阿托伐他汀对原发性高血压患者血压及AT1-R水平的影响

Effects of Atorvastatin on Blood Pressure and AngII type 1 Receptor(AT1-R) in Patients with Essential Hypertension

【目的】探讨阿托伐他汀对原发性高血压(EH)患者血压、血脂及血管紧张素Ⅱ1亚型受体(AT1-R)密度的影响。【方法】初诊1、2级EH患者140例,按随机数字表分为两组:联合治疗组(AmAt)和单纯降压组(Am),AmAt组每天予氨氯地平5 mg+阿托伐他汀20 mg;Am组每天予氨氯地平5 mg+安慰剂,治疗12周。35例正常健康者为正常对照组(HeaC)。所有参加者于基线及治疗12周后检测血压、血脂及单核细胞AT1-R密度。【结果】EH患者单核细胞AT1-R密度明显高于健康对照组(P<0.05);两组患者经12周治疗后血压较基线明显降低,以AmAt组下降更加明显(P<0.05);Am组血脂改变不明显(P>0.05),AmAt组总胆固醇水平明显降低(P<0.05);两组患者单核细胞AT1-R密度较前明显降低,以AmAt组下降更加明显(P<0.05);AT1-R密度与收缩压、舒张压、总胆固醇水平均呈正相关,相关系数r分别为0.724,0.636和0.644(P<0.05);在AmAt组中,血脂正常者经治疗后总胆固醇水平并无显著下降(P>0.05),但其AT1-R密度显著下降。【结论】阿托伐他汀有辅助降压作用,可能与其下调EH患者单核细胞表面AT1-R有关,这种作用独立于调脂作用。

[Objective]To study the effects of atorvastatin on blood pressure, blood lipids and expression of AT1-R receptor on monocytes in patients with essential hypertension. [Methods ] A total of 140 patients with mild to moderate hypertension were recruited. They were randomly assigned into group Am and group AmAt. The group AmAt was given amlodipine 5 mg/d with atorvastatin 20 mg / d, and group Am was given amlodipine 5 mg/d with placebo of atorvastatin. The therapy was 12 weeks. 35 healthy people were selected as healthy control （Group HeaC）. Blood pressure, lipid profile, and ATI-R density on monocytes （percentage of AT1-R positive monocytes） were recorded before and after treatment. [ Results ] The AT1-R density of monocytes in hypertensive patients was obviously higher than that in group HeaC （P 〈 0.05）. Blood pressure in both group Am and AmAt was lowered significantly after the therapy, and it was lower in Group AmAt than that in Group Am （P 〈 0.05）. Lipid profile was not changed significantly after the treatment in Group Am （P 〉 0.05）. Total cholesterol was lowered significantly in Group AmAt （P 〈 0.05）. The AT1-R density was decreased in both Group AmAt and Am, and it was lower in Group AmAt than that in Group Am （P 〈 0.05）. AT1-R density correlated with systolic BP, diastolic BP and total cholesterol positively, and the correlation coefficient were 0.724, 0.636, and 0.644, respectively （P 〈 0.05）. In subgroup of normal cholesterol in Group AmAt, AT1-R density was decreased significantly while the cholesterol level stayed still. [Conclusion] Atorvastatin can down-regulate the expression of AT1-R on monocytes in hypertensive patients, and has a synergic effect on lowering blood pressure, which may be independent of consequence of lowering cholesterol.