Cuspidi C, Lonati L, Sampieri L, Leonetti G, Muiesan M L, Agabiti-Rosei E, Zanchetti A
Istituto di Clinica Medica e Terapia Medica, Università di Milano, Italy.
Blood Press. 1997 Sep;6(5):307-12. doi: 10.3109/08037059709062087.
Arterial hypertension may be associated with altered left ventricular filling dynamics. The specific goal of this study was to evaluate whether short-term administration of the ACE inhibitor lisinopril in hypertensive patients with an altered diastolic pattern induced an improvement of left ventricular dynamics, assessed by the echocardio-Doppler technique, independently of effects on left ventricular mass. In a double-blind cross-over study 39 essential hypertensive patients with a ratio of peak early to peak atrial velocity (E/A) < 1 were randomized, after a run-in period of 2 weeks without any antihypertensive treatment, to receive lisinopril (20 mg once a day) and placebo for 4 weeks, respectively. At the end of both the run-in and the treatment periods, blood pressure and heart rate were measured and an echocardio-Doppler examination was carried out. The echocardio-Doppler evaluation was performed both at rest and at the peak of a hand-grip test (3 min at 30% of maximal strength). Left ventricular dimensions were obtained from two-dimensionally guided M-mode tracings using the criteria of the American Society of Echocardiography. Left ventricular peak filling rates and filling rate integrals were measured by a pulsed Doppler technique. Lisinopril caused a significant reduction in systolic and diastolic blood pressure at rest (-13/-9 mmHg vs baseline values, p < 0.05; -6/-4 mmHg vs placebo values, p < 0.05) and during isometric exercise (-17/-9 mmHg vs baseline period, p < 0.05; -6/-5 mmHg vs placebo, p < 0.05). Lisinopril did not induce any significant change in left ventricular structure and systolic function. All the left ventricular filling parameters considered (E velocity, A velocity, E/A ratio) both at rest and during isometric exercise did not significantly differ after lisinopril treatment when compared to those obtained in basal conditions and after placebo administration. This double-blind cross-over study demonstrates that short-term afterload reduction induced by lisinopril does not modify altered diastolic dynamics in hypertensive patients. Diastolic dysfunction of the left ventricle is a complex process influenced by a number of functional and structural factors and apparently cannot be significantly improved by short-term blood pressure reduction by antihypertensive therapy.
动脉高血压可能与左心室充盈动力学改变有关。本研究的具体目的是评估在舒张模式改变的高血压患者中短期给予血管紧张素转换酶抑制剂赖诺普利是否能改善左心室动力学，这是通过超声心动图 - 多普勒技术评估的，且独立于对左心室质量的影响。在一项双盲交叉研究中，39例早期峰值与心房峰值速度比（E/A）<1的原发性高血压患者，在无任何抗高血压治疗的2周导入期后，被随机分为两组，分别接受赖诺普利（每日一次，20毫克）和安慰剂治疗4周。在导入期和治疗期结束时，测量血压和心率，并进行超声心动图 - 多普勒检查。超声心动图 - 多普勒评估在静息状态和握力试验峰值（最大力量的30%，持续3分钟）时进行。左心室尺寸通过使用美国超声心动图学会的标准从二维引导的M型描记图中获得。左心室峰值充盈率和充盈率积分通过脉冲多普勒技术测量。赖诺普利使静息时收缩压和舒张压显著降低（与基线值相比为-13 / -9 mmHg，p < 0.05；与安慰剂值相比为-6 / -4 mmHg，p < 0.05）以及等长运动时降低（与基线期相比为-17 / -9 mmHg，p < 0.05；与安慰剂相比为-6 / -5 mmHg，p < 0.05）。赖诺普利未引起左心室结构和收缩功能的任何显著变化。与基础状态和安慰剂给药后相比，赖诺普利治疗后静息和等长运动时所有考虑的左心室充盈参数（E速度、A速度、E/A比值）均无显著差异。这项双盲交叉研究表明，赖诺普利引起的短期后负荷降低不会改变高血压患者改变的舒张动力学。左心室舒张功能障碍是一个受多种功能和结构因素影响的复杂过程，显然不能通过抗高血压治疗短期降低血压而得到显著改善。
