Denardo Scott J, Gong Yan, Cooper-DeHoff Rhonda M, Farsang Csaba, Keltai Matyas, Szirmai László, Messerli Franz H, Bavry Anthony A, Handberg Eileen M, Mancia Giuseppe, Pepine Carl J
Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, United States of America.
Center for Pharmacogenomics, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America.
PLoS One. 2015 Apr 2;10(4):e0122726. doi: 10.1371/journal.pone.0122726. eCollection 2015.
Elevated nighttime blood pressure (BP) and heart rate (HR), increased BP and HR variability, and altered diurnal variations of BP and HR (nighttime dipping and morning surge) in patients with systemic hypertension are each associated with increased adverse cardiovascular events. However, there are no reports on the effect of hypertension treatment on these important hemodynamic parameters in the growing population of hypertensive patients with atherosclerotic coronary artery disease (CAD). This was a pre-specified subgroup analysis of the INternational VErapamil SR-Trandolapril STudy (INVEST), which involved 22,576 clinically stable patients aged ≥ 50 years with hypertension and CAD randomized to either verapamil SR- or atenolol-based hypertension treatment strategies. The subgroup consisted of 117 patients undergoing 24-hour ambulatory monitoring at baseline and after 1 year of treatment. Hourly systolic and diastolic BP (SBP and DBP) decreased after 1 year for both verapamil SR- and atenolol-based treatment strategies compared with baseline (P<0.0001). Atenolol also decreased hourly HR (P<0.0001). Both treatment strategies decreased SBP variability (weighted standard deviation: P = 0.012 and 0.021, respectively). Compared with verapamil SR, atenolol also increased the prevalence of BP and HR nighttime dipping among prior non-dippers (BP: OR = 3.37; 95% CI: 1.26-8.97 P = 0.015; HR: OR = 4.06; 95% CI: 1.35-12.17; P = 0.012) and blunted HR morning surge (+2.8 vs. +4.5 beats/min/hr; P = 0.019). Both verapamil SR- and especially atenolol-based strategies resulted in favorable changes in ambulatory monitoring parameters that have been previously associated with increased adverse cardiovascular events.
系统性高血压患者夜间血压（BP）和心率（HR）升高、血压和心率变异性增加以及血压和心率的昼夜变化改变（夜间血压下降和清晨血压激增）均与不良心血管事件增加相关。然而，在患有动脉粥样硬化性冠状动脉疾病（CAD）的高血压患者不断增加的人群中，尚无关于高血压治疗对这些重要血流动力学参数影响的报道。这是国际维拉帕米缓释片 - 群多普利研究（INVEST）的一项预先指定的亚组分析，该研究纳入了22576名年龄≥50岁、患有高血压和CAD且临床稳定的患者，随机分为基于维拉帕米缓释片或阿替洛尔的高血压治疗策略组。该亚组由117名在基线和治疗1年后接受24小时动态监测的患者组成。与基线相比，基于维拉帕米缓释片和阿替洛尔的治疗策略在1年后每小时收缩压和舒张压（SBP和DBP）均下降（P<0.0001）。阿替洛尔还降低了每小时心率（P<0.0001）。两种治疗策略均降低了SBP变异性（加权标准差：分别为P = 0.012和0.021）。与维拉帕米缓释片相比，阿替洛尔还增加了既往无夜间血压下降者的血压和心率夜间下降的患病率（血压：OR = 3.37；95%CI：1.26 - 8.97；P = 0.015；心率：OR = 4.06；95%CI：1.35 - 12.17；P = 0.012），并减弱了心率清晨激增（+2.8对 +4.5次/分钟/小时；P = 0.019）。基于维拉帕米缓释片和特别是基于阿替洛尔的策略均导致动态监测参数出现有利变化，这些变化先前与不良心血管事件增加相关。
