马来酸依那普利联合叶酸降低血压和同型半胱氨酸的疗效

目的 评价马来酸依那普利加用叶酸用于原发性高血压患者降压和降同型半胱氨酸的疗效.方法 采用随机、开放、平行对照的临床研究设计,在一农村社区选择原发性高血压患者,随机分配到3个治疗组中,分别接受对照组(依那普利10 mg)、叶酸低剂量组(依那普利10 mg+叶酸0.4 mg)和高剂量组(依那普利10 mg+叶酸0.8 mg)治疗,每日1次,连续治疗8周.治疗前及治疗后第2、4、6、8周末进行随访,测量坐位血压,并测定给药前、给药后第4周和第8周3个不同时点的血浆同型半胱氨酸(Hcy)水平.试验开始前和结束时进行实验室检查.结果 273例原发性高血压患者进入随机试验.采用意向性分析(ITT).叶酸低剂量组和高剂量组降Hcy和降压的有效率分别为15.2%和17.1%,均显著优于依那普利组(3.8%);叶酸低剂量组和高剂量组降低Hcy或血压的有效率分别为70.9%和58.5%,亦均显著高于依那普利组(43.8%).两个叶酸组降Hcy疗效均显著优于依那普利组(均P<0.05),三组降压疗效无显著差别.结论 依那普利联合使用叶酸可用于降低原发性高血压患者的血压和血浆Hcy水平.

Efficacy of enalapril combined with folic acid in lowering blood pressure and plasma homocysteine level

Objective To investigate the efficacy of enalapril combined with folic acid in lowering both blood pressure and plasma total homocysteine (Hcy) in essential hypertensive patients. Methods A randomized, community-based clinical trial was conducted. Subjects with hypertension were randomly assigned to one of three treatment groups:enalapril 10 mg/d alone (control), enalapril 10 mg plus folio acid 0.4 mg daily (low-dose group) and enalapril 10 mg combined with folic acid 0. 8 mg daily (high-dose group) for a total of 8 weeks. Resting blood pressures of all subjects was measured at baseline, 2nd, 4th, 6th and 8th week of therapy. Plasma Hcy levels were measured at baseline, 4th week and the end of study. Results A total of 273 hypertensive patients were enrolled. All analyses were pedormed according to the intention to treat. Compared with control group, both low- and high-dose group had significantly a greater efficacy in lowering both blood pressure and plasma Hcy level, orin lowering either blood pressure or plasma Hcy level, or in lowering Hcy leveL The proportion of subjects showing a marked reduction in both blood pressure and plasma homocysteine in control group, low-dose group and high-dose group were 3.8%, 15.2% and 17. 1% respectively; the priportion of subjects showing a marked reduction in either blood pressure or plasma homocystoine in contnol group, low-close group and high-dose group were 43. 8%, 70. 9% and 58. 5% respectively. Effect upon blood pressure lowering was not significantly different among these three regimens. Conclusion As compared to enalapril alone, enalapril combined with folio acid showed a better efficacy in reducing both blood pressure and plasma Hcy level in hypertensive subjects.