不同剂量培哚普利对原发性高血压病患者血管内皮功能及血压变异性的影响研究

Effects of Different Doses of Perindopril on Vascular Endothlial Function and Blood Pressure Variability in Patients with Essential Hypertension

目的观察不同剂量培哚普利对原发性高血压病患者血管内皮功能及血压变异性(BPV)的影响。方法选取2013年9月—2015年2月在郑州大学人民医院住院的轻中度原发性高血压病患者158例,采用随机数字表法将其分为A组(n=78)、B组(n=80)。A组患者给予培哚普利4 mg/d,B组患者给予培哚普利8 mg/d。两组均连续治疗12周。记录两组治疗前空腹血糖(FPG)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿酸(UA)水平;观察两组治疗前及治疗第12周时24 h平均收缩压(24 h SBP)、24h平均舒张压(24 h DBP)、收缩压变异性(SBPV)、舒张压变异性(DBPV);并记录两组治疗前及治疗第12周时内皮功能评估指数(RHI)、尿微量清蛋白(m Alb)、超敏C反应蛋白(hs-CRP)、肌酐(Cr)、胱抑素C(Cys-C)水平。结果两组患者性别、年龄、体质指数、病程、疾病程度、FPG、TG、TC、HDL-C、LDL-C、UA水平比较,差异均无统计学意义(P>0.05)。治疗期间,A组因干咳自动退出1例,B组因头晕、干咳自动退出2例。两组治疗第12周时24 h SBP、24 h DBP、SBPV、DBPV均低于治疗前(P<0.01)。B组24 h SBP、24 h DBP、SBPV、DBPV变化值均高于A组(P<0.05)。两组治疗第12周时RHI均高于治疗前,m Alb、hs-CRP、Cr、Cys-C水平均低于治疗前(P<0.05)。B组RHI、m Alb、hs-CRP、Cr、Cys-C变化值均高于A组(P<0.05)。两组均未见过敏反应、血压下降过低及首剂低血压等严重不良反应。结论 8 mg/d培哚普利较4 mg/d培哚普利可以更好地平稳降压、改善血管内皮功能,并不产生较多的不良反应,获益呈剂量依赖性。

Objective To investigate the effects of different doses of perindopril on vascular endothelial function and blood pressure variability （ BPV ） of patients with essential hypertension. Methods 158 patients with mild and moderate essential hypertension admitted in the People＇s Hospital of Zhengzhou University from September 2013 to February 2015 were randomly divided into group A（n=78）or B（n=80）. 4 mg/d and 8 mg/d perindopril were given to patients in group A and B respectively. Both groups received continuous treatment for 12 weeks. Fasting plasma glucose（ FPG）,triacylglycerol（ TG）, total cholesterol（ TC）,high density lipoprotein cholesterol（ HDL-C）,low density lipoprotein cholesterol（ LDL-C）,uric acid （UA）of the two groups before treatment were recorded;24 h systolic blood pressure（24 hSBP）,24 h diastolic blood pressure （24 hDBP）,systolic blood pressure variability（SBPV）,diastolic blood pressure variability（DBPV）of the two groups before treatment and at the 12th week of treatment were observed;RHI,mAlb,hypersensitivity C reactive protein（ hs-CRP）, creatinine（Cr）and cystatin C（Cys-C）of the two groups before treatment and at 12th week of treatment were recorded. Results The comparison of gender, age, body mass index, course of disease, disease degree, FPG, TG, TC, HDL-C, LDL-C,UA of patients in the two groups showed that the differences were not statistically significant （ P ﹥0. 05 ）. During treatment,one case in group A withdrew voluntarily because of dry cough,two cases in group B withdrew voluntarily because of dizziness and dry cough. 24 hSBP,24 hDBP,SBPV,DBPV of both groups at 12th week of treatment were lower than those before treatment（P﹤0. 01）. Change value of 24 hSBP,24 hDBP,SBPV,DBPV of group B were higher than those of group A（P﹤0. 05）. RHI of both groups at 12th week of treatment was higher and mAlb,hs-CRP,Cr,Cys-C were lower than those before treatment（P﹤0. 05）. Change value of RHI,mAlb,hs-CRP,Cr,Cys-C of group B were higher than those of group A （P﹤0. 05）. Anaphylactic reaction,excessive decrease of blood pressure and first -dose hypotension occurrence and other adverse reactions were not found in both groups. Results The dose of 8 mg/d perindopril exerts can stably reduce pressure and improve vascular endothelial function better than 4 mg/d perindopril without many adverse reactions and benefit is dose dependent.