小剂量辛伐他汀对高血压患者血管内皮功能的影响及安全性研究

目的探讨小剂量辛伐他汀（5mg）对高血压患者血管内皮功能作用的影响及小剂量安全性。方法将204例高血压患者随机分为3组：常规对照组（仅给予常规降压治疗不予口服他汀类药物）、5mg组（辛伐他汀5mg／d）、20mg组（辛伐他汀20mg／d）各68例，均治疗12周，在治疗前及治疗2周时检测血脂、肝肾功、肌酶谱、血常规，治疗过程中患者如果出现他汀类药物的不良反应即停止治疗退出研究，治疗前后采用彩色多普勒超声检测肱动脉血管内皮的血流介导的舒张功能（flow-mediated dilation，FMD）、肱动脉血管内皮的硝酸甘油介导的舒张功能（nitroglycerin-mediated dilation，NMD，同时观察3组治疗前后血脂水平的变化，比较各组血脂水平及内皮功能的前后变化及各组他汀类药物不良反应的发生率。结果①5mg组及20mg组他汀类药物不良反应的发生率分别为4．41％、25％，5mg组他汀类药物不良反应的发生率明显低于20mg组，并且差异有统计学意义；②20mg组血清总胆固醇、LDL—C水平治疗后明显下降，与本组治疗前比较差异有统计学意义（均为P〈0．05）；5mg组及20mg组的FMD均较治疗前明显改善并且有统计学意义（P〈0．05），2组间FMD变化值比较差异无统计学意义（P〉0．05）。结论小剂量辛伐他汀药物不良反应较少，小剂量辛伐他汀与常规剂量辛伐他汀均可显著改善高血压患者的血管内皮功能，对于需长期服用他汀类药物、血脂水平不太高甚至偏低的患者，可考虑使用小剂量的他汀类调脂药，以发挥其改善血管内皮细胞功能等非调脂作用，降低心脑血管不良事件的发生率，从而减少高血压的并发症。

The research of effect of Low-dose simvastatin on vascular endothelial function in patients with hypertensives and its safety

Objective To explore the low-dose simvastatin (5 mg)on vascular endothelial function in hypertensives and safety of low-dose.Methods 204 hypertensives were randomly divided into 3 groups: conventional control group( conventional antihypertensive treatment alone without oral simvastatin),5 mg group (simvastatin 5 mg/d),20 mg group( simvastatin 20 mg/d)respectively 68 cases were treated for 12 weeks,and blood lipid,hepatic and rena function,muscle enzymes,blood cells were detected before treatment and two weeks after treatment,during the the patients with adverse drug reaction of simvastatin will withdraw from the study,Before and after treatment brachial artery endothelial FMD ( flow-mediated dilation) and NMD ( nitroglycerin-mediated dilation) were detected using color Doppler ultrasound,the changes in level of lipid of 3 groups were observed before and after treatment and changes in endothelial function and lipid levels in each group before and after treatment and incidence of adverse reactions of simvastatin each group were compared.Results ①The incidence of adverse drug reactions of simvastatin in 5 mg and 20 mg group Group were respectively 4.41%,25% and the incidence of adverse drug reactions of simvastatin in 5 ng was was significantly lower than in 20 mg group ( P ＜ 0.05 ).②The level of TC,LDL-C after treatment in 20 mg group than before treatment decreased significantly(P ＜0.05);FMD in 5 mg and 20 mg groups were significantly improved pre-treatment(P ＜0.05),Changes in the value of FMD were no difference in 5 mg and 20 mg groups( P ＞ 0.05).Conclusion The incidence of adverse drug reactions in Low-dose simvastatin is fewer,both low-dose and conventional-dose simvastatin can significantly improve vascular endothelial function in hypertensives.These patients which need long-term use of statins and whose lipid levels are not too high or low may use low doses statins drugs,which could play a role improving vascular endothelial function but not a role of regulation of lipid levels and reduce incidence of adverse cardiovascular and cerebrovascular events,ultimately reduce the complications of hypertension.