长期服用氨氯地平对老年高血压患者颈动脉内膜-中层厚度及血管内皮依赖性舒张功能的影响

Effects of long-term administration of amlodipine on the intima-media thickness and the endothelium-dependent vasodilative function of carotid artery in elderly patients with hypertension

目的探讨氨氯地平对老年高血压患者粥样硬化动脉形态及功能的影响。方法以彩色多普勒超声检测76例高血压患者颈动脉内膜中层厚度(IMT),并按照IMT的厚度将76例分为3组,分别为<x-1s组(A组,21例,男14例,女7例)、=x±1s组(B组,35例,男24例,女11例)、>x+1s组(C组,20例,男13例,女7例)。治疗前A、B、C3组的颈动脉IMT值分别为(1.03±0.06)mm、(1.24±0.06)mm、(1.34±0.01)mm。连续服用氨氯地平36个月后检测颈动脉IMT和未受干预状态下、肱动脉反应性充血时以及含服硝酸甘油后颈动脉内径,与治疗前进行比较。结果使用氨氯地平或加用利尿剂8周后血压能控制在140/90mmHg以下且保持平稳。治疗36个月后,3组的颈动脉IMT分别为(0.93±0.05)mm、(1.07±0.13)mm、(1.18±0.26)mm,各组治疗前后比较,差异有统计学意义(均为P<0.01),A组IMT恢复达正常,B组IMT值接近正常。A、B、C3组治疗前肱动脉反应性充血时颈动脉内径的变化率分别为(6.81±2.13)%、(6.07±2.07)%、(5.84±1.19)%,治疗后分别为(24.65±6.92)%、(20.71±4.36)%、(13.82±3.65)%,各组治疗后均明显升高,差异有统计学意义(均为P<0.01),A组疗效优于B组(P<0.05)及C组(P<0.01),B组疗效优于C组(P<0.01),含服硝酸甘油后颈动脉内径在治疗前后无显著变化。结论钙拮抗剂氨?

Objective To evaluate the clinical effects of amlodipine on structure and function of atherosclerotic artery in elderly hypertensive patients. Methods The intima-media thickness(IMT) and the inner diameter of carotid artery at rest and overpressure of brachial artery as well as after sublingual nitroglycerin administration were measured with amlodipine by color Doppler ultrasonograms before and after long-term (36 months) treatment. The hypertensive patients (76 cases) were divided into 3 groups according to the value of IMT. Group A, n = 21, IMT < -1s; Group B, n = 35, IMT =±1s; Group C, n = 20, IMT >+1s. Results The blood pressure was controlled to therapeutic aim and maintained stable after 8 weeks treatment with amlodipine. The carotid artery IMT of hypertensive patients was lowered significantly and the endothelium-dependent vasodilative function of common carotid artery was improved dramatically after 36 months therapy with amlodipine. The IMT and endothelium-dependent vasodilative function came up to normal standards in group A and approached the normal level in group B. Conclusions Amlodipine can improve the endothelium-dependent vasodilative function, retard or even reverse the progression of carotid artery IMT, when it lowers blood pressure stably.