增强型体外反搏对老年高血压患者血压及内皮功能障碍的改善作用

The improvement effect of enhanced external counterpulsation on blood pressure and endothelial dysfunction in elderly hypertensive patients

目的原发性高血压与内皮功能障碍密切相关,本研究旨在评估增强型体外反搏(EECP)对老年高血压患者血压及内皮功能障碍的改善作用。方法入选2021年11月至2022年7月于河北省第八人民医院(河北省老年病医院)住院及门诊就诊的360例老年原发性高血压患者为研究对象,随机分为三组,每组各120例。对照组予以生活方式指导和服药依从性管理,药物组在生活方式指导基础上给予比索洛尔口服,药物+EECP组在生活方式加比索洛尔治疗基础上给与EECP,每周5次,1h/次,共治疗3个月。比较三组患者干预前、后血清内皮素1(ET-1)和一氧化氮(NO)水平、颈动脉超声及临床血压和24 h动态血压情况。记录干预期间副作用。结果与对照组和药物组患者相比,药物+EECP组的内皮功能显著改善:血清ET-1水平、临床血压和24 h动态血压较干预前和其他两组降低,NO水平及颈动脉超声参数收缩峰值速度(PSV)、舒张末期速度(EDV)和流体剪切应力(FSS)升高(P<0.05)。相关分析显示,FSS与ET-1(r=-0.121,P=0.022)、NO-1(r=0.151,P=0.004)和临床收缩压(r=-0.154,P=0.003)变化值(干预后-干预前)之间呈相关关系。即使校正了混杂因素,这种相关性仍存在(P<0.001)。结论比索洛尔联合EECP可改善老年原发性高血压患者血管内皮功能。

Objective Primary hypertension is closely related to endothelial dysfunction.This study aims to evaluate the improvement effect of enhanced extracorporeal counterpulsation(EECP)on blood pressure and endothelial dysfunction in elderly hypertensive patients.Methods From November 2021 to July 2022,360 patients with essential hypertension were randomly divided into 3 groups with 120 patients in each group,taking inpatients and outpatients with essential hypertension in our hospital as research objects:The control group was given lifestyle guidance and medication compliance management,the drug group was given bisoprolol orally on the basis of lifestyle guidance,and the drug+EECP group was given EECP on the basis of gabisoprolol treatment,5 times a week for 1 hour each time,for a total of 3 months.Serum endothelin-1(ET-1)and nitric oxide(NO)levels,carotid artery ultrasonography,clinical blood pressure and 24 h ambulatum blood pressure were compared between the three groups before and after intervention.Any side effects during the intervention were recorded.Results The control group received lifestyle guidance and medication adherence management,while the medication group received oral bisoprolol on the basis of lifestyle guidance.The medication+EECP group received EECP on the basis of lifestyle plus bisoprolol treatment,5 times a week,1 hour/time,for a total of 3 months.Compare the levels of serum endothelin-1(ET-1)and nitric oxide(NO),carotid ultrasound,clinical blood pressure,and 24 h dynamic blood pressure among three groups of patients before and after intervention.Record the side effects during the intervention period.Compared with the control group and the drug group,the endothelial function of the drug+EECP group was significantly improved:serum ET-1 levels,clinical blood pressure,and 24 h dynamic blood pressure decreased compared to before intervention and the other two groups,while NO levels and carotid ultrasound parameters peak systolic velocity(PSV),end diastolic velocity(EDV),and fluid shear stress(FSS)increased(P<0.05).Correlation analysis showed that there was a correlation between FSS and changes in ET-1(r=-0.121,P=0.022),NO-1(r=0.151,P=0.004),and clinical systolic blood pressure(r=-0.154,P=0.003)(before intervention).Even after adjusting for confounding factors,this correlation still exists(P<0.001).Conclusion Bisoprolol combined with EECP can improve endothelial function in elderly patients with primary hypertension.