Integrative Medicine on Optimizing Clopidogrel and Aspirin Therapy

This article reviews the available published data on optimizing clopidogrel and aspirin therapy using translational and integrative medicine. Translational and evidence-based medical studies show that the CYP2 C19 gene mutation(CYP2 C19*2 and CYP2 C19*3) could affect 50% of the Chinese population, and that this mutation is closely associated with clopidogrel resistance and an increased risk of major adverse cardiovascular events, particularly stent thrombosis in patients following percutaneous coronary intervention(PCI). Adjusted-dose warfarin and aspirin reduce stroke in patients with atrial fibrillation(AF), and warfarin is substantially more efficacious than aspirin. However, a poor compliance is a big problem in warfarin use especially in China. The genetic variants of vitamin K expoxide reductase might account for the universally lower warfarin dosage used in Chinese population. The available evidence indicates that the integrating mainstream treatments(e.g., clopidogrel, CYP2 C19 genotyping) and non-mainstream medicines [e.g., Chinese medicines,Naoxintong Capsule(脑心通胶囊, NXT)] to treat CYP2 C19 gene mutation patients following PCI can be effective.Aspirin combined NXT and the adjusted-dose warfarin was equally effective in elderly patients with non-valvular AF in prevention of ischemic stroke.     

Evaluation on the Safety and Efficacy of Tirofiban in the Treatment of Acute Coronary Syndrome

To evaluate the safety and efficacy of tirofiban, a specific inhibitor of the platelet glyco- protein Ⅱb/Ⅲa receptor, in the treatment of unstable angina and myocardial infarction without per- sistent ST elevation (acute coronary syndrome, ACS), a total of 200 patients were randomly assigned to a heparin group and a tirofiban heparin group on double-blind basis and the treatment effects of the two protocols on ACS were compared when the patients of both groups were taking aspirin at the same time. The composite primary end-point events consisted of death, myocardial infarction, or re- fractory ischemia. Our results showed that the frequency of the composite primary end point events in 30 days was lower in tirofiban heparin group as compared with that of heparin group (13.9% vs 29.3 %, P=0.010). The rates of the other composite end point events in the tirofiban heparin group were also lower than those in the heparin group in 4.5 days and in 30 days. Bleeding complication occurred in 7.0% of the patients receiving heparin alone and in 12.7% of the patients receiving tirofiban and heparin in combination (P=0.1717). The study showed that the incidence of ischemic events in pa- tients with ACS receiving tirofiban heparin was lower when compared with that of patients who re- ceived only heparin and aspirin, suggesting that tirofiban might be of special value in the treatment of ACS.     

Does clopidogrel with aspirin after acute minor stroke or transient ischemic attack increase the risk of cerebral hemorrhage？

Wang et al1 recently showed that in patients with transient ischemic attack （TIA） or minor stroke that can be treated within 24 hours after the onset of symptoms, the combination of clopidogrel and aspirin was superior to aspirin alone for reducing the risk of stroke in the first 90 days, without increasing the risk of hemorrhage. We report a patient treated with this combination but suffered recurrent stroke and hemorrhage.     

Anticoagulation therapy in Chinese patients with non-valvular atrial fibrillation: a prospective, multi-center, randomized,

Background  Non-valvular atrial fibrillation is associated with an increased risk of ischemic stroke; however, the appropriate intensity of anticoagulation therapy for Chinese patients has not been determined. The purpose of this study was to compare the safety and the efficacy of standard-intensity warfarin therapy, low-intensity warfarin therapy, and aspirin therapy for the prevention of ischemic events in Chinese patients with non-valvular atrial fibrillation (NVAF).

Methods  A total of 786 patients from 75 Chinese hospitals were enrolled in this study and randomized into three therapy groups: standard-intensity warfarin (international normalized ratio (INR) 2.1 to 2.5) group, low-intensity warfarin (INR 1.6 to 2.0) group and aspirin (200 mg per day) group. All patients were evaluated by physicians at 1, 3, 6, 9, 12, 15, 18, 21 and 24 months after randomization to obtain a patient questionnaire, physical examination and related laboratory tests.

