Tada Yoshiteru, Yagi Kenji, Uno Masaaki, Matsushita Nobuhisa, Kanematsu Yasuhisa, Kuwayama Kazuyuki, Shimada Kenji, Nishi Kyoko, Hirasawa Motohiro, Satomi Junichiro, Kitazato Keiko T, Kageji Teruyoshi, Matsuura Eiji, Nagahiro Shinji
Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
J Stroke Cerebrovasc Dis. 2015 Jul;24(7):1487-92. doi: 10.1016/j.jstrokecerebrovasdis.2015.03.015. Epub 2015 Apr 16.
Managing hypertension is crucial for preventing stroke recurrence. Some stroke patients experience resistant hypertension. In our experimental stroke model, olmesartan increased the expression of angiotensin (Ang) II converting enzyme-2. We hypothesized that switching to olmesartan affects biomarkers and the blood pressure (BP) in stroke patients whose BP is insufficiently controlled by standard doses of Ang II type I receptor blockers (ARBs) other than olmesartan.
We recruited 25 patients to study our hypothesis. All had a history of stroke or silent cerebral infarction. We switched them to olmesartan (10-40 mg per day) for 12 weeks and determined their plasma level of Ang-(1-7), peroxiredoxin, oxidized low-density lipoprotein (oxLDL)/β-2-glycoprotein I (β2GPI) complex, adiponectin, high mobility group box 1 (HMGB1), and tumor necrosis factor-α (TNFα) and recorded their BP before and after olmesartan treatment.
After switching the patients to olmesartan, their plasma level of Ang-(1-7) as a vasoprotective indicator and adiponectin regulating metabolic syndrome was increased, and peroxiredoxin and the oxLDL/β2GPI complex indicating its antioxidative stress and its proatherogenicity were lower than their baseline. This suggests that olmesartan may be more effective than other ARBs to improve these conditions. Neither HMGB1 nor TNFα reflecting an inflammatory response was affected, suggesting that the anti-inflammatory effects of olmesartan are similar to those of other ARBs. The recommended BP (<140/90) was obtained in 10 of the 25 patients after switching to olmesartan. No adverse events occurred.
Switching from other ARBs to olmesartan may be a promising therapeutic option in patients with resistant hypertension.
控制高血压对于预防中风复发至关重要。一些中风患者存在顽固性高血压。在我们的实验性中风模型中，奥美沙坦可增加血管紧张素（Ang）II转换酶-2的表达。我们推测，对于血压未被除奥美沙坦之外的标准剂量I型血管紧张素II受体阻滞剂（ARB）充分控制的中风患者，改用奥美沙坦会影响生物标志物和血压（BP）。
我们招募了25名患者来研究我们的假设。所有患者均有中风或无症状性脑梗死病史。我们将他们改用奥美沙坦（每日10 - 40毫克）治疗12周，并测定他们血浆中血管紧张素-（1 - 7）、过氧化物酶、氧化型低密度脂蛋白（oxLDL）/β-2糖蛋白I（β2GPI）复合物、脂联素、高迁移率族蛋白B1（HMGB1）和肿瘤坏死因子-α（TNFα）的水平，并记录奥美沙坦治疗前后的血压。
将患者改用奥美沙坦后，作为血管保护指标的血浆血管紧张素-（1 - 7）水平以及调节代谢综合征的脂联素水平升高，而过氧化物酶以及表明其抗氧化应激和促动脉粥样硬化性的oxLDL/β2GPI复合物低于基线水平。这表明奥美沙坦在改善这些状况方面可能比其他ARB更有效。反映炎症反应的HMGB1和TNFα均未受影响，这表明奥美沙坦的抗炎作用与其他ARB相似。改用奥美沙坦后，25名患者中有10名达到了推荐血压（<140/90）。未发生不良事件。
对于顽固性高血压患者，从其他ARB改用奥美沙坦可能是一种有前景的治疗选择。
