| Objective:By use of placebo ACE inhibitor-Perindopril and angiotension II receptor angtagonist-Valsartan respectively or in combination, adopting ambulatory blood presure monitoring (ABPM) and HRV analysis, to study the effect on blood presure and function of autonomic nervous system(ANS) after inhibiting renin- angiotensin system(RAS) at different point in patients with essential hypertension.Methods(1) Study medthods: The ABPM and HRV of patients with hypertension were measured and analysed by ABPM recorder -, ambulatory electrocardiographic recording concomitantly and HRV analyzing system before and after treatment. To choose the there time segments in which blood presure (BP) circadian changes were influenced obviously and analyse it, 2 peaks: 9:00 and 16:00, one trough: 1:00, time domin and frequency domin were analysed .(2) Groups: All 80 patients with hypertension ranged from 1 to 2 grade were divided randomly into 4 groups: Placebo Perindopril Valsartan and Combination group.(3) Management: A random single-blind study was performed before and after different treatment: Placebo; <2> Perindopril 4mg; <3>Valsartan 80mg; <4>Valsartan 80mg combined with perindopril 4mg qd, all of the drugs was given at 8 +1 am and therapy time for 4 weeks.Results:(1) Many of the Hypertensive subjects ( 1 to 2 grade ) had circadian curve of BP. Hypertension can be divided into dipper and non-dipper by circadian curve of BP. Night BP and BP load were much higher in non -dipper group than in dipper group, also was ratio of LF/HF, p<0.001. Ratio of LF/HF and HFP were significantly different between C-time and A B-time in dipper group.(2) Hypertensive subjects had different changes of HRV during different time, sympathetic indicators: SDANN VLFP LFP were lowest at C-time, parasympathetic indicators-rMSSD PNN50 HFP were highest at C-time than A-and B-time, p<0.05 or 0.01; ratioes of LF/HF were much lower at C-time than A- or B-time p<0.05 or 0.01; no indicators of HRV was signifcantly different between A-and B-time, p>0.05.(3) Correlation and regression analysis indicated positive correlation existed between SBP DBP MAP and ratio of LF/HF, and correlation coefficients were 0.28 0.23 0.25, in hypertensive subjects respectively (p<0.05).(4) After treating 6 weeks by Valsartan, Perindopril, Valsartan combined with perindopril, and placebo respectively , BP and BP load deceased more (p<0.001) except for placebo (p>0.05).Reduction of BP in combined group was much bigger than adminisration respectively (p<0.001). Their effects on HRV were different. After short term of treatment, ratios of LF/HF were improved in Valsartan group and combined group, and SDANlSk VLF^ VLFP dereased obviously as well as rMSSDx PNN50 HFP increased significantly, except for perindopril and placebo groups. T/P ratio: Valsartan: SBP-68.5%, DBP-73.1% Perindopril: SBP-67.7% , DBP-70.2% , Valsartan combined with Perindopril: SBP-59.8%, DBP- 62.4%. Hypertensive patients were treated by Valsartan as safely as by placebo and had excellent tolerability.Conclusion:(1) Many of hypertensive patients ( ranged from 1 to 2 grade) had circadian curve of BP with two peaks and one trough: "dipper", while "non-dipper" without it. Compared with dipper group, BP load in non-dipper group increased significantly and HRV decresed apparently. ANS functim in dipper group had corresponding circadian changes with BP: sympathetic activity higher at day and lower at night, parasympathetic activity lower at day and higher at night.(2) Hypertensive patients had ANS disfunction: sympathetic activity increased and parsympathetic activity decreased, and the former was primary. ANS disfunction displayed decrease of HRV degree.(3) Significant correlation existed between circadian change of BP and the state of ANS disfunction in hypertensive subjects.(4) Similar efficacy of BP reduction has been shown between Va...
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