5-单硝酸异山梨醇酯改善高血压患者血压以及血管弹性的临床观察

目的 观察5-单硝酸异山梨醇酯(IS-5-MN)对脉压≥60mmHk高血压患者动脉弹性功能、反射波及血压的影响。方法 选取符合人选条件的30例原发性高血压患者，分两组进行单盲、安慰剂对照研究，每组15人分别给予IS-5-MN(30mg／d)或安慰剂，疗程四周。标准袖带水银血压计测量肱动脉血压，自动脉搏波速度测定仪测定颈动脉-股动脉脉搏波传导速度(CF-PWV)，DO-2020动脉功能测定仪获得大动脉和小动脉弹性指数(C1和C2)，桡动脉压力波形分析获得中心动脉压、外周反射波增压及增强指数。结果 校正安慰剂效应后，(1)患者CF-PWV明显减慢，C1显著提高，C2无明显改变。(2)反射波增压和增强指数明显下降。(3)外周和中心动脉收缩压和脉压显著降低。结论 5-单硝酸异山梨醇酯明显改善脉压≥60mmHg高血压患者的大动脉弹性，减弱外周波反射，降低了收缩压和脉压。     

高血压病患者动态血压与动脉顺应性的相关性研究

目的:探讨高血压病患者动脉顺应性的变化,及其与动态血压监测(ABPM)各指标间的相互关系。方法:对262例高血压病患者和104例正常人进行动态血压监测(ABPM)和脉搏波速度(PWV)测定。结果:高血压组的颈动脉-桡动脉(G-R)PWV、颈动脉-股动脉(C-F)PWV,24 h、白昼及夜间平均血压,平均脉压,心率,血压负荷均显著高于正常对照组(P<0.05~<0.01)。C-F PWV及C-R PWV与24 h、白昼及夜间平均血压,心率,血压负荷均呈显著正相关(r=0.108~0.406,P<0.05~<0.001)。C-F PWV比C-R PWV与平均收缩压和收缩压负荷的相关性更强。C-F PWV与动态脉压、年龄显著正相关(r=0.205~0.406,P<0.001)。结论:动脉顺应性减退是高血压的重要改变,大动脉顺应性与动态脉压、收缩压和年龄的关系更为密切。     

Comparative evaluation of isosorbide-5-mononitrate and nitroglycerin in chronic congestive heart failure

The hemodynamic effects of isosorbide-5-mononitrate (IS-5-MN) and nitroglycerin were compared in 10 patients with chronic congestive heart failure (CHF). Both drugs were given intravenously, at an infusion rate individually titrated to achieve a maximal increase in cardiac output and a maximal decrease in pulmonary capillary wedge pressure. Both drugs produced the typical hemodynamic responses to nitrates, the most prominent of which were decreases in pulmonary capillary wedge, pulmonary arterial and right atrial pressures, and an increase in cardiac output. Several differences in the response to these 2 drugs were observed. Pulmonary capillary wedge pressure was reduced from 31.5 +/- 3.0 to 19.6 +/- 5.0 mm Hg with nitroglycerin and to 15.0 +/- 3.12 mm Hg with IS-5-MN. Both the absolute and the percent decrease with IS-5-MN were significantly greater (p less than 0.05) than those observed with nitroglycerin. Mean systemic arterial pressure was reduced from 89.2 +/- 11.3 to 79.8 +/- 10.8 with IS-5-MN (difference not significant) and to 67.5 +/- 7.7 mm Hg with nitroglycerin (p less than 0.01). The difference, both in absolute and percent reductions, was statistically significant. Thus, in patients with chronic CHF, IS-5-MN produced a greater decrease in pulmonary capillary wedge pressure (the major beneficial effect of nitrates in this condition) and a smaller decrease in systemic arterial pressure (the potentially deleterious effects of nitrates). These findings indicate a potential advantage of IS-5-MN over nitroglycerin in patients with CHF, particularly in those with CHF of ischemic etiology.     

