Zannad F, Bray-Desboscs L, el Ghawi R, Donner M, Thibout E, Stoltz J F
Department of Cardiology, Hôpital Central, CHU, Nancy, France.
J Hypertens. 1993 May;11(5):559-64. doi: 10.1097/00004872-199305000-00012.
To compare the effects of an angiotensin converting enzyme (ACE) inhibitor and a thiazide diuretic on platelet function and haemorrheological variables, since these factors may contribute to the atherosclerotic and thrombotic complications associated with hypertension.
Following a 2-week placebo period, 80 male and female patients with mild to moderate hypertension, aged 50 +/- 10 (mean +/- SD) years, were randomly allocated in a double-blind study to 4 weeks of treatment with the ACE inhibitor lisinopril at 20 mg once a day or the diuretic hydrochlorothiazide at 25 mg once a day. Venous blood was sampled before and at the end of the 4-week treatment period to assess platelet function and haemorrheological variables.
Both treatments lowered systolic and diastolic blood pressure equally and had no significant effect on platelet counts and platelet aggregation in response to ADP and to arachidonic acid. Haematocrit plasma viscosity and blood filterability were not altered by either drug. Hydrochlorothiazide tended to increase and lisinopril tended to decrease whole blood viscosity at all shear rates but these changes did not reach statistical significance. Lisinopril increased the erythrocyte aggregation time (from 1.98 +/- 0.50 to 2.08 +/- 0.52 s) and decreased the disaggregation shear rate (from 159 +/- 46 to 153 +/- 40 s-1) and the disaggregation shear stress (from 705 +/- 257 to 659 +/- 204 mPa). Hydrochlorothiazide induced the opposite effects (2.00 +/- 0.47 to 1.92 +/- 0.39 s, 181 +/- 531 to 196 +/- 82 s-1 and 813 +/- 268 to 868 +/- 392 mPa, respectively) with a statistically significant (P < 0.05) intergroup difference.
These findings suggest that chronic treatment with the ACE inhibitor lisinopril, but not the diuretic hydrochlorothiazide, may produce favourable effects on blood rheology, but the clinical relevance requires further investigation.
比较血管紧张素转换酶（ACE）抑制剂和噻嗪类利尿剂对血小板功能和血液流变学指标的影响，因为这些因素可能导致与高血压相关的动脉粥样硬化和血栓形成并发症。
在为期2周的安慰剂期后，80例年龄为50±10（均值±标准差）岁的轻至中度高血压男女患者，在一项双盲研究中被随机分配，接受4周的治疗，其中一组每天服用一次20mg的ACE抑制剂赖诺普利，另一组每天服用一次25mg的利尿剂氢氯噻嗪。在4周治疗期开始前和结束时采集静脉血，以评估血小板功能和血液流变学指标。
两种治疗方法降低收缩压和舒张压的效果相同，且对血小板计数以及血小板对二磷酸腺苷（ADP）和花生四烯酸的聚集反应均无显著影响。两种药物均未改变血细胞比容、血浆粘度和血液滤过率。氢氯噻嗪在所有剪切速率下均有使全血粘度升高的趋势，赖诺普利则有使其降低的趋势，但这些变化均未达到统计学显著性。赖诺普利使红细胞聚集时间延长（从1.98±0.50秒增至2.08±0.52秒），使解聚剪切速率降低（从159±46降至153±40秒⁻¹），使解聚剪切应力降低（从705±257降至659±204毫帕）。氢氯噻嗪则产生相反的效果（分别从2.00±0.47秒降至1.92±0.39秒，从181±53升至196±82秒⁻¹，从813±268升至868±392毫帕），组间差异具有统计学显著性（P<0.05）。
这些研究结果表明，长期使用ACE抑制剂赖诺普利而非利尿剂氢氯噻嗪可能对血液流变学产生有益影响，但其临床相关性仍需进一步研究。