Results  The annual event rates of ischemic stroke, transient ischemic attack (TIA) or systemic thromboembolism were 2.6%, 3.1% and 6.9% in the standard-intensity warfarin, low-intensity warfarin and aspirin groups, respectively (P=0.027). Thromboembolic event rates in both warfarin groups were significantly lower than that in the aspirin group (P=0.018, P=0.044), and there was no significant difference between the two warfarin groups. Severe hemorrhagic events occurred in 15 patients, 7 (2.6%) in the standard-intensity warfarin group, 7 (2.4%) in the low-intensity warfarin group and 1 (0.4%) in the aspirin group. The severe hemorrhagic event rates in the warfarin groups were higher than that in the aspirin group, but the difference did not reach statistical significance (P=0.101). The mild hemorrhagic and total hemorrhagic event rates in the warfarin groups (whether in the standard-intensity warfarin group or low-intensity warfarin group) were much higher than that in the aspirin group with the annual event rates of total hemorrhages of 10.2%, 7.6% and 2.2%, respectively, in the 3 groups (P=0.001). Furthermore, there was no significant difference in all cause mortality among the three study groups.

Conclusion  In Chinese patients with NVAF, the warfarin therapy (INR 1.6–2.5) for the prevention of thromboembolic events was superior to aspirin.

     

Neuron-specific enolase in patients with acute ischemic stroke and related dementia.

Neuron-specific enolase (NSE) levels of cerebrospinal fluid (CSF) were measured in 39 patients with ischemic stroke and 15 controls. There was a significant increase of CSF NSE in acute ischemic stroke patients as compared with the controls. The altered CSF NSE levels correlated well with the infarct size in CT scan. The CSF NSE levels were higher in 6-multiinfarct dementia (MID) patients who were diagnosed after 6-month follow-up than those in 22 non-MID patients of this series. Our research supports the view that CSF NSE can be a useful biochemical marker for brain ischemia. The importance of CSF NSE in the study of dementia related to ischemic stroke is worth further studies.     

Effect of polymorphism and type Ⅱ diabetes on aspirin resistance in patients with unstable coronary artery disease

Background Aspirin is widely used in the secondary prevention of coronary artery diseases, including myocardial infarction, stroke, and vascular related deaths. However, the antiplatelet effect of aspirin appears to be variable and aspirin resistance (AR) is currently still controversial for Chinese patients. The aim of this study was to describe the prevalence of AR, and identify possible risk factors associated with a lack of response to aspirin treatments in patients with unstable coronary artery disease.Methods Platelet function tests with arachidonic acid (ARA) and urinary 11-dehydro-thromboxane B2 (11-DH-TXB2) concentrations were performed in 262 patients with unstable coronary artery disease who had not been taking aspirin before admission. ARA induced platelet aggregation and 11-DH-TXB2 were detected to evaluate the functional and biochemical responses to aspirin before and on days 1, 4, and 10 after aspirin administration. Six-month follow-up was completed in patients who developed AR to evaluate the effect of aspirin in a long-term treatment. GP1 Bα (C1018T), PI(A1/A2), P2Y1(A1622G), TBXA2R (T924C) were also detected to evaluate the influence of genetic variant on aspirin responsiveness.Results A total of 8.8% of patients were indentified as AR at the first day after aspirin treatment. The level of urine 11-DH-TXB2 in the AR group was higher compared to non-AR group (P ＜0.05). There was no relationship between ARA induced platelet aggregation and urinary 11-DH-TXB2 levels (r=0.038, P=0.412). The results of DNA sequencing showed that TBXA2R-924TT homozygotes had a significantly high rate of AR. Logistic regression demonstrated that diabetes was an independent risk factor of AR.Conclusions In the beginning period of administration, aspirin was not a sufficient factor that inhibits platelet aggregation. TBXA2R-g24T allele was involved in AR. Diabetes was an independent risk factor of AR.     

