| Background:The incidence of prehyertensives has reached 34%, and prehyertensives accompanied by a high risk of cardiovascular disease. Prehyertensives are the landwehr of hypertension, to postpone the development of prehyertensives to hypertension and prevent cardiovascular target organ damage has becoming a hot area. Both at home and abroad, the studies of drug treatment in prehyertensives are less, whether application of drugs or application of which drug is beneficial to prehyertensives is worth to explore. Central blood pressure is the determined factor of clinical outcome, it can better predict cardiovascular disease than peripherial blood pressure. Though different antihyertensive drugs have similar effects on peripherial blood pressure, the effects on central aortic pressures and hemodynamics are different. The drug which can significantly reduce central aortic pressure may have better protection of target organ and reduce the clinical outcomes. Therefore, when we evaluate the hemodynamic effects of antihypertensive drugs, we should pay more attention to the impact of antihypertensive drugs on central blood pressure.Objective:1. To observe the relationship between central blood pressure and brachial blood pressure in prehyertensive participants.2. To explore the relationship between central blood pressure and the subclinical target organ damage in prehyertensive participants.3. To investigate the effect of different antihypertension drugs on both central blood pressure and brachial blood pressure in prehyertensive participants.4. To observe the effect of different antihypertension drugs on subclinical target organ in prehyertensive participants.5. To investigate the effect of different antihypertension drugs on the new cases of diabetes, hypertension and cardiovascular outcomes in prehyertensive participants.Methods:600 prehyertensives aged from 50 to 79 years old were recruited, they were randomized into three groups, namely, telmisartan treatment group 200 cases, indapamide treatment group 200 cases, control group 200 cases, age and gender were matched in three groups. All the subjects were received lifestyle modification, and followed up 30 months. At the baseline and the end of the study, basic clinical data of all subjects such as age, height, weight, blood pressure and heart rate were collected; biochemical parameters such as fasting plasma glucose and lipids were measured; microalbuminuria(MAU) was tested by ELISA; Central blood pressures and its reflected wave were carried out noninvasively using SphygmoCor device, and carotid-radial pulse wave velocity (crPWV) were obtained using the Complior device, they were divided into high baPWV group and low crPWV group based on crPWV levels; carotid intima-media thickness(IMT) was measured by ultrasoundgraphy, they were divided into high IMT group and normal IMT group based on different IMT; cardiac parameters were measured by ultrasoundgraphy, and calculate the left ventricular mass index(LVMI). All the subjects were followed up every three months, recorded blood pressure, heart rate and other clinical data, collected the new cases of hypertension, diabetes and cardiovascular outcomes.Results:1. Central systolic blood pressure(CSP) and pulse pressure(CPP) in prehyertensives are lower than brachial systolic blood pressure(SBP) and pulse pressure(PP)( 11.34±3.99 mm Hg, 13.12±4.62 mm Hg, respectively, P < 0.05), central diastolic blood pressure(CDP) are higher than brachial diastolic blood pressure(DBP) (1.78±0.78 mm Hg, P < 0.05). 2. Age, brachial systolic blood pressure and diastolic blood pressure in high crPWV group are higher than that in low crPWV(P < 0.01); total cholesterol(TC) and low density lipoprotein cholesterol(LDL) in high crPWV group are higher than that in low crPWV group (P < 0.05). After adjustment for age, brachial systolic blood pressure, diastolic blood pressure, total cholesterol and low density lipoprotein cholesterol, CSP, CDP, augmentation pressure (AUG), augmentation index(AI), IMT,MAU and LVMI have no significant difference between two groups.3. Brachial systolic blood pressure, diastolic blood pressure, pulse pressure, total cholesterol and low density lipoprotein cholesterol in high IMT group are higher than that in low IMT (P < 0.01). After adjustment for brachial systolic blood pressure, diastolic blood pressure, pulse pressure, total cholesterol and low density lipoprotein cholesterol, CSP, CDP, augmentation pressure (AUG), augmentation index(AI) and LVMI have no significant difference between two groups.4. crPWV is positively correlated with central diastolic blood pressure, low density lipoprotein cholesterol, total