氨氯地平对原发性高血压患者主动脉根部顺应性的影响

The Effect of Amlodipine to the Aortic Root Compliance of Essential Hypertention

目的:观察氨氯地平对原发性高血压患者主动脉根部顺应性的影响。方法:选择冠脉造影正常的原发性高血压患者64例,随机分为A、B两组,每组32例,其中A组采用氨氯地平为基础降低治疗,B组采用以美多心安为基础降压治疗,共治疗8周另选24例血压正常者作对照。于治疗前后用食管超声检测主动脉根部扩张度(D值)和僵硬度(β值),并检测治疗前后血浆BNP水平。结果:相对于对照组,原发性高血压患者主动脉根部顺应性减弱,表现为D值的降低和β值的升高,其差异有统计学意义(P均<0.05)。氨氯地平和美多心安均能有效的改善主动脉根部顺应性,表现为D值的升高和β值的降低,其差异有统计学意义(P均<0.05)治疗前血浆脑钠肽(BNP)浓度与D值存在显著负相关(r=0.524,P<0.01)与β值存在显著正相关(r=0.425,P<0.01);治疗后血浆BNP浓度与D值仍呈显著负相关(r=0.521,P<0.01)与β值呈显著正相关(r=0.354,P<0.01)。结论:相对于选择性的β1受体阻滞剂,钙离子拮抗剂-氨氯地平能有效的改善原发性高血压患者的主动脉根部顺应性。血浆BNP水平可能是反应主动脉根部顺应性的指标,其浓度的降低可以是主动脉根部顺应性改善的预测因子之一。

Objective： To observe the effect of amlidipine to the airtic root compliance with essential hypertention （EH） patients. Method： 64 essential hypertention patients with selective coronary angiography normal were divided into two A and B group, which both including 32 cases. Amlodipine was used as the basal anti - hypertention therapy of the group A, and the Betaloc was used as the basal anti - hypertention therapy of the group B, the therapies were lasting for 8 weeks. Before and after the therapy, Transesophageal eacho-cardiography （TEE） was used to detect the dialation （D） and the stiffness （β） of the aortic root. We also used the ELISA to determine the concentration of the plasma brain natriuretic peptide （BNP） pre and after the threrapies. Result： Before therapy, There are significant differences among the control group and the group A and group B in the D and β （all P 〈 0.05）, as the D is lower and β is higher, but there is no significant difference between the group A and the group B in D and β （both P 〉 0.05）. After the therapy, both the amlodipine and betaloc can improve the aortic root compliance, as to elevate the D and to lower the β, there are both significant differences in the D and β pre and after the therapy （both P 〈 0.05）, and it seems that amlodipine can lower the β better, but dose not reach the statistical difference, the plasma BNP level of the group A and group B are significant higher than that isthe control group （both P 〈 0.01）. and the plasma BNP level is negatively related to D （r = 0.524, P 〈 0.01） And is postively related to β （r = 0.524, P 〈 0.01） before the therapy, after therapy, the correlation is still existed （D ： r = 0.521, P 〈 0.01, β ： r = 0.354, P 〈 0.01, respectively）. Conclusion： As compared to betaloc, amlodipine can effectively improve the aortic root complicance of the EH patients, the plasma BNP level may be one of the director of the aortic root compliance of EH, and the decreased plasma BNPlevel may be one of the predictor of the improvement of aortic root compliance of EH.