高血压联合降压治疗与动脉弹性的关系

目的了解以钙通道阻滞剂（CCB）为基础的不同降压药物联合治疗方案在降压达标后对中老年高血压患者动脉弹性的影响,评估其防治心脑血管危险的效果。方法 156例中老年高血压患者被随机分为两组,经5～7d药物洗脱期后分别接受CCB＋血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）以及CCB＋利尿剂（D）联合治疗,4周常规剂量治疗后血压未达标者加用小剂量β受体阻滞剂（β-B）至血压达标。治疗前和治疗后1年分别检测治疗组患者血压、心率、大动脉弹性指数（C1）和小动脉弹性指数（C2）,比较各治疗组间血压、心率、C1和C2的变化。以36例中老年健康者1年前后的C1和C2为对照,排除因增龄所致的动脉弹性改变。结果①各治疗组治疗后收缩压、舒张压、脉压均明显降低,差异有统计学意义（P均〈0.01）。②治疗后CCB＋ACEI/ARB＋β-B（C＋A＋B）组和CCB＋D＋β-B（C＋D＋B）组心率明显减慢,差异有统计学意义（P均〈0.01）;CCB＋ACEI/ARB（C＋A）组心率减慢,差异有统计学意义（P〈0.05）。③治疗后C＋A组C1减小,差异有统计学意义（P〈0.05）;治疗后C＋A＋B组和C＋D＋B组C2均增大,P〈0.05,差异有统计学意义。④健康对照组1年前后各项指标血压、心率、C1和C2均无变化（P〉0.05）。结论在降压达标情况下,C＋A和C＋D联合治疗对中老年高血压患者的动脉弹性无明确改善,C＋A＋B和C＋D＋B联合治疗可改善中老年高血压患者的小动脉弹性,小剂量β受体阻滞剂与其它常用降压药物联用对中老年高血压患者动脉弹性改善有益。

Relationship between integrative antihypertension treatment and arterial elasticity in middle-aged and old patients with essential hypertension

Objective To understand the influence of integrative therapeutic plan on arterial elasticity,which combined different antihypertension medicinal taken calcium channel blockers （CCB） as the base,after controlling blood pressure （BP） to target in middle-aged and old patients with essential hypertension.Methods The patients （n=156） were randomly divided into two groups,and then accepted integrative treatment of CCB＋converting enzyme inhibitor （ACEI） or angiotensin receptor blocker （ARB）,and CCB＋diuretic （D） after medicinal elution for 5 to 7 days.After 4 weeks of routine-dose treatment,if blood pressure was not reduced to target low-dose beta-blocker （β-B） was given to the patients until their blood pressure reached target.The BP,heart rate （HR）,large arterial capacitive index （C1） and small arterial oscillatory index （C2） in the patients were detected before and one year after treatment.The changes of BP,HR,C1 and C2 were compared between two groups.The changes of arterial elasticity induced by external factors and aging were excluded taken C1 and C2 changes as control in 36 middle-aged and old health cases around one year.Results ①In all treatment groups systolic blood pressure （SBP）,diastolic pressure （DBP） and pulse pressure （PP） decreased significantly and the difference was statistically significant （all P0.01）.②In CCB＋ACEI/ARB＋β-B group （C＋A＋B group） and CCB＋D＋β-B group （C＋D＋B group）,HR decreased significantly with statistical difference （all P0.01）,and in CCB＋ACEI/ARB group （C＋A group） HR decreased with statistical difference （P0.05）.③C1 was reduced with statistical difference （P0.05） in C＋A group,and C2 increased with statistical difference （P0.05） in C＋A＋B group and C＋D＋B group.④All indexes including BP,HR,C1 and C2 had no changes （P0.05） in health control group around one year.Conclusion With similar reduction effect on BP,the small arterial elasticity was not improved after C＋A and C＋D combination therapy,but could be improved after C＋A＋B and C＋D＋B combination therapy.It is benefit that β-B in low dose combined with other common antihypertension medicinal was used for improving arterial elasticity in middle-aged and old hypertension patients.