Miyoshi Toru, Suetsuna Ryoji, Tokunaga Naoto, Kusaka Masayasu, Tsuzaki Ryuichiro, Koten Kazuya, Kunihisa Kohno, Ito Hiroshi
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan.
Department of Internal Medicine, Kusaka Hospital, Okayama, Japan.
J Clin Med Res. 2017 Jul;9(7):618-623. doi: 10.14740/jocmr3050w. Epub 2017 May 22.
The blood pressure variability (BPV) such as visit-to-visit, day-by-day, and ambulatory BPV has been also shown to be a risk of future cardiovascular events. However, the effects of antihypertensive therapy on BPV remain unclear. The purpose of this study was to evaluate the effect of azilsartan after switching from another angiotensin II receptor blocker (ARB) on day-to-day BPV in home BP monitoring.
This prospective, multicenter, open-labeled, single-arm study included 28 patients undergoing treatment with an ARB, which was switched to azilsartan after enrollment. The primary outcome was the change in the mean of the standard deviation and the coefficient of variation of morning home BP for 5 consecutive days from baseline to the 24-week follow-up. The secondary outcome was the change in arterial stiffness measured by the cardio-ankle vascular index.
The mean BPs in the morning and evening for 5 days did not statistically differ between baseline and 24 weeks. For the morning BP, the means of the standard deviations and coefficient of variation of the systolic BP were significantly decreased from 7.4 ± 3.6 mm Hg to 6.1 ± 3.2 mm Hg and from 5.4±2.7% to 4.6±2.3% (mean ± standard deviation, P = 0.04 and P = 0.04, respectively). For the evening BP, no significant change was observed in the systolic or diastolic BPV. The cardio-ankle vascular index significantly decreased from 8.3 ± 0.8 to 8.1 ± 0.8 (P = 0.03).
Switching from another ARB to azilsartan reduced day-to-day BPV in the morning and improved arterial stiffness.
就诊间、日间以及动态血压变异性（BPV）也已被证明是未来发生心血管事件的风险因素。然而，抗高血压治疗对BPV的影响仍不明确。本研究的目的是评估在家庭血压监测中，从另一种血管紧张素II受体阻滞剂（ARB）转换为阿齐沙坦后对日间BPV的影响。
这项前瞻性、多中心、开放标签、单臂研究纳入了28例正在接受ARB治疗的患者，入组后将其转换为阿齐沙坦治疗。主要结局是从基线到24周随访期间连续5天早晨家庭血压标准差均值和变异系数的变化。次要结局是通过心踝血管指数测量的动脉僵硬度的变化。
基线和24周时，5天的早晨和晚上平均血压无统计学差异。对于早晨血压，收缩压标准差均值和变异系数分别从7.4±3.6 mmHg显著降至6.1±3.2 mmHg以及从5.4±2.7%降至4.6±2.3%（均值±标准差，P分别为0.04和0.04）。对于晚上血压，收缩压或舒张压变异性未观察到显著变化。心踝血管指数从8.3±0.8显著降至8.1±0.8（P = 0.03）。
从另一种ARB转换为阿齐沙坦可降低早晨的日间BPV并改善动脉僵硬度。