不同年龄高血压患者大动脉扩张性的临床研究

目的　探讨不同年龄段高血压患者大动脉弹性的改变及其影响因素。方法　应用脉搏波传导速度 (pulsewavevelocity ,PWV)自动测量系统测定颈动脉 股动脉PWV作为反映大动脉扩张性的参数。对 1392例高血压患者进行了PWV检测 ,其中男 95 4例 ,女 438例 ,年龄 14～ 85岁 ,平均 (5 2 .0 9± 12 .37)岁。结果　 1392例高血压患者的研究结果显示PWV随年龄增大 (不论男性还是女性 )而增加 (P<0 .0 0 0 1)。多元逐步回归分析结果表明年龄、收缩压和心率是与反映大动脉弹性的PWV关系最为密切的参数 (P<0 .0 0 1)。结论　长期高血压将导致大动脉扩张性降低 ,这种改变随年龄增大而加重。年龄、收缩压、心率与高血压患者大动脉扩张性变化关系密切。     

氨氯地平并培哚普利对合并心绞痛的高血压患者中心动脉压及血管弹性的效果

目的：观察氨氯地平并培哚普利对合并稳定型心绞痛的高血压患者中心动脉压、外周血压、动脉弹性功能及反射波的影响。方法：选取符合入选条件的46例合并稳定型心绞痛的原发性高血压患者,随机分两组进行双盲随机对照研究,治疗组24例分别给予氨氯地平（5mg／d）和培哚普利（4mg／d）,对照组22例给予氨氯地平（5mg／d）和氢氯噻嗪（12．5mg／d）,疗程半年。患者行冠脉造影确诊冠心病,造影结束后将造影导管撤到主动脉根部,测出中心动脉压．同时用标准袖带水银血压计测量肱动脉血压．自动脉搏波速度测定仪测定颈动脉一股动脉脉搏波传导速度（CF-PWV）．DO--2020动脉功能测定仪获得大动脉和小动脉弹性指数（C1和C2）．通过导管测量中心动脉压计算出反射波增压指数（AI％）,半年后复查上述指标。结果：经过半年治疗后．治疗组与对照组相比中心动脉收缩压和脉压降低更显著（P〈0．05）,而肱动脉血压二者无明显差异,CF—PwV明显减慢（P〈0．05）,c1显著提高（P〈0．05）,C2无明显改变,反射波增压指数明显下降（P〈0．05）。结论：氨氯地平联合培哚普利更显著地降低了合并稳定型心绞痛的高血压患者中心动脉压,明显改善高血压患者的大动脉弹性。     

Increased Arterial Distensibility in Postmenopausal Hypertensive Women with and Without Hormone Replacement Therapy after Acute Administration of the Ace Inhibitor Moexipril

Menopause and essential hypertension are associated with a decreased compliance and distensibility of the arteries. ACE inhibitors have been shown to improve arterial distensibility. Hormone replacement therapy (HRT), especially estrogens, could have a positive influence through their atheroprotective, vasodilative, and blood pressure–lowering effect. The vascular interactions of HRT and ACE inhibitors, like moexipril hydrochloride, have not been investigated so far. This trial was intended to assess the effect of combined sequential HRT for 25 days on acute changes in arterial distensibility after a single oral dose of 15 mg moexipril hydrochloride in postmenopausal women with borderline to mild essential hypertension. This study had a monocentric, randomized, parallel-group design, and was open for moexipril, and double-blind, and placebo-controlled for HRT. Assessment of arterial distensibility was by automatic noninvasive measurement of the carotid–femoral pulse wave velocity (PWV). The PWV and the pulse pressure decreased significantly after a single oral dose of 15 mg moexipril. An influence of HRT on the changes in the PWV and pulse pressure could not be seen. The plasma concentrations of renin increased and of aldosterone decreased after moexipril administration. Arterial function improves after acute administration of 15 mg moexipril in postmenopausal women with mild to moderate essential hypertension. The changes in PWV and pulse pressure are of similar magnitude in women with and without HRT.     

