厄贝沙坦和赖诺普利联合应用对高血压病患者血管内皮功能的影响

目的探讨厄贝沙坦、赖诺普利单独与联合治疗对高血压患者血浆一氧化氮(NO)和内皮素(ET)的调节作用。方法选择156例高血压患者,随机分为3组,51例接受厄贝沙坦治疗;55例接受赖诺普利治疗;联合治疗组50例接受厄贝沙坦和赖诺普利治疗。均于治疗前后行血压及血浆NO、ET测定。并与50例健康者血浆NO、ET对照。结果3组高血压患者NO较对照组显著降低(P<0.01),ET显著升高(P<0.01)。3组治疗后血压均有显著下降(P<0.01),厄贝沙坦组及赖诺普利组降压幅度无差异,联合用药组降压幅度明显高于两单独治疗组(P<0.05);3组血浆NO水平均有显著升高(P<0.01);厄贝沙坦组及赖诺普利组血浆NO水平升高幅度无差异(P>0.05),联合用药组NO升高幅度明显高于两单独治疗组(P<0.05);3组血浆ET水平均有显著降低(P<0.01),厄贝沙坦组及赖诺普利组ET水平下降幅度无差异(P>0.05),联合用药组ET下降幅度明显高于两单独应用组(P<0.05)。结论厄贝沙坦、赖诺普利长期单独应用可明显降低血压,同时升高血浆NO水平、降低血浆ET水平、改善血管内皮素功能。两药联用治疗高血压对改善血管内皮功能效果更好。     

赖诺普利对高血压病病人胰岛素抵抗的影响

目的 :探讨赖诺普利对高血压病 (EH)病人胰岛素抵抗 (IR)的影响。方法 :选择 30例EH病人用赖诺普利治疗 8wk ,剂量 10～ 30mg·d- 1( 16.8mg·d- 1± 1.8mg·d- 1) ,治疗前后分别进行口服葡萄糖耐量试验 (OGTT) ,同时测定其血浆胰岛素(Ins)浓度。结果 :除血压明显下降外 ,空腹及糖负荷后Ins水平、胰岛素 /血糖 (I/G)比值治疗后均下降 ,以 60min为明显 (P <0 .0 5) ,胰岛素曲线下面积 (AUCI)、糖耐量曲线下面积 (AUCG)及其比值也较前为小 (P <0 .0 5) ,空腹及糖负荷后血糖水平及其曲线下面积 ,治疗前后无明显差异 (P >0 .0 5)。结论 :赖诺普利对EH病人 ,在降压的同时有改善胰岛素抵抗的作用     

赖诺普利对老年高血压及左室舒张功能的影响

目的：探讨琐为利对老年高血压及左室舒张功能的影响,方法：对20例老年高血压病患者,给予赖诺普利口服20周。用药前后分别记录血压并用彩色多普勒技术测定左室舒张功能参数。结果：用药后,收缩压和舒张压均明显降低（P＜0.01）,E波、E波减速度用药后较用药前明显增加（P＜0.01),而A波、A／E比率和E波减速时间则明显降低（P＜0.05-0.01）。提示赖诺普利可显著降低血压并改善老年高血压患者的左舒张功能。     

赖诺普利与依那普利对高血压的疗效比较

９２例原发性Ⅰ和Ⅱ期高血压病人采用随机、单盲方法，分２组治疗。一组用赖诺普利，ｐｏ，２０－８０ｍｇ／ｄ，另一组用依那普利，ｐｏ，１０－４０ｍｇ／ｄ，疗程均为４ｗｋ。降压总有效率和降压幅度：赖诺普利是８９％和２．９／２．０ｋＰａ，依那普利是９７％和３．１／２．１ｋＰａ，２药降压均显著（Ｐ＜０．０１），降压疗效相仿（Ｐ＞０．０５）。不良反应发生率是２９％和３４％，其中最多是干咳。结果提示赖诺普利治疗轻、中度高血压有效、安全。     

