高血压患者动态血压变化与左室肥厚的关系

目的：探讨高血压病患者动态血压变化与左室肥厚的关系。方法：对50例高血压病患者进行24小时动态血压监测，对其超声心动图左室肥厚与左室质量指数的相关性分析。结果：血压昼夜节律消失的高血压病患者其左室肥厚检出率（50％）显著高于血压昼夜节律正常者（23％），夜间收缩压、舒张压与左室质量指数的相关性比白昼更密切，而夜间收缩压、舒张压下降率与左室质量指数呈负相关。结论：高血压病患者夜间血压水平与血压节律性对左室肥厚的发生、发展有重要作用。     

The efficacy of telmisartan compared with perindopril in patients with mild-to-moderate hypertension

In this study, efficacy of the angiotensin II type 1 receptor blocker telmisartan given as monotherapy was compared with that of perindopril monotherapy in patients with mild-to-moderate hypertension. After a 2-week, single-blind, placebo run-in period, 60 patients were randomised to double-blind, once-daily treatment with telmisartan 80 mg or perindopril 4 mg for 6 weeks. Clinic and ambulatory blood pressure measurements and clinical laboratory evaluation were performed at the end of the placebo run-in and active treatment phases. Both telmisartan and perindopril significantly (p < 0.0001) reduced clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared with baseline values. Also, both drugs significantly (p < 0.0001) reduced 24-h mean ambulatory SBP and DBP compared with baseline. Comparison of the mean hourly antihypertensive activities showed that the reduction in mean ambulatory DBP for the last 8 h of the dosing interval was significantly greater (p < 0.05) in telmisartan-treated patients. A 24-h mean DBP of <85 mmHg was observed in 66.6% of the telmisartan-treated patients but in only 46.6% of the perindopril-treated patients (p < 0.05). It is concluded that telmisartan and perindopril both produce significant reductions in clinic SBP and DBP, but the mean reduction in ambulatory DBP during the last 8 h of the dosing interval is greater in patients treated with telmisartan.     

A double-blind ambulatory blood pressure monitoring study of the efficacy and tolerability of once-daily telmisartan 40 mg in comparison with losartan 50 mg in the treatment of mild-to-moderate hypertension in Taiwanese patients

Ambulatory blood pressure monitoring (ABPM) was used to compare the efficacy and tolerability of once-daily telmisartan 40 mg and once-daily losartan 50 mg in Taiwanese patients with mild-to-moderate essential hypertension in a randomised, double-blind, double-dummy, parallel-group study. The initial 2-week placebo run-in phase was followed by randomisation to treatment with telmisartan 40 mg (n = 31) or losartan 50 mg (n = 30) for 6 weeks. The reduction in 18- to 24-h mean (SE) ambulatory diastolic blood pressure (DBP) from baseline was significantly greater with telmisartan 40 mg (-12.1 +/- 1.6 mmHg, p = 0.036) than with losartan 50 mg (-7.0 +/- 1.8 mmHg). The reduction in 18- to 24-h mean (SE) ambulatory systolic blood pressure (SBP) from baseline was also greater with telmisartan 40 mg (-16.0 +/- 2.4 mmHg) than with losartan 50 mg (-11.8 +/- 2.7 mmHg), but did not achieve statistical significance. Telmisartan was well tolerated; no serious adverse events occurred.     

Comparison of the efficacy and tolerability of telmisartan 40 mg vs. enalapril 10 mg in the treatment of mild-to-moderate hypertension: a multicentre, double-blind study in Taiwanese patients