高血压病患者颈-股动脉和颈-桡动脉脉搏波速度改变及其影响因素

目的探讨不同年龄和血压水平的高血压病患者颈-股动脉和颈-桡动脉脉搏波速度的改变及其影响因素。方法应用脉搏波速度(pulse wave velocity,PWV)自动测量系统测定颈-股动脉PWV(CFPWV)和颈-桡动脉PWV(CRPWV)分别作为反映中央弹性大动脉和外周中等肌性动脉弹性功能的指标,对517例高血压患者[其中男272例,女245例,年龄17~82岁,平均(52.0±13.0)岁]和118例健康人[其中男52例,女66例,年龄19~82岁,平均(54.2±13.8)岁]进行PWV检测。结果健康人和高血压病患者颈-股动脉PWV均随年龄增大而增加(P<0.001),而颈-桡动脉PWV无此变化趋势;颈-股动脉PWV和颈-桡动脉PWV均随血压水平升高而增高(P<0.001)。多元逐步回归显示,年龄和收缩压是影响颈-股动脉PWV的独立因素;舒张压是影响颈-桡动脉PWV的独立因素(各标准化回归系数P<0.001)。结论年龄和血压组分对高血压患者中央弹性大动脉和外周中等肌性动脉弹性功能的影响不同。对大动脉弹性功能改变的检测较外周中等动脉有更重要的临床价值。     

Acute effects of oral melatonin administration on arterial distensibility, as determined by carotid-femoral pulse wave velocity, in healthy young men

The aim of the present study was to investigate the effects of melatonin administration on arterial distensibility by using carotid-femoral (aortic) pulse wave velocity (PWV) measurements in healthy young men. Ten men were studied (five men in the melatonin group and five men in the placebo group) by physicians. Carotid-femoral (aortic) PWV, blood pressure and plasma melatonin were measured in the supine position before and 60 min after oral administration of melatonin or placebo. Although carotid-femoral (aortic) PWV, systolic blood pressure and mean blood pressure were decreased, pulse wave propagation time and plasma melatonin levels were increased at 60 min after oral melatonin (1 mg) administration (P=0.04, P=0.04, P=0.04, P=0.04 and P=0.04, respectively). No significant differences were found between all parameters in the placebo group (P>0.05). In conclusion, these findings indicate that melatonin administration, compared with placebo, decreased carotid-femoral PWV and systolic blood pressure in the supine position in healthy young men. Administration of melatonin may have an inhibitory effect on sympathetic tone.     

Clinical usefulness and limitations of brachial-ankle pulse wave velocity in the evaluation of cardiovascular complications in hypertensive patients.

The goal of this study was to clarify the clinical usefulness and limitations of brachial-ankle pulse wave velocity (PWV) to evaluate hypertensive complications, in comparison with carotid-femoral PWV. Patients with essential hypertension (n=296, male/female=161/135; age=61.1+/-0.7 years) were enrolled. We measured brachial-ankle PWV, femoral-ankle PWV and carotid-femoral PWV simultaneously, and evaluated target organ damage and associated clinical conditions (cerebrovascular and cardiovascular disease) using the World Health Organization classification modified in 1999. Carotid-femoral PWV (p<0.0001; r=0.521) and brachial-ankle PWV (p<0.0001; r=0.478) but not femoral-ankle PWV were significantly correlated with age. Carotid-femoral PWV was significantly higher in patients with associated clinical conditions compared with that in patients with target organ damage (p<0.05) and those with no complications (p<0.0001). Brachial-ankle PWV was significantly higher in patients with associated clinical conditions (p<0.05) and target organ damage (p<0.05) compared to those with no complications, but there was no significant difference in brachial-ankle PWV between these two groups. Moreover, femoral-ankle PWV was significantly lower in patients with associated clinical conditions compared with that in patients with target organ damage (p<0.05). These data suggest that brachial-ankle PWV could underestimate arterial stiffness in hypertensive patients with a history of cardiovascular events.     

高血压合并动脉粥样硬化与大动脉缓冲功能关系的研究

目的研究高血压病（EH）合并动脉粥样硬化患者大动脉缓冲功能的改变。方法选择313例EH患者,其中男性230例,女性83例,平均年龄（58.5±10.1）岁。应用脉搏波速度(pulse wave velocity,PWV)自动测量系统测定颈动脉-股动脉PWV作为反映大动脉节段扩张性的参数;B型超声对颈动脉进行扫查,动脉粥样硬化的定义为内膜-中层厚度≥1.3mm。颈动脉横断面顺应性和容积扩张性作为评价大动脉缓冲功能的指标。结果313例EH患者合并颈动脉粥样斑块者120例。与未合并颈动脉粥样硬化患者相比,EH合并颈动脉粥样硬化患者收缩压［（149.76±20.20）mmHg比（141.62±18.94）mmHg］、脉压［（61.72±18.94）mmHg比（52.84±14.58）mmHg］和PWV［（12.91±2.93）m/s比（10.78±2.02）m/s］显著升高(P均<0.001);颈动脉横断面顺应性［（64.68±40.52）10-3*mm2/mmHg比（81.55±63.45）10     

Relationship between cardio-ankle vascular index (CAVI) and carotid atherosclerosis in patients with essential hypertension.

