College of Medical, Veterinary and Life Sciences, Institute of Cardiovascular & Medical Sciences, University of Glasgow, Gardiner Institute, Western Infirmary, Glasgow, UK.
College of Medical, Veterinary and Life Sciences, Institute of Health & Wellbeing, Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
Heart. 2014 Jul;100(14):1085-92. doi: 10.1136/heartjnl-2014-305683. Epub 2014 May 1.
Central blood pressure (CBP) and carotid intima-media thickness (CIMT) are surrogate measures of cardiovascular risk. Allopurinol reduces serum uric acid and oxidative stress and improves endothelial function and may therefore reduce CBP and CIMT progression. This study sought to ascertain whether allopurinol reduces CBP, arterial stiffness and CIMT progression in patients with ischaemic stroke or transient ischaemic attack (TIA).
We performed a randomised, double-blind, placebo-controlled study, examining the effect of 1-year treatment with allopurinol (300 mg daily), on change in CBP, arterial stiffness and CIMT progression at 1 year and change in endothelial function and circulating inflammatory markers at 6 months. Patients aged over 18 years with recent ischaemic stroke or TIA were eligible.
Eighty participants were recruited, mean age 67.8 years (SD 9.4). Systolic CBP [-6.6 mm Hg (95% CI -13.0 to -0.3), p=0.042] and augmentation index [-4.4% (95% CI -7.9 to -1.0), p=0.013] were each lower following allopurinol treatment compared with placebo at 12 months. Progression in mean common CIMT at 1 year was less in allopurinol-treated patients compared with placebo [between-group difference [-0.097 mm (95% CI -0.175 to -0.019), p=0.015]. No difference was observed for measures of endothelial function.
Allopurinol lowered CBP and reduced CIMT progression at 1 year compared with placebo in patients with recent ischaemic stroke and TIA. This extends the evidence of sustained beneficial effects of allopurinol to these prognostically significant outcomes and to the stroke population, highlighting the potential for reduction in cardiovascular events with this treatment strategy.
ISRCTN11970568.
中心血压（CBP）和颈动脉内膜中层厚度（CIMT）是心血管风险的替代指标。别嘌醇可降低血清尿酸和氧化应激水平，改善内皮功能，因此可能降低 CBP 和 CIMT 的进展。本研究旨在确定别嘌醇是否可降低缺血性卒中和短暂性脑缺血发作（TIA）患者的 CBP、动脉僵硬和 CIMT 进展。
我们进行了一项随机、双盲、安慰剂对照研究，以检测别嘌醇（每天 300mg）治疗 1 年对 1 年内 CBP、动脉僵硬和 CIMT 进展的影响，以及 6 个月内皮功能和循环炎症标志物的变化。年龄在 18 岁以上且近期发生缺血性卒中和 TIA 的患者符合条件。
共招募了 80 名参与者，平均年龄为 67.8 岁（标准差 9.4）。与安慰剂相比，在 12 个月时，CBP 收缩压[-6.6mmHg（95%CI-13.0 至-0.3），p=0.042]和增强指数[-4.4%（95%CI-7.9 至-1.0），p=0.013]均较低。与安慰剂相比，1 年内 CIMT 的平均总进展在别嘌醇治疗组中较少[组间差异[-0.097mm（95%CI-0.175 至-0.019），p=0.015]。内皮功能的测量无差异。
与安慰剂相比，别嘌醇可降低近期缺血性卒中和 TIA 患者的 CBP，并减少 1 年内的 CIMT 进展。这将别嘌醇的持续有益作用扩展到这些具有预后意义的结果和卒中人群，突出了这种治疗策略降低心血管事件的潜力。
ISRCTN80061426。
