Study On Body Composition Of Hypertensive Patients And Evaluation Of The Efficacy Of Amlodipine Benazepril

Part 1 Study on body composition of hospitalized hypertensive patientsObjectiveHypertension is a global public health challenge,and its incidence is affected by many factors.Abnormal body composition is closely linked to hypertension,and is a risk factor for cardiovascular disease.It can be affected by age,sex,and history of medication.Studies on the body composition of hypertension have been conducted,but there are few studies on the body composition of different age,sex,and history of medication hypertensive people.Therefore,in order to establish a foundation for the prevention,diagnosis,and treatment of various hypertensive individuals,the part of this study explores the changes of body composition,blood and cardiac ultrasound indexes of different age,sex and medication history hypertensive people.MethodsUsing the technique of retrospective analysis,from January 2019 to October 2022,inpatients in the third Cardiovascular Disease area of Qilu Hospital of Shandong University were selected as subjects.1.General data of patients were collected,including age,sex,height,weight,body surface area,body mass index(BMI),history of hypertension,coronary heart disease,and type 2 diabetes,history of smoking and drinking,history of angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blocker(ACEI/ARB),calcium channel blocker(CCB)and statins.2.InBody S10 was used to analyze body composition,then related indexes were collected,including skeletal muscle content,skeletal muscle mass index(SMI),body fat content,body fat percentage,visceral fat area,total body water/fat-free mass ratio(TBW/FFM),protein content,body cell weight,bone mineral content,waist circumference,basal metabolic rate,phase angle.3.The blood indexes were record,including glucose,alanine aminotransferase,aspartate aminotransferase,low-density lipoprotein cholesterol,triglyceride,urea,creatinine,uric acid.4.The results of cardiac ultrasound were collected,including left atrium end-systolic diameter,left ventricular end-diastolic diameter,interventricular septum thickness,left ventricular posterior wall thickness,transmitral diastolic early peak inflow velocity/peak early diastolic velocities of mitral annulars(E/e’),left ventricular ejection fraction(LVEF),and left ventricular mass index.5.The inpatients were divided into hypertension group and non-hypertension group.The changes of the above indexes were analyzed,and the risk factors of hypertension were explored by binary multivariate logistic regression.6.Hypertensive patients over 65 years old were divided into elderly group(65 ≤ age<75 years old)and older group(age≥75 years old);then they were grouped by gender.all hypertensive patients were divided into non-ACEI/ARB group and ACEI/ARB group;nonCCB group and CCB group;ACEI/ARB group,CCB group and ACEI/ARB+CCB group according to hypertension medication history.ACEI/ARB group denoted the use of ACEI/ARB alone,the CCB group denoted the use of CCB alone,and the ACEI/ARB+CCB group denoted the use of ACEI/ARB coupled with CCB.The changes of various indexes were compared among the groups.Results1.General informationA total of 425 inpatients were enrolled,with an average age of 67.33± 14.54,including 275 males,150 females.2.Comparison between hypertension group(n=269)and non-hypertension group(n=156)(1)Compared with the non-hypertension group,the hypertension group had higher age,body surface area,BMI,coronary heart disease,type 2 diabetes,ACEI/ARB and CCB history of medication(P<0.05);(2)Among the body composition indexes,SMI,skeletal muscle content,body fat content,body fat percentage,visceral fat area,TBW/FFM,body cell volume,bone mineral content,waist circumference,basal metabolic rate increased in hypertension group(P<0.05);(3)In blood indexes,glucose,triglyceride,urea,creatinine,uric acid in hypertension group were significantly higher than non-hypertension group(P<0.05).But low-density lipoprotein cholesterol decreased(P<0.05);(4)Among the cardiac ultrasound results,the left atrium end-systolic diameter,left ventricular end-diastolic diameter,interventricular septum thickness,left ventricular posterior wall thickness,E/e’ and left ventricular mass index improved in hypertension group(P<0.05);(5)Binary Logistic regression analysis showed that BMI(OR=1.614,95%CI:1.099-2.370,P=0.015)is an independent risk factor and SMI(OR=0.394,95%CI:0.187-0.829,P=0.014)is independent protective factors of hypertension.3.Comparison of hypertensive patients between the elderly group(n=85)and the older group(n=92)(1)Compared with the elderly group,the age and the proportion of the history of statins in the older group increased(P<0.05),and BMI decreased(P<0.05);(2)Among the body composition indexes,SMI,skeletal muscle