The utilization status of aspirin for the secondary prevention of ischemic stroke

Background The present study was aimed to investigate the usage of aspirin for the secondary prevention of ischemic stroke, evaluate the correlated factors, and analyze the reasons for not taking and irregularly taking aspirin. Methods The patients in this group were all stroke survivors who have formerly been diagnosed with a cerebral infarction or transient ischemic attack （TIA） in our hospital. We investigated their use of aspirin over a three-year period following their hospitalization. According to the patients＇ aspirin usage, they were divided into treatment and non-treatment groups. In addition, the reasons for not taking or irregularly taking aspirin were analyzed in the two groups. Results A total of 1240 patients were studied, including 367 （29.60%） in the treatment group and 873 （70.40%） cases in the non-treatment group. In addition, 201 （16.20%） cases in the treatment group had been regularly taking aspirin （50-325 mg of aspirin daily） for 1 to 3 years or longer. The results demonstrated that the main reasons for not taking aspirin in this study were related to patients＇ concerns regarding the side effects of taking aspirin （46.45%）, as well as the doctors＇ inadequacy in informing their patients to take aspirin （38.71%）. The major reasons for patients to irregularly take aspirin were that the doctors did not notify the length of aspirin usage to their patients （41.57%）, and that doctors did not prescribe aspirin upon the patients＇ follow-up visit （26.51%）. Conclusion The most effective way to increase patient＇s compliance for aspirin consumption is to promote the guidelines for stroke treatment and to relay these advances in stroke therapy to the patient. Chin Med J 2009; 122（2）： 165-168     

Psychological Distress,Social Support and Medication Adherence in Patients with Ischemic Stroke in the Mainland of China

Stroke research and rehabilitation have traditionally focused on the physical and functional impact of a stroke. Less attention has been given to the psychosocial factors associated with this chronic condition. By the few studies that have specifically focused on psychosocial factors in the context of stroke, poststroke depression is demonstrated to significantly influence stroke outcomes. Associations of stroke with psychological symptoms other than depression have rarely been evaluated. This study was aimed to investigate the changes of psychological stress, social support and medication adherence in patients with ischemic stroke in the mainland of China. In this study, 90 patients with hemiplegia one year after first-ever middle cerebral artery infarction(stroke group) in the Zhongnan Hospital of Wuhan University from June 2008 to June 2011 were recruited for interview. Ninety age- and sex-matched normal volunteers(control group) were also examined at the same period. The psychological distress was assessed by the Symptom Checklist 90(SCL-90), the social support by the Social Support Rating Scale(SSRS), and medication adherence by Morisky’s self-reported inventory, respectively. Group differences were analyzed using unpaired-t test and chi-squared test. The results showed that total mean scores of the SCL-90 in the stroke group were higher than those in the control group(P<0.01). Except two dimensions, paranoid ideation and psychoticism, mean scores of the rest dimensions(including somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, and phobic anxiety) of SCL-90 were significantly higher in the stroke group than those in the control group(P<0.05, or P<0.01). The objective support, subjective support, support availability and total social support scores in the stroke group were significantly higher than those in the control group(P<0.05, or P<0.01). Those in the “SCL-90 total scores >150 group” were significantly higher than in the “SCL-90 total scores <100 group” and the “SCL-90 total scores between 100 to 150 group”(P<0.05, or P<0.01). Those in the “SCL-90 total scores between 100 to 150 group” were significantly higher than in the “SCL-90 total scores <100 group”(P<0.05). In 90 patients with ischemic stroke, 26(28.89%) patients obtained high medication adherence, 47(52.22%) patients medium medication adherence, and 17(18.89%) patients low medication adherence, respectively. Among these stroke patients, there were 17(50.00%) patients with high medication adherence in the “SCL-90 total scores >150 group”, 28(75.67%) patients with medium medication adherence in the “SCL-90 total scores between 100 to 150 group”, and 12(61.16%) patients with low medication adherence in the “SCL-90 total scores <100 group”, respectively. There was significant difference in the medication adherence rate among the different SCL-90 scores groups in these stroke patients(P<0.05 or P<0.01). It was led to conclude that ischemic stroke patients one year after hemiplegia have psychological distress, low level of social support and poor medication adherence in the mainland of China. Therefore, it is necessary to mobilize the government, medical institutions and various social support groups to offer psychological interventions to relieve the stress of patients with ischemic stroke, and improve their medication adherence.     

