Περίληψη:
Arterial hypertension is an established risk factor for acute coronary
syndromes, and physical exertion may trigger the onset of such an event.
The mechanisms involved include the rupture of a small, inflamed,
coronary plaque and the activation of thrombogenic factors. Blood
pressure (BP)-lowering treatment has been associated with beneficial
effects on subclinical inflammation and thrombosis at rest and during
exercise. This prospective study sought to compare the effect of
different antihypertensive drugs on the inflammatory and thrombotic
response during exercise. A total of 60 never-treated hypertensive
patients were randomized to an angiotensin receptor blocker (ARB)- or
non-dihydropyridine calcium channel blocker (CCB)-based regimen.
Patients with inflammatory or coronary artery disease were excluded. Six
months after pharmaceutical BP normalization, the patients underwent a
maximal treadmill exercise testing. High-sensitivity C-reactive protein
(hsCRP), serum amyloid A (SAA), white blood cells (WBC), tumor necrosis
factor-alpha (TNF-alpha), interleukin-6 (IL-6), total fibrinogen (TF)
and von Willebrand factor (vWF) levels, as well as plasminogen activator
inhibitor-1 (PAI-1) activity were measured in blood samples taken while
the patients were at rest and during peak exercise. All of these
biomarkers increased with exercise, except PAI-1, which decreased
(P<0.05 for the difference between resting and peak exercise for all
biomarkers). The ARB group had less marked (P<0.05) exercise-induced
changes than the CCB group in hsCRP (5.8% vs. 7.7%), SAA (4.2% vs.
7.2%), WBC (46.8% vs. 52.6%), TNF-alpha (16.3% vs. 24.3%), TF
(9.5% vs. 16.9%) and PAI-1 (-9.5% vs. -12.3%) but a similar (P = NS)
change in IL-6 (39.4% vs. 38.6%) and vWF (29.2% vs. 28.6%). In
conclusion, ARBs are most likely more effective than CCBs at suppressing
the exercise-induced acute phase response. Potential protection against
exercise-related coronary events remains to be elucidated. Hypertension
Research (2012) 35, 1193-1200; doi:10.1038/hr.2012.134; published online
6 September 2012
Συγγραφείς:
Liakos, Charalampos I.
Vyssoulis, Gregory P.
Michaelides,
Andreas P.
Chatzistamatiou, Evangelos I.
Theodosiades, George
and Toutouza, Marina G.
Markou, Maria I.
Synetos, Andreas G. and
Kallikazaros, Ioannis E.
Stefanadis, Christodoulos I.
