长期服用缬沙坦对高血压患者动脉形态和功能的影响

目的:探讨长期服用缬沙坦对高血压患者动脉形态及功能的影响。方法:以彩色多普勒超声检测颈动脉内膜-中层厚度(IMT),测定未受干预状态下、肱动脉反应性充血时及含服硝酸甘油后颈动脉内径。按血清总胆红素(TBil)水平将89例患者分为低血清胆红素水平组(A组,n=58)和高血清胆红素水平组(B组,n=31),比较2组IMT和颈动脉内径的变化。连续服用缬沙坦36mo后检测颈动脉IMT和3种状态下的颈动脉内径,并与治疗前比较。结果:89例患者血清TBil水平均在正常范围内,A组TBil水平显著低于B组,A组IMT值显著高于B组。服用缬沙坦8wk后血压能控制在140/90mmHg以下且保持平稳。治疗36mo后,A、B组的颈动脉IMT较治疗前均显著降低。A组治疗前肱动脉反应性充血时颈动脉内径的变化率显著低于B组,治疗后均显著升高;含服硝酸甘油后颈动脉内径的变化在治疗前后无显著意义。结论:血清胆红素对动脉形态与功能具有保护作用。血管紧张素Ⅱ受体拮抗药缬沙坦在平稳降压的同时,能保护血管内皮细胞,改善血管内皮依赖性舒张功能,延缓甚至逆转IMT的进展。

Effects of Long-term Administration of Valsartan on the Shape & Function of Artery in Patients with Hypertension

OBJECTIVE: To evaluate the clinical effects of long- term administration of valsartan on the shape & function in patients with hypertension. METHODS: The intima- media thickness( IMT) of carotid artery was detected by color Doppler ultrasound. The inner diameter of carotid artery was measured at a different time: when there was no intervention, during reactive hyperemia of brachial artery and after sublingual administration with nitroglycerin. A total of 89 patients with hypertension were divided into lower level TBil group( group A, n=58) and higher level TBil group ( group B, n=31) based on the level of serum total bilirubin( TBil) , with the changes of IMT and inner diameter of carotid artery in two groups compared. IMT and inner diameter of carotid artery of the patients measured under 3 different conditions after receiving valsartan for 36 months consecutively were compared with those measured before treatment. RESULTS: All the 89 cases showed a normal range serum TBil level. The TBil level in group A was significantly lower but the IMT of carotid artery was significantly higher than in group B. The blood pressure was able to be stably controlled well under 140/90mmHg after receiving valsartan for 8 weekes. The IMT in patients with hypertension was significantly lowered in both groups after receiving treatment for 36 months as against before treatment. The change rate in inner diameter of carotid artery at reactive hyperemia of brachial artery before treatment was significantly lower in group A than in group B, but all experienced a significantly increase after treatment. The change of inner diameter of carotid artery had no significant difference in patients after sublingual administration with nitroglycerin. CONCLUSION: Serum bilirubin has protection on the shape and function of artery. Valsartan, an angiotensin Ⅱ receptor antagonist, can improve the endothelium- dependent vasodilative function, retard or even reverse the progression of carotid artery IMT while stably lowering blood pressure.