Clinical Study About Effect Of Amlodipine With Compound Amiloride Or Telmisartan On Non-invasive Central Aortic Blood Pressure And Vascular Function

Objective:To observe the effect of amlodipine with compound amiloride or telmisartan on non-invasive central aortic blood pressure(CABP) and vascular function, and try to elucidate its internal relations and the possible mechanisms, which might guide the clinical manegment.Methods:76 patients with hypertension were enrolled in this prospective randomized controlled clinical research, then divided into two groups randomly:group of amlodipine with compound amiloride (group A) or group of telmisartan (group B). Following parameters were examinated at admission and after one year:blood pressure, central aortic blood pressure, augmentation index, pulse wave conduction velocity, ankle-brachial index, carotid artery intima-media thickness.These patients were followed-up and collected clinical events regularly. Control goals of blood pressure are as following:the blood pressure goal of common hypertension should be lower than 140/90mmHg, if the hypertension patients with diabetes or kidney disease, the blood pressure should be lower than 130/80mmHg; The SBP goal of elderly hypertension patients should be lower than 150mmHg. Drugs used in this research are as follows:amlodipine (2.5mg/tablet), compound amiloride (1 tablet:Ami 2.5mg/ Hydrochlorothiazide 25mg), telmisartan (40mg/tablet).All of them were provided by Dawnrays Pharmaceutical Co., Ltd..Results:18 male cases and 43 female cases have completed the one year follow-up and no serious clinical events were collected.1. As compared with admission, the blood pressure (BP) of two groups and the pulse pressure (PP) of group A decreased significantly (P≤0.010), but the pulse pressure (PP) of group B had no difference (P=0.077); No significant differences were showed in two groups about BP and PP (P<0.05).2. The central aortic blood pressure of group A and B after treatment (137.82±8.71; 135.56±10.10) compare with admission (140.53±8.18; 142.26±11.92) decreased significantly (P<0.05) and between two groups there are significant differences (P= 0.032).3. The SBP2 of group A and B After treatment (124.35±10.37,121.22±11.57) compare with admission (129.37±15.44,121.22±11.57) were lower (P<0.05) and between two groups there are no significant differences (P = 0.183).4. The augmentation index of group A and group B compared with admission (AI) had no significant difference and no difference between the two groups (P= 0.408). 5. The corrected augmentation index (AIP75) after treatment (88.26±9.72, 86.07±9.05) compared with before (89.38±11.97,92.74±11.55) were lower. However, the group A had no significant difference (P=0.474) and group B had significant difference (P=0.001).between two groups there was significant difference (P=0.001).6. The pulse wave velocity of group A and group B on the right and left side after treatment (1603.88±244.38,1634.47±274.61; 1538.22±206.48,1556.22±207.32) compared with before (1611.32±272.85,1642.41±288.11; 1619.74±254.13,1654.74±282.76) were lower, but the group A had no significant difference (P> 0.05) and group B had significant difference (P<0.01). between two groups there was no significant difference(P>0.05).7.The ankle-brachial index (ABI) of group A and group B on the right and left side after treatment (1.12±0.08,1.12±0.08; 1.11±0.07,1.12±0.07) compared with before (1.13±0.08,1.13±0.06; 1.15±0.07,1.15±0.07) were improved, but the group A had no significant difference (P> 0.05), group B has significant difference (P<0.01).between two groups there are significant differences (P<0.01).8. As compared with admission, the carotid intima-media thickness (IMT) of two groups had increased, but no significant difference (P> 0.05).between the two groups there was no significant difference (P> 0.05).9. Before treatment, the centre arterial blood pressure (CABP) and the pulse wave spread velocity (PWV) of the right or left side in group A or B were positively correlated (r= 0.45, P=0.008, r=0.374, P=0.03; r=0.569, P=0.002, r=0.522, P=0.005).after treatment,r=0.226, P=0.198, r=0.157, P=0.375; r=0.613, P=0.001, r=0.560, P=0.002),there was no positive correlation in group A(P> 0.05), but in the group B there was a positive correlation (P<0.01). Conclusion:1. Amlodipine with compound amiloride or telmisartan reduces blood pressure increasing similarly, but on the central arterial pressure and vascular function are different. 2. Amlodipine with compound amiloride or telmisartan can improve arterial compliance and delay the advancing of arteriosclerosis by blood pressure.3. The group of telmisartan can reduce central aortic blood pressure lower and delay advancing of atherosclerosis more as compared with the group of compound amiloride.4. With the improvement of PWV, CABP can be decreased. PWV with CABP might be used to estimate the effect of antihypertension.