氨氯地平联合氯沙坦钾氢氯噻嗪治疗难治性高血压患者的效果及对动脉粥样硬化的影响观察

Effect observation of amlodipine combined with losartan potassium hydrochlorothiazide in the treatment of refractory hypertension and its influence on atherosclerosis

目的观察氨氯地平联合氯沙坦钾氢氯噻嗪治疗难治性高血压患者的效果及对动脉粥样硬化的影响。方法60例难治性高血压患者,以电脑随机法分成对照组(30例)及观察组(30例)。对照组应用氨氯地平开展治疗,观察组应用氨氯地平联合氯沙坦钾氢氯噻嗪开展治疗。对比两组治疗前后临床症状积分、血压水平、血管内皮功能、动脉粥样硬化情况以及预后质量。结果两组治疗后头痛、眩晕、胸闷积分较本组治疗前均降低,且观察组治疗后头痛积分(1.47±0.52)分、眩晕积分(1.54±0.63)分、胸闷积分(1.27±0.30)分较对照组的(2.43±0.69)、(2.33±0.81)、(2.14±0.48)分均更低(P<0.05)。两组治疗后24 h收缩压、24 h舒张压及平均动脉压水平较本组治疗前均降低,且观察组治疗后24 h收缩压(121.50±17.39)mm Hg(1 mm Hg=0.133 kPa)、24 h舒张压(85.71±9.51)mm Hg及平均动脉压(108.87±5.15)mm Hg较对照组的(136.11±18.04)、(97.00±11.70)、(123.60±6.74)mm Hg均更低(P<0.05)。两组治疗后一氧化氮水平较本组治疗前升高,血管内皮生长因子水平较本组治疗前降低,且观察组治疗后一氧化氮水平(43.92±4.36)μmol/L较对照组的(34.41±5.50)μmol/L更高,管内皮生长因子水平(143.21±20.17)ng/L较对照组的(156.60±29.70)ng/L更低(P<0.05)。两组治疗后颈动脉内膜中层厚度(IMT)、颈动脉搏动指数、颈动脉斑块面积较本组治疗前均更优,且观察组治疗后较对照组均更优(P<0.05)。两组治疗后IMT、颈动脉搏动指数、颈动脉斑块面积较本组治疗前均更优,且观察组治疗后IMT(0.80±0.10)mm、颈动脉搏动指数(0.65±0.30)、颈动脉斑块面积(19.58±2.39)mm^(2)较对照组的(1.03±0.22)mm、(0.98±0.44)、(25.47±3.31)mm^(2)均更优(P<0.05)。两组治疗后躯体功能、社会功能、特异模块、治疗副作用评分均较本组治疗前均更高,且观察组治疗后较对照组均更高(P<0.05)。结论氨氯地平联合氯沙坦钾氢氯噻嗪能够提高难治性高血压患者的降压效果,改善患者动脉粥样硬化的情况,这可能与该联合方案能够改善患者血管内皮功能、调节血压水平等有关。

Objective To observe the effect of amlodipine combined with losartan potassium hydrochlorothiazide in the treatment of refractory hypertension and its influence on atherosclerosis.Methods 60 patients with refractory hypertension were randomly divided into a control group(30 cases)and an observation group(30 cases).The control group was treated with amlodipine,and the observation group was treated with amlodipine and losartan potassium hydrochlorothiazide.The clinical symptom score,blood pressure level,vascular endothelial function,atherosclerosis and prognosis quality were compared between the two groups before and after treatment.Results After treatment,the scores of headache,vertigo and chest tightness in both groups were lower than those before treatment;the observation group had headache score of(1.47±0.52)points,vertigo score of(1.54±0.63)points and chest tightness score of(1.27±0.30)points,which were lower than(2.43±0.69),(2.33±0.81)and(2.14±0.48)points in the control group(P<0.05).After treatment,the 24 h systolic blood pressure,24 h diastolic blood pressure and mean arterial pressure in both groups were lower than those before treatment;the observation group had 24 h systolic blood pressure of(121.50±17.39)mm Hg(1 mm Hg=0.133 kPa),24 h diastolic blood pressure of(85.71±9.51)mm Hg and mean arterial pressure of(108.87±5.15)mm Hg,which were lower than(136.11±18.04),(97.00±11.70)and(123.60±6.74)mm Hg in the control group(P<0.05).After treatment,the level of nitric oxide in both groups was higher than that before treatment,and the level of vascular endothelial growth factor was lower than that before treatment;the observation group had higher nitric oxide of(43.92±4.36)μmol/L than(34.41±5.50)μmol/L in the control group,and lower vascular endothelial growth factor of(143.21±20.17)ng/L than(156.60±29.70)ng/L in the control group(P<0.05).After treatment,the carotid intima-media thickness(IMT),carotid pulse index and carotid plaque area in both groups were better than those before treatment,and the observation group was better than the control group(P<0.05).After treatment,IMT,carotid pulse index and carotid plaque area in both groups were better than those before treatment;the observation group had IMT of(0.80±0.10)mm,carotid pulse index of(0.65±0.30)and carotid plaque area of(19.58±2.39)mm^(2),which were better than(1.03±0.22)mm,(0.98±0.44)and(25.47±3.31)mm^(2) in the control group(P<0.05).After treatment,the scores of physical function,social function,specific modules and treatment side effects in both groups were higher than those before treatment,and the observation group was higher than the control group(P<0.05).Conclusion Amlodipine combined with losartan potassium hydrochlorothiazide can improve the antihypertensive effect and improve the atherosclerosis of patients with refractory hypertension,which may be related to the combination of this program can improve vascular endothelial function and regulate blood pressure.