膳食硝酸盐可使高血压患者血压持续降低：一项随机、2期、双盲、安慰剂对照研究。
Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: a randomized, phase 2, double-blind, placebo-controlled study.
作者信息
Kapil Vikas, Khambata Rayomand S, Robertson Amy, Caulfield Mark J, Ahluwalia Amrita
机构信息
From the William Harvey Research Institute, Barts BP Centre of Excellence, NIHR Cardiovascular Biomedical Research Unit at Barts, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
出版信息
Hypertension. 2015 Feb;65(2):320-7. doi: 10.1161/HYPERTENSIONAHA.114.04675. Epub 2014 Nov 24.
UNLABELLED
Single dose administration of dietary inorganic nitrate acutely reduces blood pressure (BP) in normotensive healthy volunteers, via bioconversion to the vasodilator nitric oxide. We assessed whether dietary nitrate might provide sustained BP lowering in patients with hypertension. We randomly assigned 68 patients with hypertension in a double-blind, placebo-controlled clinical trial to receive daily dietary supplementation for 4 weeks with either dietary nitrate (250 mL daily, as beetroot juice) or a placebo (250 mL daily, as nitrate-free beetroot juice) after a 2-week run-in period and followed by a 2-week washout. We performed stratified randomization of drug-naive (n=34) and treated (n=34) patients with hypertension aged 18 to 85 years. The primary end point was change in clinic, ambulatory, and home BP compared with placebo. Daily supplementation with dietary nitrate was associated with reduction in BP measured by 3 different methods. Mean (95% confidence interval) reduction in clinic BP was 7.7/2.4 mm Hg (3.6-11.8/0.0-4.9, P<0.001 and P=0.050). Twenty-four-hour ambulatory BP was reduced by 7.7/5.2 mm Hg (4.1-11.2/2.7-7.7, P<0.001 for both). Home BP was reduced by 8.1/3.8 mm Hg (3.8-12.4/0.7-6.9, P<0.001 and P<0.01) with no evidence of tachyphylaxis over the 4-week intervention period. Endothelial function improved by ≈20% (P<0.001), and arterial stiffness was reduced by 0.59 m/s (0.24-0.93; P<0.01) after dietary nitrate consumption with no change after placebo. The intervention was well tolerated. This is the first evidence of durable BP reduction with dietary nitrate supplementation in a relevant patient group. These findings suggest a role for dietary nitrate as an affordable, readily-available, adjunctive treatment in the management of patients with hypertension (funded by The British Heart Foundation).
CLINICAL TRIAL REGISTRATION URL
http://www.clinicaltrials.gov. Unique identifier: NCT01405898.
未标注
饮食中的无机硝酸盐单剂量给药可通过生物转化为血管舒张剂一氧化氮，在血压正常的健康志愿者中急性降低血压（BP）。我们评估了饮食中的硝酸盐是否能使高血压患者的血压持续降低。在一项双盲、安慰剂对照的临床试验中，我们将68例高血压患者随机分组，在为期2周的导入期后，每日接受4周的饮食补充，一组补充饮食中的硝酸盐（每日250毫升，作为甜菜根汁），另一组补充安慰剂（每日250毫升，作为无硝酸盐的甜菜根汁），随后是2周的洗脱期。我们对年龄在18至85岁、未服用过降压药物（n = 34）和正在接受治疗（n = 34）的高血压患者进行了分层随机分组。主要终点是与安慰剂相比，诊室、动态和家庭血压的变化。每日补充饮食中的硝酸盐与通过3种不同方法测量的血压降低有关。诊室血压的平均（95%置信区间）降低为7.7/2.4毫米汞柱（3.6 - 11.8/0.0 - 4.9，P < 0.001和P = 0.050）。24小时动态血压降低了7.7/5.2毫米汞柱（4.1 - 11.2/2.7 - 7.7，两者P < 0.001）。家庭血压降低了8.1/3.8毫米汞柱（3.8 - 12.4/0.7 - 6.9，P < 0.001和P < 0.01），在4周的干预期内没有快速耐受的证据。饮食中摄入硝酸盐后内皮功能改善约20%（P < 0.001），动脉僵硬度降低0.59米/秒（0.24 - 0.93；P < 0.01），而服用安慰剂后无变化。该干预耐受性良好。这是在相关患者群体中饮食补充硝酸盐可持久降低血压的首个证据。这些发现表明饮食中的硝酸盐在高血压患者管理中可作为一种经济实惠、易于获取的辅助治疗方法发挥作用（由英国心脏基金会资助）。
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