Improvement of Plasma Biomarkers after Switching Stroke Patients from Other Angiotensin II Type I Receptor Blockers to Olmesartan
Improvement of Plasma Biomarkers after Switching Stroke Patients from Other Angiotensin II Type I Receptor Blockers to Olmesartan
复制标题
中风患者从其他血管紧张素 II I 型受体阻滞剂转为奥美沙坦后血浆生物标志物的改善
DOI：
10.1016/j.jstrokecerebrovasdis.2015.03.015
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Nagahiro S
中科院分区：
文献类型：
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作者：
Tada Y;Yagi K;Uno M;Matsushita N;Kanematsu Y;Kuwayama K;Shimada K;Nishi K;Hirasawa M;Satomi J;Kitazato KT;Kageji T;Matsuura E;Nagahiro S
背景控制高血压是预防中风复发的关键。一些中风患者会经历顽固性高血压。在我们的实验性卒中模型中，奥美沙坦增加了血管紧张素转换酶-2的表达。我们假设改用奥美沙坦会影响中风患者的生物标志物和血压，这些患者的血压不能通过标准剂量的血管紧张素II I型受体阻滞剂(ARB)而不是奥美沙坦控制。所有人都有中风或无症状脑梗塞的病史。奥美沙坦(10-40 mg/d)治疗12周，测定血浆血管紧张素-(1-7)、过氧化还蛋白、氧化低密度脂蛋白(OxLDL)/β-2-糖蛋白I(β2GPI)复合体、脂联素、高迁移率族蛋白1(HMGB1)、肿瘤坏死因子-α(肿瘤坏死因子-α)水平，并记录治疗前后血压。过氧化还蛋白和氧化低密度脂蛋白/β2GPI复合体，表明其抗氧化应激和致动脉粥样硬化作用均低于基线。这表明奥美沙坦可能比其他ARB更有效地改善这些情况。反映炎症反应的HMGB1和肿瘤坏死因子α均未受到影响，提示奥美沙坦的抗炎作用与其他ARB相似。在改用奥美沙坦治疗的25例患者中，有10例获得了推荐的BP(<；140/90)。未发生不良事件。结论在难治性高血压患者中，从其他ARB改用奥美沙坦可能是一种有前景的治疗选择。
BackgroundManaging hypertension is crucial for preventing stroke recurrence. Some stroke patients experience resistant hypertension. In our experimental stroke model, olmesartan increased the expression of angiotensin (Ang) II converting enzyme-2. We hypothesized that switching to olmesartan affects biomarkers and the blood pressure (BP) in stroke patients whose BP is insufficiently controlled by standard doses of Ang II type I receptor blockers (ARBs) other than olmesartan.MethodsWe recruited 25 patients to study our hypothesis. All had a history of stroke or silent cerebral infarction. We switched them to olmesartan (10-40 mg per day) for 12 weeks and determined their plasma level of Ang-(1-7), peroxiredoxin, oxidized low-density lipoprotein (oxLDL)/β-2-glycoprotein I (β2GPI) complex, adiponectin, high mobility group box 1 (HMGB1), and tumor necrosis factor-α (TNFα) and recorded their BP before and after olmesartan treatment.ResultsAfter switching the patients to olmesartan, their plasma level of Ang-(1-7) as a vasoprotective indicator and adiponectin regulating metabolic syndrome was increased, and peroxiredoxin and the oxLDL/β2GPI complex indicating its antioxidative stress and its proatherogenicity were lower than their baseline. This suggests that olmesartan may be more effective than other ARBs to improve these conditions. Neither HMGB1 nor TNFα reflecting an inflammatory response was affected, suggesting that the anti-inflammatory effects of olmesartan are similar to those of other ARBs. The recommended BP (<140/90) was obtained in 10 of the 25 patients after switching to olmesartan. No adverse events occurred.ConclusionsSwitching from other ARBs to olmesartan may be a promising therapeutic option in patients with resistant hypertension.