Schiffrin E L
Clinical Research Institute of Montreal, University of Montreal, Quebec, Canada.
Cardiology. 1997;88 Suppl 3:20-6. doi: 10.1159/000177502.
In view of the important impact of small-artery structural and functional abnormalities on complications of hypertension and recent data suggesting that some antihypertensive agents may correct some of these abnormalities, a study of resistance artery structure and function in 20 well-controlled essential hypertensive patients who had received for a prolonged period of time monotherapy with the once-a-day extended release formulation of the calcium channel antagonist nifedipine (nidefipine GITS) or with the beta-blocker atenolol is reviewed. Resistance-size small arteries (standardized lumen diameter of 247 +/- 8 microns) were studied after dissection from a gluteal subcutaneous biopsy. Small arteries were investigated on a wire myograph and as pressurized vessels. On the myograph, the media width-to-lumen diameter ratio of arteries was 5.37 +/- 0.09% in normotensive subjects, 5.38 +/- 0.18% in patients treated with nifedipine GITS, 6.81 +/- 0.18% in patients treated with atenolol and 7.08 +/- 0.12% in untreated hypertensives (p < 0.001, untreated or atenolol-treated patients vs. normotensives or nifedipine-GITS-treated hypertensives), and similar results were found in pressurized arteries. Contractility and endothelium-dependent relaxation were impaired in small arteries from untreated or atenolol-treated patients in comparison to those from normotensive subjects or nifedipine-GITS-treated patients. In conclusion, hypertensive patients with well-controlled blood pressure under treatment for more than 1 year with nifedipine GITS exhibit normal structure and function of small arteries, whereas similar patients whose blood pressure is as well controlled by the beta-blocker atenolol present abnormally thick small arteries with impaired contractility and endothelium-dependent relaxation. It will be important to determine whether small arteries of other vascular beds are also improved by nifedipine GITS treatment of elevated blood pressure and whether this results in reduced morbidity and mortality in hypertensive patients.
鉴于小动脉结构和功能异常对高血压并发症有重要影响，且近期数据表明某些抗高血压药物可能纠正其中一些异常，本文回顾了一项针对20例血压控制良好的原发性高血压患者的研究，这些患者长期接受每日一次的缓释钙通道拮抗剂硝苯地平（硝苯地平控释片）或β受体阻滞剂阿替洛尔单药治疗。从臀皮下活检标本中分离出阻力型小动脉（标准化管腔直径为247±8微米）进行研究。小动脉在钢丝肌动描记器上以及作为压力血管进行研究。在肌动描记器上，正常血压受试者动脉的中膜宽度与管腔直径之比为5.37±0.09%，接受硝苯地平控释片治疗的患者为5.38±0.18%，接受阿替洛尔治疗的患者为6.81±0.18%，未治疗的高血压患者为7.08±0.12%（p<0.001，未治疗或阿替洛尔治疗的患者与正常血压或硝苯地平控释片治疗的高血压患者相比），在压力血管中也发现了类似结果。与正常血压受试者或硝苯地平控释片治疗的患者相比，未治疗或阿替洛尔治疗的患者的小动脉收缩性和内皮依赖性舒张功能受损。总之，用硝苯地平控释片治疗血压控制良好超过1年的高血压患者，其小动脉结构和功能正常，而血压同样由β受体阻滞剂阿替洛尔控制良好的类似患者，其小动脉异常增厚，收缩性和内皮依赖性舒张功能受损。确定硝苯地平控释片治疗高血压是否也能改善其他血管床的小动脉，以及这是否会降低高血压患者的发病率和死亡率，将具有重要意义。