Effect of VKORC1 polymorphism on warfarin dose

Objective To analyze the association of polymorphism in C1173T of VKORC1 with warfarin dose. Methods There are 102 patients to be selected into the research ,who were treated with warfarin.We conducted a retrospective study to analyze the effect of C1173T polymorphism on warfarin dose. Results Of 102 patients,83(81.4%) patients with TT haplotypes,16(15.7%)     

Chemotherapy in conjunction with traditional Chinese medicine for survival of elderly patients with advanced non-small-cell lung cancer： protocol for a randomized double-blind controlled trial

BACKGROUND： Traditional Chinese medicine （TCM） is considered an important complementary therapy with beneficial effects for cancer patients. Elderly patients with non-small-cell lung cancer （NSCLC） are a complex patient group with increasing co-morbidity and shrinking physiological reserve, and may derive substantial benefit from the supportive aspects of TCM Researchers from Shanghai Longhua Hospital found that qi and yin deficiency is a common syndrome in patients with stage III or IV lung cancer. This project was designed to study the combination of single-agent chemotherapy with TCM methods of benefiting qi and yin in elderly patients with advanced NSCLC. METHODS AND DESIGN： This is a double-blind controlled, multi-center, and prospective study with randomly selected participants from elderly NSCLC patients in China. Seventy-six patients who meet the inclusion criteria will be allocated into two groups, which will receive treatments of 3-week single-agent chemotherapy with TCM or placebo for four cycles Progression-free survival （PFS） is the primary end point, and the secondary end points are overall survival, objective response rate, time-to-progression, and quality of life （EORTC QLQ-LC43, and TCM syndrome score） Meanwhile, other end points such as toxicity, side effects and safety of the treatments will be assessed. DISCUSSION： Results from this study may provide evidence on the effectiveness, and parameters for the usage of single-agent chemotherapy combined with or without TCM on PFS of elderly patients with NSCLC.     

Clinical Study on Effect of Garlicin in Stabilizing the Carotid Artery Atherosclerotic Plaque in Patients with Primary Hypertension and Coronary Artery Disease

Objective:To investigate the effect of garlicin in treating carotid artery atherosclerotic plaque (GAAP) in patients with primary hypertension and coronary heart disease (PHT-CHD).Methods:Seventynine patients with PHT-CHD were randomly divided into the treated group (39 patients) treated with garlicin and fosinopril and the control group (40 patients) treated with fosinopril alone. The change of CAAP was evaluated by high frequency ultrasonic examination every six months, and the changes of intercellular adhesion molecule-1 (ICAM-1) and high sensitive C-reactive protein (hs-CRP) were measured by ELISA, with the observation proceeding for 52 weeks totally. Results:By the end of the experiment, the number of complex plaques, Crouse integrals, intima-media thickness, serum ICAM-1 and hs-CRP were significantly lower in the treated group than those in the control group with significant difference (P<0.05). Conclusion:Garlicin could stabilize CMP to a certain extent and shows a definite vascular protective effect in patients with PHT-CHD.     