拉西地平与赖诺普利对高血压患者昼夜血压的影响

目的：比较拉西地平和赖诺普利对高血压患者的疗效。方法：６０例高血压病Ⅰ期或Ⅱ期患者按服药情况分拉西地平组、赖诺普利组、治疗８ｗｋ进行２４ｈ动态血压监测。结果：两药均能显著降低，降低偶测ＢＰ的幅度无显著差异，拉西地平降低２４ｈ平均压和白天平均压的幅度大于赖诺普利。结论：对轻中度高血压病拉西地平与赖诺普利是一种安全的药物，ｑｄ给药能维持２４ｈ降压效应。     

赖诺普利对老年高血压及左室舒张功能的影响

目的 :探讨赖诺普利对老年高血压及左室舒张功能的影响。方法 :对 2 0例老年高血压病患者 ,给予赖诺普利口服 2 0周。用药前后分别记录血压并用彩色多普勒技术测定左室舒张功能参数。结果 :用药后 ,收缩压和舒张压均明显降低(P <0 .0 1) ,E波、E波减速度用药后较用药前明显增加 (P <0 .0 1) ,而A波、A/E比率和E波减速时间则明显降低 (P <0 .0 5～ 0 .0 1)。提示赖诺普利可显著降低血压并改善老年高血压患者的左室舒张功能     

赖诺普利对高血压患者左心室肥厚的逆转作用

目的：探讨赖诺普利对原发性高血压患者左心室肥厚逆转及对C-反应蛋白、尿酸水平的影响。方法：83例原发性高血压1、2级患者，给予赖诺普利10～20mg，每天1次口服，把血压控制到〈18．62／11．97kPa，疗程为16wk，监测治疗前后收缩压、舒张压、C-反应蛋白、尿酸、舒张期室间隔厚度、舒张末期左室后壁厚度、左室舒张末内径、左心室质量指数变化。结果：用赖诺普利治疗16wk后，患者血压、C-反应蛋白和尿酸水平明显降低；经赖诺普利治疗后，室间隔厚度、左心室后壁厚度和左心室质量指数均有明显改善。结论：赖诺普利能够显著降低血压，干预和逆转左心室肥厚，降低C-反应蛋白和尿酸水平，是治疗原发性高血压安全有效的药物。     

氯沙坦钾和赖诺普利对老年高血压患者的疗效比较

目的比较氯沙坦钾和赖诺普利治疗老年高血压的临床效果。方法选择我院2008年至2011年收治的老年高血压患者62例,按照入院日期,分为2组,单日为观察组,双日为对照组,每组各31例,A组口服给予氯沙坦钾50mg,1次/d,B组口服给予赖诺普利10mg/次,1次/d,两组患者疗程均为8周,治疗后比较两组临床效果,不良反应。结果治疗8周后,A和B组治疗总有效率分别为80.6%和77.4%,两组间差异不具有统计学意义(P>0.05),但A组不良反应率仅为3.2%,显著低于对照组12.9%,差异具有统计学意义(P<0.05)。结论氯沙坦钾和赖诺普利治疗老年高血压临床效果相似,均能显著改善高血压症状,赖诺普利成本较低,但不良反应发生率较高,选择何种治疗方案应依据患者病情及经济状况等综合考虑。     

赖诺普利对高血压病患者血脂和血糖的影响

研究发现,高血压病不仅是血流动力学异常疾病,也是代谢病,它与脂肪、糖等代谢紊乱共存也说明这些因素是高血压好发并发症,也支持了高血压属于代谢紊乱综合征的论点。     

The effects of long term administration of dopamine on renal function in hypertensive patients

Summary The effect of an intravenous infusion of dopamine (0.5 to 1.25 µg/kg/min) for periods of between 36 and 105h has been studied in eight patients with hypertension and varying degrees of renal impairment. There was a significant rise in the glomerular filtration rate (GFR) from 31.2±20.2 to 42.8±26.8 ml/min (p<.05) after four hours of the infusion but after 48 h of infusion the mean GFR was no different from the control value. The paraaminohippuric acid (PAH) clearance also rose from 129.8±115.4 ml/min to 173.1±164.3 ml/min (p<0.05) after four hours of infusion, but like the GFR it was no different from control after 48 h of the infusion. The daily urine volumes increased significantly during the dopamine infusion from 2176.0±49.2 ml/day to 3809.0±118.8 ml/day (p<0.002) but had returned to control values after 48 h of continuing dopamine infusion. Following the end of the infusion there was a significant reduction in the urine volume to 1213.0±195.0 ml/day (p<0.001). There was a rise in sodium excretion during the dopamine infusion from 94.8±50.7 meq/day to 264.7±172.8 meq/day (p<0.01) with a fall after the end of the infusion to 33.2±27.5 meq/day (p<0.05). There was no change in the blood urea during the dopamine infusion but after stopping the infusion the blood urea rose from 83.5±39.4 mg% to 95.1±39.0 mg% (p<0.02). We conclude that intravenous infusion of dopamine to patients with hypertension and renal impairment may produce initial clinical improvement but is of little therapeutic benefit when given for prolonged periods.     

