马来酸依那普利叶酸片治疗H型高血压疗效及其与同型半胱氨酸关系研究

Effects of enalapril maleate and folic acid tablet on H-type hypertension and the correlation between the hypertension and homocysteine

目的观察马来酸依那普利叶酸片(依叶片)治疗H型高血压患者降压效果,观察高血压分级与同型半胱氨酸(Hcy)的关系,探讨Hcy与依叶片对高血压的影响。方法 140例H型高血压患者完全随机分成依那普利组(70例)和依叶组(70例),分别使用马来酸依那普利片10 mg/d和依叶片10.8 mg/d治疗24周。检测治疗前及治疗12、24周后的血压、Hcy变化。结果 (1)依那普利组治疗后收缩压、舒张压均有明显降低[收缩压:(170.1±16.5)mm Hg对(131.7±11.1)mm Hg,舒张压:(105.3±11.9)mm Hg对(81.1±8.4)mm Hg(P均<0.01)];依叶组治疗后收缩压、舒张压也有明显降低[收缩压:(170.2±15.0)mm Hg对(125.1±12.4)mm Hg,舒张压:(104.3±12.3)mm Hg对(75.5±8.6)mm Hg(P均<0.01)]。与依那普利组相比较,依叶组治疗后收缩压、舒张压均低于依那普利组,[收缩压:(125.1±12.4)mm Hg对(131.7±11.1)mm Hg,舒张压:(75.5±8.6)mm Hg对(81.1±8.4)mm Hg(P均<0.05)]。(2)依叶组治疗24周后Hcy与治疗前相比降低有统计学意义[(23.6±11.9)μmol/L对(14.1±5.8)μmol/L,(P<0.01)];依那普利组治疗前后Hcy差异无统计学意义[(25.7±14.7)μmol/L对(28.5±13.0)μmol/L,(P>0.05)]。(3)依叶组1级、2级和3级的高血压患者治疗24周后Hcy与治疗前相比较,差异有统计学意义(P<0.01);不同分级H型高血压患者治疗前Hcy差异有统计学意义(P<0.05),不同分级H型高血压患者治疗24周后,Hcy差异无统计学意义(P>0.05)。结论依叶片较依那普利更有效降低血压和Hcy;提示Hcy与血压水平关系密切,Hcy可能参与高血压发生和发展。

Objective To observe the efficacy of enalapril maleate and folic acid tablets in the treatment of patients with H-type hypertension and to investigate the correlation between hypertension and homocysteine. Methods One hundred and forty patients with H-type hypertension were randomly divided into two groups： the enalapril maleate folic acid group （n=70） and the enalapril group （n=70）. Blood pressure （BP） and plasma Hcy were analyzed the first 24 h after admission, 12 weeks and 24 weeks after treatment. Results Systolic BP （SBP） and diastolic BP （DBP） were significantly lower after 24 weeks treatment in the enalaprfl group [SBP （170.1±16.5） mmHg vs. （131.7±11.1） mmHg; DBP （105.3±11.9） mmHg vs. （81.1±8.4） mmHg respectivel）5 P〈0.01]. SBP and DBP were significantly lower after 24 weeks treatment in the enalapril maleate folic acid group [SBP （170.2±15.0） mmHg vs. （125.1±12.4） mmHg; DBP （104.3±12.3） mmHg vs. （75.5±8.6） mmHg respectivel）5 P〈0.01]. The levels of SBP, DBP and Hcy of the H-type hypertensive patients in the enalapril and folic maleate folic acid group were significantly lower than those of enalapril group after 24-week treatment [SBP： （125.1±12.4）mmHg vs. （131.7±11.1） mmHg; DBP （75.5±8.6） mmHg vs. （81.1±8.4） mmHg; Hcy （14.1±5.8）μmol/L vs. （28.5± 13.0） 8mol/L, all P〈0.05）]. all level of Hcy in patients with primary grade 3 hypertension was higher than that in patients with primary grade 2 hypertension [（28.1±14.3） 8rnol/L vs. （21.5＋9.3） μmol/L, P〈0.05 ] and primary grade 1 hypertension [（28.1±14.3） μmol/L vs. （18.4±7.4） μmol/L, P〈0.05]. Conclusion Enalapril maleate and folic acid tablets appear to have a better efficacy in controlling the blood pressure and Hc~ indicating that Hcy is closely related the blood pressure. Hcy may be one cause of hypertension and take part in the progression of hypertension.