坎地沙坦联合辛伐他汀对高胆固醇血症高血压患者血管内皮功能的影响

Effects of combined therapy with simvastatin and candesartan on vasodilatation function in patients with hypertension and hypercholesterol

目的观察他汀类调脂药物辛伐他汀联合使用血管紧张素Ⅱ受体拮抗剂(ARB)坎地沙坦对伴有高胆固醇血症的高血压患者血管内皮功能和炎症因子的影响。方法采用自身对照研究,给予46例伴有高胆固醇血症的高血压患者坎地沙坦4mg/d结合膳食治疗,8周后加服辛伐他汀每晚20mg。服药治疗前、8周以及16周结束时采用高分辨率超声系统检测肱动脉血流介导的血管舒张反应(FMD)评价血管内皮功能,并抽血比较血胆固醇、三酰甘油、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、血糖、血胰岛素、高敏C反应蛋白水平变化。结果坎地沙坦可以显著降低血压,加服辛伐他汀后血脂明显下降,血压没有进一步下降。联合治疗较单用坎地沙坦能进一步改善内皮依赖的血管舒张功能。结论辛伐他汀联合应用血管紧张素Ⅱ受体拮抗剂坎地沙坦可以进一步改善伴有高胆固醇血症的高血压患者的内皮功能。

Objective To observe the effect of combined therapy with simvastatin and candesartan on endothelium function and inflammation factor and the blood pressure control in the patients with hypertension and hypercholesterol. Methods Forty-six cases with hypertension and hypercholesterol were received candesartan 4mg per day and dietary therapy in a self-controlled study, then simvastatin 20mg per night was added as combined therpy after 8 weeks. The noninvasive ultrasonic examination was used to observe the changes of brachial artery diameter during baseline, reactive hyperemia and sublingual nitroglycerin administration, flow mediated vasodilatation（FMD） and nitroglycerin mediated vasodilatation（NMD）. Blood pressure, plasma cholesterol, plasma tri- glyceride,insulin,blood glucose and C-reaction protein were also measured at 0,8,16 weeks. Results The levels of blood pressure were decreased significantly at 8 week after using candesartan（P〈0.01）, combined therapy could not decrease the levels of blood pressure further. But combined therapy significantly improved flow-mediated dilator response to hyperemia compared with candesartan alone（P〈0.05）. Conclusion The use of simvastatin in combination with candesartan improves endothelial function in hypercholesterolemic and hypertensive patients.