The purpose of this randomised, double-blind, double-dummy, parallel-group study was to evaluate the efficacy and tolerability of telmisartan 40 mg once daily vs. enalapril 10 mg once daily in 147 Taiwanese patients with mild-to-moderate essential hypertension (diastolic blood pressure [DBP] 90-109 mmHg). After 6 weeks' treatment, telmisartan produced a significantly greater reduction from baseline in the primary endpoint of trough seated DBP compared with enalapril 10 mg (11.7 vs. 8.7 mmHg, respectively; p = 0.02). Numerically greater reductions compared with baseline in seated systolic blood pressure (SBP), standing DBP, and standing SBP were achieved with telmisartan compared with enalapril. Also, numerically greater proportions of patients achieved blood pressure control (DBP/systolic blood pressure [SBP] <90/140 mmHg) and responded to treatment (reduction from baseline in trough seated DBP > or = 10 mmHg and/or post-treatment DBP <90 mmHg; reduction from baseline in trough seated SBP > or = 10 mmHg and/or post-treatment SBP <140 mmHg) with telmisartan 40 mg compared with enalapril 10 mg. Although both treatments were well tolerated, the incidence of cough was markedly lower with telmisartan 40 mg (8.5%) than with enalapril 10 mg (18.4%) in this population of Taiwanese hypertensive patients.     

Pre-clinical and clinical experience of telmisartan in cardiac remodelling

Epidemiological studies have established that left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular and cerebrovascular morbidity and mortality. In turn, hypertension is a well-established risk factor for LVH. Ambulatory blood pressure monitoring has shown that 24-h mean ambulatory blood pressure is a particularly powerful predictor of LVH, being superior to casual clinic blood pressure measurements. The magnitude of the rise in blood pressure in the early morning correlates with the extent of LVH. Prospective studies have shown the advantageous effects of antihypertensive therapy on LVH in terms of regression of left ventricular mass (LVM) and subsequent reduction in overt cardiovascular disease. Meta-analysis has identified differences in the ability of different classes of anti-hypertensive agents to bring about regression of LVH, with agents that target the renin angiotensin system (RAS) appearing superior to other agents, such as beta-blockers and diuretics. The distinct pharmacological features of telmisartan suggest that it may be a suitable agent for managing hypertensive patients because it provides sustained control of blood pressure and appears to be very effective in reversing cardiac remodelling. Pre-clinical evaluation has demonstrated that telmisartan suppresses angiotensin II-induced collagen production and secretion by cultured fibroblasts, and reduces left ventricular weight in different animal models. Several clinical studies have demonstrated that, as well as reducing blood pressure (including 24-h mean ambulatory values), telmisartan brings about LVM regression in patients with hypertension, and improves left ventricular and left atrial function. Comparative studies have shown telmisartan's superiority compared with both hydrochlorothiazide and carvedilol in regressing LVM, the additional activity probably being explained by the sustained blood pressure control and the non-haemodynamic effects of targeting the RAS. The ultimate proof of the clinical value of telmisartan will be provided by the outcome trials ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in aCE iNtolerant subjects with cardiovascular Disease (ONTARGET/TRANSCEND) currently being conducted in high-risk patients.     

依伦平对高血压病及左心室肥厚的影响

目的探讨依伦平对高血压左心室肥厚的影响。方法将72例伴有左心室肥厚的高血压病人随即分成2组,依伦平组36例,用依伦平150 mg,非洛地平组36例,用非洛地平5 mg,均1次/d,晨服,疗程24周。观察用药前后血压、左心室重量指数(LVMI)等指标变化。结果 2组病人治疗后血压、室间隔及左室后壁厚度、左室重量指数等指标均较用药前显著下降。结论依伦平可减轻高血压病人左心室肥厚,且能显著降低血压,不良反应相对较小。     

高血压患者血压变异性和左室肥厚关系的研究

目的观察原发性高血压患者血压变异性与左心室肥厚的关系。方法原发性高血压患者60例,分别进行超声心动图检查和24 h动态血压监测,根据超声心动图测量指标计算所得的左心室重量指数(LVMI)分为左心室肥厚(LVH)组和无LVH组,分析比较两组间的血压均值和血压变异性。结果 LVH组24 h、白昼、夜间的收缩压和舒张压水平以及各阶段的收缩压和舒张压标准差均比无LVH组明显增大,差异有显著性;且LVH组LVMI高于无LVH组,差异有显著性。结论原发性高血压患者LVH的发生和血压变异性密切相关,血压变异性增高对左心室肥厚风险有一定预测价值。     

