Rizzoni D, Muiesan M L, Porteri E, Castellano M, Zulli R, Bettoni G, Salvetti M, Monteduro C, Agabiti-Rosei E
Cattedra di Semeiotica e Metodologia Medica, U.O.P. Scienze Mediche, University of Breschia, Italy.
J Hypertens. 1997 Feb;15(2):197-204. doi: 10.1097/00004872-199715020-00011.
To evaluate the effects of long-term antihypertensive therapy with the angiotensin converting enzyme inhibitor lisinopril on structural alterations and the endothelial function of small resistance arteries in hypertensive patients with left ventricular hypertrophy.
Fourteen patients with left ventricular hypertrophy were treated for 3 years with a lisinopril-based regimen. Patients underwent an echocardiographic evaluation of left ventricular mass index at baseline, during the first and third years of treatment. At the end of the treatment period, subcutaneous small resistance arteries (obtained by biopsy of the subcutaneous fat from the gluteal region) were dissected and mounted on a micromyograph (Mulvany's technique); the media : lumen ratio was then calculated. Data obtained were compared with those observed for 14 untreated essential hypertensive patients and 14 normotensive subjects, age- and sex-matched.
In the present study, a significantly lower media : lumen ratio was observed in treated compared with untreated hypertensive patients, although it remained significantly higher than that in normotensive subjects. In treated hypertensive patients a significant reduction in clinic blood pressure was observed. However, their blood pressure remained significantly higher than that in normotensive subjects. Significant correlations between the media : lumen ratio and blood pressure, left ventricular mass index or changes in left ventricular mass index during treatment were observed. The response to acetylcholine administration was reduced in untreated hypertensives compared with that in normotensives. In patients treated with lisinopril, the vasodilatation obtained with the two higher doses of acetylcholine was greater than that in untreated hypertensives, thus suggesting an improvement of endothelial function.
Long-term therapy based on lisinopril was associated with a smaller media : lumen ratio in the subcutaneous small resistance arteries of hypertensive patients with left ventricular hypertrophy. Our retrospective study confirms previous findings obtained in prospective studies with other angiotensin converting enzyme inhibitors. Endothelial function was probably improved by lisinopril therapy.
评估血管紧张素转换酶抑制剂赖诺普利长期抗高血压治疗对左心室肥厚高血压患者小阻力动脉结构改变及内皮功能的影响。
14例左心室肥厚患者接受以赖诺普利为主的治疗方案治疗3年。患者在基线时、治疗的第1年和第3年接受左心室质量指数的超声心动图评估。在治疗期结束时，解剖皮下小阻力动脉（通过臀区皮下脂肪活检获得）并安装在微血管张力测定仪上（穆尔瓦尼技术）；然后计算中膜与管腔比值。将获得的数据与14例未经治疗的原发性高血压患者和14例年龄及性别匹配的血压正常受试者的数据进行比较。
在本研究中，与未经治疗的高血压患者相比，治疗后的患者中膜与管腔比值显著降低，尽管仍显著高于血压正常受试者。在接受治疗的高血压患者中，临床血压显著降低。然而，他们的血压仍显著高于血压正常受试者。观察到中膜与管腔比值与血压、左心室质量指数或治疗期间左心室质量指数变化之间存在显著相关性。与血压正常者相比，未经治疗的高血压患者对乙酰胆碱给药的反应降低。在用赖诺普利治疗的患者中，两种较高剂量乙酰胆碱引起的血管舒张大于未经治疗的高血压患者，从而提示内皮功能得到改善。
基于赖诺普利的长期治疗与左心室肥厚高血压患者皮下小阻力动脉较小的中膜与管腔比值相关。我们的回顾性研究证实了先前在前瞻性研究中使用其他血管紧张素转换酶抑制剂所获得的结果。赖诺普利治疗可能改善了内皮功能。
