阿托伐他汀对原发性高血压合并高胆固醇血症患者血压和左心室重塑的影响

Effects of atorvastatin on blood pressure and left ventricular remodeling in patients with both essential hypertension and hypercholesterolemia

目的比较原发性高血压合并高胆固醇血症患者治疗前后血清高敏 C 反应蛋白(hs-CRP)浓度和血尿酸(UA)水平的变化,探讨阿托伐他汀对其血压和左心室重塑的影响。方法将126例高血压合并高胆固醇血症患者随机分为氨氯地平(10 mg/d)组(A 组,65例)、氨氯地平(10mg/d)加阿托伐他汀(20 mg/d)组(B 组,61例),连续治疗3个月。观察给药前后两组患者血压的变化,测定其血清总胆固醇(TC)、低密度脂蛋白胆同醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)和 hs-CRP 浓度以及 UA 水平。采用心脏彩色超声测其左心室后壁厚度(LVPWT)和室间隔厚度(IVST),计算左心室重量指数(LVMI)。结果治疗3个月后,B 组患者血清 TC、LDL-C、TG、hs-CRP 浓度及 UA 水平均显著降低,而 HDL-C 明显增高(P<0.05)。两组患者收缩压和舒张压明显降低,B 组血压显著低于 A 组(P<0.05)。与治疗前比较,两组患者 LVMI 均明显降低,B 组患者 LVMI显著低于 A 组(P<0.05)。结论阿托伐他汀可降低原发性高血压合并高胆固醇血症患者血 hs-CRP 浓度和 UA 水平,显著降低血压,逆转左心室肥厚。其可能通过减轻炎症、改善血管内皮功能、降低血压及抑制左心室心肌细胞肥大,从而影响高血压患者左心室重塑的过程。

Objective To compare the changes in serum levels of high sensitive C-reactive protein （hs-CRP） and uric acid （UA） before and after atorvaststin treatment for the patients with both essential hypertension and hypercholesterolemia, and to evaluate its effects on blood pressure and left ventricular remodeling. Methods One hundred and twenty-six hypertensive patients complicated with hypercholesterolemia were randomized into group A with amlodipine 10 mg/d （ n = 65 ） and group B with amlodipine 10 mg/d plus atorvastatin 20 mg/d （ n = 61 ）, for three months continuously. Serum levels of total cholesterol （ TC ）, low-density lipoprotein-cholesterol （ LDL-C）, high-density lipoprotein-cholesterol （HDL-C）, triglycerides （TG）, hs-CRP and UA, as well as blood pressure, were determined for both groups before and after treatment. Left ventricular posterior wall thickness （LPWT） and interventricular septum thickness （IVST） were measured by echocardiography and left ventricle mass index （LVMI） was calculated. Results Serum levels of TC, LDL-C, HDL-C, TG, hs-CRP and UA decreased significantly in group B after three-month treatment with atorvastatin, while serum level of HDL-C increased significantly. And, systolic and diastolic blood pressure reduced in both groups, but significantly lower in group B than those in group A, after treatment （P 〈 0.05）. As compared with that before treatment, LVMI in both groups decreased significantly, but significantly lower in group B than that in group A （ P 〈 0.05 ）. Conclusions Atorvastatin can decrease serum levels of hs-CRP and UA, remarkedly reduce blood pressure and reverse left ventricle hypertrophy in patients with essential hypertension complicated with hypercholesterolemia. Atorvastatin possibly ameliorated inflammation, improve blood vessel endothelial function, reduced arterial blood pressure and inhibited cardiac hypertrophy in the left ventricle, all of which then affected the progress of left ventricular remodeling in hypertensives.