氨氯地平对老年高血压患者内皮功能及颈动脉内中膜的影响

Effects of Amlodipine on Endothelial Function and Intima-media Thickness of Carotid Arteries in Elderly Hypertensive Patients

目的 了解氨氯地平降压治疗对老年高血压患者血管内皮依赖性舒张功能、颈动脉内膜中层厚度 (IMT)及血浆内皮素 (ET)、一氧化氮 (NO)、神经肽Y(NPY)的影响。方法 采用高分辨率超声技术 ,检测 4 2例原发性高血压患者降压治疗前后及 4 0例对照者休息状态、反应性充血后的肱动脉内径变化并检测颈动脉IMT值 ,测定高血压患者治疗前后血浆ET、NO、NPY浓度变化。结果 与对照组比较 ,服氨氯地平 5～ 10mg d ,治疗 4个月后 ,血压明显下降 ,肱动脉内皮依赖性舒张较治疗前明显改善 ,但仍低于对照。血浆ET、NPY水平明显下降 ,NO水平明显升高。治疗前后颈动脉IMT无显著性改变。结论 经氨氯地平降压治疗 4个月后 ,血管内皮功能明显改善 ,而颈动脉IMT无明显改善。

Aim To investigate the effect of amlodipine on endothelium dependent relaxing function in brachial artery,intima media thickness (IMT) in carotid and the changes of plasma endothelin(ET), nitric oxide(NO), neuropeptide(NPY) levels in elderly hypertensive patients. Methods With high resolution ultrasound, before and after amlodipine treatment, we measured endothelium dependent relaxing function in brachial artery and IMT of carotid arteries in 42 subjects with essential hypertension and 40 controls, the serum ET, NO, NPY levels were examined as well. Results In elderly hypertensive patients, IMT of carotid arteries was greater and flow mediated dilatation was much reduced in brachial artery, Serum ET?NPY level were higher and NO level was lower than control group. After treated with amlodipine 5～10 mg at 4 months, blood pressure was evidently reduced and flow mediated vasodilation in brachial artery was increased, although it was still lower than control group. The plasma ET?NPY levels decreased, NO level was increased markedly after amlodipine traetment. No significant change of carotid arteries IMT were found. Conclusion Endothelium function and endothelium dependent vasodilation were impaired in elderly patients with primary hypertension. IMT of carotid arteries was increased in elderly hypertensive patients. Amlodipine improves impaired endothelium dependent vasodilatation in btachial artery, but with little effect on increased intima media thickness of carotid arteries.