Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan Health Care Center, Kumamoto University, Japan.
Eur J Prev Cardiol. 2016 Jun;23(9):913-21. doi: 10.1177/2047487315603221. Epub 2015 Aug 31.
A trial of telmisartan prevention of cardiovascular disease (ATTEMPT-CVD) was performed to compare the effects of angiotensin II receptor blocker (ARB) therapy and those of non-ARB standard therapy on biomarker level changes and the incidence of cardiovascular events in hypertensive patients.
In this multicenter, open-label, randomized, parallel-group, comparative study, the effects of ARB therapy and those of non-ARB standard therapy on urinary albumin creatinine ratio (UACR) and plasma brain natriuretic peptide (BNP) level changes were investigated for three years from the start of antihypertensive treatment as the primary endpoints. The incidences of cardiovascular composite events were compared between the two groups, and the relationship between the incidence of the events and biomarker changes were investigated as secondary endpoints. The study started with 615 patients in the ARB group and 613 patients in the non-ARB group. The ARB group had a significant effect on UACR and plasma BNP level changes compared with the non-ARB group. Fewer cardiovascular events occurred in the ARB group, but the difference was not statistically significant. UACR and plasma BNP levels at baseline were associated with cardiovascular events.
This study provided the first evidence that ARB treatment caused a smaller increase in plasma BNP and a greater decrease in UACR than non-ARB treatment, independently of blood pressure control, and gives a novel insight into the significance of BNP and UACR as predictors of cardiovascular and renal risk on antihypertensive treatment.
一项替米沙坦预防心血管疾病（ATTEMPT-CVD）试验旨在比较血管紧张素 II 受体阻滞剂（ARB）治疗与非 ARB 标准治疗对高血压患者生物标志物水平变化和心血管事件发生率的影响。
在这项多中心、开放标签、随机、平行组、对照研究中，从开始抗高血压治疗的三年内，将 ARB 治疗与非 ARB 标准治疗对尿白蛋白肌酐比值（UACR）和血浆脑钠肽（BNP）水平变化的影响作为主要终点进行了研究。比较了两组之间心血管复合事件的发生率，并作为次要终点研究了事件发生率与生物标志物变化之间的关系。研究开始时，ARB 组有 615 例患者，非 ARB 组有 613 例患者。与非 ARB 组相比，ARB 组对 UACR 和血浆 BNP 水平变化有显著影响。ARB 组心血管事件发生率较低，但差异无统计学意义。基线时 UACR 和血浆 BNP 水平与心血管事件相关。
本研究首次提供了证据表明，ARB 治疗与非 ARB 治疗相比，独立于血压控制，可使血浆 BNP 增加减少，UACR 降低更多，为 BNP 和 UACR 作为降压治疗心血管和肾脏风险预测指标的意义提供了新的认识。
