Selective Angiotensin Receptor Antagonism with Valsartan Decreases Arterial Stiffness Independently of Blood Pressure Lowering in Hypertensive Patients
Selective Angiotensin Receptor Antagonism with Valsartan Decreases Arterial Stiffness Independently of Blood Pressure Lowering in Hypertensive Patients
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DOI：
10.1291/hypres.28.937
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发表时间：
2005-12
影响因子：
5.4
通讯作者：
Tetsuya Nakamura;S. Fujii;J. Hoshino;Y. Saito;H. Mizuno;Yuichiro Saito;M. Kurabayashi
中科院分区：
文献类型：
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作者：
Tetsuya Nakamura;S. Fujii;J. Hoshino;Y. Saito;H. Mizuno;Yuichiro Saito;M. Kurabayashi
血管紧张素II在血管疾病的发展中起关键作用。我们研究了缬沙坦选择性血管紧张素II受体（ATR）阻滞剂对动脉壁僵硬度的长期影响。对28例女性和25例男性高血压患者（平均年龄：62±2岁）的臂踝脉搏波速度（baPWV）进行了测量。在缬沙坦40 - 160 mg/天治疗24周后，与（n=10）或不与（n=36）他汀类药物联合治疗，重复测量。通过多元回归分析，基线baPWV与年龄（p<0.001）、收缩压（SBP，p<0.0001）、体重指数（p=0.018）和脉压（p=0.005）相关，但与总胆固醇无关（p=0.446）。缬沙坦使平均SBP和舒张压（DBP）分别从155±3降至140±3 mmHg和从90±2降至82±2 mmHg，平均baPWV从1，853 ±49降至1，682 ±52 cm/s。他汀类药物治疗不影响baPWV的降低。进行重叠分析以将血管紧张素II受体阻滞剂的作用与血压（BP）降低的作用分开。在相似的平均SBP水平（149±2 vs. 146±3 mmHg，p=0.304）下，缬沙坦治疗前baPWV值降低1，794 ±46 cm/s（n=39），缬沙坦治疗期间baPWV值降低1，663 ±45 cm/s（p= 0.048，n=31），证实ATR阻滞具有独立于血压降低的有益作用。SBP对baPWV有显著影响。然而，缬沙坦的baPWV降低与BP降低无关。他汀类药物对baPWV无协同作用。baPWV的降低可能是缬沙坦独立于其降血压作用的治疗获益的原因。
Angiotensin II plays a key role in the development of vascular disease. We examined the long-term effects of selective angiotensin II receptor (ATR) blockade with valsartan on arterial wall stiffness. Brachial to ankle pulse wave velocity (baPWV) was measured in 28 women and 25 men with hypertension (mean age: 62±2 years). The measurements were repeated after 24 weeks of treatment with valsartan, 40 to 160 mg/day, with (n=10) or without (n=36) concomitant statin therapy. By multiple regression analysis, baseline baPWV was correlated with age (p<0.001), systolic blood pressure (SBP, p<0.0001), body mass index (p=0.018), and pulse pressure (p=0.005), but not with total cholesterol (p=0.446). Valsartan lowered mean SBP and diastolic blood pressure (DBP) from 155±3 to 140±3 mmHg and from 90±2 to 82±2 mmHg, respectively, and mean baPWV from 1,853±49 to 1,682±52 cm/s. Lowering of baPWV was not influenced by statin therapy. An overlap analysis was performed to separate the effect of angiotensin II receptor blockade from that of blood pressure (BP) lowering. The decrease in the baPWV value of 1,794±46 cm/s before valsartan (n=39) vs. 1,663±45 cm/s during valsartan (p=0.048, n=31) at a similar mean SBP level (149±2 vs. 146±3 mmHg, p=0.304) confirmed that ATR blockade had a beneficial effect independent of BP lowering. SBP strongly influences baPWV. However, the decrease in baPWV with valsartan was independent of BP lowering. Statins had no synergistic effect on baPWV. Lowering of baPWV may account for the therapeutic benefit conferred by valsartan independent of its BP-lowering effect.