Treatment of patients older than 60 years with symptomatic vertebrobasilar artery stenosis

Background Vertebrobasilar artery stenosis is an important cause of ischemic posterior circulation strokes. This study aimed at evaluating the safety and efficacy of treatment including conservative therapy alone and conservative plus endovascular therapy for elderly patients with symptomatic vertebrobasilar artery stenosis.
Methods Patients older than 60 years with symptomatic vertebrobasilar artery stenosis （ ≥50%） confirmed by cerebral angiography were enrolled. All of them were treated with medical therapy and some with additional stent-assisted angioplasty （the stenting subgroup）. Their clinical, imaging, intervention and follow-up data were analyzed.Results One hundred and seventeen consecutive elderly patients （100 men, mean age （68.1 ±5.1） years） were enrolled and followed up for a mean time of 28.4 months; 81.7% of them were symptomatically resolved or improved; a stroke rate of 5.1% and a stroke-related death rate of 1.7% were found among them during the hospitalization and follow-up. In the stenting subgroup, 78 balloon expandable stents were employed in the 70 patients with a technical success rate of 98.7% and the mean degree of stenosis was significantly reduced from （81.7±14.3）% before stenting to （8.3±4.2）% after stenting （P 〈0.001）. Four （5.7%） periprocedural strokes occurred, of whom two led to death within 30 days after the procedure. During the follow-up （mean 27.7 months）, sixty of the surviving 68 patients in the stenting subgroup were symptomatically resolved or improved. Only one （1.5%） posterior circulation stroke occurred, while duplex ultrasound scan of 34 patients demonstrated 10 （29.4%） in-stent restenosis.
Conclusions Appropriate utilization of conservative therapy alone and conservative plus endovascular therapy may improve short-term clinical outcomes for elderly patients with symptomatic vertebrobasilar artery stenosis. Furthermore, stent-assisted angioplasty is technically feasible and relatively safe in elderly patients.     

A double-blind,randomized, placebo- and positive-controlled phase III trial of 1% benvitimod cream in mild-to-moderate plaque psoriasis

Background: Benvitimod cream, a novel synthetic small molecule, was effective in treating mild-to-moderate plaque psoriasis. We conducted a phase III clinical trial to assess the efficacy and safety of benvitimod cream in patients with mild-to-moderate plaque psoriasis.Methods: We randomly assigned 686 patients (2:1:1) to receive 1% benvitimod cream, 0.005% calcipotriol ointment or placebo twice a day for 12 weeks. The primary efficacy end points were the percentage of patients with a 75% or gre...     

A high maintenance dose of clopidogrel improves short-term clinical outcomes in patients with acute coronary syndrome undergoing drug-eluting stent implantation

Background Recurrent ischemic events occurred even during routine use of 75 mg clopidogrel in addition to aspirin, that indicated a potentially insufficient maintenance dosage of clopidogrel. The aim of the present study was to evaluate the short-term efficacy and safety of a 150 mg maintenance dose of clopidogrel following a 600 mg loading dose in patients with an acute coronary syndrome （ACS） undergoing drug eluting stent （DES） implantation.
Methods Between November 2005 and November 2006, a total of 813 consecutive ACS patients undergoing DES implantation were enrolled. A 600 mg loading dose was administered before percutaneous coronary intervention （PCI） and patients were randomized to receive clopidogrel 75 mg or 150 mg for 30 days in addition to 300 mg aspirin daily. Primary end points were the composite of cardiac death, non-fatal myocardial infarction （MI） and urgent target vessel revascularization （UTVR）. Secondary end points included stent thrombosis （ST）, major and minor bleeding events at 30 days. Results At a follow-up period of 30 days, 4 （1.0%） patients in the 150 mg group and 9 （2.2%） patients in the 75 mg group （P 〉0.05） reached the primary end points. There was no significant difference in the incidences of MI （0.5% vs 1.2%, P〉0.05）, UTVR （0.7% vs 2.0%, P 〉0.05）, and cardiac death （0.2% vs 0.2%, P 〉0.05） between the two groups. The incidence of ST （0 vs 1.5%, P 〈0.05） was significantly lower in the 150 mg group than that in the 75 mg group. There were no significant differences between both groups regarding the risk of major （0.2% vs 0, P 〉0.05） or minor （0.5% vs 0.2%, P 〉0.05） bleedings.
Conclusion A high clopidogrel maintenance dose of 150 mg daily following a 600 mg loading dose for the first month after PCI procedure reduces the risk of ST and appears to be safe in patients with ACS undergoing DES implantation.     

