氯沙坦和阿替洛尔对高血压患者纤溶系统及血浆血管性血友病因子的作用比较

目的比较血管紧张素受体拮抗剂(ARB)氯沙坦和β受体阻滞剂阿替洛尔对原发性高血压患者纤溶系统及血浆血管性血友病因子(vWF)的影响。方法轻中度原发性高血压患者60例随机分成氯沙坦组和阿替洛尔组(每组30例),分别给予氯沙坦50mg/(次.d)或阿替洛尔50mg/(次.d),共治疗8周。每4周随访1次,4周时血压如不达标(BP<140/90mmHg)则加用双氢克尿噻12.5mg/(次.d)。治疗前后行血浆组织型纤溶酶原激活物(tPA)及纤溶酶原激活物抑制剂1(PAI-1)检测,并计算PAI-1/tPA作为纤溶参数,同时测定血浆vWF的含量。结果两组的基线血压等一般情况具有可比性。治疗4周及8周时两组血压均较治疗前显著下降,组间比较无差异。同治疗前相比,氯沙坦组治疗8周时血浆PAI-1和vWF水平下降(P值分别<0.05及<0.01),PAI-1/tPA也有显著下降(P<0.05),而tPA则无显著变化(P>0.05);阿替洛尔组治疗8周时血浆PAI-1和vWF水平及PAI-1/tPA均无显著变化,而tPA则有所上升(P<0.05)。治疗后血浆vWF两组间比较,差异有非常显著意义。结论氯沙坦治疗能改善原发性高血压患者的纤溶系统并降低血浆vWF,而阿替洛尔则未见有此作用。

The Fibrinolytic Efficacy and Impact on Plasma von Willlebrand Factor of Losartan Compared with Atenolol in Essential Hypertensives

Objectives To compare the effects of losartan and atenolol on fibrinolytic system and plasma von willebrand factor (vWF) in patients with essential hypertension. Methods Sixty patients with mild to moderate essential hypertension were randomized to receive lostartan(50 mg/d, n=30) or atenolol(50 mg/d, n=30) for 8 weeks. If the goal blood pressure(<140/90 mm Hg) were not achieved at 4th week, hydrochlorothiazides 12.5 mg were added. Plasma tissue plasminogen activator (tPA) and plasminogen activator inhibitor-1 (PAI-1) and vWF were determined before and after treatment. PAI-1/tPA ratio was calculated as fibrinolytic index. The baseline characterstics were comparable between the two groups. Results Blood pressures were decreased similarly in both 2 groups after treatment. Losartan reduced plasma PAI-1 (P<0.05), vWF (P<0.01) and PAI-1/tPA (P<0.05). Although plasma tPA were increased(P<0.05) while in atenolol group, PAI-1, vWF and PAI-1/tPA were not changed. Conclusion Losartan, but not atenolol, improve the fibrinolytic system and reduce plasma vWF level in patients with essential hypertension.