Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes - Principal results of the Conduit Artery Function Evaluation (CAFE) study
Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes - Principal results of the Conduit Artery Function Evaluation (CAFE) study
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DOI：
10.1161/circulationaha.105.595496
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发表时间：
2006-03-07
期刊：
影响因子：
37.8
通讯作者：
Thurston, H
中科院分区：
文献类型：
--
作者：
Williams, B;Lacy, PS;Thurston, H
背景-不同的降压药物对中心主动脉压的影响不同，因此对心血管结局的影响不同，尽管对肱动脉血压的影响相似。导管动脉功能评价（CAFE）研究，盎格鲁-斯堪的纳维亚心脏结局试验（阿斯科特）的一项子研究，研究了2种不同的降压方案（阿替洛尔+/-噻嗪为基础的与阿替洛尔+/-培哚普利为基础的治疗）对衍生的中心主动脉压和血流动力学的影响。方法和结果-CAFE研究招募了2199例患者在5阿斯科特中心。桡动脉压平张力计和脉搏波分析用于获得中心主动脉压和血流动力学指标，重复访问长达4年。大多数患者在整个研究期间接受联合治疗。尽管治疗组之间的肱动脉收缩压相似（Δ 0.7 mm Hg; 95% CI，-0.4至1.7; P = 0.2），使用RHD方案时中心主动脉压显著降低（中心主动脉收缩压，Δ 4.3 mm Hg; 95% CI，3.3 - 5.4; P < 0.0001;中心主动脉脉压，Δ 3.0 mm Hg; 95% CI，2.1 - 3.9; P < 0.0001）。考克斯比例风险模型显示，在CAFE队列中，中心脉压与事后定义的总心血管事件/手术和肾损害发生的复合结局显著相关（未校正，P < 0.0001;调整基线变量，结论：降压药物对中心主动脉压和血流动力学的影响有很大的不同，尽管对肱动脉血压的影响相似。此外，中心主动脉脉压可能是临床结局的决定因素，中心主动脉压的差异可能是解释阿斯科特中2个BP治疗组之间临床结局不同的潜在机制。
Background - Different blood pressure (BP)-lowering drugs could have different effects on central aortic pressures and thus cardiovascular outcome despite similar effects on brachial BP. The Conduit Artery Function Evaluation ( CAFE) study, a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), examined the impact of 2 different BP lowering-regimens (atenolol +/- thiazide-based versus amlodipine +/- perindopril-based therapy) on derived central aortic pressures and hemodynamics.Methods and Results - The CAFE study recruited 2199 patients in 5 ASCOT centers. Radial artery applanation tonometry and pulse wave analysis were used to derive central aortic pressures and hemodynamic indexes on repeated visits for up to 4 years. Most patients received combination therapy throughout the study. Despite similar brachial systolic BPs between treatment groups (Delta 0.7 mm Hg; 95% CI, -0.4 to 1.7; P = 0.2), there were substantial reductions in central aortic pressures with the amlodipine regimen ( central aortic systolic BP, Delta 4.3 mm Hg; 95% CI, 3.3 to 5.4; P < 0.0001; central aortic pulse pressure, Delta 3.0 mm Hg; 95% CI, 2.1 to 3.9; P < 0.0001). Cox proportional-hazards modeling showed that central pulse pressure was significantly associated with a post hoc - defined composite outcome of total cardiovascular events/procedures and development of renal impairment in the CAFE cohort ( unadjusted, P < 0.0001; adjusted for baseline variables, P < 0.05).Conclusions - BP-lowering drugs can have substantially different effects on central aortic pressures and hemodynamics despite a similar impact on brachial BP. Moreover, central aortic pulse pressure may be a determinant of clinical outcomes, and differences in central aortic pressures may be a potential mechanism to explain the different clinical outcomes between the 2 BP treatment arms in ASCOT.