Selective reduction of cardiac mass and central blood pressure on low-dose combination perindopril/indapamide in hypertensive subjects
Selective reduction of cardiac mass and central blood pressure on low-dose combination perindopril/indapamide in hypertensive subjects
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DOI：
10.1097/01.hjh.0000125448.28861.fc
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发表时间：
2004-08-01
影响因子：
4.9
通讯作者：
Safar, ME
中科院分区：
文献类型：
--
作者：
de Luca, N;Asmar, RG;Safar, ME
目的在高血压患者中，阻断肾素-血管紧张素系统可降低左心室质量（LVM），而与肱动脉收缩压（S）、舒张压（D）和平均血压（M）无关。从中央动脉到外周动脉，平均动脉压和舒张压几乎没有变化，而收缩压和脉搏压（PP）显着增加。目的是确定药物治疗下左心室质量的变化是否优先与中心或肱动脉收缩压和脉压的变化相关。设计从469例高血压患者中选择了146例受试者进行一项双盲随机试验，比较培哚普利联合（2 mg; Per）和吲达帕胺（0.625 mg; Ind）与阿替洛尔（50毫克，每天一片）。主要结果测量治疗1年前后：LVM（超声心动图），其中52例，中心（颈动脉）血压和波反射时间结果左心室质量变化与降压治疗显著相关，Per/Ind组左心室质量低于阿替洛尔组。SBP和PP的变化，但不是MBP和DBP的变化，与Per/Ind比与阿替洛尔更显著相关，使用中心测量的效果比肱动脉测量的效果更显著，并且Per/Ind下波反射的中心返回延迟更长。在52例患者的眼压测量样本中，两种药物方案之间的LVM变化与中心而不是肱动脉显著相关，PP变化。结论这项观察性研究显示，Per/Ind的LVM低于阿替洛尔。Per/Ind的左心室质量变化较大与中心血压相关，而与肱动脉血压无关。
Objective In hypertension, blockade of the renin-angiotensin system reduces left ventricular mass (LVM) independently of brachial systolic (S), diastolic (D), and mean (M) blood pressure (BP). From central to peripheral arteries, MBP and DBP are practically unchanged, whereas SBP and pulse pressure (PP) increase significantly. The objective was to determine whether changes in LVM under drug treatment was preferentially associated with changes in central or brachial SBP and PP.Design A substudy of 146 subjects was selected from 469 hypertensive patients submitted to a double-blind randomized trial comparing the combination of perindopril (2 mg; Per) and indapamide (0.625 mg; Ind) with atenolol (50 mg, one tablet per day).Main outcome measures Before and after 1 year of treatment: LVM (echocardiography) in 146 subjects and, in 52 of them, central (carotid) BP and timing of wave reflections (tonometry).Results LVM changes were significantly associated with anti hypertensive treatment, with lower LVM with Per/Ind than with atenolol. Changes in SBP and PP, but not in MBP and DBP, were more significantly associated with Per/Ind than with atenolol, with more pronounced effects using central than brachial measurements, and a longer delay in central return of wave reflections under Per/Ind. In the sampling of 52 patients with tonometry, the change in LVM between the two drug regimens was significantly linked to central, but not brachial, PP change.Conclusions This observational study shows a lower LVM under Per/Ind than under atenolol. The greater change in LVM on Per/Ind was linked to central and not brachial blood pressure.