降压调脂联合应用对高血压病患者动脉弹性的影响

Effect of Combinated Antihypertensive and Cholesterol Lowering treatment on the Arterial Elasticity in Patients with Essential Hypertension

目的探讨降压和他汀类降脂的联合治疗对高血压合并高胆固醇血症患者动脉弹性功能和血压的短期影响。方法166例患者被分成5组,正常对照组30例,高血压和高血脂控制组(双高控制组)34例,高血压控制而血脂未控制组(高血脂组)37例,高血压未控制而血脂控制组(高血压组)30例,高血压和高血脂未控制组(双高未控制组)35例,各治疗组均服降血压药及阿托伐他汀12周。用美国HDI公司生产的CVProfilor DO-2020动脉弹性测定仪同步记录血压和动脉顺应性[大动脉弹性(C1),小动脉弹性(C2)]。结果在C1和C2方面,自正常对照组至双高未控制组,呈逐渐下降趋势,双高未控组明显低于其他4组(P<0·01),双高未控组、高血压组和高血脂组分别较双高控制组及正常对照组明显下降,(P<0·01),双高未控组也明显低于高血压组和高血脂组(P<0·01),高血压组与高血脂组相比,前者主要表现在C1下降为主(P<0·01),后者为C2下降为主(P<0·01),双高控制组及正常对照组之间无显著性差异(P>0·05);在收缩压(SBP)、舒张压(DBP)和脉压(PP)方面,高血压组、高血脂组和双高未控组明显高于双高控制组、对照组(P<0·01)。C1和C2与血压、脉压差和血脂(除HDL-C)呈正相关,与HDL-C呈负相关,并且与SBP、LDL-C呈强相关。结论降压降脂联合治疗较单纯降压/降脂更能改善动脉弹性功能,延缓动脉硬化。

Objective To evaluate the efficacy of combinated antihypertension and cholesterol（CH） lowering treatment on arterial elasticity in patients with essential hypertension（EH）. Methods One hundred sixty-six patients with EH were divided into 5 groups： group A（control group, n=301 ; group B （EH and CH-controlled, n= 341 ;group C （CH-uncontrolled, n = 371 ; group D （EH-uncontrolled, n = 301 ; group E（EH and CH-uncontrolled, n=351. Blood pressure and arterial compliance were determined using HDI-2020（C1-large artery, C2-small artery）. Results A declining tendency of C1 and C2 from patients in group A to group E was found. C1 and C2 in patients of group E was significantly lower than the other 4 groups （P〈0.011, showing both C1 and C2 were deteriorated in patinets of uncontrolled hypertension and hyperlipidemia. C1 was greater in patients of hyperlipidemia than that in hypertension （9.5±0.6 vs 8.3±0.2, P〈0. 05）, while C2 tend to be greater in patients of hypertension than that in hyperlipidenmia （5. 3±0.4 vs 4.5 ± 0.7, P〉0. 051. However, the patients in both hypertension and hypercholesterimia controlled group were shown to heve best C1 and C2 value （C1 ： 11.8 ± 0.8 and C2 ： 6.2 ± 0.61 which was analogous to that of control （11.2±0.4 and 6.7±0.71. C1, C2 positively related to BP, PP, cholesterol, negatively related to HDL-C. Conclusion The combination therapy with antihypertension and cholesterol lowering was better than only antihypertension and cholesterol lowering on the arterial elasticity in patients with essential hypertension.