Aortic stiffness measured by aorta-iliac or carotid-femoral pulse wave velocity (PWV) predicts all-cause and cardiovascular mortality. Brachial-ankle PWV (baPWV) has been developed as a more convenient assessment of arterial stiffness. However, the problem with clinical use of baPWV is that the index itself is closely dependent on blood pressure. Recently, a new method, termed the cardio-ankle vascular index (CAVI), has been proposed in Japan to overcome the disadvantages associated with measuring PWV. However, its clinical usefulness has not yet been fully clarified. In the present study, we compared the usefulness of CAVI with that of ultrasound for evaluating atherosclerosis in patients with essential hypertension. CAVI was measured in 70 hypertensive patients. The intima-media thickness (IMT), cross-sectional distensibility coefficient (CSDC), stiffness parameter beta, and mean diastolic (V(d)) and systolic (V(s)) flow velocities were evaluated by carotid ultrasound. The V(d)/V(s) ratio, an index of peripheral arterial resistance, was also calculated. CAVI was positively correlated with IMT (r=0.360, p=0.0022) and stiffness beta (r=0.270, p=0.0239) and negatively correlated with V(d)/V(s) (r=-0.471, p<0.0001) and CSDC (r=-0.315, p=0.0079). Stepwise regression analysis revealed that age (r=0.475, p<0.0001) and pulse pressure (r=0.492, r<0.0001) were independent determinants of CAVI. These results suggest that CAVI is a useful clinical marker for evaluating atherosclerosis and arteriolosclerosis in patients with essential hypertension.     

Hemodynamic, anti-ischemic, and neurohumoral effects of slow-release isosorbide-5-mononitrate in patients with coronary artery disease after short- and long-term therapy.

In 20 patients with established coronary artery disease, stable angina pectoris and reproducible ST-segment depression, the pharmacokinetics and pharmacodynamic effects of 60 mg slow-release isosorbide-5-mononitrate (IS-5-MN) (10 patients) after a 7-day therapy were compared with those of a placebo group (10 patients) using a randomized double-blind, placebo-controlled study design. Ten patients could be controlled after long-term therapy over a mean of 399 +/- 111 days. There was no significant change under IS-5-MN of either blood pressure, heart rate, rate-pressure product, or myocardial oxygen consumption. Treatment over one week significantly reduced ST-segment depression 4 and 8 h after drug intake (38-48% of the placebo value, p less than 0.01). Maximum reduction in ST-segment depression was found 4 and 8 h after IS-5-MN intake both after one-week and long-term therapy at the time of peak plasma drug concentration (341 +/- 95 and 405 +/- 125 ng/ml, respectively). At a residual plasma concentration below 100 ng/ml, ST depression was not significantly improved 24 h after drug intake compared with placebo. Technetium-99m ventriculography showed an insignificant increase in ejection fraction and a slight reduction of ventricular volumes after both short- and long-term therapy with IS-5-MN (p greater than 0.05). The drug's plasma levels were higher under chronic than under short-term therapy which may be due to enzyme saturation. Maximum IS-5-MN plasma concentrations at a mean of 445 +/- 116 ng/ml were reached after 5.8 +/- 2.9 h. Beta-phase half-life of elimination was 9 +/- 3 h. IS-5-MN administered as a single 60 mg dose of a slow-release preparation/day proved to have a favorable pharmacokinetic profile as well as an efficient antiischemic activity after both short- and long-term therapy. Problems of tolerance or activation of hormonal counter-regulation due to vasodilation were not observed.     

