血管紧张肽转换酶抑制剂对高血压病人心脏和大动脉的影响

目的 :评价血管紧张肽转换酶 (ACE)抑制剂对原发性高血压病人心脏和大动脉结构和功能的影响。方法 :应用二维超声、超声心动图及自动脉搏波传导速度 (PWV)测定仪观察 16例采用ACE抑制剂培哚普利治疗 (4mg ,po ,qd ;4wk后若血压 >18.6 / 12 .0kPa ,加服吲哒帕胺 2 .5mg ,po ,qd)的原发性高血压病人心脏、大动脉结构和功能的改变 ,分别在治疗前和治疗 12wk后进行上述检测。结果 :收缩压、脉压、颈动脉 股动脉PWV、颈总动脉内膜 中层厚度和左室后壁厚度在 12wk培哚普利治疗后显著降低 分别为 (2 0 .4±s 1.4 )kPavs (18.0± 1.2 )kPa ,(7.5± 1.1)kPavs (6 .9± 1.2 )kPa ,(10 .5± 1.3)m·s- 1vs (8.6± 1.0 )m·s- 1,(0 .71± 0 .14 )mmvs (0 .5 9± 0 .14 )mm ,(10 .5± 1.0 )mmvs (9.8± 1.0 )mm ,P <0 .0 1或P <0 .0 5 ];颈总动脉横断面顺应性、容积扩张性在治疗前后无显著性差异(P >0 .0 5 )。结论 :培哚普利对心血管系统的影响不仅仅是与血压降低有关 ,药物引起动脉平滑肌松驰 ,对全身和局部肾素 血管紧张肽系统的抑制能有效地改善高血压导致的心脏、血管结构和功能的改变。

Effects of angiotensin converting enzyme inhibitor on cardiac and large arterial structure and function in patients with essential hypertension

AIM: To evaluate the effects of angiotensin converting enzyme (ACE) inhibitor on cardiac and large arterial structure and function in patients with essential hypertension. METHODS: Two dimensional ultrasound,echocardiography and automatic pulse wave velocity (PWV) measurement system were used to evaluate cardiac and large arterial structure and function in sixteen patients with sustained essential hypertension before and after 12 wk treatment with perindopril(4 mg, po ,qd). If BP>18.6/12.0 kPa after 4 wk treatment indapamide ( 2.5 mg , po ,qd) was added. RESULS:After 12 wk treatment with perindopril the systolic blood pressure, pulse pressure, carotid femoral PWV, common carotid artery intima media thickness, and left ventricular posterior wall thickness were significantly reduced (20.4±1.4) kPa vs (18.0±1.2) kPa, P <0.01;(7.5±1.1) kPa vs (6.9±1.2) kPa, P < 0.05 ;( 10.5 ±1.3) m·s -1 vs (8.6±1.0) m·s -1 , P <0.01 ;(0.71±0.14) mm vs (0.59±0.14) mm, P <0.01;( 10.5 ±1.0) mm vs (9.8±1.0) mm, P <0.05 , respectively]; common carotid cross sectional compliance and volumic distensibility had no significant change ( P >0.05) after 12 wk treatment. CONCLUSION: Angiotensin converting enzyme inhibitor perindopril can not only reduce blood pressure, but also relax vessel smooth muscle cell, revert large artery structural and functional damage by sustained hypertension.