安博维抗动脉粥样硬化作用v2幻灯片.pptVIP

* Media to lumen ratio(M/L ratio) of small resistance arteries dissected from gluteal subcutaneous biopsies performed in untreated normotensive subjects (control); and in hypertensive patients before and after 1 year of treatment with atenolol crossed over to irbesartan for 1 year * Irbesartan improves structure of small resistance arteries in hypertensive patients In this study, 11 hypertensive patients with good blood pressure control were treated with the beta blocker atenolol for one year, then switched to irbesartan 300 mg/day for a second year. Small resistance arteries were dissected from biopsies at baseline and their structure analysed. As shown here, irbesartan reversed smooth muscle cell proliferation and associated thickening of the arterial wall: After 1 year of treatment with irbesartan, mean arterial medial width fell from 19.7 to 15.4um (p 0.001). The mean arterial medial width to lumen ratio fell from 8.44 to 6.46 (p 0.01). Medial cross sectional area (MCSA) was also reduced in the irbesartan group. These benefits were achieved independently of blood pressure, which remained well controlled on both atenolol and irbesartan throughout the study. The mechanisms by which these effects are achieved are under investigation: Blockade of the AT1receptor by irbesartan would be expected to inhibit - AT1 mediated stimulation of smooth muscle cell growth and collagen deposition. In addition, AT2 receptor stimulation, which is unaffected by irbesartan, may reverse medial thickening by stimulating nitric oxide-mediated apoptosis. Other actions of irbesartan or atenolol may also play a role in mediating their different effects on vascular morphology. Reference Schiffrin EL, Park JB, Pu Q. Effect of crossing over hypertensive patients from a beta-blocker to an angiotensin receptor antagonist on resistance artery structure and on endothelial function. J Hypertens 2002; 20:71-78  SILVHIA研究是一项随机、双盲、平行试验。入选102例有轻中度高血压和左室肥厚患者，随机接受平均安博维? 251mg/天或阿替洛尔69mg/天，探索安博维