持续不卧床腹膜透析患者中不同血压表型与左心室肥厚患病率之间的关系研究

目的探讨持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者中不同的血压表型与左心室肥厚的患病率之间的关系及对左心室心肌重构的影响。方法选择127例CAPD患者,根据诊室测量的肱动脉血压将患者分为4组:正常血压组(46例):收缩压(SBP)140mmHg(1mm Hg=0.133kPa)且舒张压(DBP)90mm Hg;孤立收缩期高血压(isolated systolic hypertension,ISH)组(42例):SBP≥140mm Hg且DBP90mm Hg;双期高血压(systolic/diastolic hypertension,SDH)组(39例):SBP≥140mm Hg且DBP≥90mm Hg;孤立舒张期高血压(isolated diastolichypertension,IDH)组(0例):SBP140mm Hg且DBP≥90mm Hg。收集患者基本资料、血生化检查资料,并采用超声心动图检查评估3组患者的心脏形态功能及血流动力学指标,包括左心室质量(LVM)、左心室质量指数(LVMI,身高2.7标化的LVM)、左心室肥厚(LVH)患病率、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、左心室舒张期早晚期二尖瓣口血流频谱(E峰、A峰、E/A)、心输出量(CO)、心脏指数(CI)、心每搏输出量(SV)、心每搏指数(SI)、总外周阻力(TPR)和总外周血管阻力指数(TPRI)等,并将血压表型、体质量指数(BMI)、性别、透析龄、血肌酐(SCr)、TPRI等纳入左心室肥厚的可能危险因素进行多因素logistics回归分析。结果 3组间基本资料、血脂状态、贫血状况差异均无统计学意义(P0.05);SBP、DBP、平均动脉压(MAP)、脉压(PP),SDH组ISH组正常血压组(P0.01),LVM、LVMI在ISH组和SDH组均高于正常血压组(P0.05);LVH的患病率在ISH组为76.2%,在SDH组为71.8%,均高于正常血压组(50.0%,P0.05)。LVEF、LVFS,SDH组和ISH组均低于正常血压组(P0.01)。LVEDD和LVESD在SDH组和ISH组高于正常血压组(P0.01),E峰在3组间无差异,而A峰在SDH组低于ISH组(P0.01),E/A在SDH组高于ISH组及正常组(P0.01);TPR和TPRI在SDH组高于ISH组和正常血压组。多因素logistics回归分析显示,ISH组和SDH组患LVH的风险分别是正常血压组的2.01倍和1.74倍;女性患LVH的风险是男性的1.36倍;透析龄每增加一个月患LVH的风险增加0.03倍。结论 CAPD患者中,高血压表型是左心室肥厚的独立危险因素,SDH表型患者外周血管阻力较高,左心室舒张功能减低明显,而ISH表型患者LVH患病率和危险度较高,因此高血压不同表型对心血管损伤机制可能存在差异,其中ISH压型对心脏重构的影响较大,LVH患病危险度较高。     

多普勒超声对依那普利逆转高血压左室肥厚的评价

作者应用转换酶抑制剂（ＡＣＥＩ）──依那普利（Ｅｎａｌａｐｒｉｌ）对３０例轻、中度高血压病患者进行治疗。观察８周后发现：①该药能有效控制血压，治疗前后比较收缩压、舒张压均明显下降（Ｐ＜０．００１），而并无心率增快的副作用；②能逆转左室肥厚（ＬＶＨ），减轻左室心肌重量、左室心肌重量指数等指标（Ｐ＜０．００１）；③对左室收缩功能指标如射血分数等没有明显影响（Ｐ＞０．００５）；④能改善左室舒张功能指标，而以ＰＥ／ＰＡ、Ｅｉ／Ａｉ最为显著Ｐ＜０．００１。结果提示，应用依那普利治疗高血压，短时间内（８周）不仅能有效控制血压，且具有一定逆转ＬＶＨ和改善左室舒张功能的作用。     

Efficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomized, placebo-controlled study

