Ki You-Jeong, Seo Jae-Bin, Kim Hack-Lyoung, Lim Woo-Hyun, Seo Hye Yeon, Lee Jin Yong, Chung Woo-Young
Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea.
Seoul National University, College of Medicine, Seoul, South Korea.
Clin Hypertens. 2017 Feb 15;23:4. doi: 10.1186/s40885-016-0060-y. eCollection 2017.
Endothelium has a function to regulate vascular tone by releasing mediators either vasodilating or vasoconstricting blood vessels. Endothelial dysfunction can be measured conveniently by Reactive Hyperemia Index (RHI) with a peripheral arterial tonometry. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II (AT II) receptor blockers (ARBs) are considered to have beneficial effects on endothelium through inhibition of AT II. This study was performed to compare the effect of ACEIs or ARBs on endothelial function estimated by RHI in hypertensive patients.
Twenty consecutive patients with hypertension (57.9 ± 11.3 years, 60% men) were assigned to receive treatment with ramipril or telmisartan for eight weeks ( 10 per group). Blood pressure (BP) and RHI were measured at baseline and after eight weeks treatment.
The two groups were similar in terms of demographic and laboratory characteristics. But baseline systolic BP and pulse pressure (PP) were higher in telmisartan group than ramipril group (systolic BP, 159 ± 6.83 vs 150 ± 7.49, 0.028; PP, 75.0 ± 14.0 vs 60.3 ± 12.4, 0.034). In both groups, systolic and diastolic BP decreased significantly after eight weeks treatment (p < 0.05 for each). Although PP reduced in both group (ramipril group, 60.3 ± 12.4 mm Hg to 50.4 ± 7.60 mm Hg; telmisartan group, 75.0 ± 14.0 mm Hg to 57.4 ± 15.1 mm Hg), change was statistically remarkable only in telmisartan group. During eight weeks, there was no significant changes of RHI in both groups. There was a positive relationship between decrease of PP after 8 weeks and the improvement of endothelial function only in ramipril group, but not in telmisartan group (ramipril group, = 0.671, 0.034; telmisartan group, = -0.487, 0.153).
Despite PP reduction effect favoring endothelial function, it's not correlated with RHI improvement with telmisartan. These findings suggest telmisartan itself may negatively influence endothelium dependent vasodilatation different from ramipril.
内皮细胞具有通过释放使血管舒张或收缩的介质来调节血管张力的功能。内皮功能障碍可通过外周动脉张力测定法的反应性充血指数（RHI）方便地进行测量。血管紧张素转换酶抑制剂（ACEIs）和血管紧张素II（AT II）受体阻滞剂（ARBs）被认为通过抑制AT II对内皮细胞有有益作用。本研究旨在比较ACEIs或ARBs对高血压患者中通过RHI评估的内皮功能的影响。
连续纳入20例高血压患者（年龄57.9±11.3岁，男性占60%），分为两组，每组10例，分别接受雷米普利或替米沙坦治疗8周。在基线及治疗8周后测量血压（BP）和RHI。
两组在人口统计学和实验室特征方面相似。但替米沙坦组的基线收缩压和脉压（PP）高于雷米普利组（收缩压，159±6.83 vs 150±7.49，P = 0.028；PP，75.0±14.0 vs 60.3±12.4，P = 0.034）。两组治疗8周后收缩压和舒张压均显著下降（每组P < 0.05）。虽然两组的PP均降低（雷米普利组，60.3±12.4 mmHg降至50.4±7.60 mmHg；替米沙坦组，75.0±14.0 mmHg降至57.4±15.1 mmHg），但仅替米沙坦组的变化有统计学意义。在8周期间，两组的RHI均无显著变化。仅在雷米普利组，8周后PP的降低与内皮功能的改善呈正相关，而替米沙坦组无此相关性（雷米普利组，r = 0.671，P = 0.034；替米沙坦组，r = -0.487，P = 0.153）。
尽管替米沙坦降低PP的作用有利于内皮功能，但与RHI的改善无关。这些发现提示替米沙坦本身可能与雷米普利不同，会对内皮依赖性血管舒张产生负面影响。