Inhibition of platelet function during in vivo infusion of isosorbide mononitrates: relationship between plasma drug concentration and hemodynamic effects

Isosorbide monitrates (IS-2-MN and IS-5-MN), hepatic metabolites of isosorbide dinitrate, inhibit platelet function in vitro very differently, with IS-2-MN being much more potent than IS-5-MN. To assess their antiplatelet properties in vivo and to compare time and dosage requirements, we infused both IS-2-MN and IS-5-MN for 30 minutes, on 2 separate days, into nine patients with stable coronary artery disease, at rates of 4 mg/hr (n = 4) and 8 mg/hr (n = 5). Two additional patients received IS-5-MN at 16 mg/hr. Platelet aggregation and thromboxane (TX) B2 generation in response to various agonists, drug plasma concentrations, and blood pressure were monitored throughout the study. A significant decrease in platelet aggregation and TXB2 production by adenosine diphosphate and adrenaline occurred in seven of nine patients receiving IS-2-MN and in 7 of 11 patients receiving IS-5-MN. Response was dose related, with more patients responding at 8 mg/hr to IS-2-MN (five of five) than to IS-5-MN (three of five), and was maximum at the end of the infusion time, corresponding to peak plasma levels. Patients responding to drug infusions with an inhibition of platelet function were characterized by a greater vascular responsiveness compared to nonresponders, since the decrease in systolic blood pressure (mean +/- SEM) was significantly greater in the former (15.4 +/- 3.2) than in the latter (2.5 +/- 2.1, p less than 0.05). Therefore both mononitrates, when administered at infusion rates between 8 and 16 mg/hr, are accompanied by a consistent inhibition of adenosine diphosphate- and adrenaline-induced aggregation and TX generation.(ABSTRACT TRUNCATED AT 250 WORDS)     

高血压不同部位大动脉缓冲功能不均一性的临床研究

目的：研究正常人和高血压患者不同部位动脉缓冲功能的变化。方法：对１２０例正常人和２０５例原发性高血压患者应用动脉搏波速度（Ｐｕｌｓｅ ｗａｖｅ ｖｅｌｏｃｉｔｙＰＷＶ）测定仪进行检测。颈动脉－股动脉ＰＷＶ（ＣＦＰＷＶ）、肱动脉－找动脉ＰＷＶ（ＢＲＰＷＶ）和股动脉－足背动脉ＰＷＶ（ＦＴＰＷＶ）分别为反映大动脉和中等动脉扩张性（Ｄｉｓｔｅｎｓｉｂｉｌｉｔｙ）的参数。并能敏感反映动脉缓冲功能的改变。结果：无论正常人还是高血压患者,ＣＦＰＷＶ与年龄和收缩压成正相关关系（Ｐ均小于０．００１）,而ＢＲＰＷＶ和ＦＴＰＷＶ并不随年龄和收缩压的改变而改变。结论：正常人和高血压患者不同部位动脉节段的缓冲功能发生不同的变化,大动脉扩张性降低,中等动脉无明显变化。对大动脉缓冲功能变化的早期检测和有效治疗具有重要的临床价值。     

Arterial distensibility as determined by carotid-femoral pulse wave velocity in patients with Behçet’s disease

Behçets disease (BD) is a chronic, multisystem disorder characterized by genital and oral aphthae, skin lesions, uveitis, and tendency to thrombosis. Pulse wave velocity (PWV) is an important factor in determining cardiovascular mortality and morbidity. It is an index of arterial wall stiffness and inversely related to the arterial distensibility. In this study we investigated the arterial distensibility in BD by PWV. We studied 14 patients with BD (18–44 years old, 10 men) and 28 healthy subjects (18–39 years old, 21 men) without known cardiovascular disease. Arterial distensibility was assessed by automatic carotid-femoral PWV measurement using the Complior Colson device. PWV is calculated from measurements of pulse transit time and the distance traveled by the pulse between two recording sites, according to the following formula: pulse wave velocity (m/s)=distance (m)/transit time(s). The mean ages, systolic blood pressure, diastolic blood pressure, pulse pressure, heart rate, and PWV of Behçets disease and control subjects were 32.1±7.4 vs 27.9±6.1 years, 112.9±12.0 vs 108.7±10.0 mmHg, 72.1±10.7 vs 67.7±7.5 mmHg, 40.7±12.2 vs 41.0±10.7 mmHg, 74.1±10.2 vs 77.2±10.1 bpm, and 8.4±1.4 vs 8.5±1.1 m/s, respectively. Differences between all parameters studied were not found to be statistically significant (p>0.05). The carotid-femoral PWV, an index of arterial stiffness and a marker of atherosclerosis, is not increased in patients with BD compared with control subjects.     

