Laurent S, Becquemont L, Laloux B, Asmar R, Hugue C, Vayssairat M, Billaud E, Bauthier P, Cohen N, Houri L
Service de pharmacologie, hôpital Broussais, Paris.
Arch Mal Coeur Vaiss. 1994 Aug;87(8):987-90.
To determine whether long-term treatment with cilazapril (CIL) may improve pulse pressure (PP), arterial compliance and ankle-arm systolic index (AAI) in patients with lower-extremity arterial disease (LEAD). Indeed, in both systolic hypertension and LEAD, the increase in pulse pressure has been attributed to a reduced compliance.
Thirteen patients (age: 65 +/- 5 yrs; AAI: 0.78 +/- 0.15; m +/- SD) were included in a double-blind randomized parallel study to compare the effects of a 6 month treatment with CIL (10 mg per day; n = 6) to those of placebo (PL; n = 7) Blood pressure, AAI and arterial compliance were determined at baseline (MO) and after 3 (M3) and 6 months (M6). Common carotid (CC) and common femoral (CF) artery compliances were noninvasively determined from pulsatile changes in arterial diameter (Wall Track System, Hoeks et al., 1990) and pressure (PP).
Both groups were comparable at MO. Compared to PL, CIL significantly reduced PP (-22 +/- 4 vs -2 +/- 9 mmHg) and MAP (-16 +/- 11 vs -4 +/- 7 mmHg) and improved CC (+54 +/- 34 vs +5 +/- 21 mm2.mmHg-1.10(-3)) at M6. Weaker effects were observed at M3. No significant changes in AAI and CF compliance were observed.
A direct effect of CIL on the large artery wall was suggested by 1) a greater reduction in PP than in MAP and 2) a disproportionately greater improvement in CC compliance compared with the reduction in distending pressure (MAP). These results indicate that long-term treatment with CIL may improve large artery function in patients with LEAD.
确定用西拉普利（CIL）长期治疗是否可改善下肢动脉疾病（LEAD）患者的脉压（PP）、动脉顺应性和踝臂收缩压指数（AAI）。实际上，在收缩期高血压和LEAD中，脉压升高均归因于顺应性降低。
13例患者（年龄：65±5岁；AAI：0.78±0.15；均值±标准差）纳入一项双盲随机平行研究，比较CIL（每日10 mg；n = 6）与安慰剂（PL；n = 7）治疗6个月的效果。在基线（M0）、3个月（M3）和6个月（M6）时测定血压、AAI和动脉顺应性。通过动脉直径（Wall Track系统，Hoeks等人，1990年）和压力（PP）的搏动变化无创测定颈总动脉（CC）和股总动脉（CF）的顺应性。
两组在M0时具有可比性。与PL相比，CIL在M6时显著降低了PP（-22±4 vs -2±9 mmHg）和平均动脉压（MAP）（-16±11 vs -4±7 mmHg），并改善了CC顺应性（+54±34 vs +5±21 mm2.mmHg-1.10（-3））。在M3时观察到的效果较弱。未观察到AAI和CF顺应性有显著变化。
1）PP降低幅度大于MAP以及2）与扩张压（MAP）降低相比，CC顺应性改善程度不成比例地更大，提示CIL对大动脉壁有直接作用。这些结果表明，CIL长期治疗可能改善LEAD患者的大动脉功能。
