氨氯地平加替米沙坦对轻、中度高血压的疗效及与AVP和NO的关系

目的 观察氨氯地平加替米沙坦对轻、中度高血压的疗效,探讨高血压患者血管加压素(AVP)和一氧化氮（NO）的变化与疗效的关系。方法 将60例轻、中度高血压病患者（包括:正在服用降压药的高血压病患者和新发病例没有服用降压药的患者）随机分为:氨氯地平组,替米沙坦组和氨氯地平＋替米沙坦组（氨+替组）,每组各20例。测定各组治疗前后血压的变化。采用放免法、比色法测定各组患者治疗前后血浆AVP和NO的含量。结果 ①氨氯地平组、替米沙坦组及氨＋替组治疗前收缩压（SBP）分别为:(146.31±3.15)mmHg、(145.92±2.71)mmHg及(146.00±2.42)mmHg;舒张压(DBP)分别为:(93.77±2.39)mmHg、(92.54±2.68)mmHg及(94.93±1.15)mmHg。在治疗6个月后,SBP分别为:(126.69±1.74)mmHg、(126.08±1.52)mmHg及(102.71±2.20)mmHg;DBP分别为:(80.76±1.13)mmHg、(81.00±0.80)mmHg和(76.11±1.36)mmHg,与治疗前比较明显降低（P<0.05）。氨+替组患者的SBP和DBP均明显低于氨氯地平组和替米沙坦组（P<0.05）;氨氯地平组与替米沙坦组比较无显著差异。②治疗1月、2月末,氨+替组患者的血压达标率均明显高于氨氯地平组和替米沙坦组（P<0.05）;氨氯地平组和替米沙坦组比较无显著差异。③氨氯地平组、替米沙坦组及氨＋替组治疗前血浆NO的含量分别为:(12.77±0.23)μmol/L、(11.68±0.35)μmol/L及(10.09±1.04)μmol/L;治疗6个月后其含量分别为:(18.50±2.14)μmol/L、(19.07±1.96)μmol/L及(25.47±1.84)μmol/L,与治疗前比较差异显著（P<0.05）。氨+替组患者NO的含量明显高于氨氯地平组和替米沙坦组（P<0.05）;氨氯地平组和替米沙坦组比较无显著差异。④氨氯地平组、替米沙坦组及氨＋替组患者治疗前血浆AVP的含量分别为:(34.71±4.36)ng/L、(33.07±3.77)ng/L及(35.06±4.12)ng/L;治疗6个月后分别为:(22.35±2.71)ng/L、(24.12±3.11)ng/L及(17.98±1.79)ng/L,与治疗前比较差异显著（P<0.05）。氨+替组血浆AVP的含量低于氨氯地平组和替米沙坦组（P<0.05）,氨氯地平组和替米沙坦组组间比较无显著差异。结论 ①3个组均能有效控制血压,但氨+替组的降压效果更佳。②3个组在显著降低血压的同时,均伴有血浆AVP含量降低和血浆NO含量增高,氨+替组的效果更明显,提示AVP和NO参与了高血压的发生发展,可作为观察高血压疗效的指标。

Effects of amlodipine plus telmisartan on mild to moderate hypertension and their relationship to plasma AVP and NO

AIM To observe the effect of amlodipine plus telmisartan on mild to moderate hypertension and to explore the changes of arginine vasopressin (AVP) and nitric oxide (NO) and their relationship to the therapeutic results in patients with essential hypertension. METHODS Sixty cases of mild to moderate hypertensive patients were randomly divided into: amlodipine group, telmisartan group and amlodipine+telmisartan group (n=20, each). Blood pressure was measured, and plasma AVP and NO were measured by RIA and colorimetric method before and after treatment. RESULTS After six months’ treatment, systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the three groups decreased significantly (P<0.05). SBP and DBP in amlodipine+telmisartan group were lower than those in amlodipine group and telmisartan group (P<0.05), but no significant difference was observed between amlodipine group and telmisartan group. After one and two months’ treatment, the rate of well-controlled blood pressure in amlodipine+telmisartan group was higher than that in amlodipine or telmisartan group (P<0.05), and no significant difference was observed between amlodipine group and telmisartan group. After six months’ treatment, the plasma NO content increased significantly in the three groups (P<0.05). The plasma NO content in amlodipine+telmisartan group was significantly higher than that in amlodipine group or telmisartan group (P<0.05), with no significant difference between the latter two groups. The plasma AVP content decreased significantly in the three groups (P<0.05). The plasma AVP in amlodipine+telmisartan group was significantly lower than that in amlodipine group or telmisartan group (P<0.05), with no significant difference between the latter two groups. CONCLUSION Though single administration of amlodipine or telmisartan well controls blood pressure, amlodipine combined with telmisartan achieves better results. The decrease of plasma AVP content and the increase of NO content during the drug administration suggest that AVP and NO may participate in the occurrence and development of hypertension. Thus both of them can serve as indicators for curative effects.