content,protein content,body cell weight,bone mineral content.waist circumference,basal metabolic rate and phase angle in the older group were lower(P<0.05),while TBW/FFM increased(P<0.05);(3)In blood indexes,the levels of alanine aminotransferase and low-density lipoprotein cholesterol were lower with age(P<0.05),while the levels of urea and creatinine were higher with age(P<0.05);(4)Among the cardiac ultrasound results,the interventricular septum thickness and E/e’were higher with age(P<0.05).4.Comparison of elderly male(n=110)and female(n=67)hypertensive patients(1)The body surface area,the proportion of smoking history,drinking of male were higher than female patients(P<0.05);(2)Among the body composition indexes,SMI,skeletal muscle content,TBW/FFM,Protein content,body cell volume,bone mineral content,basal metabolic rate and phase angle in male were higher than female(P<0.05),while body fat percentage and visceral fat area were lower(P<0.05);(3)In blood indexes,urea,creatinine,uric acid in male patients were higher than female(P<0.05);(4)Among the cardiac ultrasound results,the left atrium end-systolic diameter,left ventricular end-diastolic diameter,interventricular septum thickness and left ventricular posterior wall thickness in males were higher than females(P<0.05),and LVEF was lower(P<0.05).5.Comparison of hypertensive patients between ACEI/ARB group(n=149)and nonACEI/ARB group(n=120)(1)The BMI,the proportion of smoking and statins in the ACEI/ARB group were improved(P<0.05).There was no significant difference in age,sex,body surface area,history of coronary heart disease,type 2 diabetes and drinking(P>0.05);(2)Among the body composition indexes,SMI,skeletal muscle content,protein content,body cell weight,bone mineral content and basal metabolic rate increased in the ACEI/ARB group(P<0.05),while the visceral fat content decreased(P<0.05);(3)In the blood indexes,the low-density lipoprotein cholesterol in the ACEI/ARB group was lower,and the urea was higher(P<0.05);(4)Among the cardiac ultrasound results,the left ventricular end-diastolic diameter and left ventricular mass index reduced in the ACEI/ARB group,but the difference was not significant(P>0.05).6.Comparison of hypertensive patients between CCB group(n=153)and non-CCB group(n=116)(1)There was no difference in age,sex,body surface area,BMI,history of coronary heart disease and type 2 diabetes,history of smoking and drinking and history of statins between the two groups(P>0.05);(2)Among the body composition indexes,SMI,skeletal muscle content decreased in CCB group,but the difference was not statistically significant(P>0.05).While body fat content and visceral fat area and TBW/FFM raised in CCB group(P<0.05);(3)Among the cardiac ultrasound results,the interventricular septum thickness and left ventricular mass index increased in CCB group(P<0.05).7.Comparison of hypertensive patients in ACEI/ARB group(n=62),CCB group(n=61)and ACEI/ARB+CCB group(n=35)(1)There was no significant difference in age,sex,body surface area,BMI,history of coronary heart disease,type 2 diabetes,smoking,drinking,and statins among the three groups(P>0.05).(2)Among the body composition indexes,the visceral fat area in ACEI/ARB group was significantly lower than that in CCB group(P<0.05),the percentage of body fat and visceral fat area in ACEI/ARB group was the lowest,the visceral fat area was the highest in CCB group,and the level in ACEI/ARB+CCB group were in the middle level.SMI,skeletal muscle content,protein content,body cell volume,bone mineral content and basal metabolic rate in ACEI/ARB+CCB group were higher than those in the other two groups(P>0.05).(3)In blood indexes,low-density lipoprotein cholesterol in ACEI/ARB group was lower than CCB group(P<0.05).(4)The left ventricular end-diastolic diameter in ACEI/ARB+CCB group was lower than that in CCB group,the left ventricular end-diastolic diameter ACEI/ARB group was lower than CCB group.The left ventricular mass index in ACEI/ARB group was smaller than CCB group(P<0.05).Conclusion1.BMI is an independent risk factor of hypertension,and SMI is an independent protective factor of hypertension;2.With the increase of age,the indexes such as SMI,skeletal muscle content,protein content,body cell quantity,bone mineral content,waist circumference,basal metabolic rate and phase angle decreased,urea nitrogen and creatinine were expanded;3.The SMI,skeletal muscle content,TBW/FFM,protein content,body cell weight,bone mineral content,basal metabolic rate and phase angle in elderly male hypertensive patients were higher than females,while the amount of fat was lower.The levels of urea nitrogen,creatinine and uric acid were higher than females,and there were gender differences in cardiac function;4.ACEI/ARB can increase muscle mass,reduce fat content.CCB can increase fat weight,reduce muscle mass