| Objectives:1.To observe the clinical,antihypertensive and Hcy lowering effects in patients with primary hypertension of Yinxu-Yangkang type treated by fixed changing TCM of Tianma-Gouteng Decoction;2.To observe the antihypertensive and Hcy effects in patients with primary hypertension of Yinxu-Yangkang type treated by Levamlodipine besylate tablets plus Folic acid tablet.3.To compare the difference on clinical effect,clinic blood pressure(CBP),dynamic blood pressure(ABP)and Hcy between the two groups after treatment and to discuss the similarities or differences of Chinese between western medicine and their joint point.Methods:A total of 126 patients with H-type primary hypertension of Yinxu-Yangkang type who met the inclusion criteria were randomly divided into group of fixed changing TCM of Tianma-Gouteng Decoction(group of TCM)and group of Levamlodipine besylate tablets plus Folic acid tablet(group of L plus F).In the group of L plus F,2.5 mg of levamlodipine besylate tablets and 0.8 mg of folic acid tablets were taken once a day.The group of TCM was given a fixed dose of Tianma Gouteng Decoction four times a day,and was treated continuously for 4weeks in two groups.The clinical symptoms,occasional blood pressure and ambulatory blood pressure of whole-day mean blood pressure,mean daytime blood pressure,mean nighttime blood pressure,blood pressure load,blood pressure variability,nocturnal blood pressure drop rate,heart rate[ and],adverse reactions[,]and changes in serum Hcy of two groups before and after treatment were observed,and the difference between 2 groups was compared.Results:(1)Efficacy of TCM symptom: The symptoms of TCM were improved before and after treatment in both groups,but the improvement degree of the group of TCM was significantly better than that of the group of L plus F(P<0.01).(2)Efficacy of CBP: The CBP of the group of L plus F was significantly decreased after treatment(P<0.01),and the CBP of the group of TCM did not decrease significantly after treatment(P>0.05).(3)mean change of dynamic blood pressure: whole-day mean blood pressure(149±10.70/94±9.74 vs132±12.32/84±8.90),meandaytime blood pressure(152±10.91/96±10.13 vs 134±12.65/86±9.39),The mean nighttime blood pressure(142±14.24/87±10.11vs125±13.84/78±9.37)in group of L plus F after treatment were significantly lower than that before treatment(p<0.01);whole-day mean blood pressure after treatment(149±11.83/91±11.32 vs 144±12.27/ 88±10.13),mean daytime systolic blood pressure(156±11.44vs151±11.43)and nighttime average diastolic blood pressure(87±11.90vs84±11.02)in group of TCM after treatment were significantly lower than before treatment(p<0.01),and mean diastolic blood pressure during the day(95±11.55vs92±10.85)The mean nighttime systolic blood pressure(146±15.91vs142±15.34)were lower than that before treatment(p<0.05).There were no significant difference between the two groups before treatmentfor mean blood pressure of all day,daytime,and nighttime.(p>0.05),the whole-day mean blood pressure and nocturnal mean blood pressure between the two groups after treatment were statistically significant(p<0.05).There were a statistically significant difference of mean daytime blood pressure between the two groups after treatment(p< 0.01).(4)Comparison of blood pressure load values:daytime systolic pressure load(76±19.13 vs34±27.59),daytime diastolic pressure load(69±29.10 vs39±30.34),nighttime systolic pressure load(80±22.33 vs43±31.33)The nighttime diastolic pressure load(70±26.91vs45±29.73)in group of L plus F after treatment was significantly lower than that before treatment(p<0.01);the daytime systolic pressure load(80±17.42vs67±29.62)in the group of TCM was significantly lower than that before treatment(p< 0.01),daytime diastolic pressure load(65±29.88vs59±29.85),nocturnal systolic pressure load(84±21.61vs78±22.01),nighttime diastolic pressure load(67±30.14vs62±32.14)in group of TCM were no significant decrease after treatment than before treatment(p average >0.05);There was a statistically significant difference between the two groups after treatment of daytime systolic blood pressure load(p<0.05).There were significant statistical difference after treatment for comparison between two groups of daytime diastolic blood pressure load,nighttime systolic blood pressure load and nighttime diastolic blood pressure load(p<0.01).(5)Comparison of standard deviation of bloodpressure(BPSD): BPSD of daytime after treatment(13.64±3.817/9.8±2.534vs7.76±7.273/5.17±4.889),standard deviation of nocturnal blood pressure(12.48±4.465/9.89±3.134vs7.53±7.044 /5.68±5.151)in group of L plus F was significantly less than before treatment(p<0.01);BPSD of daytime after treatment(9.58±6.948/7.97±5.016vs14.61±6.847/9.85±5.164),nocturnal blood pressure standard deviation(8.58±6.849)/6.76±5.174vs12.61±6.375/8.85±5.266)in group of TCM was greater than before treatment(p<0.05);the difference between the two groups before treatment was statistically significant(p<0.05),and the two groups were incomparable.(6)Comparison of blood pressure drop rate at night: The blood pressure drop rate at night after treatment was not significantly lower than that before treatment(p>0.05)in each group;there were no difference between the two groups before and after treatment(p>0.05).(7)Comparison of pulse pressure difference: The difference of pulse pressure in all day,daytime and nighttime after treatment was significantly lower than that before treatment(p<0.01)in each group;comparison between two groups,whole-day,daytime,nighttime pulse pressure difference before treatment were no comparable(p < 0.05).(8)Comparison of mean arterial pressure:The mean arterial pressure of all day,daytime and nighttime after treatment was significantly lower than that before treatment(p<0.01)in each group.The difference between the two groups after treatment for whole-day,daytime and nighttime MAP was statistically significant(p<0.05).(9)Comparison of Heart rate : Heart rate of all day(71.±8.79vs75±8.67),daytime(74±9.48vs78±9.27),and nighttime(63±7.28vs66±8.32)were increased after treatment compared with before treatment.(p<0.01);in the group of TCM,Heart rate of the whole day(72±9.55 vs 73±9.44),the average heart rate of daytime(75±10.27 vs 77±15.72),and the average nighttime heart rate(64±7.75 vs 65±12.34)were significantly increased after treatment compared with before treatment.(p<0.01);there was no difference between the two groups before and after treatment(p>0.05).(10)Comparison of serum Hcy:Hcy of group of L plus F(18.26±6.437vs12.76±5.070)after treatment,it was significantly lower than before treatment(p<0.01);Hcy of group of TCM(16.24±4.131vs14.05±3.367)after treatment compared with before treatment,there was a significant decrease(p<0.01);the difference between the two groups was statistically significant(p<0.05).(11).It was safe and had fewer adverse reactions during treatment process: One case of palpitation was observed in the group of L plus F,and one case had adverse reactions of lower extremity edema.One case of diarrhea in group of TCM.Conclusion:(1)Both groups can improve the symptoms of patients with H-type primary hypertension of Yinxu-Yangkang type,and the effect of group of TCM is better.(2)It can significantly reduce the [even blood pressure]CBP after treatment in group of L plus F.The blood pressure of CBP did not decrease significantly after the treatment in group of TCM,indicating the existence of the white coat effect.It can improve the white coat effect to a certain extent in group of L plus F,and not in group of TCM.(3)Both groups can reduce the mean blood pressure and blood pressure load,and thegroup of L plus F has a greater degree of reduction,and the effect is stable.[Both groups] but increased their heart rate slightly. |
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