比索洛尔联合左旋氨氯地平对高血压患者肾素-血管紧张素-醛固酮系统、颈动脉血管弹性功能的影响

Effects of bisoprolol combined with levamlodipine on renin-angiotensin-aldosterone system and carotid artery elasticity in patients with hypertension

目的分析比索洛尔联合左旋氨氯地平对高血压患者肾素-血管紧张素-醛固酮系统(RAAS)、颈动脉血管弹性功能的影响。方法回顾性选择2021年1—8月就诊于嘉兴市秀洲区王江泾医院的90例高血压患者为研究对象,按治疗方法的不同分为对照组和联合组,每组45例。对照组采用左旋氨氯地平治疗,联合组采用比索洛尔+左旋氨氯地平治疗。治疗3个月为1个疗程,两组均连续治疗5个疗程。比较两组临床疗效、治疗前后心室重构指标、RAAS系统相关激素水平、颈动脉血管弹性功能及不良反应。结果联合组总有效率高于对照组[95.56%(43/45)比82.22%(37/45)],差异有统计学意义(χ^(2)=4.05,P<0.05)。联合组治疗后室间隔厚度(IVST)、左心室舒张末期内径(LVEDD)、左心室后壁厚度(LVPWT)、左心室质量指数(LVMI)低于对照组[(8.52±1.84)mm比(9.41±2.09)mm、(48.53±1.94)mm比(50.47±2.35)mm、(9.12±2.10)mm比(11.06±2.38)mm、(88.96±12.72)g/m^(2)比(96.56±13.39)g/m^(2)],差异有统计学意义(P<0.05)。联合组治疗后血清血管紧张素Ⅱ、肾素、血管紧张素转化酶、醛固酮水平低于对照组[(44.47±4.27)ng/L比(48.63±5.34)ng/L、(0.34±0.07)μg/(L·h)比(0.41±0.08)μg/(L·h)、(9.09±0.66)U/L比(9.45±0.75)U/L、(123.43±14.08)ng/L比(131.36±15.7)ng/L],差异有统计学意义(P<0.05)。两组治疗前后左、右侧颈动脉内膜中层厚度(IMT)、颈动脉阻力指数(RI)比较差异无统计学意义(P>0.05);两组治疗后左、右侧颈总动脉收缩起始时脉搏波传导速度(PWV-BS)、收缩结束时脉搏波传导速度(PWV-ES)均降低,并且联合组治疗后左、右侧PWV-BS、PWV-ES低于对照组[(5.42±0.64)m/s比(6.02±0.8)m/s、(4.89±0.67)m/s比(5.86±0.98)m/s、(8.02±0.86)m/s比(9.34±1.24)m/s、(6.98±0.67)m/s比(8.02±0.87)m/s],差异有统计学意义(P<0.05)。结论比索洛尔联合左旋氨氯地平可有效提高高血压患者血压控制效果,调节RAAS系统相关激素水平,逆转心室重构,改善颈动脉血管弹性功能,且未增加不良反应风险。

Objective To analyze the effects of bisoprolol combined with levamlodipine on renin-angiotensin-aldosterone system(RAAS)and carotid artery elasticity in patients with hypertension.Methods The 90 hypertensive patients who treated in the Wangjiangjing Hospital of Jiaxing Xiuzhou District from January 2021 to August 2021 were enrolled in this study,and they were divided into the control group and the combination group according to the treatment methods,each with 45 cases.The control group was treated with levoamlodipine,and the combination group was treated with bisoolol plus levoamlodipine.Three months of treatment was a course,and both groups were treated for 5 consecutive courses.The clinical efficacy,ventricular remodeling indicators,RAAS related hormone levels,carotid artery vascular elasticity function,and adverse reactions were compared between the two groups.Results The total effective rate in the combination group was higher than that in the control group:95.56%(43/45)vs.82.22%(37/45),there was statistical difference(χ^(2)=4.05,P<0.05).After treatment,the interventricular septal thickness,left ventricular end-diastolic diameter,left ventricular posterior wall thickness and left ventricular mass index in combination group were lower than those in control group:(8.52±1.84)mm vs.(9.41±2.09)mm,(48.53±1.94)mm vs.(50.47±2.35)mm,(9.12±2.10)mm vs.(11.06±2.38)mm,(88.96±12.72)g/m^(2) vs.(96.56±13.39)g/m^(2),there were statistical differences(P<0.05).After treatment,the serum levels of angiotensin Ⅱ,renin,angiotensin converting enzyme and aldosterone in combination group were lower than those in control group:(44.47±4.27)ng/L vs.(48.63±5.34)ng/L,(0.34±0.07)μg/(L·h)vs.(0.41±0.08)μg/(L·h),(9.09±0.66)U/L vs.(9.45±0.75)U/L,(123.43±14.08)ng/L vs.(131.36±15.7)ng/L,there were statistical differences(P<0.05).There were no significant differences in left and right carotid intima media thickness and carotid resistance index before and after treatment between the two groups(P>0.05).After treatment,the pulse wave conduction velocity at the beginning of left and right common carotid artery contraction(PWV-BS)and the pulse wave conduction velocity at the end of contraction(PWV-ES)were decreased in both groups,and the left and right PWV-BS and PWV-ES in the combination group were lower than those in the control group:(5.42±0.64)m/s vs.(6.02±0.8)m/s,(4.89±0.67)m/s vs.(5.86±0.98)m/s,(8.02±0.86)m/s vs.(9.34±1.24)m/s,(6.98±0.67)m/s vs.(8.02±0.87)m/s,there were statistical differences(P<0.05).Conclusions Bisoprolol combined with levamlodipine can effectively improve the blood pressure control effect of hypertensive patients,improve the levels of RAAS related hormones,reverse ventricular remodeling,and improve carotid artery vascular elasticity function,without increasing the risk of adverse reactions.