苯磺酸氨氯地平片和硝苯地平控释片在老年高血压患者中的疗效比较

目的评价苯磺酸氨氯地平片和硝苯地平控释片对老年高血压患者血压和血压变异性的影响。方法 80例高血压患者随机分成2组,每组40例,分别服用苯磺酸氨氯地平片(5 mg.d-1)和硝苯地平控释片(30 mg.d-1),服用3个月,比较2种药物对血压和血压变异性的影响。结果 2种药物均能有效降低24 h收缩压,但苯磺酸氨氯地平片控制24 h收缩压和24 h收缩压变异性疗效比硝苯地平控释片好(P<0.05)。结论苯磺酸氨氯地平片是1种理想的控制老年高血压患者收缩压和收缩压变异性的钙拮抗剂。     

Pharmacokinetics and antihypertensive effects of lisinopril in hypertensive patients with normal and impaired renal function.

The antihypertensive effects and pharmacokinetic properties of lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, were investigated in hypertensive patients with normal renal function (NRF, mean serum creatinine 1.0 mg/dl, n = 9) and those with impaired renal function (IRF, mean serum creatinine 1.7 mg/dl, n = 8). Lisinopril was administered orally (10-mg dose once daily for 5 or 8 days). Measurement of blood pressure (BP) and sampling of blood specimens were made on the first and last days of treatment. During consecutive dosing of lisinopril, its antihypertensive effects were sustained for greater than or equal to 12 h with less diurnal variation of BP. Serum ACE activity was markedly suppressed for 24 h. Plasma levels of lisinopril in the IRF group were higher than those in NRF with significant differences in the peak levels and areas under the plasma concentration time curve (AUC). A significant inverse correlation was found between the creatinine clearance and the AUC for lisinopril. These results suggest that lisinopril has a long-lasting action and that it is a useful antihypertensive agent for controlling BP in patients with either NRF or mild IRF. When administered for an extended period, however, more careful consideration should be given to the dose in patients with IRF than in patients with NRF to minimize the possibility of untoward side effects.     

Pharmacokinetics of lisinopril in hypertensive patients with normal and impaired renal function

Summary The pharmacokinetics of lisinopril was studied after administration of single and multiple doses of 5 mg to hypertensive patients with normal and impaired renal function.In patients with severe renal failure the peak concentrations were higher, the decline in serum concentration was slower and the time to peak concentration was extended. Accumulation of lisinopril was highly correlated with the creatinine clearance. The effective half-life was doubled and tripled in patients with mild and severe renal impairment, respectively, as compared to patients with a normal renal function. Lisinopril lowered blood pressure in all three groups over 24 h.It is suggested that smaller doses of lisinopril should be administered to patients with severe renal failure.     

优化苯磺酸氨氯地平服药时间对高龄高血压患者晨峰血压的影响

目的观察优化苯磺酸氨氯地平服药时间对高龄高血压患者晨峰血压(起床后2 h内的收缩压的平均值与夜间最低收缩压前后1 h的平均之间的差值)及24 h动态血压的影响。方法≥80岁且晨峰血压≥35 mmHg高血压患者68例,分成优化组[34例,年龄(83±3)岁,苯磺酸氨氯地平5 mg/次,1次·d~(-1),睡醒即刻及空腹服药]和对照组[34例,年龄(82±2)岁,苯磺酸氨氯地平5 mg/次,1次·d~(-1),起床后60 min,早餐后服药],治疗4周,比较2组治疗前后晨峰血压和24 h动态血压的变化。结果优化组较对照组晨峰血压和白天平均收缩压及舒张压显著下降(均P<0.05)。结论优化苯磺酸氨氯地平服药时间能显著降低晨峰血压和白天平均收缩压舒张压。     