One Year Follow-up Study on Cognitive Performances in Patients with Ischemic Vascular Events

Objective To assess the cognitive state in patients after first ever stroke/transient ischemic attack. Methods We studied 82 patients who were hospitalized in The Clinic of Neurology from Craiova between 2007 February-2008 February, for first ever ischemic stroke or transient ischemic attack. We have also studied a control group composed of 96 control subjects without signs of cerebrovascular disease but with vascular risk factors present. To assess the cognitive state we tested the patients using Mini Mental State Examination and Addenbrooke＇s Cognitive Examination revised version at baseline, after 6 months respectively one year. We performed in both of groups brain computed tomography for a correct diagnosis. Results At baseline the patient group showed a mean Mini Mental State Score 27.9 and a mean Addenbrooke＇s Cognitive score 89.7. The control subjects showed a mean Mini Mental State score 28.7 and a mean Addenbrooke＇s Cognitive score 90.3. One year later the patient group showed a mean Mini Mental State score 25.1 and mean Addenbrooke＇s Cognitive score 84.2 points. In the control group we obtained a mean Mini Mental State score 27.7 and Addenbrooke＇s Cognitive score 88.1. Multiple risk factors were present in 59 （71.95%） patients. Conclusions The patients with cerebrovascular disease showed a greater cognitive impairment than control group. We observed in patients with ischemic stroke a greater cognitive impairment than in the patients with transient ischemic attack. In subjects with cerebrovascular risk factors there were signs of cognitive impairment even before the cerebrovascular disease became clinically evident. Addenbrooke＇s Cognitive Examination proved to be an appropriate scale for cognitive assessment of patients with vascular cognitive impairment.     

Effect and Safety of Tongyan Spray (通咽喷雾剂) on Hyoid Motion in Patients with Dysphagia after Ischemic Stroke

Objective: To observe the effects and safety of Tongyan Spray (通咽喷雾剂) on the range and time of hyoid motion in patients with ischemic post-stroke dysphagia. Methods: Seventy-two patients with ischemic post-stroke dysphagia were selected and randomly assigned to a treatment group (36 cases) and a control group (36 cases) by a random number table from January 2013 to October 2014. All patients swallowed 4 kinds of barium meals with different traits respectively, and each patient underwent video fluoroscopy (VF) examination twice. In the treatment group, Tongyan Spray was sprayed to the pharynx on both sides and the middle part once respectively. The spray was applied 30 min before the second examination. Purified water at room temperature was used as placebo in the control group. The changes in the range and time of hyoid motion in both groups were observed before and after treatment. Results: Six patients dropped out in each group, and 60 patients completed the study and were included in the final analysis. Significant improvement was observed in the range of superior hyoid excursion distance and the time of hyoid motion in the treatment group compared with the control group (P<0.05). There were no obvious adverse reactions observed in oral mucosa in both groups during the whole study. Conclusion: Tongyan Spray was an effective and safe medicine for improving swallowing function in patients with ischemic post-stroke dysphagia.     

