| PrefaceIn recent years, the morbidity of hypertension keeps increasing in China. There are approximately 1,6 billion peoples suffering from hypertension. High blood pressure could cause pathological changes in blood vessel and further endanger organs like heart, brain, kidney or eye, etc., to show serious complications.To improve the prognosis of patients with high blood pressure, the treatment of hypertension should not just control the blood pressure within normal ranges, but also include reversing the subclinical pathological changes like the reduced flexibility of artery and the functional disturbance of endodermis. Therefore, physicians should also evaluate whether a certain types of medicine could improve the flexibility of artery in order to make proper choice of different medicine.Automatic measurement of the brachial-ankle pulse wave velocity (baPWV), which is a good index of woundless reversion of the flexibility of major artery, is easy to do and duplicate. Previous investigation of reducing baPWV are done in small numbers of samples with short-term follow-up. Those studies showed that the angiotensin-converting enzyme inhibitor (ACEI), calcium channel blocker (CCB) and antgiotensin-receptor blocker (ARB) could improve arterial stiffness in patients with hypertension. In China, there are limited amount of studies using baPWV as a clinical index to evalutate the treatment effect of hypertension. Here, by comparing the changes of baPWV in patients treated with ACEI, CCB and ARB, we investigate the effect of those three medicines in improving the artery flexibility in patients with hypertension. Our follow-up visit also studies whether continued controlling of blood pressure will improve the flexibility of artery.Meterials and methodFor this study, we included 112 patients with primary hypertension. Patients were randomly assigned to three groups. Three groups were treated with either ACEI, CCB or ARB, once in the morning. All patients will receive periodic biochemical anaysis of serum, and exam of urine samples. baPWV was measured before the treatment, one-month and three-month after the treatment by PWV/ABI type instrument (form PWV/ABI; Colin, Co., Ltd., Komaki, Japan). Statistical analysis was determined by SPSS 13.0. Data were expressed as mean plus or minus one SD. Significant differences between pre- and post-treated were determined by paired-samples t-test. Difference among three groups were determined by one-wayanalysis of variance (ANOVA).Results1. Subjects were randomly assigned to one of three groups for treatment with the follow drugs: ACEI group, CCB group or ARB group. There were no statistically significant differences among the three treatment groups in their background factors such as age, sex, baPWV, ABI, ambulatory BP, heart rate, body mass index (BMI), or smoking habit.2. SBP, DBP and PP were significantly decreased in all three groups (P<0.001) . There were no significant changes in HR in all three groups (P>0.05) .3. BaPWV was significantly decreased in the ACEI, CCB, ARB groups. Compare the baPWV one-month after the treatment to before the treatment P<0.001; Compare the baPWV three-month after the treatment to before the treatment P<0.001; Compare the baPWV three-month to one-month after the treatment ACEI group and ARB group P<0.01,CCB group P<0.001.4. BaPWV was significantly decreased in all three groups in one or three months. The changes of baPWV in one or three months were significantly more in the ARB group than in the ACEI and CCB groups (1 months p<0.01 3 months p<0.05). The change of baPWV was significantly greater in three months than in one monthin in all three grops (p<0.01).DiscussionHypertension is one of the main risk factors for cardiovascular diseases. Hypertension has attracted more and more attention globally. Mounting evidences indicate that blood pressure must be reduced to below target levels, which vary according to the presence or absence of risk factors and complications. Since the anti-hypertensive therapy has the objective of preventing cardiovascular complications, the organ protective effect of anti-hypertensive drugs is very important. To improve the prognosis of patients with hypertension, we need not only to lower the blood pressure, but also to reduce the artery stiffness. This needs a simple indicator, which can be used to evaluate whether a medicine has improved the artery stiffness or not. This indicator will be useful for physicians to select medicine for the treatment of patients with hypertension.Currently, pulse wave velocity (PWV) and ankle-brachial pressure index (ABI) are employed as indicators not only for arteriosclerosis, but also for the mortality of cardiovascular disease. Owing to the recent development of an easy-to-use, non-invasive device, Form ABI/PWV (Nihon Colin, Aichi, Japan), brachial-ankle PWV (baPWV) is rapidly used as a effective parameter to evaluate the efficacy of anti-hypertensive therapy.Previous clinical studies in anti-hypertension therapy suggested that although different medicines could reduce the blood pressure within normal range, they had different effect in changing the vascular stiffness. baPWV measurement can be used for our valuation of a medicine which is improving the flexibility of artery and guide for proper usage a medicine in anti-hypertension therapy.It has been shown by many clinical studies that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are effective for protecting against hypertension-related organ damages. Here, we recorded PP waveforms in the right forearm and rightankle simultaneously using a simple, non-invasive oscillometricmethod and determined baPWV as an index of arterial stiffness to examine the effects of various antihypertensive agents in hypertensive patients. Our conclusion is that SBP, DBP and PP were significantly decreased in all three groups. HR remained unchanged in all three groups (P>0.05) . BaPWV was significantly decreased in the ACEI, CCB, ARB groups. The reductions in baPWV was significantly greater in the ARB group than in the ACEI and CCB groups (one months p<0.01; three months p<0.05). The efficacy of improving artery flexibility is as follows, telmisartan > amlodipine> perindopril. Our results show that telmisartan plays a role in the improvement of artery function of the flexibility outside of anti-hypertensive therapy. The changes of baPWV were significantly greater in three months than in one month in all three grops (p<0.05).Conclusions1. Our study shows that all three medicines, telmisartan, amlodipine and perindopril have the effect of improving the flexibility of artery in anti-hypertensive therapy for one and three months.2. We concluded that telmisartan had better effect than amlodipine and perindopril with regard to improving the flexibility of artery in one and three months of anti-hypertension therapy.3. Our results also suggested that continuous anti-hypertensive treatment with telmisartan , amlodipine and perindopril will have a persistent improvement of the artery flexibility.
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