BACKGROUND: Stevioside, a natural glycoside isolated from the plant Stevia rebaudiana Bertoni, has been used as a commercial sweetening agent in Japan and Brazil for >20 years. Previous animal and human studies have indicated that stevioside has an antihypertensive effect. OBJECTIVES: This study was undertaken to investigate the long-term (2-year) efficacy and tolerability of stevioside in patients with mild essential hypertension. Secondary objectives were to determine the effects of stevioside on left ventricular mass index (LVMI) and quality of life (QOL). METHODS: This was a multicenter, randomized, double-blind, placebo-controlled trial in Chinese men and women aged between 20 and 75 years with mild essential hypertension (systolic blood pressure [SBP] 140-159 mm Hg and diastolic blood pressure [DBP] 90-99 mm Hg). Patients took capsules containing 500 mg stevioside powder or placebo 3 times daily for 2 years. Blood pressure was measured at monthly clinic visits; patients were also encouraged to monitor blood pressure at home using an automated device. LVMI was determined by 2-dimensional echocardiography at baseline and after 1 and 2 years of treatment. QOL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey. Electrocardiographic, laboratory, and QOL parameters were assessed at the beginning of treatment, and at 6 months, 1 year, and 2 years. RESULTS: One hundred seventy-four patients (87 men, 87 women) were enrolled in the study, and 168 completed it: 82 (42 men, 40 women; mean [SD] age, 52 [7] years) in the stevioside group and 86 (44 women, 42 men; mean age, 53 [7] years) in the placebo group. After 2 years, the stevioside group had significant decreases in mean (SD) SBP and DBP compared with baseline (SBP, from 150 [7.3] to 140 [6.8] mm Hg; DBP, from 95 [4.2] to 89 [3.2] mm Hg; P < 0.05) and compared with placebo (P < 0.05). Based on patients' records of self-monitored blood pressure, these effects were noted beginning approximately 1 week after the start of treatment and persisted throughout the study. There were no significant changes in body mass index or blood biochemistry, and the results of laboratory tests were similar in the 2 groups throughout the study. No significant difference in the incidence of adverse effects was noted between groups, and QOL scores were significantly improved overall with stevioside compared with placebo (P < 0.001). Neither group had a significant change in mean LVMI. However, after 2 years, 6 of 52 patients (11.5%) in the stevioside group had left ventricular hypertrophy (LVH), compared with 17 of 50 patients (34.0%) in the placebo group (P < 0.001). Of those who did not have LVH at baseline, 3 of 46 patients (6.5%) in the stevioside group had developed LVH after 2 years, compared with 9 of 37 patients (24.3%) in the placebo group (P < 0.001). CONCLUSIONS: In this 2-year study in Chinese patients with mild hypertension, oral stevioside significantly decreased SBP and DBP compared with placebo. QOL was improved, and no significant adverse effects were noted.     

原发性高血压患者脉压指数、胰岛素抵抗与左心室肥厚的关系

目的探讨原发性高血压患者脉压指数（PPI）、胰岛素抵抗与左心室肥厚（LVH）的关系。方法对258例原发性高血压患者测定空腹血糖（FSG）、空腹血胰岛素浓度（INS）及血压水平,计算胰岛素敏感指数（ISI）、脉压指数（PPI）。采用超声心动图测量舒张末期左心室内径、室间隔厚度、左心室后壁厚度,计算左心室重量指数（LVMI）。结果LVH组收缩压（SBP）、PPI、INS、年龄、高血压病程高于非LVH组,舒张压（DBP）、ISI低于非LVH组（均P〈0.05）。高PPI组LVMI、INS高于低PPI组,ISI低于低PPI组（均P〈0.05）。高胰岛素组LVMI高于正常胰岛素组,ISI低于正常胰岛素组（均P〈0.05）。单因素相关分析示LVMI与PP、PPI、INS、年龄呈正相关,与ISI呈负相关（均P〈0.05）;多元逐步回归分析示PPI的标准化回归系数最大。结论原发性高血压患者的PPI、胰岛素抵抗与LVH密切相关,PPI、ISI可作为LVH的预测指标。     

