缬沙坦改善高血压房颤患者血管内皮功能

目的比较缬沙坦和氨氯地平对老年高血压伴永久性心房颤动(房颤)患者内皮功能及炎症因子的影响。方法将年龄60岁以上的老年原发性轻中度(1~2级)高血压伴永久性房颤的患者64例,随机分为缬沙坦组(80~160mg/d)32例和氨氯地平组(5~10mg/d)32例,分别接受12周的缬沙坦和氨氯地平治疗。治疗期间监测血压,分别于治疗前和治疗12周后测定血浆血管假性血友病因子(vWF)、一氧化氮(NO)、高敏C反应蛋白(hsCRP)水平,同时选择年龄匹配的高血压窦性心律者20例作为对照组,并检测上述指标。结果两组患者治疗后血压均明显下降(P<0·01),且下降程度差异无显著性;治疗前,两组房颤患者NO水平显著低于对照组(P<0·01),vWF、hsCRP水平显著高于对照组(P<0·01),但两组房颤患者之间上述3项指标无明显差别;降压治疗后,和治疗前相比,两组房颤患者NO水平显著升高(P<0·01),vWF、hsCRP水平显著降低(P<0·01);在相同降压程度条件下,和氨氯地平组相比,缬沙坦组降低vWF、hsCRP水平和升高NO水平更显著(P<0·05)。结论缬沙坦和氨氯地平均能有效降压,改善内皮功能及降低炎症因子;在同等降压条件下,缬沙坦改善内皮功能和降低炎症因子的作用强于氨氯地平。这可能对预防高血压房颤患者脑卒中的发生有一定的意义。

Effects of Valsartan on Endothelial Function in Essential Hypertension Patients with Atrial Fibrillation

Objective Compare the effects of valsartan and amlodipine on endothelial function and inflammation marker in elderly hypertention patients with permanent atrial fibrillation (AF). Methods Sixty-four elderly mild to moderate hypertentive patients with permanent AF were randomly assigned to valsartan (80 mg/d, n=34) or amlodipine(5 mg/d, n=34) and treated to 80-160 mg valsartan or 5-10 mg amlodipine to achieve goal BP(<140/90 mm Hg). von Willebrand factor(vWF), nitric oxide (NO) and C reactive protein (CRP) were determined before and after 12 wks therapy. 20 age-matched essential hypertention patients with sinus rhythm served as controls. Results BP were significantly decreased in both groups with similar magnitude of reduction. NO was lower, vWF and CRP were higher in patients with hypertension complicated with AF(P<0.01). Although both valsartan and amlodipine increased NO and decreased vWF and CRP(P<0.01), however the extent of decrease in vWF and CRP and increase in NO was significantly higher in valsartan group. Conclusion Both valsartan and amlodipine are effective to reduce blood pressure, improve endothelial function and reduce CRP. However valsartan has been shown a much greater effect on improvement of endothelial functon and reduction of inflammatory marker than amlodipine. This finding may be important in the prevention of stroke in elderly hypertentive patients with atrial fibrillation.