Different aortic reflection wave responses following long-term angiotensin-converting enzyme inhibition and beta-blocker in essential hypertension
Different aortic reflection wave responses following long-term angiotensin-converting enzyme inhibition and beta-blocker in essential hypertension
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DOI：
10.1046/j.1440-1681.2001.03570.x
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发表时间：
2001-12-01
影响因子：
2.9
通讯作者：
London, GM
中科院分区：
文献类型：
--
作者：
Pannier, BM;Guerin, AP;London, GM
1.在动脉高血压中，主动脉波反射有助于确定中心收缩压和脉压。本研究评估了培哚普利或阿替洛尔治疗1个月后颈总动脉水平的中心压变化，并在服药后8小时内进行了研究.在为期4周的安慰剂导入期后，20名患有永久性高血压的患者被纳入一项双盲、随机交叉研究，比较血管紧张素转换酶（ACE）抑制剂培哚普利与β受体阻滞剂阿替洛尔在为期4周的治疗期内的疗效。在服药前和服药后8小时内，连续测量肱动脉收缩压和舒张压（分别为SBP和DBP;水银血压计）、颈动脉SBP和脉压（PP;压平张力测定法），主动脉脉搏波速度（Complior; Colson，Les Lilas，法国）和主动脉的动脉波反射（压平张力计; Sphygmocor; PWV Medical，悉尼，新南威尔士州，澳大利亚）。4.两种治疗均降低肱动脉和颈动脉SBP、DBP和PP。阿替洛尔治疗后心率和脉搏波传导速度下降（P < 0.001）。培哚普利（NS）治疗后脉搏波速度略有降低。与阿替洛尔相比，培哚普利显著（P < 0.001）降低了动脉波反射，但对波反射的这种影响与颈动脉PP的较大降低无关。因此，在长期治疗期间，ACE抑制和选择性β（1）-肾上腺素受体阻滞剂导致肱动脉和颈动脉PP相似的降低，但只有阿替洛尔降低心率。两种药物均降低了主动脉脉搏波速度，但阿替洛尔在改善主动脉僵硬度方面更有效。动脉波反射仅在培哚普利后降低。在用培哚普利降低动脉波反射和用阿替洛尔降低局部主动脉僵硬度1个月后，用ACE抑制剂或β-肾上腺素受体阻滞剂治疗1个月后，中心脉压改善。
1. In arterial hypertension, aortic wave reflections contribute to determining central systolic and pulse pressures. The present study assessed the central pressure alterations at the level of the common carotid artery following 1 month treatment with perindopril or atenolol and investigated during the 8 h following drug intake.2. Twenty patients suffering from permanent hypertension were included after a 4 week run-in placebo period in a double-blind, randomized cross-over study comparing the angiotensin-converting enzyme (ACE) inhibitor perindopril with the beta-blocker atenolol during a 4 week treatment period.3. Before and during the 8 h after drug intake, serial measurements included brachial artery systolic and diastolic blood pressures (SBP and DBP, respectively; mercury sphygmomanometer), carotid artery SBP and pulse pressure (PP; applanation tonometry), aortic pulse wave velocity (Complior; Colson, Les Lilas, France) and arterial wave reflections from the aorta (applanation tonometry; Sphygmocor; PWV Medical, Sydney, NSW, Australia).4. Both treatments decreased brachial and carotid artery SBP, DBP and PP. Heart rate and pulse wave velocity decreased following atenolol (P < 0.001). Pulse wave velocity was reduced slightly following perindopril (NS). Arterial wave reflections were significantly (P < 0.001) decreased with perindopril in comparison with atenolol, but this effect on wave reflections was not associated with a larger decrease in carotid artery PP.5. Thus, during chronic treatment, ACE inhibition and selective beta(1)-adrenoceptor blockade resulted in a similar decrease in brachial and carotid artery PP, but only atenolol reduced heart rate. Aortic pulse wave velocity was reduced with both drugs, but atenolol appeared more effective in improving aortic stiffness. Arterial wave reflections were decreased only following perindopril.6. Central pulse pressure was improved following 1 month treatment with an ACE inhibitor or beta-adrenoceptor blockade following a decrease in arterial wave reflections with perindopril and a higher decrease in regional aortic stiffness with atenolol.