Heesen W F, Beltman F W, Smit A J, May J F, de Graeff P A, Havinga T K, Schuurman F H, van der Veur E, Meyboom-de Jong B, Lie K I
Department of Cardiology, University of Groningen, The Netherlands.
J Cardiovasc Pharmacol. 1998 Feb;31(2):187-94. doi: 10.1097/00005344-199802000-00003.
We compared, in a prospective double-blind randomized study, the effect of the angiotensin-converting enzyme inhibitor quinapril (QUI) with that of triamterene/hydrochlorothiazide (THCT) treatment on cardiovascular end-organ damage in subjects with untreated isolated systolic hypertension (ISH). End-organ damage measurements, performed initially and after 6 and 26 weeks of treatment, included echocardiographic determination of left ventricular mass index (LVMI) and of diastolic function and measurement of aortic distensibility and peripheral vascular resistance. Blood pressure was significantly reduced in the 44 subjects (21 QUI, 23 THCT) completing the study. Both LVMI and aortic distensibility had changed at 6 weeks, with comparable improvements in both groups. LV diastolic function showed overall no significant changes, although patterns of early filling did differ between the two drug groups. Peripheral vascular resistance appeared to increase between 6 and 26 weeks in THCT subjects only, along with a decreased aortic distensibility. Blood pressure and LV mass were rapidly and markedly reduced in both treatment groups of ISH subjects, paralleled by an improvement of aortic distensibility. In interpreting these results, the pathophysiologic alterations in ISH need to be taken into account, because these differ strongly from those in diastolic hypertension. Results of LV diastolic function and peripheral vascular resistance were less clear but appear to show less favorable changes in the THCT subjects treatment group.
在一项前瞻性双盲随机研究中，我们比较了血管紧张素转换酶抑制剂喹那普利（QUI）与氨苯蝶啶/氢氯噻嗪（THCT）治疗对未经治疗的单纯收缩期高血压（ISH）患者心血管终末器官损害的影响。在治疗开始时以及治疗6周和26周后进行的终末器官损害测量，包括通过超声心动图测定左心室质量指数（LVMI）和舒张功能，以及测量主动脉扩张性和外周血管阻力。44名完成研究的受试者（21名接受QUI治疗，23名接受THCT治疗）的血压显著降低。两组在6周时LVMI和主动脉扩张性均发生了变化，且改善程度相当。尽管两个药物组之间早期充盈模式有所不同，但LV舒张功能总体上无显著变化。仅在接受THCT治疗的受试者中，外周血管阻力在6至26周之间似乎有所增加，同时主动脉扩张性降低。ISH患者的两个治疗组中血压和LV质量均迅速且显著降低，同时主动脉扩张性得到改善。在解释这些结果时，需要考虑ISH中的病理生理改变，因为这些改变与舒张期高血压中的改变有很大差异。LV舒张功能和外周血管阻力的结果不太明确，但似乎显示THCT治疗组的变化不太有利。
