- 作者：Mitsuyasu Terashima ; MD?/sup> ; mterashima-circ@umin.ac.jp ; Hideaki Kaneda ; MD&dagger ; ; Kenya Nasu ; MD?/sup> ; Hitoshi Matsuo ; MD?/sup> ; Maoto Habara ; MD?/sup> ; Tsuyoshi Ito ; MD?/sup> ; Nobuyoshi Tanaka ; MD?/sup> ; Sudhir Rathore ; MD?/sup> ; Yoshihisa Kinoshita ; MD?/sup> ; Masashi Kimura ; MD?/sup> ; Mariko Ehara ; MD?/sup> ; Yasuyoshi Suzuki ; BS?/sup> ; Takahiko Suzuki ; MD?/sup>
- 关键词：acetylcholine ; angiotensin-II receptor blocker ; drug-eluting stent(s) ; endothelial function ; vasoconstriction
- 刊名：JACC: Cardiovascular Interventions
- 出版年：2012
- 出版时间：February, 2012
- 年：2012
- 卷：5
- 期：2
- 页码：182-190
- 全文大小：1463 K
Objectives
The aim of this prospective, randomized study was to evaluate the effects of telmisartan, compared with the calcium-channel blocker amlodipine, on endothelial function after coronary drug-eluting stent (DES) implantation in hypertensive patients.Background
DES implantation impairs local endothelial function, which may be associated with future cardiovascular events. Telmisartan, which has unique peroxisome proliferator-activated-receptor-gamma-mediated effects in addition to its renin-angiotensin system-inhibition effects, has favorable effects on endothelial function.
Methods
Fifty-one hypertensive patients with coronary artery stenosis but without coronary artery spasm, treated with a sirolimus-eluting stent, were randomly assigned to either the telmisartan (25 cases) or amlodipine (26 cases) treatment groups. At baseline and at 3 months after DES implantation, endothelium-dependent and -independent vasomotion were evaluated by quantitative coronary angiography under the condition of medication withdrawal. The mean luminal diameter of a 20-mm coronary segment, beginning 5 mm distal to the stent, was measured before and after infusion of intracoronary acetylcholine (10?, 10? mol/l) and then again after infusion of nitroglycerin.
Results
Blood pressure was comparable between groups at baseline and after 3 months. Vasoconstriction after acetylcholine infusion at 3 months (impaired endothelial function) was less pronounced in the telmisartan group than in the amlodipine group (p < 0.0001), although there was no significant difference between the 2 groups before DES implantation. The response to nitroglycerin did not differ between groups before or at 3 months after DES implantation.
Conclusions
Telmisartan, compared with amlodipine, significantly ameliorated endothelial dysfunction after DES implantation in terms of vasoconstriction induced by acetylcholine.