Effects Of Diltiazem And Statins On Endothelium Dependent Vasodilatation In Primary Hypertensives

Objective: To investigate the effects of diltiazem and statins on the endothelium-dependent vasodilatation in essential hypertensives.Methods: Seventy-eight patients with glade I-Ⅱessential hypertension were divided into two groups. Forty-four hypertensives received atrovastin 10mg or fluvastatin 20~40 mg each day (control group); thirty-four hypertensives received diltiazem hydrochloride sustained-release tablets 90mg and atrovastin 10mg or fluvastatin 20~40mg each day (combined therapy group). The inner diameter of brachial artery and anterior tibial artery were assessed by a high-resolution ultrasound system before and after reactive hyperemia. Endothelium-dependent flow-mediated dilation (EDF) was calculated as the percent change in brachial artery and anterior tibial artery diameter 1 min after reactive hyperemia compared with baseline, patients were followed for an average of 7.49±3.80 months and all parameters were determined at baseline. Pairs T-test was used in comparison of pre-treatment and post-treatment. Variance analysis was used to determine the difference between groups.Results: 1,Blood pressure decreased significantly in combined therapy group after treatment (P<0.05, P<0.05).2.Plasma lipid decreased significantly in both groups after treatment (P<0.05), but the reduction of low density lipoprotein in combination group was greater than control group (P<0.05).3.The△Dia-P (endothelium- dependent vasodilatation function) of brachial artery before treatment were (7.64±4.11)% and(8.02±3.38)% in control and combined therapy group respectively, and turned out to be (8.97±3.64)% and(11.04±3.88)% respectively, after treatment.The△Dia-P of post-treatment improved significantly in both groups when compared with that of pre-treatment (P<0.05), but there is a significant difference between combined therapy group and control group (P<0.05). The△Dia-P of anterior tibial artery before treatment were(8.02±4.78)% and(8.30±3.82)% respectively in control group and combined therapy group, which came to be (9.86±4.48)%,(11.22±4.42)% respectively, after treatment.The△Dia-P were all significantly improved in both groups when compared with that of pretreatment (P<0.05). Greater improvement was seen in combined therapy group (P<0.05). There was no difference of Nitroglycerine-mediated endothelium-independent dilatation among the two groups (P>0.05).4. The△Dia-P and non-endothelium dependent diastole function of brachial artery and anterior tibial artery after the beta receptor blocker treatment did not change remarkably, when compared with that of pre-treatment (n=16, P>0.05).5. The△Dia-P of brachial artery was negatively correlated with Age (r=0.123), Course of Disease (r=0.146), BUN (r=0.108) and LVMI (r=0.121) (n=379, P<0.05). And the best correlation lay between the△Dia-P of brachial artery and Course of Disease:△Dia-P=9.732-0.007*Course of Disease (r =0.146,F=8.042,P<0.01). The△Dia-P of anterior tibial artery was positively correlated with GPT (r=0.130), and negatively correlated with Age (r=0.206), Cr (r=0.103) and LVMI (r=0.121) (n=379, P<0.05). And the most correlated with the△Dia-P of anterior tibial artery was Age:△Dia-P =16.923-0.042*Age (r=0.206,F=16.728,P<0.01). Stepwise multiple regression analysis showed that the△Dia-P of brachial artery was affected by TG, Age, Fg Gender and BUN(r2=0.122,F=6.352,P<0.01), and the△Dia-P of anterior tibial artery was influenced by Age and Hb (r2=0.084,F=10.581,P<0.01).Conclusion: 1.The combined therapy of diltiazem and statins has marked effect in reducing blood lipid.2. The combined therapy of diltiazem and statins not only attribute to stable blood pressure reduction, but also protect vascular endothelial function and improve the endothelium-dependent vasodilatation function.3. Beta receptor blocker not only can not improve the△Dia-P, but also has the possibility to resist the improvement of the other medicines on the△Dia-P.4. The△Dia-P of brachial artery was negatively correlated with Age, Course of Disease, BUN and LVMI. The△Dia-P of anterior tibial artery was negatively correlated with Age, Cr and LVMI and positively correlated with GPT.5. The△Dia-P of brachial artery in primary hypertensives is affected by TG, Age, Fg, Gender and BUN, especially TG. The△Dia-P of anterior tibial artery was affected by Age and Hb, especially Age.