The role of high-sensitivity C-reactive Protein,interleukin-6 and cystatin C in ischemic stroke complicating atrial fibrillation

This study examined the role of high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6) and cystatin C in ischemic stroke complicating atrial fibrillation (AF) and the relationship of systemic inflammation with this disease in order to identify AF patients who are at high risk of stroke and need optimal anticoagulant therapy.A total of 103 AF patients, simple (n=75) or complicated by ischemic stroke (n=28), and 112 control subjects were recruited.IL-6 level was detected by using enzyme linked immunosorbent assay.Cystatin C and hsCRP levels were measured by means of a particle-enhanced immunonephelometric assay.The results showed that the AF patients had higher levels of hsCRP (P=0.004), IL-6 (P=0.000), and cystatin C (P=0.000) than control subjects.Plasma hsCRP level was increased in the AF patients with ischemic stroke as compared to the patients with simple AF (P=0.036).The AF patients who had the level of hsCRP exceeding 3.83 mg/L were at a higher risk than those with hsCRP level lower than 3.83 mg/L (P=0.030).After adjusting for other factors, cystatin C remained positively associated with IL-6 (r=0.613) and hsCRP (r=0.488).It was concluded that hsCRP is positively correlated with ischemic stroke complicating AF and may be a risk factor independent of other risk factors for AF.Elevated cystatin C level is also indicative of the increased risk of AF.     

Embolic events in 93 elderly Chinese patients with atrial fibrillation

Objectives To evaluate the prevalence of embolic events and relevant factors in elderly Chinese patients with atrial fibrillation(AF), and to provide evidence on ways to prevent embolic events.Methods Autopsy data from ninety-three continous elderly Chinese patients with AF were analysed. The incidence of embolic events and its relationship to underlying disease, pathologic changes in the heart, and other clinical characteristics were examined.Results Embolism were observed in 27 of 93 cases, with an incidence of 29.03%. The incidence of embolic events was higher in elderly patients with rheumatic heart disease than those with coronary artery disease, hypertensive myocardiopathy and heart diseases. Patients with chronic AF,with a course of AF≥3 years, and those with heart failure or diabetes had a higher incidence of embolic events than those without these complications. There was significant difference in incidence between paroxysmal and chronic AF. Patients with left atrial or ventricular enlargement, mural thrombosis in cardiac chambers, valvular calcification and valvular vegetation also had a higher incidence of embolic events. Oral dipyridamole (75-150 mg/d) or aspirin (50-150 mg/d) showed no definite effects in preventing embolism in some patients.Conclusions There was a high incidence of embolic events in elderly Chinese patients with AF. Anticoagulation therapy should be provided to the elderly patients with AF, especially to the patients with risk factors for embolism.     

Effects of Combined Therapy of Xuezhikang Capsule(血脂康胶囊)and Valsartan on Hypertensive Left Ventricular Hypertrophy and Heart Rate Turbulence

<正>Objective:To observe the effect of combined therapy with Xuezhikang Capsule(血脂康胶囊,XZK) and Valsartan on left ventricular hypertrophy(LVH) and heart rate turbulence(HRT) in hypertensive patients. Methods:Ninety primary hypertensive patients with LVH were randomly assigned to three groups.Basic treatment,including aspirin,β-blockers,calcium antagonists,etc.were administered to all patients.Additionally, Valsartan(VS,80 mg once a day) was given to the 30 patients in the VS group.Valsartan(in the same dosage) and XZK(600 mg,twice a day) were given to the 32 patients in the Chinese medicine(CM) group,while none was given to the 28 patients in the control group.The therapeutic course lasted for 24 months.Changes in left ventricular mass index(LVMI) measured by cardiac ultrasonic indices,HRT parameters,including the original heart rate(TO) and slope coefficient(TS),systolic and diastolic blood pressures(SBP and DBP),as well as blood cholesterol level(TC) were measured before and after treatment.Results:After treatment,TO and LVMI were lowered,while TS increased in both the VS group and the CM group(P0.01),but changed insignificantly in the control group.Significant differences between the CM group and the control group were shown in terms of TO,LVMI,SBP,DBP and TS(P0.01);and between the CM group and the VS group in terms of TO,LVMI and TS(P0.01).Moreover,HRT parameters showed an evident correlation with LVMI(r=0.519-0.635,P0.01). Conclusion:Combined therapy with XZK and Valsartan can improve hypertensive LVH and HRT parameters, and lessen the damage on the autonomous nervous system.