[培哚普利与氨氯地平固定复方疗法对高血压合并脉搏波速度升高患者血压控制及动脉弹性的优化作用]
[Optimization of BP Control and Arterial Elasticity With Fixed Combination Therapy Perindopril and Amlodipine In Patients With Arterial Hypertension and Increased Pulse Wave Velocity].
作者信息
Nedogoda S V, Konradi A O, Zvartau N E, Chumachek E V, Ledyaeva A A, Tsoma V V, Salasyuk A S, Judina J S, Smirnova V O, Khripaeva V J, Palashkin R V
机构信息
Volgograd State Medical University, Volgograd, Russia.
Federal Almazov North-West Medical Research Centre, Saint-Petersburg, Russia.
出版信息
Kardiologiia. 2017 Mar;57(3):31-38.
UNLABELLED
The aim of the study was to assess the possibility of fixed combination perindopril+amlodipine to improve arterial elesticity in patients with hypertension and high pulse wave velocity, despite previous combination antihypertensive therapy. In an open, multicenter, observational study duration of 24 weeks 80 patients were included, divided into 4 equal-sized groups, depending on initial antihypertensive therapy: Group 1 - the combination of ACE inhibitor and diuretic, Group 2 - the combination of ACE inhibitor and calcium channel blocker, Group 3 - the combination of diuretic and angiotensin receptor blocker, Group 4 - the combination of angiotensin receptor blocker and calcium antagonist. All patients underwent ambulatory BP monitoring, applanation tonometry (assessment of augmentation index and central blood pressure), pulse wave velocity measurement. According to the office BP measurements fixed combination perindopril+amlodipine provided the SBP reduction by 17.5%, 15.6%, 15, 6%, 15.5% and 17.7%, DBP reduction by 14.6%, 12.9%, 13.8%, respectively, in groups ACEI+D initial combination therapy, ACEI+AC initial combination therapy, ARB+D initial combination therapy, ARB+AC initial combination therapy. According ABPM data SBP has been decreased by 12.2%, 12.4%, 11.3%, 12.6% and DBP by 14.3%, 11.1%, 8.9%, 12.6%. The fixed combination perindopril+amlodipine reduced PWV by 25.2%, 21.6%, 23.1%, 23.0%, augmentation index by 43.4%, 48.9%, 41.5%, 38.3%, central SBP by 16.1%, 15.5%, 14.4%, 15.2%, the central DBP by 15.1%, 13.8%, 13.8%, 18.0% (p<0.01 vs. baseline).
CONCLUSIONS
Fixed combination perindopril+amlodipine provides goal blood pressure control, improves arterial elasticity indexes (augmentation index, PWV, central blood pressure). Additional properties include reduction of BMI and lipid metabolism improving in patients initially treated with a combination antihypertensive therapy.
未标注
本研究的目的是评估培哚普利+氨氯地平固定复方制剂在高血压和高脉搏波速度患者中，即便之前接受过联合抗高血压治疗，是否有可能改善动脉弹性。在一项为期24周的开放性、多中心观察性研究中，纳入了80例患者，根据初始抗高血压治疗将其分为4个等规模组：第1组——ACE抑制剂与利尿剂联合；第2组——ACE抑制剂与钙通道阻滞剂联合；第3组——利尿剂与血管紧张素受体阻滞剂联合；第4组——血管紧张素受体阻滞剂与钙拮抗剂联合。所有患者均接受动态血压监测、压平式眼压测量（评估增强指数和中心血压）、脉搏波速度测量。根据诊室血压测量结果，培哚普利+氨氯地平固定复方制剂在ACEI+D初始联合治疗组、ACEI+AC初始联合治疗组、ARB+D初始联合治疗组、ARB+AC初始联合治疗组中，使收缩压分别降低了17.5%、15.6%、15.6%、15.5%和17.7%，舒张压分别降低了14.6%、12.9%、13.8%。根据动态血压监测数据，收缩压降低了12.2%、12.4%、11.3%、12.6%，舒张压降低了14.3%、11.1%、8.9%、12.6%。培哚普利+氨氯地平固定复方制剂使脉搏波速度降低了25.2%、21.6%、23.1%、23.0%，增强指数降低了43.4%、48.9%、41.5%、38.3%，中心收缩压降低了16.1%、15.5%、14.4%、15.2%，中心舒张压降低了15.1%、13.8%、13.8%、18.0%（与基线相比，p<0.01）。
结论
培哚普利+氨氯地平固定复方制剂可实现目标血压控制，并改善动脉弹性指标（增强指数、脉搏波速度、中心血压）。其他作用包括降低初始接受联合抗高血压治疗患者的体重指数，并改善脂质代谢。
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