HMG-CoA还原酶抑制剂对原发性高血压患者血管性认知功能障碍的治疗价值

Effects of HMG-CoA Reductase Inhibitors on Primary Hypertension Patients with Vascular cognitive Impairment

目的评价降压治疗对原发性高血压患者血管性认知功能障碍的疗效,以及在此基础上联用阿托伐他汀能否使患者进一步获益。方法将143例合并血管性认知功能障碍的原发性高血压患者分为3组,A组(57例)均合并高胆固醇血症,接受降压+阿托伐他汀治疗。其余86例血胆固醇水平正常的患者随机分为2组,B1组(42例)接受降压+安慰剂治疗。B2组(44例)接受降压+阿托伐他汀治疗。所有患者在治疗前及治疗后1年均接受MMSE量表和ADAS-cog量表评价认知功能,SF-36量表评价生活质量。结果3组患者治疗后MMSE及SF-36量表得分较治疗前显著增加,ADAS-cog量表得分均较治疗前显著减少。治疗后B1、B22组间MMSE及ADAS-cog量表得分变化无显著差异,而B2组SF-36量表总分提高程度却较B1组存在显著差异。A组MMSE量表和SF-36量表总分提高程度、ADAS-cog量表总分降低程度均较B2组患者存在显著差异。结论单纯降压治疗可显著改善血胆固醇水平正常的原发性高血压患者的认知功能及生活质量。对于血胆固醇水平正常的原发性高血压患者,联合阿托伐他汀治疗不能在降压治疗基础上进一步改善认知功能,但能改善生活质量。对于合并高胆固醇血症的原发性高血压患者,联合阿托伐他汀治疗可使患者在降压治疗基础上进一步获益。

OBJECTIVE To assess the effects of blood pressure lowering treatments for the prevention of cognitive decline on primary hypertension patients with vascular cognitive impairment, and to investigate whether those patients could benefit from the treatment of atorvastatin in addition to blood pressure lowering treatments. METHODS 143 primary hypertension patients with vascular cognitive impairment were allocated into three groups. Patients in Group A （ n = 57 ） , with hypercholesterolemia, undertook blood pressure lowering treatments and atorvastatin. The others, with normal plasma cholesterol levels, were randomly divided into two subgroups. Patients in Group BI （n = 42）, undertook blood pressure lowering treatments and placebo. Patients in Group B2 （n = 44 ）, undertook blood pressure lowering treatments and atorvastatin. At baseline and 1 year after treatment, cognitive function was evaluated by using MMSE scale, ADAS-cog scale and SF-36 scale. RESULTS After treatment, all patients had significantly increase on the MMSE scores and the SF-36 scores between the baseline scores and the final socres, and they also had significantly decrease on the ADAS-cog scores. There were no significant difference in the alteration of the MMSE scores and the ADAS-cog scores between Group B1 and Group B2. The increase of the SF-36 scores in Group B2 was more significant than Group B1. The increase of the MMSE scores and the SF-36 scores in Group A were more significant than those of Group B2. And the decreases of the ADAS-cog scores in Group A was more significant than those of Group B2. CONCLUSION Blood pressure lowering treatments can improve cognitive function and life quality in primary hypertension patients with vascular cognitive impairment. Primary hypertension patients with normal plasma cholesterol levels can not have more benefit to cognitive function from the the treatment of atorvastatin in addition to blood pressure lowering treatments, in spite of improving the life quality. However, primary hypertension patients with hypercholesterolemia can have more benefit to cognitive function from the the treatment of atorvastatin in addition to blood pressure lowering treatments.