| Objective:Using a systematic evaluation method based on international evidence-based medicine,different antihypertensive drugs with different mechanisms were selected,namely calcium channel blocker(CCB)and angiotensin converting enzyme inhibitor(ACEI),combined with the same statin,to treat senile hypertension with carotid atherosclerosispatients.By monitoring C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),endothelin-1(ET-1),serum nitric oxide(NO),homocysteine(HCY),dynamic blood pressure indicators and carotid intima-media thickness(IMT)changes under different antihypertensive treatment regimens,compare the effects of different antihypertensive drugs combined with statins on vascular function and structure of patients.The purpose is to clarify the following questions:(1)Whether different types of antihypertensive drugs have improved vascular compliance in senile hypertensive patients;(2)Further evaluate the difference between different types of antihypertensive drugs in improving vascular endothelial function;(3)Evaluatethe difference of different antihypertensive drugs combined with statins to improve the atherosclerosis(AS)or atherosclerotic plaque;(4)Explore the clinical value of levamlodipine besylate combined with statins in the treatment of senile hypertension with carotid atherosclerosis.Methods:The clinical diagnosis and follow-up data of senile hypertension with carotid atherosclerosis patients admitted to the Retired Military Hospital of Liaocheng from June 2013 to December 2014 were collected and analyzed.All the selected subjects met the diagnostic criteria for hypertension and were all essential hypertension.Inclusion criteria:(1)age≥70 years;(2)3 times blood pressure measurement on different days,diastolic blood pressure(DBP)≥90 mmHg and/or systolic blood pressure(SBP)≥140 mmHg;(3)Carotid atherosclerosis was diagnosed by color doppler ultrasound;(4)CCB,ACEI/angiotensin receptor antagonist(ARB)and statins were not used within two weeks.Exclusion criteria:The following conditions occurred within 8 weeks(1)with cerebral hemorrhage;(2)combined with secondary hypertension;(3)acute cardiovascular disease,such as acute myocardial infarction,acute left heart failure,etc.;(4)malignant tumors;(5)poor nutritional status;(6)severe liver and renal dysfunction;(7)arteritis,peripheral vascular disease,and autoimmune diseases;(8)allergic reactions to the study drugs.A total of 100 senile hypertension with carotid atherosclerosis patients were enrolled in this study,and were randomly divided into 2groups:the control group and the observation group,and 50 patients in each group.There was no difference in the general data of age,sex,length of disease,severity of illness between the two groups(P>0.05).There were no statistically significant differences between the two groups in terms of blood lipid analysis,fasting plasma glucose(FPG)and white blood cell count(WBC)(P>0.05).The two groups of senile hypertension with carotid atherosclerosis patients were treated with aspirin enteric-coated tablet 0.1 g q.d.after admission.The observation group was treated with levamlodipine besylate 2.5-5 mg q.d.in combination with simvastatin 20 mg q.n..The control group was treated with benazepril hydrochloride 10-20 mg q.d.in combination with simvastatin 20 mg q.n..The data collected included:The general data such as patient’s age,gender,height,weight,WBC,FPG,total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),etc.The clinical observation data such as SBP,DBP,blood pressure variability(BPV),IMT,CRP,TNF-α,NO,ET-1,HCY,etc.on admission and follow-up nodes.Results:One hundred senile hypertension with carotid atherosclerosis patients,including 51 males and 49 females.The age was 71-79 years old,and the median age was 75 years old.After treatment with two antihypertensive drugs combined with statins,the two groups of patients were effective in reducing blood pressure and had good antihypertensive effect.1.Changes in BPV:24hSBPV,24hDBPV,dSBPV,dDBPV,nSBPV,nDBPV values in the control group and the observation group before treatment and after 12 months treatment,the values of control group before treatment were 14.35 ±2.13mmHg、16.45±4.06mmHg、13.56±2.45mmHg、16.94±3.45mmHg、10.12± 2.74mmHg、12.65±2.74mmHg,the values of control group after 12 months treatment were 10.61 ± 1.43mmHg、13.31±3.67mmHg、10.06±1.51mmHg、12.85±3.04mmHg、9.82±6.23mmHg、11.12±3.77mmHg;the values of observation group before treatment were 14.12 ± 2.30mmHg、16.72±3.31mmHg、13.12 ±2.67mmHg、16.01 ±3.81mmHg、9.69±1.99mmHg、12.73±3.98mmHg,the values of observation group after 12 months treatment were 9.46±2.76mmHg、10.46 ±3.13mmHg、9.45±3.28mmHg、10.04±3.13mmHg、8.20±0.79mmHg、10.90±3.10mmHg.The BPV of the two groups decreased,and the BPV of the observation group was significantly lower than that of the control group.The difference was statistically significant(P<0.05).2.Changes in ET-1,NO,CRP,TNF-a,and HCY:The values of control group before treatment were 45.25 ± 8.1 lng/L、26.49±9.08μmol/L、9.25±1.11mg/L、28.42±4.08nmol/L、16.31±2.30μmol/l;the values of control group after 12 months treatment were 41.78 ± 5.43ng/L、44.11±10.67μmol/L、7.78±1.41mg/L、23.11±1.67nmol/L、15.98±3.11μmol/l.The values of observation group before treatment were 44.92±9.37ng/L、28.92±6.39μmol/L、9.27± 1.37mg/L、28.92±4.71nmol/L、17.75 ± 1.97μmol/l;the values of observation group after 12 months treatment were 34.76±4.77ng/L、60.13±13.01μmol/L、4.76±0.77mg/L、20.13±3.09nmol/L、8.09±2.5 μumol/1.The NO level of the two groups increased,and the degree of elevation was higher in the observation group than in the control group.The difference was statistically significant(P<0.05).CRP,TNF-a,ET-1,HCY,etc.were decreased in the two groups,and the degree of decline was higher in the observation group than in the control group.The difference was statistically significant(P<0.05).3.Changes in IMT:IMT values of the control group and the observation group before and after treatment at 3 months,8 months,and 12 months,the values of control group were 1.38±0.17mm、1.36 ± 0.16mm、1.33 ± 0.14mm、1.32 ± 0.14mm;the values of observation group were 1.3 9±0.15mm、1.32 ± 0.20mm、1.19±0.09mm、0.86±0.11MM.After treatment,the IMT of the two groups decreased significantly.Especially in the 12-month follow-up node,the decrease of IMT in the observation group was more significant than that in the control group,and the difference was statistically significant(P<0.05).4.Levamlodipine besylate combined with simvastatin compared withbenazepril hydrochloride combined with simvastatin can increase NO,reduce CRP,TNF-a,ET-1,HCY,BPV and IMTmore clearly.The difference was statistically significant(P<0.05).Conclusion:1.The levels of CRP,TNF-α,ET-1,NO and HCY in senile hypertension patients are related to blood pressure and BPV.2.The IMT of senile hypertension with carotid atherosclerosis patients were correlated with CRP,TNF-α,ET-1,NO,HCY levels and BPV.3.CRP,TNF-α,ET-1,NO,HCY,BPV and IMT levels can be used to evaluate the therapeutic effect and prognosis of senile hypertension with carotid atherosclerosispatients.4.CCB levamlodipine besylate combined with simvastatin is more suitable for the treatment of senile hypertension with carotid atherosclerosis patients than ACEI benazepril hydrochloride combined with simvastatin. |
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