阿托伐他汀联合厄贝沙坦对应激状态下血压升高患者血管内皮功能的影响

目的探讨阿托伐他汀联合厄贝沙坦对应激状态下血压升高的非高血压患者血管内皮功能的影响。方法选择634例行冠脉造影的非高血压患者,但术中监测血压均≥140/90 mmHg。根据冠脉造影结果,将冠脉无狭窄者分为正常组,将冠脉存在狭窄者随机分为对照组和治疗组,正常组术后不予任何治疗,对照组常规给予阿司匹林肠溶片及阿托伐他汀钙片,治疗组在治疗基础上加用厄贝沙坦连续治疗6个月。所有患者均于冠脉造影前及药物治疗后6个月行超声检测肱动脉介导的血管舒张功能。结果三组患者术前、术中、术后及服药治疗6个月时,血压比较差异无统计学意义,但术中血压均≥140/90 mmHg,显著高于本组其他时刻血压;对照组与治疗组狭窄<50%和狭窄>50%例数比较差异无统计学意义;药物治疗前对照组与治疗组血管内皮舒张功能显著低于正常组,且对照组与治疗组比较差异无统计学意义,但药物治疗后对照组与治疗组内皮舒张功能较治疗前均明显改善,且治疗组内皮舒张功能明显高于对照组。结论在应激状态下血压升高的非高血压患者,其冠状动脉狭窄与内皮功能障碍有关,阿托伐他汀联合厄贝沙坦可显著改善其内皮功能。

Effect of atorvastatin combined with irbesartan on the vascular endothelial function about non hypertensive patients with elevated blood pressure under stress state

Objective To investigate the impact of atorvastatin combined with irbesartan on the vascular endo- thelial function about non hypertensive patients with elevated blood pressure under stress state. Methods 634 non hy- pertensive patients whose blood pressure ≥ 140/90 mmHg during the coronary angiography were selected, the patients without coronary artery stenosis were as normal group, while the patients with coronary artery stenosis were randomly divided into control group and treatment group. Normal group was not given any treatment. Control group was given as- pirin enteric-coated tablets and atorvastatin. Treatment group was given irbesartan on the base of control group. The flow mediated dilatation （FMD） was investigated before coronary angiography and after being given the above treat- ment for 6 months. Results There was no significant difference about blood pressure of three groups patient in preop- erative,intraoperative, and postoperative after 6 months treatment, but all the patient＇s blood pressures were ≥ 140/90 mmHg during the coronary angiography. Those were significantly higher than other time in the same group. The num- bers of the coronary artery stenosis 〈 50% and 〉 50% of control group and treatment group had no significant differ- ence. The vascular endothelial function of control group and treatment group were significantly lower than those of nor- real group before treatment. There was no significant difference about vascular endothelial function between control group and treatment group before treatment. The endothelial function of control group and treatment group were signifi- cantly improved compared with those before treatment, and the endothelial function of treatment group was significantly higher than that of control group. Conclusion The coronary artery stenosis is associated with endothelial dysfunction in non-hypertensive patients with elevated blood pressure under stress, the atorvastatin combined with irbesartan can sig- nificantly improve their endothelial function.