替米沙坦、贝那普利及非洛地平对冠心病合并轻度高血压患者血管内皮功能及炎症因子的影响

目的比较冠心病合并轻度高血压患者在他汀和阿司匹林等治疗降脂达标的基础上分别加用替米沙坦、贝那普利或非洛地平能否进一步获益。方法将伴有1级高血压的冠心病患者162例,随机分为3组:非洛地平组(n=51),非洛地平缓释片5mg每日1次;贝那普利组(n=51),贝那普利10mg每日1次;替米沙坦组(n=51),替米沙坦80mg每日1次。连续治疗6个月后,检测降压治疗前及治疗6个月后血浆内皮素1(ET-1)、一氧化氮(NO)、高敏C反应蛋白(hsCRP)、白细胞介素6(IL-6)及基质金属蛋白酶9(MMP-9)水平,观察治疗期间心血管事件的发生率。结果治疗前,3组ET-1、NO、hsCRP、IL-6及MMP-9水平比较差异均无统计学意义(P0.05);非洛地平组治疗后与治疗前比较ET-1下降(P0.05),NO上升(P0.05),hsCRP、IL-6及MMP-9差异无统计学意义(P0.05);贝那普利组、替米沙坦组治疗后与治疗前比较ET-1下降及NO上升更为显著(P0.01),且优于非洛地平组(P0.05)。hsCRP、IL-6和MMP-9均显著下降(P0.05或0.01),替米沙坦组各项炎症指标的下降优于贝那普利组(P0.05)。结论冠心病伴轻度高血压患者在降脂达标的基础上,加用贝那普利或替米沙坦改善血管内皮功能的作用优于非洛地平,替米沙坦抑制炎症反应的作用优于贝那普利,可进一步抑制炎症反应,稳定粥样斑块。

Effects of teimisartan,benazepril and felodipine on vascular endothelial function and inflammatory factors in patients with coronary heart disease and mild hypertension

Objective To determine if further benefits can be achieved by adding telmisartan,benazepril or felodipine respectively on patients with coronary heart diseases（CHD）and mild hypertension who reached lipid target after treatment with statins and aspirin.Methods One hundred and sixty-two patients with CHD and mild hypertension were randomly assigned to group felodipine （felodipine：5 mg qd,n=51）,group benazepril （benazepril：10 mg qd,n=57）or group telmisartan （telmisartan：80 mg qd,n=54）.Plasma endothelin-1（ET-1）,nitric oxide （NO）,high-sensitivity C reactive protein （hsCRP）,interleukin-6 （IL-6 ）and matrix metalloprotease-9 （MMP-9 ）were measured before and after 6 months＇treatment.Cardiovascular events were analyzed during treatment.Results ET-1 , NO,hsCRP,IL-6 and MMP-9 levels in three groups showed no significant difference before treatment（P〉0.05）;In Group Felodipine,the levels of plasma ET-1 decreased and NO increased after treatment （P〈0.05）.but the levels of plasma hsCRP,IL-6 and MMP-9 did not change significantly（P〉0.05）.In Group Benazepril and Group Telmisartan, decrease of ET-1 and increase of NO were even significant after treatment（P 〈0.01）,which were more significant than those in Group Benazepril （P 〈 0.05 ）.The levels of inflammatory indices hsCRP,IL-6 and MMP-9 all significantly decreased after benazepril or telmisartan treatment（P〈0.05 or 〈0.01）.The decreases of inflammatory indices in Group Telmisartan were more significant than in Group Benazepril（P〈0.05）.Conclusion On the basis of reaching lipid target,the effects of benazepril or telmisartan on improvement of endothelial function were superior to felodipine in patients with CHD and mild hypertension.The effect of telmisartan on prevention of inflammatory reaction was superior to benazepril,which could further prevent inflammatory reaction and stabilize atherosclerotic plaque.