血管紧张素Ⅱ1型受体拮抗剂对高血压患者动脉弹性及脉压的影响

Clinical study of Irbesartan on improving arterial elasticity and pulse pressure in essential hypertensives

目的观察厄贝沙坦对脉压(PP)≥60 mm Hg(1 mm Hg=0．133 kPa)高血压患者的动脉弹性功能、反射波及PP的影响。方法选取符合入选条件的原发性高血压患者30例,男13例、女17例,平均年龄为(65．2±8．5)岁(51～83岁),随机分成治疗组和对照组,分别给予厄贝沙坦(150 mg/d)和安慰剂治疗3个月。结果与治疗前相比,对照组治疗后中心和肱动脉收缩压、舒张压及PP轻度下降,但差异无显著性(P＞0．05)；而治疗组显著下降(P＜0．05),治疗组的降幅均显著高于对照组(P值分别＜0．05和0．01)。治疗后,治疗组的反射波增强压(AP)和增强指数(A1)明显下降(P＜0．01),颈-股动脉脉搏波传导速度(CF-PWV)显著变慢(P＜0．01),降幅显著高于对照组；大、小动脉弹性功能指数(Cl、C_2)值均显著增加(P值分别＜0．05和0．01),增幅显著高于对照组。分别以C_1和CF-PWV变化为应变量,收缩压、舒张压降幅为自变量行多元线形回归分析,决定系数(R2)为0．486及0．384(P＜0．05)。结论厄贝沙坦可明显改善PP≥60mm Hg高血压患者的大、小动脉弹性,减弱外周波反射,缩小PP。

Objectives To investigate the effects of Irbesartan on arterial elasticity, wave reflection and pulse pressure in essential hypertensives with pulse pressure of 60 mm Hg（1 mm Hg=0. 133 kPa） or more. Methods Thirty elderly essential hypertensives with pulse pressure of 60 mm Hg or more [13 males and 17 females, average age （65.2±8. 5）years] were enrolled and divided into two groups in equal number （treatment and controlled groups）. The treatment group received Irbesartan （150 mg/d） individually and the controlled group with placebo therapy for 12 weeks. Brachial blood pressure was measured by standardized mercury cuff sphygnomanometer. Automatic pulse wave velocity （PWV） measurement system and DO-2020 Arterial Pulse Contour Instrument were applied to examine the carotid-femoral PWV （CF-PWV） and the large and small arterial elastic indexes （C1 and C2 ） respectively. Central arterial pressure, augmentation pressure and augmentation index （AI） were acquired by using the radial pulse wave analysis system. Results After three months treatment, the controlled group showed insignificant changes of pulse pressure and artery elasticity index. The treatment group, after excluding the placebo effect, showed significant increase of C1 and C2 , CF-PWV slowed down obviously; both augmentation pressure and AI dropped significantly; together with significant decrease of peripheral and central systolic pressure, diastolic pressure and pulse pressure. The decreased blood pressure could partialy explain the improvement of large artery elasticity. Conclusion Irbesartan improves the small and large arterial elasticity, attenuates the wave reflex amplitude and reduces pulse pressure in the essential hypertensives with pulse pressure of 60 mmHg or more. （Shanghai Med J, 2006, 29：636-639）