Impacts of lisinopril and lisinopril plus simvastatin on erythrocyte and plasma arginase, nitrite, and nitrate in hypertensive patients

Angiotensin-converting enzyme inhibitors are effective at reducing blood pressure, whereas statins decrease plasma cholesterol, impeding atherosclerosis. The authors hypothesize that these medications may improve blood pressure by modifying the arginase-nitric oxide synthase system of erythrocytes. In this study, the effects of lisinopril alone versus lisinopril + simvastatin on erythrocyte and plasma arginase enzyme and nitric oxide metabolites are compared. Patients with atherosclerosis and hypertension are randomly assigned to receive lisinopril 10 to 20 mg/d or lisinopril 10 to 20 mg/d plus simvastatin 20 mg/d for 24 weeks. Higher arginase activity is observed in erythrocytes from 100% of patients and mainly recovered after 12 and 24 weeks of treatment with lisinopril or lisinopril + simvastatin. Plasma arginase activity is 3 orders of magnitude lower than erythrocyte arginase activity in all participants, suggesting a lack of its clinical significance. Both treatments cause the increase in plasma $$\hbox{ N }{\hbox{ O }}_{2}^{-}$$ , $$\hbox{ N }{\hbox{ O }}_{3}^{-}$$ , and $$\hbox{ N }{\hbox{ O }}_{2}^{-}$$ + $$\hbox{ N }{\hbox{ O }}_{3}^{-}$$ in 100% of patients. Erythrocyte $$\hbox{ N }{\hbox{ O }}_{2}^{-}$$ + $$\hbox{ N }{\hbox{ O }}_{3}^{-}$$ concentration is greatly decreased in hypertensive patients but recovers after monotherapy and combined therapy. The results show for the first time that lisinopril monotherapy and combined lisinopril + simvastatin therapy exhibit pronounced and equipotential normalizing effects on erythrocyte arginase and nitric oxide synthase activities.     

贝那普利联用氨氯地平对高血压患者血压、左室肥厚和心功能的影响

目的探讨贝那普利联用氨氯地平的降压效果以及逆转左心室肥厚、改善心功能的作用。方法将140例原发性高血压伴左心室肥厚患者随机分为贝那普利组（46例）、氨氯地平组（47例）、贝那普利联用氨氯地平组（47例）,分别接受贝那普利、氨氯地平、贝那普利加氨氯地平治疗12个月,观察期间定期测量血压,服药前后做超声心动图检查。结果用药后三组血压、超声心动图各指标较用药前变化显著（P〈0．05）,两单用药组比较各指标差异无显著性（P〉0．05）,联合用药组与单用药组比较各指标差异有显著性意义（P〈0．05）。结论贝那普利联合应用氨氯地平治疗原发性高血压降压效果好,逆转左室肥厚效果好,改善心功能作用明显,不良应少。     

Effect of amlodipine,lisinopril and allopurinol on acetaminophen-induced hepatotoxicity in rats

