高血压病患者冠状动脉内皮功能的超声心动图研究

Echocardiographic Evaluation of Coronary Endothelial Function in Patients with Essential Hypertension

目的 应用超声心动图评价高血压病患者冠状动脉内皮功能及血管紧张素II 1型受体 (AT1)拮抗剂对冠状动脉内皮功能的影响。方法 研究对象包括 2 4例轻至中度原发性高血压病患者和 2 4例健康对照组。分别于AT1拮抗剂 (Losartan或Telmisartan)服用前和服用 12周后应用超声心动图测量冷加压试验和硝酸甘油诱导的冠脉左主干内径变化。结果 冷加压试验诱导的冠脉左主干内径百分变化率在高血压病组 (- 4.3± 8.7% )显著低于对照组(10 .5± 3.9% ,P <0 .0 0 0 1)。服用AT1拮抗剂后 ,高血压病组冷加压试验诱导的冠脉左主干内径百分变化率 (13 .7±8.0 % )明显高于服用前 (- 4.3± 8.7% ,P <0 .0 0 0 1) ,冷加压试验诱发的冠状动脉左主干内径百分变化率在 14例血压控制满意的患者中 (从 - 5 .7± 7.7%变为 14.1± 8.8% ,P <0 .0 0 0 1)和 10例血压控制不满意的患者中 (从 - 2 .3±10 .0 %变为 13 .1± 7.0 % ,P =0 .0 0 2 )均得到改善。高血压病组舌下含服硝酸甘油诱导的冠脉左主干内径百分变化率在治疗前后无明显差异 (2 3.2± 14.4%比 2 7.2± 13.5 % ,P =0 .2 )。结论 本研究证明轻至中度原发性高血压病患者冠状动脉内皮功能受损 ,经AT1拮抗剂治疗后 ,冠脉左主干可恢复对冷加压试验的正常反应 。

Objective We attempted to evaluate the coronary endothelial function and the effects of angiotensin II type 1 receptor (AT1) antagonists on coronary endothelial function in patients with essential hypertension using echocardiography. Methods The study population included 24 patients with mild to moderate essential hypertension and 24 matched healthy subjects. Measurements of the cold pressor test induced and nitroglycerin induced changes in the left main coronary artery diameter by echocardiography were performed before and after 12 weeks of AT1 antagonists (Losartan or Telmisartan) administration. Results The percent change in the left main coronary artery diameter (D%) induced by the cold pressor test in hypertensive patients (-4.3±8.7%) was significantly lower than that in control subjects (10.5±3.9%, P <0.0001). The D% induced by cold pressor test in patients with essential hypertension after treatment (13.7±8.0%) was significantly higher than that before treatment (-4.3±8.7%, P <0.0001). The D% induced by the cold pressor test after treatment was not significantly different between the 14 hypertensive patients with satisfactory control of blood pressure (14.1±8.8%) and the 10 hypertensive patients without satisfactory control of blood pressure (13.1±7.0%, P = 0.8). Treatment with AT1 antagonists in patients with essential hypertension did not modify the D% caused by sublingual administration of nitroglycerin (23.2±14.4% vs 27.2±13.5%, P = 0.2). Conclusion This study demonstrates that impaired coronary endothelial function was present and treatment with the AT1 antagonists normalized response of the left main coronary artery to the cold pressor test in patients with mild to moderate essential hypertension and this effect is not dependent on the reduction of blood pressure.