贝那普利联合氨氯地平治疗对老年高血压病人血压变异性及血管内皮功能影响

EFFECT OF BENAZEPRIL COMBINED WITH AMLODIPINE ON BLOOD PRESSURE VARIABILITY AND VASCULAR ENDOTHELIAL FUNCTION IN ELDERLY HYPERTENSIVE PATIENTS

目的探讨贝那普利联合氨氯地平治疗对老年高血压病人血压变异性及血管内皮功能影响。方法选取2016年1月—2017年1月在我科住院的老年高血压病人80例为研究组,以同期老年健康体检者40例为对照组。研究组病人给予贝那普利联合氨氯地平降压治疗。比较对照组和研究组病人治疗前、治疗8周、治疗16周时的24h动态血压,内皮素(ET)、一氧化氮(NO)、内皮型一氧化氮合成酶(eNOS)水平,颈动脉内膜中层厚度(IMT)和反应性充血后血管内径的变化率(FMD)。结果治疗前,研究组收缩压变异性(SBPV)、舒张压变异性(DBPV)均高于对照组(t=9.903～19.414,P<0.05);治疗8周时,研究组24hSBPV、白天SBPV、夜间SBPV、24h DBPV、夜间DBPV较治疗前降低(F=10.672～15.786,P<0.05);治疗16周时,研究组24hSBPV、白天SBPV、24hDBPV、白天DBPV较治疗前降低(F=17.788～23.016,P<0.05)。研究组治疗前ET、NO、eNOS、IMT、FMD与对照组相比,差异有统计学意义(t=7.949～20.404,P<0.05);治疗后,研究组ET、IMT进行性下降(F=26.473、65.998,P<0.05),NO、eNOS、FMD进行性升高(F=12.874～62.264,P<0.05)。结论贝那普利联合氨氯地平治疗老年高血压病人临床效果显著,且能改善其血管内皮功能。

Objective To investigate the effect of benazepril combined with amlodipine on blood pressure variability and endothelial function in elderly hypertensive patients. Methods A total of 80 elderly hypertensive patients who were hospitalized in our department from January 2016 to January 2017 were enrolled as study group, and 40 elderly volunteers who underwent physical examination during the same period of time were enrolled as control group. The patients in the study group were given antihypertensive treatment with benazepril and amlodipine. The two groups were compared in terms of 24 h ambulatory blood pressure, levels of endothelin （ET）, nitric oxide （NO）, and endothelial nitric oxide synthase （eNOS）, carotid intima-media thickness （IMT）, and flow-mediated dilation （FMD） before treatment and at weeks 8 and 16 of treatment. Results Before treatment, the study group had significantly higher systolic blood pressure variability （SBPV） and diastolic blood pressure variability （DBPV） than the control group （ t =9.903 and 19.414, P 〈0.05）. At week 8 of treatment, the study group had significant reductions in 24 h SBPV , daytime SBPV, nighttime SBPV,24 h DBPV, and nighttime DBPV （ F =10.672-15.786, P 〈0.05）; at week 16 of treatment, the study group had significant reductions in 24 h SBPV, daytime SBPV,24 h DBPV, and daytime DBPV （ F =17.788- 23.016 , P 〈0.05）. Before treatment, there were significant differences between the two groups in ET, NO, eNOS, IMT, and FMD （ t =7.949-20.404, P 〈0.05）; after treatment, the study group had progressive reductions in ET and IMT （ F =26.473 and 65.998, P 〈0.05） and progressive increases in NO, eNOS, and FMD （ F =12.874-62.264, P 〈0.05）. Conclusion Benazepril combined with amlodipine has a marked clinical effect in the treatment of elderly hypertensive patients and can improve their vascular endothelial function.