比较替米沙坦与美托洛尔对高血压患者动脉僵硬度的影响：前瞻性随机平行组试验。
To compare the effect of Telmisartan with Metoprolol on arterial stiffness in hypertension: prospective randomized parallel group trial.
作者信息
Sumbria Minakshi, Negi Prakash C, Sahai Ashok K, Kaundal Purshotam K
机构信息
Senior Resident, Department of Pharmacology, IGMC, Shimla, India.
Prof and Head, Department of Cardiology, IGMC, Shimla, India.
出版信息
Indian Heart J. 2014 Jul-Aug;66(4):415-21. doi: 10.1016/j.ihj.2014.05.020. Epub 2014 Jun 14.
BACKGROUND
Hypertension is often complicated by increased arterial stiffness and is an independent predictor of adverse cardiovascular (CV) outcome. Beta blockers and angiotensin receptor blockers (ARBs) are commonly used antihypertensive agents. The effect of beta blockers and ARBs on arterial stiffness has not been compared adequately. The aim of the present study is to compare the effect of telmisartan with metoprolol on arterial stiffness in hypertensive patients in prospective open label randomized parallel group intervention study.
METHODS
100 patients of hypertension, not on any antihypertensive agents, were enrolled after obtaining informed consent. Baseline recording of data related to demographics, CV risk factors, anthropometry and BP were made. Arterial stiffness was measured noninvasively by recording pulse wave velocity (PWV) using periscope (Genesis medical system). Left ventricular (LV) mass was measured using 2D guided M-mode echocardiography. Blood sugar, renal function, lipids and uric acid estimations were done in fasting state. Patients were randomized to receive metoprolol and telmisartan using stratified randomization technique. Dose of the study drugs were titrated to achieve target BP of <140/90 mmHg. Data related to PWV, BP, anthropometry and blood biochemistry was repeated after 6 months of treatment with study drugs.
RESULTS
Telmisartan resulted in significantly greater reduction in arterial stiffness index (ASI) in left and right lower limb arterial bed (39.9 ± 11.7 vs. 46.8 ± 17.0 m/s, p < 0.02) and (36.4 ± 9.6 vs. 44.86 ± 15.1 m/s, p < 0.002) respectively and systolic blood pressure (SBP) (-4.9 mmHg with 95% C.I. of -8.0-1.7 mmHg, p < 0.003) compared to metoprolol. Reduction in diastolic blood pressure (DBP) in telmisartan and metoprolol groups was not different statistically (-1.0 mmHg with 95% C.I. of -3.3-1.2 mmHg, p < 0.3). The change in LV mass was not significantly different between the study groups (135.5 ± 37.6 vs. 143.2 ± 41.5, p < 0.3).
背景
高血压常伴有动脉僵硬度增加，是不良心血管（CV）结局的独立预测因素。β受体阻滞剂和血管紧张素受体阻滞剂（ARB）是常用的抗高血压药物。β受体阻滞剂和ARB对动脉僵硬度的影响尚未得到充分比较。本研究的目的是在前瞻性开放标签随机平行组干预研究中，比较替米沙坦与美托洛尔对高血压患者动脉僵硬度的影响。
方法
在获得知情同意后，纳入100例未服用任何抗高血压药物的高血压患者。记录与人口统计学、CV危险因素、人体测量学和血压相关的基线数据。使用潜望镜（Genesis医疗系统）记录脉搏波速度（PWV），以无创方式测量动脉僵硬度。使用二维引导M型超声心动图测量左心室（LV）质量。在空腹状态下进行血糖、肾功能、血脂和尿酸测定。采用分层随机技术将患者随机分为接受美托洛尔和替米沙坦治疗组。调整研究药物剂量以达到目标血压<140/90 mmHg。在使用研究药物治疗6个月后，重复记录与PWV、血压、人体测量学和血液生化相关的数据。
结果
与美托洛尔相比，替米沙坦使左下肢和右下肢动脉床的动脉僵硬度指数（ASI）显著降低（分别为39.9±11.7 vs. 46.8±17.0 m/s，p<0.02）和（36.4±9.6 vs. 44.86±15.1 m/s，p<0.002），收缩压（SBP）降低（-4.9 mmHg，95%置信区间为-8.0-1.7 mmHg，p<0.003）。替米沙坦组和美托洛尔组舒张压（DBP）的降低在统计学上无差异（-1.0 mmHg，95%置信区间为-3.3-1.2 mmHg，p<0.3）。研究组之间左心室质量的变化无显著差异（135.5±37.6 vs. 143.2±41.5，p<0.3）。
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