The Relationship Between Digital Vascular Function and Combination Hypertension Therapy in Patients with Newly Diagnosed Hypertension

初診斷之高血壓患者指尖血管功能與複合式藥物治療之關係

林俊忠(Chun-Chung Lin) ； 羅顯榮(Hsien-Jung Lo) ； 杜宗明(Chung-Ming Tu) ； 方偉泉(Wei-Quan Fang) ； 李愛先(Ai-Hsien Li)

《內科學誌》 26卷5期 (2015/10) Pp. 268-276

摘要

血管內皮功能不良與許多的心血管疾病形成有關，而高血壓是許多心血管疾病與血管硬化的早期表現。過去已有文獻用FMD的方式證明高血壓的患者有血管功能異常，用周邊動脈測量儀來測量反應性充血指標(RHI)是一種新的血管內皮評估工具。吾人設計一前瞻性研究，以enoPAT機器，測量初診斷的54位高血壓患者之血管功能並與40位正常血壓族群來比較與評估高血壓患者是否有內皮功能不良，以及患者在接受目前第一線之A+C合併治療之後之血管功能參數變化。結果顯示雖然高血壓患者有較高的比例內皮功能不良但未達到統計學的意義。另外在經過三個月治療之後，雖然大部分患者RHI 有改善但也未達統計學的意義。不過吾人發現“對側手”充血指數0。879是一個有統計意義的數字，可以預測病人治療後RHI改變的趨勢。同時發現相較於受側手在充血期有充血反應，對側手則出現周邊血管收縮血流減少現象。其機制與重要性不明。

並列摘要

Endothelial dysfunction plays a key role in cardiovascular diseases and hypertension is associated to endothelial dysfunction. Measuring digital vascular function through peripheral arterial tonometry is an innovative method to evaluate endothelial function. The aim of this study was to evaluate the changes in digital vascular function in hypertensive patients before and after anti-hypertension therapy. We recruited 54 newly diagnosed hypertensive patients and 40 normotensive participants. Among these 54 hypertensive patients, 29 received a complete 3 months combination anti-hypertension therapy with angiotensin-converting enzyme inhibitors (or angiotensin receptor antagonist) and calcium channel blockers. Their digital vascular function were evaluated through peripheral arterial tonometry before and after anti-hypertensive therapy and compared with the normotensive participants’ data. The percentage of endothelial dysfunction was nonsignificantly higher (13% V.S 7.9%, P .34) in hypertensive group than in normotensive group. After combination antihypertensive therapy, the reactive hyperemia indices (RHIs) of the majority of the patients (65%) improved albeit nonsignificantly (mean RHI before therapy 2.07 +/- 0.39, mean RHI after therapy 2.03 +/- 0.79, P=.825). However, the hyperemia ratio of 0.879 of the control arm was a significant predictor (P .0273 and 0.003 respectively) of the RHI response of after pharmacological therapy. The hypertensive patients showed a nonsignificant higher percentage of the endothelial dysfunction than did the normotensive participants. Combination therapy did not significantly improve RHI. A hyperemia ratio of 0.879 of the control arm was a significant predictor of the response of RHI after pharmacological therapy.

並列關鍵字

Endothelial function ； Reactive hyperemia index ； Hypertension ； Combination therapy