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马瑞新:血管紧张素Ⅱ受体阻滞剂和血管紧张素转换酶抑制剂对左心室结构和功能的作用比较 PPT讲座视频 2016年中国高血压年会暨第18届国际高血压及相关疾病学术研讨会
标题: 血管紧张素Ⅱ受体阻滞剂和血管紧张素转换酶抑制剂对左心室结构和功能的作用比较
讲者: 马瑞新
单位: 兰州大学第二医院
播放: 1510
论文摘要:
Objective
Angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) ameliorate oxidative stress and fibrosis of myocardium through inhibiting the renin angiotensin system (RAS) in different ways, but if there is difference between this two kind of agents in protection to organ damages remains controversial. The purpose of this study is to study if irbesartan and benazepril would have different protective effects on left ventricular structure, systolic and diastolic function, and if they were different in suppress the process of oxidative stress, vascular remodeling and fibrosis
  

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Design and method
Sixteen-weeks old female spontaneously hypertensive rats (SHR) (n=8) were treated with irbesartan (Irb), benazepril (Ben) or vehicle for 12 weeks. Wistar Kyoto (WKY) rats (n=8) receive vehicle. Echocardiography was performed for evaluation of left ventricular structure, systolic and diastolic function at 12 weeks.
 In order to assess the process of oxidative stress, vascular remodeling and fibrosis, the expression of transforming growth factor-β (TGF-β), Collagen type (Col ) and endothelial nitric oxide synthase (eNOS) in myocardial tissue were measured by western blot.

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Results
Systolic blood pressure demonstrated significant improvement in Irb rats or Ben rats than in untreated SHR. No statistical difference was observed between Irb rats and Ben rats in blood pressure. IVSd was significantly lower in the Irb rats and Ben rats than untreated SHR (P=0.035, P=0.028, separately). There was no difference in the LVEDD, LVEF and FS between SHR in each group and WKY. E/A showed no statistical difference between groups. E/E’ decreased in Irb rats and Ben rats compared with untreated SHR (P=0.020, P=0.039, separately). E’/A’ increased in Irb rats and Ben rats compared with untreated SHR (P=0.032, P=0.041, separately). No statistical difference was observed between Irb rats and Ben rats in blood pressure and echocardiographic parameters (P
0.05 for all). eNOS was decreased in untreated SHR, and significantly increased in Irb rats and Ben rats. No difference was detected in TGF-β between untreated SHR and WKY, however, It was declined under treatment with irbesartan and benazepril (P=0.027, P=0.010, separately). Col was decreased in SHR (P=0.014), and increased in Irb rats and Ben rats (P=0.028, P=0.007, separately) almost close to the level in WKY. Among these two drugs, Benazepril resulted in better outcomes in eNOS, TGF-β and Col . The expression of eNOS was higher in Ben rats than Irb rats (P=0.028). TGF-β and Col were lower under benazepril than irbesartan  (P=0.035, P=0.040, respectively). .

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Conclusions
Hypertension associated with diastolic dysfunction. Irbesartan and benazepril provide therapeutic benefit in the blood pressure control , as well as improvement of left ventricular hypertrophy and diastolic dysfunction. Although Benazepril showed a little stronger suppression of oxidative stress and fibrosis than irbesartan, there was no evidence of differential effects of irbesartan and benazepril on the outcomes of left ventricular structure and function.

高血压病科

兰州大学第二医院

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