Comparative study of ACE-inhibition, angiotensin II antagonism, and calcium channel blockade on flow-mediated vasodilation in patients with coronary disease (BANFF study)
Comparative study of ACE-inhibition, angiotensin II antagonism, and calcium channel blockade on flow-mediated vasodilation in patients with coronary disease (BANFF study)
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DOI：
10.1016/s0735-1097(99)00537-9
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发表时间：
2000-01-01
影响因子：
24
通讯作者：
Charbonneau, F
中科院分区：
文献类型：
--
作者：
Anderson, TJ;Elstein, E;Charbonneau, F
为了确定血管紧张素转换酶（ACE）抑制剂对肱动脉血流介导的血管舒张的影响，背景喹那普利，一种具有高亲和力的ACE抑制剂，已被证明可以改善冠状动脉疾病患者的冠状动脉内皮功能障碍。不同的血管活性药物，以改善人体内皮functions.METHODS的有效性是未知的高分辨率超声被用来评估内皮依赖性肱动脉血流介导的血管舒张（FMD）在冠心病患者。我们在一项部分区组交叉设计试验中研究了80例患者（平均年龄58 ± 0.9岁）。患者被随机分配到四种不同的药物序列中的一种，每天接受喹那普利20 mg，依那普利10 mg，氯沙坦50 mg或氯沙坦5 mg。每名患者接受三种药物治疗，两次治疗之间有两周的洗脱期。主要终点是每种研究药物8周后FMD与各自基线相比的绝对差异，以盲法分析。FMD较基线的变化仅在喹那普利组有显著性（1.8 ± 1%，p < 0.02）。洛沙坦（0.8 +/-1.1%，p = 0.57）、氨氯地平（0.3 +/-0.9%，p = 0.97）或依那普利（-0.2 +/-0.8%，p = 0.84）没有观察到变化。药物治疗对硝酸甘油诱导的血管扩张无显著影响。在DD ACE基因型的患者中，没有观察到喹那普利反应的改善（0.5 +/- 2.1%），但在ID和II基因型患者中观察到（分别为3.3 +/- 1.2和3.2 +/-1.9%，p = 0.03）。结论只有喹那普利与FMD的显著改善相关，这种反应与ACE基因型的插入等位基因的存在有关。(C)1999年由美国心脏病学会。
OBJECTIVES To determine the effect of angiotensin-converting enzyme (ACE) inhibition on brachial flow-mediated vasodilation.BACKGROUND Quinapril, an ACE inhibitor with high affinity, has been shown to improve coronary endothelial dysfunction in patients with coronary artery disease. The effectiveness of different vasoactive agents to improve human endothelial function is unknown.METHODS High resolution ultrasound was used to assess endothelium-dependent brachial artery flow-mediated vasodilation (FMD) in patients with coronary disease. We studied 80 patients (mean age 58 +/- 0.9 years) in a partial-block, cross-over design trial. Patients were randomized to one of four different drug sequences to receive quinapril 20 mg, enalapril 10 mg, losartan 50 mg or amlodipine 5 mg daily. Each patient received three drugs with a two-week washout period between treatments. The primary end point was the absolute difference in FMD after eight weeks of each study drug compared with their respective baselines analyzed in a blinded fashion.RESULTS There was mild impairment of FMD at baseline (7.3 +/- 0.6%). The change in FMD from baseline was significant only for quinapril (1.8 +/- 1%, p < 0.02). No change was seen with losartan (0.8 +/- 1.1%, p = 0.57), amlodipine (0.3 +/- 0.9%, p = 0.97) or enalapril (-0.2 +/- 0.8%, p = 0.84). No significant change in nitroglycerin-induced dilation occurred with drug therapy. The improvement in quinapril response was not seen in those with the DD ACE genotype (0.5 +/- 2.1%) but was seen in those with the ID and II genotype (3.3 +/- 1.2 and 3.2 +/- 1.9%, respectively, p = 0.03).CONCLUSION Only quinapril was associated with significant improvement in FMD, and this response is related to the presence of the insertion allele of the ACE genotype. (C) 1999 by the American College of Cardiology.