| Objective: Essential hypertension is a common disease of cardiovascular disease. Hypertension can cause heart, brain, kidney and other target organ damage,which is a serious threat to human health. Currently,we have found in patients with essential hypertension exist endothelial dysfunction, the balance of the vasodilator factors and vasoconstrictor factors are broken, ET-1 increased. It is well known that blood pressure control is effective to reduce cardiovascular events. Clinical doctor should pay attention to endothelial dysfunction on the prognosis of patients with essential hypertension, choose a reasonable treatment programs to effectively reduce blood pressure in the meanwhile should be able to better improve endothelial dysfunction in patients. In this study, we compared effects of different doses of valsartan (80mg and 160mg) as well as combination of valsartan 80mg and amlodipine 5mg on blood pressure and ET-1 in patients with essential hypertension, investigated whether combination therapy is superior to single drug dose increased.Methods: We selected 110 cases with mild-moderate hypertension patients, which in line with the program inclusion criteria and exclusion criteria. Experienced elution period and a two-week single-blind placebo treatment, 75 cases entered the double-blind period. They were randomly divided into three treatment groups, respectively received valsartan 80mg, QD; valsartan 160mg, QD; or valsartan 80mg plus Amlodipine 5mg, QD treatment for 8 weeks. Systolic blood pressure(SBP) and diastolic blood pressure(DBP) were measured, blood lipids such as total cholesterol (TC), high density lipoprotein (HDL), triglycerides (TG), low density lipoprotein (LDL), very low density lipoprotein (VLDL), as well as fasting blood glucose(FBG) were determined before and after double-blind period treatment. Meanwhile age, height, weight, waist circumference(WC), hip circumference(HC) were recorded. Serum levels of ET-1 before and after double-blind treatment was determined by using enzyme-linked immunosorbent assay. Statistical analysis of data was performed using the SPSS13.0 statistical software pack for Windows. Measurement data were expressed as mean±standard deviation(±s). Comparison inside group used paired t-test, comparison among groups used analysis of variance(ANOVA), P<0.05 was considered significance.Results: Clinical characteristics including age, height, body weight, MBI, WC, HC, WHR parameters or laboratory measurements such as TC, HDL, TG, LDL, VLDL and FBG at baseline have no significant differences among the three groups (P>0.05). Blood pressure regardless of SBP and DBP have no significant statistical difference before treatment among groups (P>0.05), which are significantly decreased after double-blind treatment in three groups. Comparison has significant statistical difference within group(P<0.05). SBP before and after treatment in each group are as follows: Valsartan 80mg group 137.44±13.007mmHg vs 128.72±10.937mmHg(P<0.05); valsartan 160mg group 139.84±13.999mmHg vs 130.80±14.295mmHg(P<0.05); Valsartan 80mg plus Amlodipine 5mg group 142.88±10.647mmHg vs 124.32±8.577 mmHg(P<0.05). DBP before and after treatment are as follows: Valsartan 80mg group 96.56±5.903mmHg vs 89.44±7.246mmHg(P<0.05); Valsartan 160mg group 96.56±5.672mmHg vs 89.28±9.361mmHg(P<0.05); Valsartan 160mg plus Amlodipine 5mg group 96.56±5.083mmHg vs 81.84±7.570mmHg(P<0.05). Reductions in SBP and DBP from baseline are statistically significance (P<0.05). Decreased value are as follows: Valsartan 80mg group 8.72±11.149mmHg, valsartan 160mg group 9.04±12.989mmHg, valsartan 80mg plus Amlodipine 5mg group 18.56±12.255mmHg(P<0.05). SBP in Valsartan 80mg plus Amlodipine 5mg group are greater decreased than another two groups between which there is no significant difference (P>0.05). Valsartan 80mg plus Amlodipine 5mg group compared with other two groups have significant statistical differences( P<0.05). DBP decreased value were as follows: Valsartan 80mg group 7.12±5.294mmHg; Valsartan 160mg 7.28±8.677mmHg; Valsartan 80mg + Amlodipine 5mg group 14.72±6.755mmHg(P<0.05). DBP in Valsartan 80mg plus Amlodipine 5mg group are greater decreased than another two groups between which there is no significant difference (P>0.05). Valsartan 80mg plus Amlodipine 5mg group compared with other two groups have significant statistical differences( P<0.05). ET-1 has no significant statistical difference before treatment among groups (P>0.05). ET-1 is significantly decreased after double-blind treatment in three groups. Comparison has significant statistical difference within group(P<0.05). ET-1 before and after treatment in each group are as follows: Valsartan 80mg group 6.675±2.231pg/ml vs 3.944±2.685pg/ml(P<0.05); Valsartan 160mg group 7.631±4.368pg/ml vs 4.029±2.224pg/ml(P<0.05); Valsartan 80mg plus Amlodipine 5mg group 8.809±3.489pg/ml VS 3.657±2.051pg/ml(P<0.05). The reductions of ET-1 before and after treatment are as follows: Valsartan 80mg group 2.731±1.894pg/ml, Valsartan 160mg group 3.603±3.042pg/ml, Valsartan 80mg plus Amlodipine 5mg group 5.152±2.615pg/ml(P<0.05). The reduction of Valsartan 80mg plus Amlodipine 5mg group is bigger than another two groups which there is no significant difference(P>0.05). Valsartan 80mg plus Amlodipine 5mg group compares with other two groups have significant statistical differences (P<0.05).Conclusion: Valsartan and Amlodipine in combination can decrease SBP, DBP and ET-1 significantly in mild-moderate hypertension patients. The effects of combination of Valsartan and amlodipine on blood pressure control and improving endothelial dysfunction are better than that of double-dose Valsartan alone.
|
PDF Full Text Request