长效钙离子拮抗剂对高血压心肌肥厚患者的作用

目的探讨长效钙离子拮抗剂对高血压伴左心室肥厚患者的影响。方法将120例病例分为A组(硝苯地平控释片30mg/d,n=60)和B组(氨氯地平片5mg/d,n=60),治疗12周后观察两组治疗前后舒张压(SBP)、收缩压(DBP)、血浆脑钠素(BNP)、左心室质量指数(LVMI)和左心室射血分数(LVEF)的变化及治疗期间的不良反应。结果两组治疗12周后SBP、DBP、BNP和LVMI均较治疗前明显降低,差异均有统计学意义(t分别=2.39、2.39、2.53、2.46、2.41、2.39、2.50、2.43,P均<0.05),但两组治疗前后LVEF无明显变化,差异均无统计学意义(t分别=1.63、1.67,P均>0.05);两组治疗后各指标值组间比较,差异均无统计学意义(t分别=1.32、1.54、1.35、1.46、1.57,P均>0.05)。两组的不良反应发生率比较,差异无统计学意义(χ2=0.31,P>0.05)。结论长效钙离子拮抗剂对高血压并左心室肥厚患者能逆转左心室肥厚。     

阿托伐他汀对高血压患者左心室肥厚的影响

目的 研究阿托伐他汀对高血压合并左心室肥厚的影响.方法 选择2008年1月至2009年6月,在我科门诊就诊的无脂代谢异常的高血压合并左心室肥厚患者56例,随机分为阿托伐他汀组和对照组.两组均常规给予厄贝沙坦150 mg,口服每天1次.阿托伐他汀组在常规用药基础上加用阿托伐他汀10 mg,口服每天1次.比较治疗6个月后心脏超声检查两组患者的左心室质量指数(LVMI).结果 两组患者的24小时平均收缩压(SBP)、平均舒张压(DBP)和LVMI在治疗6个月后均有所降低,治疗组24小时平均SBP(158.4±13.0)mmHg vs(124.5±7.8)mmHg(P<0.01),对照组24小时平均SBP(158.8±12.1)mmHg vs(125.3±9.1)mmHg(P<0.01);治疗组24小时平均DBP(109.7±11.0)mmHg vs(78.8±6.9)mmHg(P<0.01),对照组24小时平均DBP(106.2±13.6)mmHg vs(79.4±6.1)mmHg(P<0.01);治疗组LVMI(155±20)g/m2vs(138±10)g/m2(P<0.01),对照组LVMI(151±22)g/m2vs(141±12)g/m2(P<0.01).与对照组相比,阿托伐他汀组的LVMI降低更多(P<0.05).结论 在常规治疗基础上加用阿托伐他汀,更有助于降低高血压合并左心室肥厚患者的LVMI.     

Disorders of 24-h rhythm of blood pressure in patients with chronic glomerulonephritis

AIM: To characterize 24-h profile of blood pressure (BP) and to clarify prognostic significance of 24-h BP variability in patients with chronic glomerulonephritis (CGN) with intact renal function and hypofunction of the kidneys. MATERIAL AND METHODS: A total of 38 hypertensive CGN patients (29 males and 9 females, mean age 37.9 +/- 12.4 years) entered the trial. All the patients had systolic BP (SBP) > 140 mm Hg and/or diastolic BP (DBP > 90 mm Hg. RESULTS: Twenty patients with renal hypofunction (creatinine > 1.4 mg/dl) had significantly higher (p < 0.05) SBP, day and 24-h SBP duration, high variability of day-time and 24-h SBP. Significantly higher mean day-time, night-time and 24-h SBP, SBP day-time and 24-h duration SBP duration, variability of SBP and DBP for a day and 24-h, respectively, were observed in 15 patients with left ventricular hypertrophy. Of prognostic significance in relation to renal survival estimated by Cox in 21 patients in multifactorial analysis were blood creatinine level, glomerular filtration rate, the patient's age, SBP duration for day, night and 24 hours. In multifactorial analysis, the final model included only age of the patient and blood creatinine. CONCLUSION: CGN patients with renal hypofunction had higher SBP and its variability associated with left ventricular variability.     

