Tomiyama H, Kimura Y, Sakuma Y, Shiojima K, Yamamoto A, Saito I, Ishikawa Y, Yoshida H, Morita S, Doba N
Department of Internal Medicine, Teikyo University School of Medicine, Ichihara Hospital, Chiba, Japan.
Am J Hypertens. 1998 Jun;11(6 Pt 1):682-9. doi: 10.1016/s0895-7061(98)00049-1.
We investigated the relationship between cardiovascular autonomic nervous system function and carotid arterial distensibility during treatment with an angiotensin converting enzyme inhibitor (derapril) or a calcium channel blocker (manidipine) for hypertension. In 37 patients with hypertension, autonomic function was assessed by heart rate variability and baroreceptor sensitivity using phenylephrine injection. Left ventricular mass index and carotid arterial distensibility were assessed by ultrasound examinations. Before the medication, both baroreceptor sensitivity and heart rate variability correlated with carotid arterial distensibility, but not with left ventricular mass index by multiple regression analysis. Subsequently, patients were randomly allocated into two groups, derapril (n = 18) and manidipine (n = 19) for 20 weeks. At the end of the study, the change in baroreceptor sensitivity correlated with change in carotid arterial distensibility (r = 0.41, P < .05), but not with change in left ventricular mass index. Although derapril and manidipine decreased blood pressure and left ventricular mass index to the same extent, the former improved heart rate variability, baroreceptor sensitivity (5.0 +/- 1.9 --> 5.6 +/- 2.0 msec/mm Hg), and carotid arterial distensibility (2.1 +/- 0.8 --> 2.5 +/- 1.0 %kPa), but the latter did not improve them at all. Thus, impairment of the autonomic balance was related to the impairment of carotid arterial distensibility in hypertension; derapril, but not manidipine, significantly improved these abnormalities.
我们研究了在使用血管紧张素转换酶抑制剂（地拉普利）或钙通道阻滞剂（马尼地平）治疗高血压期间，心血管自主神经系统功能与颈动脉扩张性之间的关系。在37例高血压患者中，通过使用去氧肾上腺素注射，以心率变异性和压力感受器敏感性评估自主神经功能。通过超声检查评估左心室质量指数和颈动脉扩张性。用药前，通过多元回归分析，压力感受器敏感性和心率变异性均与颈动脉扩张性相关，但与左心室质量指数无关。随后，患者被随机分为两组，地拉普利组（n = 18）和马尼地平组（n = 19），治疗20周。研究结束时，压力感受器敏感性的变化与颈动脉扩张性的变化相关（r = 0.41，P <.05），但与左心室质量指数的变化无关。尽管地拉普利和马尼地平在同等程度上降低了血压和左心室质量指数，但前者改善了心率变异性、压力感受器敏感性（5.0 +/- 1.9 --> 5.6 +/- 2.0毫秒/毫米汞柱）和颈动脉扩张性（2.1 +/- 0.8 --> 2.5 +/- 1.0 %kPa），而后者对此毫无改善。因此，自主神经平衡受损与高血压患者的颈动脉扩张性受损有关；地拉普利可显著改善这些异常，而马尼地平则不能。