BackgroundExposure to chemotherapeutic agents such as acetaminophen may lead to serious liver injury. Calcium deregulation, angiotensin II production and xanthine oxidase activity are suggested to play mechanistic roles in such injury.ObjectiveThis study evaluates the possible protective effects of the calcium channel blocker amlodipine, the angiotensin converting enzyme inhibitor lisinopril, and the xanthine oxidase inhibitor allopurinol against experimental acetaminophen-induced hepatotoxicity, aiming to understand its underlying hepatotoxic mechanisms.Material and methodsAnimals were allocated into a normal control group, a acetaminophen hepatotoxicity control group (receiving a single oral dose of acetaminophen; 750 mg/kg/day), and four treatment groups receive N-acetylcysteine (300 mg/kg/day; a reference standard), amlodipine (10 mg/kg/day), lisinopril (20 mg/kg/day) and allopurinol (50 mg/kg/day) orally for 14 consecutive days prior to acetaminophen administration. Evaluation of hepatotoxicity was performed by the assessment of hepatocyte integrity markers (serum transaminases), oxidative stress markers (hepatic malondialdehyde, glutathione and catalase), and inflammatory markers (hepatic myeloperoxidase and nitrate/nitrite), in addition to a histopathological study.ResultsRats pre-treated with amlodipine, lisinopril or allopurinol showed significantly lower serum transaminases, significantly lower hepatic malondialdehyde, myeloperoxidase and nitrate/nitrite, as well as significantly higher hepatic glutathione and catalase levels, compared with acetaminophen control rats. Serum transaminases were normalized in the lisinopril treatment group, while hepatic myeloperoxidase was normalized in the all treatment groups. Histopathological evaluation strongly supported the results of biochemical estimations.ConclusionAmlodipine, lisinopril or allopurinol can protect against acetaminophen-induced hepatotoxicity, showing mechanistic roles of calcium channels, angiotensin converting enzyme and xanthine oxidase enzyme in the pathogenesis of hepatotoxicity induced by acetaminophen.     

Pharmacoeconomic consequences of amlodipine besylate therapy in patients undergoing PTCA.

In Italy, revascularization interventions increased from 44,600 in 1996 to more than 100,000 in 2001. In particular, the occurrence of percutaneous transluminal coronary angioplasty (PTCA) increased from 239 cases per million population in 1994 to about 1300 cases per million population in 2001. This trend has caused a concomitant increase in revascularization costs, which have doubled in few years, rising from Euro 421 millions in 1996 to Euro 850 millions in 2001. In 2001, PTCA amounted to 55% of total cost of revascularizations. The aim of this study was to assess the pharmacoeconomic consequences of amlodipine besylate therapy administered in patients at high risk of restenosis after PTCA. We conducted a cost-effectiveness analysis comparing therapy with amlodipine besylate added to standard care versus standard care alone. Information on clinical outcomes was drawn from the Coronary Angioplasty Amlodipine Restenosis Study (CAPARES). Medical costs were estimated with reference to drug therapy and hospitalizations for coronary events and revascularization procedures. The study was conducted from the perspective of the Italian third party payer (National Health Service). The analysis was applied to a time horizon of 4 months. Amlodipine besylate resulted less expensive and more effective than standard care. It reduced mortality, morbidity for coronary reasons and the need of revascularization procedures. The cost per 1000 patients was estimated at Euro 1,166,000 in the placebo and Euro 950,000 in the amlodipine besylate group, resulting into a cost saving of Euro 216,000, that is 18.5% of total cost of standard care. Results are sensitive to the cost of amlodipine besylate and the cost of hospitalizations, but therapy with amlodipine besylate resulted dominant even in the most unfavorable hypothesis.     

硝苯地平控释片氨氯地平对原发性高血压患者血压和心率变异性的影响

目的 :研究长效二氢吡啶类钙拮抗剂硝苯地平控释片与氨氯地平在治疗原发性高血压时对血压、心率变异性的影响。方法 :40例原发性高血压患者随机分为硝苯地平控释片组 (n=2 0 )及氨氯地平组 (n=2 0 ) ,分别予硝苯地平控释片 30～ 6 0mg/ d或氨氯地平 5～ 10 mg/ d,共 8wk。治疗前后行 HRV检测 ,并做对比分析。结果 :2组经 8wk治疗后血压均非常显著下降 (P<0 .0 1)。 2组治疗前后 HRV时域 6项指标 ,包括平均 R- R间期 (AVGR- R)、平均 R- R间期标准差 (SDAR- R)、平均 R- R间期的变异系数 (CV)、平均 R- R间期标准差的均值 (SD)、平均 R- R间期标准差的标准差 (SDSD)、相邻 R- R间期差值平方根的均值 (rm SASD)及频域 4项指标 ,包括低频 (L F 0 .0 2 5～ 0 .1Hz)、中频 (MF 0 .1～ 0 .2 Hz)、高频 (HF 0 .2～ 0 .3Hz)、低频 /高频 (R:L F/ HF)均无变化 (P>0 .0 5 )。结论 :长效二氢吡啶类钙拮抗剂治疗原发性高血压病 ,在降血压时对心率变异性无不利影响。