Improvement in blood pressure, arterial stiffness and wave reflections with a very-low-dose perindopril/indapamide combination in hypertensive patient - A comparison with atenolol
Improvement in blood pressure, arterial stiffness and wave reflections with a very-low-dose perindopril/indapamide combination in hypertensive patient - A comparison with atenolol
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DOI：
10.1161/hy1001.095774
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发表时间：
2001-10-01
期刊：
影响因子：
8.3
通讯作者：
Safar, ME
中科院分区：
文献类型：
--
作者：
Asmar, RG;London, GM;Safar, ME
国际指南建议，抗高血压药物治疗不仅应使舒张压（DBP）正常化，还应使收缩压（SBP）正常化。基于心血管死亡率的治疗试验最近表明，降低收缩压需要大动脉僵硬度和波反射正常化。本研究的目的是比较极低剂量组合吲达帕胺 (0.625 mg) 和培哚普利 (2 mg) (Per/Ind) 与 β 受体阻滞剂阿替洛尔 (50 mg) 的抗高血压作用，以确定 Per/Ind 是否比阿替洛尔更能降低 SBP 和脉压 (PP)，如果是，这种降低是否主要是由于 主动脉脉搏波速度 (PWV)（自动测量）和减少波反射（脉搏波分析、压平眼压测量）。在一项双盲随机研究中，对 471 名原发性高血压患者进行了为期 12 个月的随访。对于相同的 DBP 降低，Per/Ind 显着比阿替洛尔降低肱 SBP（-6.02 mm Hg，95% 置信区间，-8.90 至 -3.14）和 PP（-5.57；95% 置信区间，-7.70 至 -3.44）。颈动脉的这种差异比肱动脉的差异更为明显。虽然 2 种抗高血压药物降低 PWV 的程度相似，但只有 Per/Ind 显着减弱颈动脉波反射，导致 SBP 和 PP 选择性降低。极低剂量的 Per/Ind 组合使 SBP、PP 和动脉功能正常化的程度明显高于阿托托尔，阿托托尔是一种血流动力学特征，已知可以提高心血管风险高的高血压人群的生存率。
International guidelines recommend that antihypertensive drug therapy should normalize not only diastolic (DBP) but also systolic blood pressure (SBP). Therapeutic trials based on cardiovascular mortality have recently shown that SBP reduction requires normalization of both large artery stiffness and wave reflections. The aim of the present study was to compare the antihypertensive effects of the very-low-dose combination indapamide (0.625 mg) and perindopril (2 mg) (Per/Ind) with the beta -blocking agent atenolol (50 mg) to determine whether Per/Ind decreases SBP and pulse pressure (PP) more than does atenolol and, if so, whether this decrease is predominantly due to reduction of aortic pulse wave velocity (PWV) (automatic measurements) and reduction of wave reflections (pulse wave analysis, applanation tonometry). In a double-blind randomized study, 471 patients with essential hypertension were followed for 12 months. For the same DBP reduction, Per/Ind decreased brachial SBP (-6.02 mm Hg, 95% confidence interval, -8.90 to -3.14) and PP (-5.57; 95% confidence interval, -7.70 to -3.44) significantly more than did atenolol. This difference was significantly more pronounced for the carotid artery than for the brachial artery. Whereas the 2 antihypertensive agents decreased PWV to a similar degree, only Per/Ind significantly attenuated carotid wave reflections, resulting in a selective decrease in SBP and PP. The very-low-dose combination Per/Ind normalizes SBP, PP, and arterial function to a significantly larger extent than does atenotol, a hemodynamic profile that is known to improve survival in hypertensive populations with high cardiovascular risk.