and increase the risk of edema.ACEI/ARB+CCB can increase muscle mass,reduce fat content and improve ventricular remodeling.Part 2 Evaluation of the efficacy of amlodipine benazeprilObjectiveMost people with high blood pressure have difficulty achieving their blood pressure with a specific drug.Thus,about half of the patients require combination therapy to get blood pressure to normal values.Single pill combination(SPC)is composed of two or more antihypertensive drugs,which can achieve better antihypertensive effect.It has been recommended for the initial treatment of most patients by domestic and international guides in recent years.Amlodipine benazepril tablets(Ⅱ)is a common SPC combined with ACEI/ARB and CCB.Some studies have proved that ACEI/ARB affects human muscle content,and the first part of this study also found that the combination of ACEI/ARB and CCB can affect human body composition.However,there are few studies on body composition with amlodipine benazepril tablets(Ⅱ).Therefore,this study further explores the antihypertensive effect of amlodipine benazepril tablets(Ⅱ)and its effects on body composition,blood,urine,cardiac ultrasound indexes,to guide its clinical application and achieve a higher blood pressure control rate.MethodsPatients with essential hypertension were recruited in Qilu Hospital of Shandong University from April 2019 to December 2021.They were treated with amlodipine benazepril(Ⅱ)1 tablet per day.General data of patients were collected,including sex,age,height,weight,history of hypertension,coronary heart disease,and type 2 diabetes,history of smoking,drinking and family history of hypertension.All patients were followed for 3-6 months.The following indexes were monitored before and after treatment,including ambulatory blood pressure(daytime systolic blood pressure,daytime diastolic blood pressure,nocturnal systolic blood pressure,nocturnal diastolic blood pressure,24-hour systolic blood pressure,24-hour diastolic blood pressure,smoothing index),family self-measured blood pressure(morning systolic blood pressure,morning diastolic blood pressure,night systolic blood pressure,night diastolic blood pressure),body composition indexs(SMI,skeletal muscle content,body fat content),blood indexs(glucose,alanine aminotransferase,aspartate aminotransferase,lowdensity lipoprotein cholesterol,triglyceride,urea nitrogen,creatinine,uric acid,serum potassium),urine indexs(urinary total protein,urinary albumin,urinary protein-creatinine ratio,urinary albumin to creatinine ratio),cardiac ultrasound indexs(left atrium end-systolic diameter,left ventricular end-diastolic diameter,interventricular septum thickness,left ventricular posterior wall thickness,E/e’,left ventricular mass index).The changes of the above indexes were observed 3-6 months after treatment.Results1.A total of 120 patients with essential hypertension were selected.After 3 months of follow-up,110 patients were included,including 80 males and 30 females,with an average age of 53.95±12.34.There were 50 patients were followed up for 6 months with good compliance,including 36 males and 14 females,with an average age of 53.76±12.60.2.After 3-months treatment,daytime systolic blood pressure,daytime diastolic blood pressure,nocturnal systolic blood pressure,nocturnal diastolic blood pressure,24-hour systolic blood pressure,24-hour diastolic blood pressure decreased significantly(P<0.05),the smoothing index increased significantly(P<0.05).3.After 3-months treatment,the skeletal muscle content and SMI were significantly higher,while the body fat content was significantly decreased(P<0.05).4.After 6-months treatment,morning systolic blood pressure,morning diastolic blood pressure,nocturnal systolic bloodpressure and nocturnal diastolic blood pressure reduced(P<0.05).5.After 6-months treatment,glucose,urinary total protein,urinary albumin,urinary protein-creatinine ratio,urinary protein-creatinine ratio decreased(P<0.05).There were no difference in alanine aminotransferase,aspartate aminotransferase,low-density lipoprotein cholesterol,triglyceride,urea nitrogen,creatinine,uric acid,serum potassium(P>0.05).6.After 6-months treatment,the left atrium end-systolic diameter,left ventricular enddiastolic diameter,interventricular septum thickness,left ventricular posterior wall thickness,E/e’ and left ventricular mass index were significantly lower than those before treatment(P<0.05).Conclusion1.Amlodipine benazepril tablets(Ⅱ)can steadily and effectively reduce ambulatory blood pressure and family self-measured blood pressure,and play an excellent antihypertensive effect;2.Amlodipine benazepril tablets(Ⅱ)can increase muscle mass,reduce fat weight;3.Amlodipine benazepril tablets(Ⅱ)can’t affect the function of liver and kidney,and can reverse myocardial remodeling,which is worthy of clinical application.