The efficacy and tolerability of barnidipine hydrochloride in Thai patients with hypertension

This open-label, blinded study was performed to evaluate the efficacy and tolerability of barnidipine at a titrated dose of 10-15 mg once daily for 8 weeks in the treatment of essential hypertension in 40 Thai patients. 'Office' blood pressure (BP) and 24-h ambulatory BP measurements were recorded. A systolic BP/diastolic BP (SBP/DBP) reduction of 18.0 +/- 13.6/9.1 +/- 6.6 mmHg was obtained. The full response rate among patients with systolic and diastolic hypertension was 63% using either SBP or DBP criteria, and 54% using both SBP and DBP criteria. One of the two patients with isolated systolic hypertension had a full response, and the BP in two of the three patients with isolated diastolic hypertension was normalized. The trough-to-peak ratio and smoothness index for SBP/DBP were acceptable (0.76 +/- 0.63/0.55 +/- 0.26 and 1.2 +/- 0.4/1.2 +/- 0.3, respectively). In conclusion, once-daily barnidipine monotherapy provides effective 24-h BP control and is generally well tolerated in ambulatory patients.     

The adjunctive effect of telmisartan in patients with hypertension uncontrolled on current antihypertensive therapy

This prospective, double-blind, randomised, parallel-group, multicentre study assessed the adjunctive effect of telmisartan monotherapy versus placebo in controlling blood pressure during the last six hours of the 24-hour dosing period. After a two-week run-in phase, 375 patients with essential hypertension uncontrolled on existing therapy were randomised to either placebo or telmisartan (40 mg uptitrated to 80 mg after four weeks, if needed) for eight weeks. Ambulatory blood pressure monitoring (ABPM) was conducted at randomisation (baseline) and treatment end. The change from baseline in diastolic blood pressure (DBP) over the last six hours (primary endpoint) was significantly greater with telmisartan than placebo (adjusted mean treatment difference in favour of telmisartan: -3.7 mmHg, 95% confidence interval (CI) -5.5, -1.9 mmHg, p < or = 0.001, n = 350), as was the reduction in 24-hour DBP (adjusted mean treatment difference: -5.0 mmHg, 95% CI -6.5, -3.5 mmHg, p < or = 0.001). Telmisartan also reduced mean systolic blood pressure significantly more than placebo over the last six hours and the entire 24-hour dosing interval. Responder rates (ABPM DBP, seated DBP, and overall [seated SBP/DBP]) at 8 weeks were significantly higher with telmisartan than with placebo (p < or = 0.01). All treatments were well tolerated. When added to existing antihypertensive regimens, telmisartan offers additional effectiveness while maintaining placebo-like tolerability.     

Comparison of a fixed-dose combination of 40 mg telmisartan plus 12.5 mg hydrochlorothiazide with 40 mg telmisartan in the control of mild to moderate hypertension

This study investigated whether a fixed-dose combination of 40 mg of the angiotensin II antagonist telmisartan plus 12.5 mg of the diuretic hydrochlorothiazide (HCTZ) was superior to 40 mg telmisartan in patients with mild to moderate hypertension who failed to respond adequately to 40 mg telmisartan monotherapy. One hundred forty-six patients were withdrawn before randomization. Nonresponders (n = 327) were double blind and randomized to 40 mg telmisartan + 12.5 mg HCTZ (n = 160) or 40 mg telmisartan (n = 167). After 8 weeks of treatment, 40 mg telmisartan + 12.5 mg HCTZ lowered diastolic blood pressure (DBP) by an additional 3.5 mm Hg (P <.01) and systolic blood pressure (SBP) by 7.4 mm Hg (P <.01) compared with 40 mg telmisartan. Most of the additional effect of the combination was seen after 4 weeks of treatment. At week 8, blood pressure was normalized (SBP <140 mm Hg and DBP <90 mm Hg) in 51.6% of patients on 40 mg telmisartan + 12.5 mg HCTZ compared with 23.5% on 40 mg telmisartan (P <.05). The combination of 40 mg telmisartan + 12.5 mg HCTZ normalized DBP in 64.8% of patients, whereas 40 mg telmisartan normalized DBP in 40.1% (P <.05). SBP decreased by > or =10 mm Hg from baseline in 63.5% of patients receiving the fixed-dose combination compared with 42.6% of those receiving 40 mg telmisartan (P <.05). Both treatments were well tolerated. Adverse events were predominantly mild, transient, and considered unrelated to therapy. These findings indicate that a fixed-dose combination of 40 mg telmisartan + 12.5 mg HCTZ is clinically and statistically superior to 40 mg telmisartan in patients with mild to moderate hypertension failing to respond to 40 mg telmisartan alone.     

