Kollias Anastasios, Rarra Vayia, Karpettas Nikos, Roussias Leonidas, O'Brien Eoin, Stergiou George S
Hypertension Center, STRIDE -7, Third University Department of Medicine, Sotiria Hospital, Athens, Greece.
Conway Institute, University College, Dublin, Ireland.
Hypertens Res. 2015 Sep;38(9):627-31. doi: 10.1038/hr.2015.44. Epub 2015 Mar 26.
The ambulatory arterial stiffness index (AASI) has been introduced as an index of arterial function, predicting cardiovascular events. However, treatment-induced changes in AASI are rather equivocal. This study aims to: (i) present the results of treatment-induced changes in AASI in untreated subjects with elevated blood pressure (BP), subjected to antihypertensive treatment for 1 year and (ii) perform a meta-analysis of studies reporting on treatment-induced change in AASI. A total of 104 subjects (mean age 51.4±10.3 years, 62% males, mean follow-up: 13.6±2.4 months) were analyzed. Despite significant reductions in 24-h ambulatory systolic/diastolic BP, pulse pressure and pulse wave velocity (mean change: -15.9±12/-10.4±7.6 mm Hg, -5.4±6.8 mm Hg, -0.7±1.9 m s(-1), respectively, all P<0.05), there was no significant change (Follow up-Baseline) in AASI values (mean change: 0.01±0.17, P=not significant). The treatment-induced change in AASI was correlated with baseline AASI (r=-0.61), baseline 24-h pulse pressure (-0.26), treatment-induced change in 24-h pulse pressure (0.26) and in systolic/diastolic nocturnal dipping (-0.25/-0.40, respectively). Meta-analysis of eight trials (n=990) revealed a marginal decrease in AASI with antihypertensive treatment (pooled change: -0.018 (95% confidence interval (CI): -0.033,-0.003)). When the analysis was restricted to data with renin-angiotensin system blockers (n=755, 76% of total), the results did not significantly change (pooled change -0.028 (95% CI -0.048, -0.007)). In conclusion, although AASI is an independent predictor of cardiovascular events, its response to antihypertensive treatment is only marginal and clinically uncertain, which may render its use as a therapeutic target in clinical practice questionable.
动态动脉僵硬度指数（AASI）已被引入作为动脉功能指标，用于预测心血管事件。然而，治疗引起的AASI变化相当不明确。本研究旨在：（i）呈现未经治疗的高血压患者接受1年抗高血压治疗后AASI的治疗诱导变化结果，以及（ii）对报告AASI治疗诱导变化的研究进行荟萃分析。共分析了104名受试者（平均年龄51.4±10.3岁，62%为男性，平均随访时间：13.6±2.4个月）。尽管24小时动态收缩压/舒张压、脉压和脉搏波速度显著降低（平均变化分别为：-15.9±12/-10.4±7.6 mmHg、-5.4±6.8 mmHg、-0.7±1.9 m s⁻¹，均P<0.05），但AASI值无显著变化（随访-基线，平均变化：0.01±0.17，P=不显著）。治疗诱导的AASI变化与基线AASI（r=-0.61）、基线24小时脉压（-0.26）、治疗诱导的24小时脉压变化（0.26）以及收缩压/舒张压夜间下降（分别为-0.25/-0.40）相关。八项试验（n=990）的荟萃分析显示，抗高血压治疗后AASI略有下降（合并变化：-0.018（95%置信区间（CI）：-0.033，-0.003））。当分析仅限于肾素-血管紧张素系统阻滞剂的数据时（n=755，占总数的76%），结果无显著变化（合并变化-0.028（95%CI-0.048，-0.007））。总之，尽管AASI是心血管事件的独立预测因子，但其对抗高血压治疗的反应仅为轻微且临床不确定，这可能使其在临床实践中作为治疗靶点的应用受到质疑。
