of cardiovascular events than brachial BP. Modifications of central, beyond brachial BP, can be assessed by pressure amplification, a potential new cardiovascular risk factor. Comparison between drugs' effect on central hemodynamics has been poorly studied. Our aim was to assess the hemodynamic effect of a 12-week treatment with amlodipine 5mg, or candesartan 8mg, or indapamide sustained-release 1.5mg, in comparison with placebo.
We analyzed 145 out-patients with essential hypertension in primary prevention enrolled in the Natrilix SR Versus Candesartan and Amlodipine in the Reduction of Systolic Blood Pressure in Hypertensive Patients (X-CELLENT) study, a multicenter, randomized, double-blinded, placebo-controlled trial. Arterial stiffness, central BP, pressure amplification, and wave reflection were measured by applanation tonometry.
Baseline characteristics of patients were homogeneous between groups. After treatment, we found that active drugs produced similar reduction of both central and peripheral BPs, with no significant interdrug differences (all P < 0.05; excluded peripheral pulse pressure, compared with placebo). Second, amlodipine (1.9% ± 15.3%), candesartan (3.0% ± 14.6%) and indapamide (4.1% ± 14.4%) all increased pulse pressure amplification, but only indapamide was statistically different from placebo (P = 0.02). Finally, no significant changes were observed on pulse wave velocity, heart rate, and augmentation index.
The 3 antihypertensive drugs similarly reduced peripheral and central BP, as compared with placebo, but a significant increase in pulse pressure amplification was obtained only with indapamide, independently of arterial stiffness modifications.
3283161 by BIOPHARMA.
与肱动脉血压相比，中心血压（BP）被认为是心血管事件更好的预测因子。除肱动脉血压外，还可以通过压力放大来评估中心血压的变化，这是一个新的潜在心血管危险因素。药物对中心血液动力学影响的比较研究甚少。我们的目的是评估氨氯地平 5mg、坎地沙坦 8mg 或吲达帕胺缓释片 1.5mg 治疗 12 周对中心血液动力学的影响，并与安慰剂进行比较。
我们分析了原发性高血压患者中 145 例患者的资料，这些患者参加了 Natrilix SR 与坎地沙坦和氨氯地平在降低原发性高血压患者的收缩压中的比较（X-CELLENT）研究，这是一项多中心、随机、双盲、安慰剂对照试验。使用平板张力测定法测量动脉僵硬度、中心血压、压力放大和波反射。
各组患者的基线特征无差异。治疗后，我们发现，活性药物可使中心和外周血压均相似降低，且药物间无显著差异（均 P<0.05；与安慰剂相比，外周脉搏压除外）。其次，氨氯地平（1.9%±15.3%）、坎地沙坦（3.0%±14.6%）和吲达帕胺（4.1%±14.4%）均增加了脉搏压力放大，但只有吲达帕胺与安慰剂有统计学差异（P=0.02）。最后，脉搏波速度、心率和增强指数无显著变化。
与安慰剂相比，3 种降压药均能相似地降低外周和中心血压，但仅吲达帕胺可显著增加脉搏压力放大，且不依赖于动脉僵硬度的改变。
3283161，由 BIOPHARMA 注册。