丹参酮ⅡA对腹主动脉缩窄高血压大鼠JAK/STAT通路的影响

目的:观察丹参酮ⅡA对腹主动脉缩窄高血压大鼠心肌肥厚的作用,并研究其对左心室肌JAK/STAT通路的影响。方法:取32只9周龄SD大鼠,环扎其腹主动脉,制成高血压大鼠模型;术后4周将手术大鼠分为心肌肥厚组,丹参酮高、低剂量组和缬沙坦组。另取8只行假手术(假手术组)。测量大鼠的尾动脉收缩压(SBP)、室间隔厚度(IVS)及左室重量指数(LVMI),采用Western blot方法测定各组大鼠JAK1和STAT3的表达。结果:与假手术组相比,心肌肥厚组的SBP、IVS、LVMI以及JAK1、STAT3的表达均明显升高。丹参酮高、低剂量组上述指标(除SBP外)均较心肌肥厚组明显降低。结论:JAK、STAT的表达在心肌肥厚的信号通路中起着重要的作用。丹参酮ⅡA有可能是通过干预JAK/STAT通路而逆转左室肥厚。     

Clinical efficacy and safety of telmisartan 80 mg once daily compared with enalapril 20 mg once daily in patients with mild-to-moderate hypertension: results of a multicentre study

The efficacy and safety of once-daily telmisartan 80 mg vs. once-daily enalapril 20 mg in the treatment of essential hypertension were evaluated in a multicentre, single-blind, placebo-controlled, randomised trial. In total, 68 patients (49 females, 19 males) with mild-to-moderate hypertension, defined as morning supine systolic blood pressure (SBP) 141-149 mmHg, diastolic blood pressure (DBP) 95-114 mmHg, were enrolled. After a 4-week placebo run-in phase, patients were randomly assigned to treatment with telmisartan or enalapril administered once daily in the morning for 8 weeks. No statistically significant differences were found in the baseline characteristics of patients in either group. Both SBP and DBP were decreased in both treatment groups, but the reductions were statistically different in favour of telmisartan (SBP, p = 0.013; DBP, p = 0.002). The incidence of adverse effects was lower in the telmisartan group, with the absence of cough. In conclusion, telmisartan is more effective and better tolerated than enalapril for the treatment of hypertension and has the advantage that it does not cause cough.     

ABPM comparison of the anti-hypertensive profiles of telmisartan and enalapril in patients with mild-to-moderate essential hypertension

In this multicentre, prospective, randomized, open-label, blinded-endpoint (PROBE) study, the efficacy of 12 weeks' treatment with once-daily telmisartan 40-80 mg and enalapril 10-20 mg was evaluated using ambulatory blood pressure monitoring (ABPM) in 522 patients with mild-to-moderate essential hypertension. Patients were titrated to the higher dose of study drug at week 6 if mean seated diastolic blood pressure (DBP) was > or = 90 mmHg. The primary endpoint was the change from baseline in ambulatory DBP in the last 6 h of the 24-h dosing interval after 12 weeks' treatment. Telmisartan and enalapril produced similar reductions from baseline in DBP and systolic blood pressure (SBP) over all ABPM periods evaluated (last 6 h, 24-h, daytime and night-time). Telmisartan produced a significantly greater reduction in mean seated trough DBP, measured unblinded with an automated ABPM device in the clinic, amounting to a difference of -2.02 mmHg (P < 0.01). A significantly greater proportion of patients achieved a seated diastolic response with telmisartan than enalapril (59% versus 50%; P < 0.05), also measured with the same ABPM device. Both treatments were well tolerated. Compared with telmisartan, enalapril was associated with a higher incidence of cough (8.9% versus 0.8%) and hypotension (3.9% versus 1.1%). Therefore, telmisartan may provide better long-term compliance and, consequently, better blood pressure control than enalapril.