Effects of amlodipine and valsartan on vascular damage and ambulatory blood pressure in untreated hypertensive patients
Effects of amlodipine and valsartan on vascular damage and ambulatory blood pressure in untreated hypertensive patients
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DOI：
10.1038/sj.jhh.1002067
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发表时间：
2006-10-01
影响因子：
2.7
通讯作者：
Sakoda, M.
中科院分区：
文献类型：
--
作者：
Ichihara, A.;Kaneshiro, Y.;Sakoda, M.
本研究旨在比较缬沙坦和曲马多对未经治疗的高血压患者24小时动态血压（BP）控制的长期影响。氨氯地平和缬沙坦对高血压患者的心血管死亡率和发病率有益处。虽然动态血压与高血压患者靶器官损害的严重程度相关，但尚未比较沙丁胺醇与缬沙坦控制动态血压对血管损害的有益作用。对100例未经治疗的高血压患者在开始服用缬沙坦或曲马多降压治疗前和治疗后12个月测定脉搏波传导速度（PWV）、颈动脉内膜中层厚度（IMT）、尿白蛋白排泄量（UAE）和24小时动态血压。氨氯地平和缬沙坦降低动态血压相似，但氨氯地平显著降低了24小时和白天动态收缩压的变异性，而缬沙坦则没有。尽管两种药物降低PWV的效果相似，但由阿托伐他汀引起的动态收缩压变异性降低显著有助于PWV的改善。颈动脉IMT不受任何一种药物治疗的影响。缬沙坦可显著降低UAE，而缬沙坦对UAE无影响。这些结果表明，在12个月的治疗结束时，用缬沙坦控制24小时动态血压在功能上改善了高血压患者的动脉硬化，部分原因是降低了血压变异性，而用缬沙坦控制动态血压在降低动脉硬化程度上与用缬沙坦相同，而不影响血压变异性，可能是通过一些多效性效应。
The present study was performed to compare the long-term effects of 24-h ambulatory blood pressure (BP) control with amlodipine versus valsartan on vascular damage in untreated hypertensive patients. Amlodipine and valsartan have benefits on cardiovascular mortality and morbidity in hypertensive patients. Although ambulatory BP is associated with severity of target-organ damage in hypertensive patients, beneficial effects of ambulatory BP control with amlodipine versus valsartan on vascular damage have not been compared. Pulse wave velocity (PWV), intima - media thickness (IMT) of the carotid arteries, urinary albumin excretion (UAE) and 24-h ambulatory BP were determined in 100 untreated hypertensive patients before and 12 months after the start of antihypertensive therapy with amlodipine or valsartan. Amlodipine and valsartan decreased ambulatory BP similarly, but the variability of 24-h and daytime ambulatory systolic BP was significantly reduced by amlodipine but not by valsartan. The reduced variability of ambulatory systolic BP caused by amlodipine significantly contributed to the improvement of PWV, although both drugs decreased PWV similarly. Carotid IMT was unaffected by treatment with either drug. Valsartan significantly decreased UAE independently of its depressor effect, but amlodipine had no effect on UAE. These results suggest that the 24-h control of ambulatory BP with amlodipine had functionally improved the stiffened arteries of hypertensive patients by the end of 12 months of treatment, in part through reducing BP variability, whereas ambulatory BP control with valsartan decreased the arterial stiffness to the same degree as amlodipine without affecting BP variability maybe through some pleiotropic effects.