Losartan improves exercise tolerance in patients with diastolic dysfunction and a hypertensive response to exercise.
Losartan improves exercise tolerance in patients with diastolic dysfunction and a hypertensive response to exercise.
复制标题
氯沙坦可改善舒张功能障碍和对运动有高血压反应的患者的运动耐量。
DOI：
10.1016/s0735-1097(99)00048-0
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发表时间：
1999
影响因子：
24
通讯作者：
Little,WC
中科院分区：
文献类型：
--
作者：
WarnerJr,JG;Metzger,DC;Kitzman,DW;Wesley,DJ;Little,WC
本研究的目的是检验血管紧张素II（AngII）阻断剂能改善运动时收缩压（SBP）显著升高的舒张功能障碍患者的运动耐量这一假设。血管紧张素II可能有助于高血压对运动的反应和损害舒张performance. METHODS我们进行了一项随机，双盲，安慰剂对照，交叉研究两个星期的氯沙坦（50毫克q.d.）对运动耐力和生活质量的影响。受试者为20例患者，平均年龄64 ± 10岁，左心室收缩功能正常（EF >50%），负荷超声心动图无缺血，二尖瓣血流速度E/A <1，静息SBP正常（<150 mm Hg），运动后高血压反应（SBP >200 mm Hg）。运动超声心动图（改良布鲁斯方案）和明尼苏达州生活与心力衰竭问卷调查在基线时进行，并在每个两周的治疗期后，由两周的洗脱期分开。在对照期间，患者能够运动11.3 ± 2.5（平均值±标准差）分钟，峰值运动SBP为226 ± 24 mm Hg。服用氯沙坦两周后，基线血压没有改变，但运动时SBP峰值下降至193 ± 27 mm Hg（与基线和安慰剂相比p < 0.05），运动时间增加至12.3 ± 2.6 min（与基线和安慰剂相比p < 0.05）。安慰剂组运动持续时间（11.0 ± 2.0 min）或运动SBP峰值（217 ± 26 mm Hg）无改善。与安慰剂组（22 ± 26）相比，氯沙坦组的生活质量改善（18 ± 22，p < 0.05）。结论：在静息时有舒张功能障碍的多普勒证据和对运动有高血压反应的患者中，血管紧张素Ⅱ受体阻滞剂可减弱对运动的高血压反应，增加运动耐量，改善生活质量。
OBJECTIVESThe aim of the study was to test the hypothesis that angiotensin II (Ang II) blockade would improve exercise tolerance in patients with diastolic dysfunction and a marked increase in systolic blood pressure (SBP) during exercise.BACKGROUNDDiastolic dysfunction may be exacerbated during exercise, especially if there is a marked increase in SBP. Angiotensin II may contribute to the hypertensive response to exercise and impair diastolic performance.METHODSWe performed a randomized, double-blind, placebo-controlled, crossover study of two weeks of losartan (50 mg q.d.) on exercise tolerance and quality of life. The subjects were 20 patients, mean age 64 ± 10 years with normal left ventricular systolic function (EF >50%), no ischemia on stress echocardiogram, mitral flow velocity E/A <1, normal resting SBP (<150 mm Hg), and a hypertensive response to exercise (SBP >200 mm Hg). Exercise echocardiograms (Modified Bruce Protocol) and the Minnesota Living With Heart Failure questionnaire were administered at baseline, and after each two-week treatment period, separated by a two-week washout period.RESULTSResting blood pressure (BP) was unaltered by placebo or losartan. During control, patients were able to exercise for 11.3 ± 2.5 (mean ± SD) min, with a peak exercise SBP of 226 ± 24 mm Hg. After two weeks of losartan, baseline BP was unaltered, but peak SBP during exercise decreased to 193 ± 27 mm Hg (p < 0.05 vs. baseline and placebo), and exercise time increased to 12.3 ± 2.6 min (p < 0.05 vs. baseline and placebo). With placebo, there was no improvement in exercise duration (11.0 ± 2.0 min) or peak exercise SBP (217 ± 26 mm Hg). Quality of life improved with losartan (18 ± 22, p < 0.05) compared to placebo (22 ± 26).CONCLUSIONSIn patients with Doppler evidence of diastolic dysfunction at rest and a hypertensive response to exercise, Ang II receptor blockade blunts the hypertensive response to exercise, increases exercise tolerance and improves quality of life.