Add-on amlodipine improves arterial function and structure in hypertensive patients treated with an angiotensin receptor blocker
Add-on amlodipine improves arterial function and structure in hypertensive patients treated with an angiotensin receptor blocker
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DOI：
10.1097/fjc.0b013e31803104e5
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发表时间：
2007-03-01
影响因子：
3
通讯作者：
Itoh, Hiroshi
中科院分区：
文献类型：
--
作者：
Ichihara, Atsuhiro;Kaneshiro, Yuki;Itoh, Hiroshi
本研究旨在确定在使用血管紧张素II I型受体阻滞剂(ARB)后血压已得到很好控制的高血压患者中，加用尼洛地平是否能进一步改善心血管功能和结构性损害。观察50例高血压病患者加用氨氯地平或安慰剂治疗前及服药12个月后胸片心胸比率、尿白蛋白排泄率、颈动脉脉搏波速度(PWV)、颈动脉内膜中层厚度(IMT)及24小时动态血压(BP)的变化。加用氨氯地平治疗后，ARB治疗高血压患者的PWV从1689+/-61增加到1447+/-47 cm/S，IMT从0.88+/-0.08增加到0.75+/-0.06 mm，但对心胸比率和尿白蛋白排泄量无明显影响。氨氯地平也能显著降低动态血压变异性，但对PWV和IMT的影响不明显。因此，附加的小剂量氨氯地平治疗对使用ARB治疗的高血压患者的血管功能和血管结构有好处，这些血管功能和血管结构独立于其降压作用。氨氯地平的抗动脉粥样硬化多效性对接受ARB治疗的高血压患者的动脉僵硬进展有预防作用。
The present study was designed to determine whether adding anilodipine further improved functional and structural cardiovascular damage in hypertensive patients whose blood pressure was already well controlled with an angiotensin II type I receptor blocker (ARB). The cardiothoracic ratio on chest radiographs, level of urinary albumin excretion, pulse wave velocity (PWV), intima-media thickness (IMT) of the carotid arteries, and 24 hour ambulatory blood pressure (BP) were evaluated before and 12 months after the start of add-on of amlodipine or placebo in 50 hypertensive patients being treated with an ARB. The add-on amlodipine therapy significantly improved the PWV from 1689 +/- 61 to 1447 +/- 47 cm/s and the IMT from 0.88 +/- 0.08 to 0.75 +/- 0.06 mm in the hypertensive patients treated with an ARB without altering their mean 24 hour ambulatory BP values, but did not alter the cardiothoracic ratio or urinary albumin excretion. Amlodipine also significantly decreased the variability of ambulatory BP, but the decrease did not significantly contribute to the changes in PWV or IMT. Thus, the add-on low-dose amlodipine therapy had benefits in terms of the vascular function and vascular structure of hypertensive patients treated with an ARB that were independent of its depressor effects. The antiatherogenic pleiotropic properties of amlodipine have a preventive effect on the progression of arterial stiffness in hypertensive patients treated with an ARB.