Increased arterial stiffness, as estimated from aortic pulse wave velocity (Ao-PWV), and albuminuria are independent predictors for cardiovascular disease in type 2 diabetes mellitus (T2DM). Whether angiotensin receptor blockers (ARBs), drugs with cardio-renal protective effects, improve Ao-PWV to a greater extent than other equipotent antihypertensive medications remains unclear. After a 4-week washout phase, we compared the effects of valsartan (n=66), an ARB, with that of amlodipine (n=65), a calcium channel blocker on Ao-PWV in 131 T2DM patients with pulse pressure (PP) >or=60 mm Hg and raised albumin excretion rate (AER) in a 24-week randomized, double-blind, parallel group study. Hydrochlorothiazide (HCTZ) 25 mg/d was added to valsartan 160 mg and amlodipine 5 mg/od uptitrated to 10 mg/od after 4 weeks to ensure equivalent BP control. After 24 weeks brachial and central aortic PP had fallen to a similar extent with attained mean (SD) brachial and central PP of 61.6 (13.6) and 47.3 (14.1) mm Hg in the valsartan/HCTZ group and 61.5 (12.2) and 47.3 (9.9) mm Hg in the amlodipine group, respectively. Ao-PWV showed a significantly greater reduction, mean (95% CI), -0.9 m/s (-1.4 to -0.3) for valsartan/HCTZ compared to amlodipine (P=0.002). AER fell significantly only with Val/HCTZ from 30.8(20.4, 46.5) to 18.2(12.5, 26.3) mcg/min, (P=0.01) with between treatment difference in favor of Val/HCTZ of -15.3mcg/min (P<0.001). Changes in AER and Ao-PWV were not correlated. Valsartan/HCTZ improves arterial stiffness and AER to a significantly greater extent than amlodipine despite similar central and brachial BP control. These 2 effects, which appear independent of each other, may explain the specific cardio-renal protective properties of ARBs.

译文

根据主动脉脉搏波速度 (Ao-PWV) 估计,动脉僵硬度增加和蛋白尿是2型糖尿病 (T2DM) 心血管疾病的独立预测因素。血管紧张素受体阻滞剂 (arb) 是具有心肺保护作用的药物,是否比其他同等降压药物在更大程度上改善Ao-PWV尚不清楚。经过4周的冲洗阶段,我们比较了缬沙坦 (n = 66) (ARB) 和氨氯地平 (n = 65) 的作用,在一项为期24周的随机,双盲,平行组研究中,131例脉压 (PP)> 或 = 60毫米Hg且白蛋白排泄率 (AER) 升高的T2DM患者的Ao-PWV钙通道阻滞剂。将氢氯噻嗪 (HCTZ) 25 mg/d添加至缬沙坦160 mg,并在4周后将氨氯地平5 mg/od上调至10 mg/od,以确保等效的BP控制。24周后,在缬沙坦/HCTZ组和61.5 (12.2) 和47.3 (9.9) mm Hg的平均 (SD) 肱动脉和中央PP下降到类似的程度,达到61.6 (13.6) 和47.3 (14.1) mm Hg在氨氯地平组,分别。与氨氯地平 (P = 0.002) 相比,缬沙坦/HCTZ的Ao-PWV降低幅度明显更大,平均 (95% CI),-0.9 m/s (-1.4至-0.3)。仅Val/HCTZ从30.8(20.4,46.5) 到18.2(12.5,26.3) mcg/min,AER显着下降 (P = 0.01),两种治疗之间的差异有利于Val/HCTZ为-15.3mcg/min (P<0.001)。AER和Ao-PWV的变化不相关。尽管中枢和肱动脉血压控制相似,但缬沙坦/HCTZ比氨氯地平在更大程度上改善了动脉僵硬度和AER。这两种作用似乎彼此独立,可以解释arb的特定心肺保护特性。

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