长期服用氢氯噻嗪对中心动脉压的影响

The Effect of Long-Term Administration of Hydrochlorothiazide on Central Blood Pressure

目的:观察长期服用单药氢氯噻嗪对高血压患者中心动脉压的影响。方法:回顾性分析了参加非洛地平降低心血管事件试验(FEVER)的3个研究中心的受试者资料,选择其中只服用氢氯噻嗪且完成3年以上脉搏波检查随访的76例患者的资料。脉搏波检查在入组时做1次作为基线值,随后每12个月1次至研究结束。观察的中心动脉脉搏波主要指标包括:中心动脉第一峰收缩压、中心动脉第二峰收缩压、中心动脉舒张压、反射波增压及反射波增压指数。结果:与基线值比较,12、24和36个月随访时肱动脉的收缩压和舒张压及中心动脉第一峰收缩压和中心动脉舒张压均有极显著的下降(P<0.001),反射波增压有所下降(P<0.05),而反射波增压指数和心率无显著变化(P>0.05)。结论:长期服用小剂量氢氯噻嗪降低肱动脉压及中心动脉压一样,对反射波增压指数无影响,提示不能产生额外的中心动脉降压获益。

Objective：To evaluate the effects of long-tetm administration of hydrochlorothiazide on the central blood pressure in patients with essential hypertension. Methods：The retrograde analysis was conducted at three of the participating centers in the Felodipine Event Reduction （FEVER） study. Seventy-six of 129 patients in placebo group, who kept hydrochlorothiazide monotherapy over 36 months period, and took pulse wave recording at randomization, 12 month,24 month and 36 month, were included into the final analysis. Radial artery pressure waveforms were measured with applanation tonometry, and convolved into the ascending aortic pressure waveforms, using the FDA-approved SphygmoCor system. The analysed parameters in aortic pressure waveform included first peak pressure, secondary peak pressure, diastolic pressure, pulse pressure, augmentation and augmentation index. Results：In comparison with baseline, there were substantial and significant falls （P 〈 0. 001 ）in braehial SP/DP and in central aortic SP/DP, and with no difference befween them, slight falls（ P 〈 0. 05 ）in aortic augmentation, and no significant falls （P 〉 0.05 ） in augmentation index and heart rate. Conclusions：Long-term administration of hydrochlorothiazide resulted in the similar reduction of both braehial pressure and central aortic pressure without the change of augmentation index, which could exclude definite benefit on central aortic pressure than braehial pressure.