硝苯地平缓释片联合依那普利治疗老年冠心病合并高血压患者的临床分析

Clinical analysis of nifedipine sustained-release tablets combined with enalapril in the treatment of elderly patients with coronary heart disease and hypertension

目的探究硝苯地平缓释片联合依那普利治疗老年冠心病合并高血压患者的效果以及对心功能、血管内皮功能的影响,为治疗该病症提供方法。方法遴选2020年2月—2023年2月于西部战区总医院收治的115例冠心病合并高血压的老年患者,采用简单随机方法分为依那普利组(n=58)和联合组(n=57)。2组均行常规治疗,依那普利组加用依那普利,联合组加硝苯地平缓释片联合依那普利。观察并比较2组临床疗效;比较2组治疗前后心功能指标值[收缩压(SBP)、舒张压(DBP)]、血压变异性指标值[24 h平均收缩压变异性(24 h SBPV)、24 h平均舒张压变异性(24 h DBPV)]、血管内皮功能指标值[一氧化氮(NO)、血浆内皮素(ET)、血管内皮生长因子(VEGF)水平]、氧化应激指标值[丙二醛(MDA)、超氧化物歧化酶(SOD)、晚期蛋白氧化产物(AOPP)水平]变化;比较2组不良反应。结果联合组临床总有效率明显高于依那普利组(94.74%vs 81.04%,P<0.05)。治疗后,2组LVEF水平较同组治疗前升高(P<0.05),LVEDD、LVESD、MAP、HR水平均较同组治疗前下降(P<0.05),且2组间差异均有统计学意义(P<0.05);2组SBP、DBP、24 h SBPV、24 h DBPV均较同组治疗前下降(P<0.05),且联合组上述指标值均显著低于依那普利组(P<0.05);2组NO水平均较同组治疗前升高(P<0.05),ET、VEGF水平均较同组治疗前下降(P<0.05),且2组患者NO、ET、VEGF水平差异均有统计学意义(P<0.05);2组SOD水平均较同组治疗前升高(P<0.05),MDA、AOPP水平均均较同组治疗前下降(P<0.05),且2组SOD、MDA、AOPP水平差异均有统计学意义(P<0.05);2组治疗不良反应发生率差异无统计学意义(P>0.05)。结论硝苯地平缓释片联合依那普利治疗老年冠心病合并高血压患者的疗效显著,可能有效稳定患者的血压,改善心功能和血管内皮功能,减轻氧化应激反应,具有一定的临床应用价值。

Objective To explore the effects of nifedipine sustained-release tablets combined with enalapril in the treatment of elderly patients with coronary heart disease complicated with hypertension and its influence on cardiac function and vascular endothelial function,and provide methods for the treatment of this disease.Methods 115 elderly patients with coronary heart disease and hypertension admitted to General Hospital of Western Theater Command from February 2020 to February 2023 were enrolled and divided into enalapril group(n=58)and combined group(n=57)by simple randomization method.Both groups received conventional treatment.In addition,the enalapril group was treated with enalapril,and the combined group was treated with nifedipine sustained-release tablets combined with enalapril.The clinical efficacy of the two groups were observed and compared.The changes in cardiac function index values[systolic blood pressure(SBP),diastolic blood pressure(DBP)],blood pressure variability index values[24-hour mean systolic blood pressure variability(24 h SBPV),24-hour mean diastolic blood pressure variability(24 h DBPV)],vascular endothelial function index values[nitric oxide(NO),plasma endothelin(ET),vascular endothelial growth factor(VEGF)levels],oxidative stress index values[malondialdehyde(MDA),superoxide dismutase(SOD),and advanced oxidation protein products(AOPP)levels]before and after treatment were compared between the two groups.The adverse reactions of the two groups were compared.Results The total clinical effective rate of the combined group was significantly higher than that of the enalapril group(94.74%vs 81.04%,P<0.05).After treatment,the LVEF levels of both groups were higher than those of the same groups before treatment(P<0.05),while the levels of LVEDD,LVESD,MAP and HR were lower than those of the same groups before treatment(P<0.05),but the differences before and after treatment between the two groups were statistically significant(P<0.05);the levels of SBP,DBP,24-hour SBPV,and 24-hour DBPV of both groups were lower than those of the same group before treatment(P<0.05),and the above indicators of the combined group were significantly lower than those of the enalapril group(P<0.05);the levels of NO of both groups were higher than those of the same group before treatment(P<0.05),while the levels of ET and VEGF were lower than those of the same group before treatment(P<0.05),but the differences before and after treatment in the levels of NO,ET,and VEGF between the two groups were statistically significant(P<0.05);the levels of SOD of both groups were higher than those of the same group before treatment(P<0.05),while the levels of MDA and AOPP were lower than those of the same group before treatment(P<0.05),but the differences before and after treatment in the levels of SOD,MDA,and AOPP between the two groups were statistically significant(P<0.05).There were no statistical differences in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The combination of nifedipine sustained-release tablets and enalapril has a significant therapeutic effect on elderly patients with coronary heart disease and hypertension.It can effectively stabilize blood pressure,improve heart and endothelial function,alleviate oxidative stress response,and has certain clinical application value.