새로 진단된 고혈압 환자에서 경동맥 경직도에 대한 Valsartan의 효과: 전반적인 동맥경직도와의 비교연구
Effects of Valsartan on Carotid Arterial Stiffness in Patients with Newly Diagnosed Hypertension: A Comparative Study with Global Arterial Stiffness
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초록
연구배경: 본 연구는 새로 진단된 치료받지 않은 고혈압 환자에서 국소 경동맥 경직도와 전반적인 동맥경직도와의 연관성을 알아보고, 국소 및 전반적인 동맥경직도에대한 안지오텐신 II 수용체 차단제(angiotensin II receptor blocker, ARB)의 효과를 알아보기 위해 시행하였다. 방법: 새로 고혈압으로 진단된 50명의 환자에서 치료시작 전에 국소 경동맥 경직도 변수들과 전반적인 동맥경직도의 변수들 사이의 상관관계들을 비교하였고, valsar- tan 6개월 치료 후 이러한 변수들의 변화를 평가하였다. 국소 경동맥 경직도의 변수들로서 경동맥의 내경 변화, strain 및 speckle tracking method를 이용해 측정한 2-di- mensional circumferential strain (2D CS)을 이용하였고, 전반적인 동맥경직도의 표준변수들로서 pulse wave ve- locity (PWV)와 pulse wave analysis (PWA)의 변수들을이용하였다. 결과: 경동맥의 2D CS은 나이(r = -0.592, p < 0.01), BAPWV (r = -0.338, p < 0.05), 및 AI (r = 0.298, p < 0.05)와 유의한 연관성을 보여주었으나, 경동맥의 strain 과 내경 변화는 연관성이 없었다. 6개월의 약물 치료 후수축기혈압은 155.9 ± 14.2 mm Hg에서 137.6 ± 10.5 mm Hg (p < 0.01)로, 이완기혈압은 90.1 ± 11.8 mm Hg 에서 81.6 ± 8.0 mm Hg (p < 0.01)로 유의하게 감소되었다. PWV와 PWA 변수들은 약물 치료 후 유의하게 호전되었으나 경동맥 경직도의 변수들은 유의한 변화를 보이지 않았다. 결론: 새로 진단된 고혈압 환자에서 경동맥의 2D CS는기존의 경동맥 경직도 변수들보다 나이와 전반적인 동맥경직도의 변수들과 더 좋은 연관성을 보여주었다. ARB 로 6개월 약물 치료 후 전반적인 동맥경직도의 변수들은호전되었으나 국소 경동맥 경직도의 변수들은 유의한 변화를 보이지 않았다.
Abstract
Background: To compare the parameters of local carotid stiffness with those of global arterial stiffness and to investigate theeffects of angiotensin II receptor blocker (ARB) on the parameters of local carotid arterial stiffness as well as global arterialstiffness. Methods: The correlations of the parameters between local carotid and global arterial stiffness were compared atbaseline, and the changes of these parameters were evaluated after 6 months of valsartan therapy in 50 patients with newlydiagnosed hypertension. Diameter change, strain, and 2-dimensional circumferential strain (2D CS) of the carotid arterymeasured by speckle tracking method were used as parameters of local arterial stiffness, and the parameters of pulse wavevelocity (PWV) and pulse wave analysis (PWA) were used as standard parameters of global arterial stiffness. Results:Carotid 2D CS, not conventional strain or diameter change, showed significant correlation with age (r = -0.592, p < 0.01),brachial-ankle PWV (r = -0.338, p < 0.05), and augmentation index (r = -0.298, p < 0.05). After 6 months of medicaltherapy, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were decreased significantly (SBP: 155.9 ± 14.2to 137.6 ± 10.5 mm Hg, p < 0.01; DBP: 90.1 ± 11.8 to 81.6 ± 8.0 mm Hg, p < 0.01). The parameters of PWV and PWA weresignificantly improved, but the parameters of carotid arterial stiffness were not changed significantly. Conclusions: Inhypertensives, carotid 2D CS showed better correlation with ageing and the parameters of global arterial stiffness thanconventional strain or diameter change of the carotid artery. Global arterial stiffness was improved by 6 months of medicaltreatment with ARB, but the local carotid arterial stiffness was not changed.
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