Girerd X, Giannattasio C, Moulin C, Safar M, Mancia G, Laurent S
Department of Internal Medicine, Broussais Hospital and INSERM U337, Paris, France.
J Am Coll Cardiol. 1998 Apr;31(5):1064-73. doi: 10.1016/s0735-1097(98)00043-6.
The present study was designed to assess whether a diuretic- or an angiotensin-converting enzyme inhibitor-based treatment can reduce arterial wall hypertrophy of a distal muscular medium-sized artery--the radial artery--and the stiffness of a proximal large elastic artery--the common carotid artery.
Large-artery wall thickness and stiffness are increased during sustained essential hypertension and contribute to the increased risk of complications. Whether antihypertensive treatment can normalize the wall hypertrophy of conducting arteries has not yet been determined.
Seventy-seven elderly hypertensive patients were randomized to receive 9 months of double-blind treatment with perindopril (2 to 8 mg/day) or the diuretic combination of hydrochlorothiazide (12.5 to 50 mg/day) plus amiloride (1.25 to 5 mg/day) after a 1-month placebo washout period. If systolic blood pressure remained at >160 mm Hg after 5 months, chlorthalidone or atenolol was added, respectively. Arterial variables, including radial artery mass and common carotid artery compliance, were calculated from noninvasive measurements of internal diameter and wall thickness with the use of high resolution echo-tracking systems at baseline and after 5 and 9 months.
During treatment, blood pressure and arterial variables changed to the same extent in both groups. After a 9-month treatment, systolic, diastolic and pulse pressures and radial artery wall thickness, mass and thickness/radius ratio decreased significantly (p < 0.01), whereas carotid compliance increased (p < 0.001). The decrease in radial artery thickness/radius ratio after a 9-month treatment was significantly related to the reduction in pulse pressure (p < 0.01), whereas the improvement in carotid compliance was related to the reduction in mean arterial pressure (p < 0.01). In healthy subjects and untreated hypertensive patients, radial artery diameter, wall thickness and thickness/radius ratio and carotid artery compliance did not change significantly during a 9-month observation period.
These results indicate that in elderly hypertensive patients, both angiotensin-converting enzyme inhibitor- and diuretic combination-based treatments can reduce radial artery wall hypertrophy and improve carotid artery compliance.
本研究旨在评估基于利尿剂或血管紧张素转换酶抑制剂的治疗是否能够减轻远端肌性中动脉（桡动脉）的动脉壁肥厚以及近端大弹性动脉（颈总动脉）的僵硬度。
在持续性原发性高血压期间，大动脉壁厚度和僵硬度增加，并导致并发症风险增加。抗高血压治疗是否能够使传导动脉的壁肥厚恢复正常尚未确定。
77例老年高血压患者在经过1个月的安慰剂洗脱期后，被随机分配接受培哚普利（2至8毫克/天）或氢氯噻嗪（12.5至50毫克/天）加阿米洛利（1.25至5毫克/天）的利尿剂组合进行为期9个月的双盲治疗。如果5个月后收缩压仍高于160毫米汞柱，则分别加用氯噻酮或阿替洛尔。在基线以及5个月和9个月后，使用高分辨率回声跟踪系统通过无创测量内径和壁厚度来计算包括桡动脉质量和颈总动脉顺应性在内的动脉变量。
在治疗期间，两组的血压和动脉变量变化程度相同。经过9个月的治疗后，收缩压、舒张压和脉压以及桡动脉壁厚度、质量和厚度/半径比显著降低（p < 0.01），而颈动脉顺应性增加（p < 0.001）。9个月治疗后桡动脉厚度/半径比的降低与脉压的降低显著相关（p < 0.01），而颈动脉顺应性的改善与平均动脉压的降低相关（p < 0.01）。在健康受试者和未经治疗的高血压患者中，在9个月的观察期内桡动脉直径、壁厚度和厚度/半径比以及颈动脉顺应性没有显著变化。
这些结果表明，在老年高血压患者中，基于血管紧张素转换酶抑制剂和利尿剂组合的治疗均可减轻桡动脉壁肥厚并改善颈动脉顺应性。
