依那普利叶酸片联合维生素B_(12)治疗H型高血压临床效果观察

目的探讨依那普利叶酸片联合维生素B12片对H型高血压患者血浆高同型半胱氨酸(homocysteine,Hcy)水平、血压和颈动脉粥样硬化斑块的影响。方法入选H型高血压患者148例,随机分为对照组和观察组。对照组给予依那普利片,观察组给予马来酸依那普利叶酸片和维生素B12片,疗程48周。静脉血检测患者治疗前后Hcy水平,24 h动态血压监测治疗前后血压变异性,动脉彩超观察治疗前后颈动脉粥样硬化斑块。结果对照组和观察组治疗48周后血浆Hcy浓度分别为(13.72±2.67)和(11.06±2.14)μmol/L,差异具有统计学意义(P<0.05)。与对照组治疗后比较,观察组24 h收缩压平均值(24 h m SBP)、24 h收缩压标准差(24 h SSD)、白昼收缩压标准差(d SSD)和夜间收缩压标准差(n SSD)较对照组明显降低,组间差异具有统计学意义(P<0.05)。治疗后观察组颈动脉斑块面积(Smax)较对照组减小,组间比较差异具有统计学意义(P<0.05)。结论马来酸依那普利叶酸片联合维生素B12片治疗H型高血压疗效明显,可能与其降低Hcy水平、改善血压变异性和减轻动脉硬化有关。

Objective To investigate the effect of Enalapril-folic aicd combined with vitamin B12 on plasma Hcy, blood pressure and carotid atherosclerosis plaque in patients with H-type hypertension. Methods Monitoring venous blood Hcy level, 24h ambulatory blood pressure and carotid atherosclerotic plaque. Results 1） The plasma Hcy concentration in the control group and the observation group after 48 weeks treatment were （13.72±2.67） and （11.06 ±2.14） mol/L respectively, the difference was statistically significant （P 〈 0.05）; 2） The observation group 24h mSBP, 24h SSD, dSSD and nSSD decreased significantly compared with the control group, the difference was statistically significant （P〈0.05）; 3） The Smax in observation group decreased more than the control group, the difference was statistically significant （P〈0.05）. Conclusion Blood pressure can be effectively lowered by Enalapril-folic aicd combined with vitamin B12 in patients with H -type hypertension, may via reduce the level of Hcy, improve blood pressure variability and rrelieve arteriosclerosis.