Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Division of Regeneration and Medicine, Hiroshima University Hospital, Hiroshima, Japan.
Am J Hypertens. 2019 Jun 11;32(7):640-648. doi: 10.1093/ajh/hpz061.
Differences between the effects of calcium channel blockers (CCBs) and other antihypertensive drugs on vascular function have not been fully investigated. The purpose of this study was to determine the confounding effect of CCBs on vascular function tests.
We measured flow-mediated vasodilation (FMD), nitroglycerine-induced vasodilation (NID), and brachial-ankle pulse wave velocity (baPWV) in 1,134 subjects who underwent health-screening examinations or who visited the outpatient clinic at Hiroshima University Hospital.
FMD and NID were significantly lower (4.3 ± 3.2% vs. 2.3 ± 2.4% and 14.1 ± 5.8% vs. 10.6 ± 5.3%, P < 0.001, respectively) and baPWV was significantly higher (1,604 ± 412 cm/s vs. 1,715 ± 343 cm/s, P < 0.001) in subjects receiving CCB treatment than in subjects without CCB treatment. Multivariate analyses revealed that CCB treatment was significantly associated with lower FMD (β = -0.151, P < 0.001) and lower NID (β = -0.120, P < 0.001) but not with baPWV (β = 0.017, P = 0.42). Propensity score matching analyses revealed that FMD and NID were significantly lower and baseline brachial artery diameter was significantly larger in subjects receiving CCB monotherapy than in subjects without antihypertensive medication or subjects receiving non-CCB antihypertensive monotherapy.
CCB treatment was significantly associated with lower FMD and lower NID, which might be, at least in part, due to larger baseline brachia artery diameter, whereas there was no significant association between CCB treatment and baPWV. FMD and NID may be of no use as prognostic markers of cardiovascular events in individuals who have been receiving CCB treatment.
Trial Number UMIN000003409.
钙通道阻滞剂 (CCB) 和其他降压药物对血管功能的影响差异尚未得到充分研究。本研究旨在确定 CCB 对血管功能测试的混杂影响。
我们在 1134 名接受健康筛查检查或在广岛大学医院门诊就诊的受试者中测量了血流介导的血管扩张 (FMD)、硝酸甘油诱导的血管扩张 (NID) 和肱踝脉搏波速度 (baPWV)。
接受 CCB 治疗的受试者的 FMD 和 NID 明显较低（分别为 4.3 ± 3.2% vs. 2.3 ± 2.4%和 14.1 ± 5.8% vs. 10.6 ± 5.3%，P < 0.001），baPWV 明显较高（1604 ± 412 cm/s vs. 1715 ± 343 cm/s，P < 0.001）。多变量分析显示，CCB 治疗与较低的 FMD（β = -0.151，P < 0.001）和较低的 NID（β = -0.120，P < 0.001）显著相关，但与 baPWV 无关（β = 0.017，P = 0.42）。倾向评分匹配分析显示，与未接受降压药物治疗或接受非 CCB 降压单药治疗的受试者相比，接受 CCB 单药治疗的受试者的 FMD 和 NID 明显较低，基线肱动脉直径明显较大。
CCB 治疗与较低的 FMD 和较低的 NID 显著相关，这可能至少部分归因于基线肱动脉直径较大，而 CCB 治疗与 baPWV 之间无显著相关性。在接受 CCB 治疗的个体中，FMD 和 NID 可能不能作为心血管事件的预后标志物。
UMIN000003409。
