cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-2140Research ArticleАРТЕРИАЛЬНАЯ ГИПЕРТОНИЯARTERIAL HYPERTENSIONОбратное развитие сосудистой гипертрофии под действием блокады рецепторов ангиотензина II у пациентов с артериальной гипертензиейReversal of vascular hypertrophy in hypertensive patients through blockade of angiotensin II receptorsСмитР. Д.SmithR. D.YokoyamaH.YokoyamaaH.AverillD. B.AverillD. B.SchiffrinE. L.SchiffrinE. L.

Department of Medicine

FerrarioC. M.FerrarioC. M.Hypertension and Vascular Disease Center, Wake Forest University School of Medicine, Winston-Salem, North CarolinaСоединённые Штаты АмерикиHypertension and Vascular Disease Center, Wake Forest University School of Medicine, Winston-Salem, North CarolinaUnited StatesSir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, QuebecКанадаDepartment of Medicine, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, QuebecCanada201020122010961724Copyright © Смит Р.Д., Yokoyama H., Averill D.B., Schiffrin E.L., Ferrario C.M., 20102010Смит Р.Д., Yokoyama H., Averill D.B., Schiffrin E.L., Ferrario C.M.Smith R.D., Yokoyamaa H., Averill D.B., Schiffrin E.L., Ferrario C.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/2140

Цель. Определить, способна ли терапия блокаторами рецепторов ангиотензина (БРА) вызвать обратное развитие гипертрофии стенок сосудов, независимо от степени снижения артериального давления (АД). Материал и методы. В исследовании пациенты с артериальной гипертензией (АГ) I ст. и без сопутствующего сахарного диабета — 61 % мужчин; возраст 38-67 лет, после 4-недельного периода отмывания, рандомизировались в группы (гр.) олмесартана медоксомила (20-40 мг/сут.) либо атенолола (50-100 мг/ сут.). Дополнительная антигипертензивная терапия (АГТ) включала гидрохлортиазид, амлодипин либо гидралазин. Целевой уровень АД <140/90 мм рт.ст. Исходно и через 1 год от начала терапии оценивали процесс ремоделирования сосудов, путем миографического исследования подкожных резистивных артерий глютеальной области. Биоптаты были получены у 22 больных из гр. атенолола, 27 пациентов из гр. олмесартана медоксомила и 11 здоровых лиц из гр. контроля (ГК). Результаты. Степень снижения АД, по сравнению с исходным уровнем, была сопоставимой на фоне приема олмесартана медоксомила — со 149±11/92±8 до 120±9/77±6 мм рт.ст. (р<0,05); и атенолола — со 147±10/90±6 до 125±12/78±7 мм рт.ст. (р<0,05). Через 40 нед. терапии величина р для сравнения двух гр. составляла 0,08. Через 1 год лечения отношение толщины сосудистой стенки к диаметру просвета сосуда достоверно снизилось в гр. олмесартана медоксомила с 14,9 % до 11,1 % (р<0,01), в то время как на фоне приема атенолола этот показатель существенно не изменился — 16,0 % и 15,5 % (нд). В ГК величина отношения толщины сосудистой стенки к диаметру просвета сосуда составляла 11,0 %. Заключение. У больных с эссенциальной АГ прием БРА сопровождался обратным развитием гипертрофии стенок резистивных сосудов, с достижением показателей, сходных с таковыми у здоровых, нормотензивных лиц. Этот положительный эффект не зависел от степени снижения уровня АД.

Aim. May blockade of the angiotensin II type 1 receptor (AT1) with an angiotensin receptor blocker reverse vascular pathology independent of blood pressure (BP) lowering. Material and methods. Stage I hypertensive, nondiabetic patients (61% male; age 38 to 67 years) were randomized after a 4-week washout period to olmesartan medoxomil 20 to 40 mg or atenolol 50 to 100 mg plus additional agents (hydrochlorothiazide, amlodipine, or hydralazine) as needed for a goal BP <140/90 mm Hg. At baseline and after 1 year of treatment, subcutaneous gluteal resistance arteries were examined on a pressurized myograph to evaluate remodeling. Biopsies were available from 22 atenolol recipients, 27 olmesartan medoxomil recipients, and 11 normal volunteer controls. Results. BP was reduced to a comparable degree by olmesartan medoxomil (from 149±11/92±8 mm Hg to 120±9/77±6 mm Hg; p<0,05 [mean ± standard deviation]) and atenolol (from 147±10/90±6 mm Hg to 125±12/78±7 mm Hg; p<0,05 [mean ± standard deviation]) from baseline for each arm (p=0,08 for the 40-week treatment mean between arms). After one year’s treatment, the wall-to-lumen ratio in arteries from patients treated with olmesartan medoxomil was significantly reduced (from 14,9% to 11,1%; p<0,01), whereas no significant change was observed in arteries from atenolol-treated patients (from 16,0% to 15,5%; p=NS); the wall- to-lumen ratio in controls was 11,0%. Conclusion. Blockade of AT1 receptors showed a superior corrective effect on the altered structure of resistance arteries in essential hypertension that was independent of the magnitude of BP reduction, and resulted in values similar to those in normotensive controls.

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The authors declare that there are no conflicts of interest present.