Assessment of arterial distensibility in patients with cardiac syndrome X

This study aims to investigate arterial distensibility by using carotid-femoral (aortic) pulse wave velocity measurements in patients with cardiac syndrome X. The authors studied 10 patients with cardiac syndrome X (mean age 49.4 +/-7.5, 39 to 67 years old, 3 men) and 10 healthy subjects (mean age 50.0 +/-10.5, 38 to 70 years old, 3 men). Carotid-femoral pulse wave velocity measured by a Complior Colson device was calculated for each patient. The carotid-femoral pulse wave velocity was increased in patients with cardiac syndrome X as compared with age-matched control subjects (10.25 +/-1.28 vs 8.95 +/-0.89 m/s, p = 0.01). In contrast, there were no significant differences in the age, weight, height, body mass index, waist/hip ratio, systolic blood pressure, diastolic blood pressure, mean blood pressure, pulse pressure, and heart rate (p=0.76,p=0.17,p=0.36,p=0.08, p=0.21,p=0.14,p=0.89,p=0.30,p=0.10, p = 0.36, respectively). No significant correlation was found between pulse wave velocity and age, sex, height, weight, heart rate, systolic blood pressure, diastolic blood pressure, mean blood pressure, and pulse pressure in the studied groups (p>0.05). The arterial distensibility was decreased in patients with cardiac syndrome X. The deterioration in these patients showed that this disease might be a more generalized disturbance of the vasculature. Measurements of carotid-femoral pulse wave velocity may provide a simple and noninvasive technique to identify patients at increased risk of vascular disease.     

Dose-ranging study of isosorbide-5-mononitrate in chronic congestive heart failure treated with diuretics and angiotensin-converting enzyme inhibitor

The hemodynamic response of isosorbide-5-mononitrate (IS-5-MN) to the addition of the widely used therapy of diuretic drugs and the maximally tolerated dose of enalapril for heart failure was assessed in 8 patients with congestive heart failure (CHF) (New York Heart Association class II and III). The diuretic therapy was furosemide, 40 to 80 mg/day, with or without amiloride, 5 to 10 mg/day. The dose of enalapril was 5 to 20 mg/day. Four hours after the administration of the morning dose of enalapril, a Swan-Ganz catheter was positioned in the pulmonary artery. Patients received increasing doses of IS-5-MN to produce a satisfactory decrease in pulmonary capillary wedge pressure. Two of the first 3 patients studied had a large reduction in blood pressure when given 10 mg of IS-5-MN. Subsequent patients were therefore given an initial dose of 5 mg, the total dose being 5 to 20 mg over 2 hours. Results at baseline and 1 hour after the final dose of IS-5-MN are expressed as mean +/- standard deviation. Both pulmonary artery systolic and diastolic pressures decreased significantly (p less than 0.05) by 12.2 +/- 8.9/4.2 +/- 5.2 mm Hg, from 47.2 +/- 16.0/21.6 +/- 6.0 mm Hg to 35.0 +/- 15.2/17.4 +/- 9.3 mm Hg. Pulmonary capillary wedge pressure decreased by 8.6 +/- 4.4 mm Hg, from 22.1 +/- 5.4 to 13.6 +/- 7.5 mm Hg (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Pulse wave velocity as endpoint in large-scale intervention trial. The Complior study. Scientific, Quality Control, Coordination and Investigation Committees of the Complior Study