cholesterol, central systolic blood pressure, augmentation index, age, brachial diastolic blood pressure, augmentation pressure, brachial systolic blood pressure; IMT is positively correlated with central pulse pressure, systolic blood pressure, low density lipoprotein cholesterol, brachial systolic blood pressure, total cholesterol, augmentation pressure, brachial pulse pressure, augmentation index, brachial diastolic blood pressure, central diastolic blood pressure; MAU is positively correlated with central systolic blood pressure, low density lipoprotein cholesterol, total cholesterol, brachial systolic blood pressure, augmentation pressure, central pulse pressure, augmentation index, central diastolic blood pressure; LVMI is positively correlated with central systolic blood pressure, pulse pressure, augmentation pressure, brachial systolic blood pressure, low density lipoprotein cholesterol, total cholesterol, brachial pulse pressure, augmentation index, age.5. Multiple liner regression showed that: crPWV(m/s)=-10.195+0.108×CDP(mm Hg)+0.071×CSP(mmHg)+0.034×age(year), CDP, CSP and age were risk factors for crPWV; IMT(mm)=0.652+0.005×CPP(mm Hg)+0.053×LDL(mmol/L), CPP and low density lipoprotein cholesterol were risk factors for IMT; MAU(mg/L)=2.294+0.051×CSP(mm Hg)+0.447×LDL-C(mmol/L), CSP and low density lipoprotein cholesterol were risk factors for MAU; LVMI(g/m2) = -2.894+0.783×CSP(mm Hg),CSP was risk factors for LVMI.6. After treatment, fasting plasma glucose, total cholesterol, triglyceride, low density lipoprotein cholesterol are decreased, while high density lipoprotein cholesterol are increased in telmisartan treatment group (P < 0.05). There is no significant difference in indapamide treatment group.7. After treatment, CSP, CDP, CPP, AUG and SBP, DBP, PP are decreased in both telmisartan treatment group and indapamide treatment group (P < 0.01). In telmisartan treatment group, AI was decreased(P < 0.01), the reducing extent of CSP and CPP are higher than that in SBP and PP(16.69±5.05 vs. 13.55±4.16, P < 0.01; 7.16±6.13 vs. 4.42±5.26, P < 0.01), there are no significant difference in indapamide treatment group. The reducing extent of CSP and CPP in telmisartan treatment group are higher than that in indapamide treatment group(16.69±5.05 vs. 12.82±4.62, P < 0.01; 7.16±6.13 vs. 4.27±5.70, P < 0.01).8. After treatment, crPWV, IMT, MAU, LVMI are decreased in telmisartan treatment group (P < 0.01). There is no significant difference in indapamide treatment group. In telmisartan treatment group, the cases of low crPWV increased, while the cases of high crPWV decreased, (P = 0.036), In indapamide treatment group, there are have the trend of the cases of low crPWV increasing and the cases of high crPWV decreasing,but have no significant difference (P = 0.686). In telmisartan treatment group, the cases of low IMT increased, while the cases of high IMT decreased, (P = 0.016); In indapamide treatment group, there are have the trend of the cases of low IMT increasing and the cases of high IMT decreasing, but have no significant difference (P = 0.607).9. Compared with control group, the new cases of hypertension in telmisartan treatment group and indapamide treatment group are decreased (P < 0.01), compared with control group and indapamide treatment group, the new cases of diabetes in telmisartan treatment group are decreased (P < 0.01). The cases of clinical cardiovascular outcomes have no significant difference in three groups.Conclusion:1. In prehyertensives, central systolic blood pressure and pulse pressure were lower than brachial systolic blood pressure and pulse pressure, while central diastolic blood pressure was higher than brachial diastolic blood pressure, it exists pressure amplification between brachial and central pressure.2. Central blood pressures are closely related with pulse wave velocity, carotid intima-media thickness, microalbuminuria, left ventricular mass index in prehyertensives.3. Two antihypertensive drugs were significantly reduced both central and brachial blood pressures in prehyertensives.4. Two antihypertensive drugs have similar effects on brachial blood pressures, however,.the effects on central blood pressures were different, telmisartan can optimize the wave reflection and further reduce central blood pressures.5. Telmisartan can improve glucose and lipid metabolism, reduce the new cases of diabetes and have better protection of subclinical target organ.6. Two antihypertensive drugs effectively reduce the new cases of hypertension, there is no significant difference on reducing cardiovascular outcome. |
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