阿托伐他汀对原发性高血压患者血压及内-中膜厚度的影响

Effect of atorvastatins on BP and IMT

目的探讨阿托伐他汀对原发性高血压(essential hypertension,EH)患者血压、血脂及内-中膜厚度(intima-media thick-ness,IMT)的影响。方法1、2级原发性高血压(EH)78例,分为正常胆固醇组(NC)和高胆固醇组(HC)组,各39例。NC组和HC组再按随机数字表分别分为他汀治疗组(NCS,HCS)和对照组(NCC,HCC),他汀治疗组每天予氨氯地平5 mg+阿托伐他汀20 mg;对照组每天予氨氯地平5 mg,均为12周。20例正常健康者为正常对照组。患者于基线及治疗12周后检测血压、血脂及IMT。结果EH各组患者经12周治疗后血压较前明显降低(P<0.05),以他汀治疗组下降幅度更加明显(P<0.05);NCC、HCC组血脂改变不明显(P>0.05),NCS和HCS组,TC、TG、LDL-C下降明显,HDL-C明显增高(P<0.05);EH组内血压、IMT、IMT/D及颈动脉斑块明显高于健康对照组(P<0.05);治疗后IMT及IMT/D均下降(P<0.05),治疗后各亚组内他汀治疗组与对照组比较下降有统计学意义(P<0.05);治疗后颈动脉斑块较对照组斑块改善不明显(P>0.05),但治疗组中位数较对照组有下降趋势。结论阿托伐他汀与氨氯地平等降压药物合用使降压效果更明显,有辅助降压作用;有效调脂的同时,可以使IMT/D改善明显,但短期内颈动脉斑块未见明显改善。

Aim To discuss the effect of atorvastatins on blood pressure and intima-media thickness（IMT） in patients with essential hypertension. Methods 78 patients with hypertension were selected,whose systolic blood pressure（SBP） was between 140 mmHg and 179 mmHg and diastolic blood pressure（DBP） was between 90 mmHg and 109 mmHg. The 39 EH patients with hypercholesterolemia（HC） and the rest without were randomized, double-blind, and assigned to atorvastatin （ 20 mg ·d^-1, NC group, n = 19, HC group, n=20 ） and amlodipine （5 mg·d^-1）or to the control group with amlodipine （5 mg·d^-1 ） （no lipid-lower-drugs NC group, n = 20, HC group, n = 19 ） for 12 weeks. 20 healthy people were selected as health control. Changes in blood pressure, blood cholesterol, and carotid arterial IMT were investigated respectively. Results Blood pressures decreased more markedly in patients taking statins no matter with or without hypercholesterolemia than in those not taking statins（ P 〈 0.05 ）. Compared with control group, there was a significant reduction in serum TC, TG and low density lipoprotein cholesterol concentrations in 20 mg atorvastatin group （ P 〈 0.05 ） and high density lipoprotein cholesterol concentrations was higher. The level of BP, IMT/D and carotid arterial plaque in EH group was higher than that in health control group. After treatment of atorvastatin, IMT and IMT/D decreased markedly（ P 〈 0.05 ）, but carotid arterial plaque didn＇t develop obviously. Through the analysis of the results, we could see the tendency of improvement （P 〉 0.05 ）. Conclusion Atorvastatin together with amlodipine can significantly lower blood pressure better. Modulating blood lipid effectively, it can develop IMT in short time, but not in carotid arterial plaque.