OBJECTIVE: To evaluate the ability of an antihypertensive therapy to improve arterial stiffness as assessed by aortic pulse wave velocity (PWV) in a large population of hypertensive patients. SETTING: Sixty-nine healthcare centres, private and institutional (19 countries). PATIENTS: Subjects aged 18-79 years, with essential hypertension. A total of 2,187 patients were enrolled; 1,703 (52% male) completed the study: mean age = 50 +/- 12 years; mean baseline systolic/diastolic blood pressure (S/D BP) = 158 +/- 15/98 +/- 7 mmHg; mean baseline carotid-femoral PWV = 11.6 +/- 2.4 m/s. INTERVENTIONS: Patients were treated for 6 months, starting with perindopril (angiotensin converting enzyme (ACE) inhibitor) 4 mg once daily (OD), increased to 8 mg OD, and combined to diuretic (indapamide 2.5 mg OD) if BP was uncontrolled (> 140/90 mmHg). RESULTS: It was feasible to measure carotid-femoral PWV using the automatic device Complior at inclusion, 2 and 6 months, along with conventional BP assessments in a population of 1,703 patients. Significant decreases (P < 0.001) in BP (systolic: -23.7 +/- 16.8, diastolic: -14.6 +/- 10 mmHg), and carotid-femoral PWV (-1.1 +/- 1.4 m/s) were obtained at 2 and 6 months. CONCLUSIONS: The Complior Study is the first study to show the feasibility of a large-scale intervention trial using PWV as the endpoint in hypertensive patients. Adequate results may be obtained using an automatic device and rigorous criteria for assessment. A long-term controlled intervention study is needed to confirm the results of the present uncontrolled trial.     

Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients

Although various studies reported that pulse pressure, an indirect index of arterial stiffening, was an independent risk factor for mortality, a direct relationship between arterial stiffness and all-cause and cardiovascular mortality remained to be established in patients with essential hypertension. A cohort of 1980 essential hypertensive patients who attended the outpatient hypertension clinic of Broussais Hospital between 1980 and 1996 and who had a measurement of arterial stiffness was studied. At entry, aortic stiffness was assessed from the measurement of carotid-femoral pulse-wave velocity (PWV). A logistic regression model was used to estimate the relative risk of all-cause and cardiovascular deaths. Selection of classic risk factors for adjustment of PWV was based on their influence on mortality in this cohort in univariate analysis. Mean age at entry was 50+/-13 years (mean+/-SD). During an average follow-up of 112+/-53 months, 107 fatal events occurred. Among them, 46 were of cardiovascular origin. PWV was significantly associated with all-cause and cardiovascular mortality in a univariate model of logistic regression analysis (odds ratio for 5 m/s PWV was 2.14 [95% confidence interval, 1.71 to 2.67, P<0.0001] and 2.35 [95% confidence interval, 1.76 to 3.14, P<0.0001], respectively). In multivariate models of logistic regression analysis, PWV was significantly associated with all-cause and cardiovascular mortality, independent of previous cardiovascular diseases, age, and diabetes. By contrast, pulse pressure was not significantly and independently associated to mortality. This study provides the first direct evidence that aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in patients with essential hypertension.     

Arterial dilation and reduced wave reflection. Benefit of dilevalol in hypertension

We compared dilevalol (an isomer of labetalol), 200-400 mg daily, against atenolol, 50-100 mg daily, in a double-blind, crossover, placebo-controlled trial with respect to effects on arterial distensibility (measured as pulse wave velocity [PWV]) and wave reflection (assessed from carotid pressure wave contour). Twelve patients of mean age 58 years (range 44-73 years) with essential hypertension (supine diastolic blood pressure 95-114 mm Hg) took active therapy for 12 weeks, separated by a 2-4 week placebo period. Carotid pressure waveforms were recorded noninvasively by applanation tonometry with a Millar micromanometer-tipped probe. PWV was measured between carotid and femoral arteries (aortic PWV), carotid and radial arteries (arm PWV), and femoral and pedal arteries (leg PWV). Early wave reflection was calculated from the ratio of the height of the peak of the carotid wave above its shoulder to the pulse pressure and was expressed as an augmentation index. Both drugs were equally effective in reducing brachial sphygmomanometric pressure and PWV in all three regions (active vs. placebo, p less than 0.001), but there was no significant difference between the two active therapies. However, the augmentation index (averaged during the treatment period) was significantly lower with dilevalol (19%) than with atenolol (28%, p less than 0.01), corresponding to a greater decrease of 5-8 mm Hg in carotid systolic pressure compared with the brachial artery. Although both drugs were equally effective in reducing arterial distensibility, the vasodilating action of dilevalol gave added benefit in reducing wave reflection, presumably through its vasodilatory effect on peripheral conduit arteries.