氨氯地平联合复方阿米洛利或联合替米沙坦对高血压患者颈动脉粥样硬化的对比研究

The comparative study of amlodipine combined with amiloride or with telmisartan on carotid atherosclerosis in hypertensive patients

目的探讨氨氯地平联合复方阿米洛利与氨氯地平联合替米沙坦对高血压患者颈动脉粥样硬化的影响。方法将原发性高血压患者随机分为氨氯地平联合复方阿米洛利组(A组,n=207)和氨氯地平联合替米沙坦组(B组,n=211)。分别观察治疗12和24月两组药物的降压效果,应用高分辨超声技术检测两组患者颈动脉内膜中层厚度(IMT)、血管内径、血流参数、颈动脉斑块发生率及Crouse积分。结果两组患者在治疗12和24月的血压均较自身基线时降低(P<0.05)。与同组基线相比,两组患者治疗12、24月时动脉内径增宽[A组(7.92±1.51)比(8.32±1.47)比(7.45±1.36)mm;B组(7.95±1.55)比(8.33±1.62)比(7.39±1.44)mm]、Crouse积分减小(A组3.12±2.76比2.61±2.10比3.67±2.87;B组2.97±2.32比2.34±1.87比3.71±3.02)、收缩期峰值血流速度(PSV)及舒张期末血流速度(EDV)加快,阻力指数减轻,并且随治疗时间延长,趋势更明显(均P<0.05)。氨氯地平联合替米沙坦组治疗第12、24月时颈动脉IMT较基线时减轻[(0.94±0.16)比(0.91±0.14)比(0.98±0.15)mm,均P<0.05],而氨氯地平联合复方阿米洛利组12月时颈动脉IMT减轻并不明显[(0.95±0.15)比(0.97±0.12)mm,P>0.05],24月时才出现减轻[(0.91±0.14)比(0.97±0.12)mm,P<0.05]。与氨氯地平联合复方阿米洛利比较,氨氯地平联合替米沙坦患者在12、24月时颈动脉IMT减轻、Crouse积分减少、阻力指数改善更明显(P<0.05)。结论氨氯地平联合替米沙坦与联合复方阿米洛利均能有效降低原发性高血压患者的血压,改善颈动脉粥样硬化和血流动力学,并且随治疗时间的延长效果更明显,但氨氯地平联合替米沙坦能更有效地改善大动脉结构和功能异常。

Objective To investigate the effects of either combining amlodipine with amiloride or with telmisartan on carotid atherosclerosis in hypertensive patients.Methods The patients were randomly divided into amlodipine with amiloride group （Group A,n=207） or amlodipine with telmisartan group （Group B,n=211）.Carotid arterial mean intimal｜medial thickness （MIMT）,carotid inner diameters and blood flow parameter were measured with high resolution ultrasound and later again after 12 and 24 month treatment.Results There was no significant difference in reducing blood pressure between two groups （P0.05）.Compared to baseline,in both groups,the artery diameters after 12,or 24 month treatment became larger A group （7.92±1.51） vs （8.32±1.47） vs （7.45±1.36） mm;B group （7.95±1.55） vs （8.33±1.62） vs （7.39±1.44） mm,Crouse points decreased A group （3.12±2.76） and （2.61±2.10） vs （3.67±2.87）mm;B group （2.97±2.32） and （2.34±1.87） vs （3.71±3.02）,peak systolic velocity （PSV）,end diastolic velocity （EDV） became quicker,and resistance index （RI） became less.With prolonged treatment,the trend is more evident （all P0.05）.With the treatment combing amlodipine with telmisartan,at 12,24 month,MIMT reduced significantly from baseline （0.94±0.16） vs （0.91±0.14） vs （0.98±0.15） mm,P0.05,however with combing amlodipine with amiloride,at 12 month,MIMT was not significantly reduced （0.95±0.15） vs （0.97±0.12） mm,P0.05 while at 24 month,reduction of MIMT appeared significantly （0.91±0.14） vs （0.97±0.12） mm,P0.05.Compared to combined with amiloride,amlodipine combined with telmisartan in patients after 12 and 24 month treatment,the MIMT reduction,Crouse points decrease,RI decrease,all are significant （P0.05）.Conclusion The combination therapy of amlodipine with amiloride/HCTZ or amlodipine with telmisartan are similar in lowering BP,easing atherosclerosis,and are more significant with a longer treatment time.However combing amlodipine with telmisartan has a better effect on correcting abnormal function and structure of large arteries,which may delay the progression of atherosclerosis.