To evaluate the effect of ramipril, an ACE inhibitor, on flow-mediated dilation (FMD) of the brachial artery (an index of endothelium-dependent vasodilation), in patients with hypertension. The study population included 96 Chinese patients with newly diagnosed essential hypertension (52 men and 44 women; mean age 56 ± 7 years) and 30 normotensive subjects (16 men and 14 women; mean age 53± 9 years). The 96 patients with essential hypertension were randomised to receive 3 months of oral ramipril 5mg once daily (ramipril group, 49 cases) or oral nitrendipine 10mg twice daily (nitrendipine group, 47 cases). Baseline diameter, reactive hyperaemia (RH), FMD and nitroglycerin-induced dilation (NTG dilation) were evaluated with the non-invasive ultrasound method before and after treatment in the two hypertensive groups. FMD was significantly lower in the two hypertensive groups than in the control group before treatment and improved significantly in the ramipril group after treatment compared with before treatment (5.1± 2.2 versus 1.8 ± 1.2, p < 0.01). The baseline diameters of the brachial arteries, RH and NTG dilation showed no difference between the control group and the two hypertensive groups before treatment and remained unchanged after treatment in both the ramipril group and the nitrendipine group. Blood pressure was reduced to the same extent in the two hypertensive groups (p > 0.05) and the changes in mean blood pressure did not correlate with the changes in FMD in the ramipril group (r = 0.22). In addition to blood pressure control, ramipril can improve endothelial dysfunction in patients with essential hypertension.
评价
雷米普利(一种
血管紧张素转换酶
抑制剂)对高血压患者肱动脉血流介导扩张(
FMD,内皮依赖性血管扩张的指标)的影响。研究人群包括96名新诊断的原发性高血压的中国患者(52名男性和44名女性;平均年龄56±7岁)和30名血压正常者(16名男性和14名女性;平均年龄53±9岁)。96名原发性高血压患者被随机分配接受3个月的口服
雷米普利5mg每日一次(
雷米普利组,49例)或口服
尼群地平10mg每日两次(
尼群地平组,47例)。使用无创超声方法在治疗前后评估两个高血压组的基线直径、反应性充血(RH)、
FMD和
硝酸甘油诱导的扩张(NTG扩张)。两个高血压组的
FMD在治疗前明显低于对照组,在治疗后
雷米普利组明显改善(5.1±2.2对1.8±1.2,p < 0.01)。肱动脉的基线直径、RH和NTG扩张在治疗前对照组和两个高血压组之间无差异,治疗后雷米普利组和尼群地平组保持不变。两组高血压患者的血压降低程度相同(p > 0.05),平均血压的变化与
雷米普利组
FMD的变化无相关性(r = 0.22)。除了控制血压外,
雷米普利还可以改善原发性高血压患者的内皮功能障碍。