Therapeutic Effect And Mechanism Of Jiangya Capsule On Elderly Isolated Systolic Hypertension Patients

Objective:To evaluate the therapeutic effect and mechanism of Jiangya Capsule on elderly isolated systolic hypertension(EISH),and study the effect of therapeutic mode of integration of disease and syndromes.Methods:(1) To review pertinent literature about EISH of ancient times and recent ten years,arrange and analyze current situation of ISH and EISH in west medicine,TCM and integrated traditional Chinese and west medicine domain.(2) Multi-centre,randomized, double-blind and controlled experiment design was applied.270 cases of EISH patients were divided into 3 groups,Jiangya capsule combined with Nimodipine group(combination group),Jiangya capsule group(Chinese medicine group) and Nimodipine group(west medicine group),and there were 90 cases in each group.241 cases finished the trail and 29 case were lost,and the rate was 10.7%(10 cases in Chinese medicine group,14 cases in combination group,5 cases in west medicine group).The course of treatment was 4 weeks.To observe and evaluate the changes of clinical symptom integral,blood pressure and quality of life before and after the treatment.To observe changes of IgG,mALB,β₂-MG,TRF and NAG in urine before and after the treatment,and analyze the preventive and therapeutic effect on early kidney injury.To detect NO,ET-1, TXB₂,6-Keto-PGF_1α and hs-CRP level in blood plasma before and after the treatment,and explore its mechanism.(3) 66 spontaneous hypertensive rats were randomized into 6 groups:model group,Nimodipine(5mg/kg) and Jiangya capsule low dose group(2g crude drug/kg),Nimodipine(5mg/kg)and Jiangya capsule large dose group(4g crude drug/kg), Jiangya capsule low dose group(2g crude drug/kg),Jiangya capsule large dose group(4g crude drug/kg),Nimodipine group(5mg/kg).The course of intragastric administration was 8 weeks.To detect blood pressure before and after treatment,detect LVMI,ET,CGRP, Angâ…¡,expression of protein and mRNA of AT1 receptor after the treatment.Results:(1) EISH is a common type of ESH,characterized by systolic pressure rising with age,fluctuation,prone to cardio-cerebral events,and influencing quality of life seriously. There were some progresses in TCM area,and therapeutic mode of integrated Chinese and west medicine had its clinical dominance,but lack of evidence based on large sample clinical study.(2) Jiangya capsule could decrease systolic blood pressure after the treatment,and Jiangya capsule combined with Nimodipine had the same effect on systolic blood pressur(P＜0.05),and the effect of combination group was superior to Chinese medicine group or west medicine group.Jiangya capsule had better effect in decreasing systolic pressure of yin deficiency with yang hyperactivity patients than non- yin deficiency with yang hyperactivity patients(P＜0.05).And the effect on blood pressure of yin deficiency with yang hyperactivity patients in combination group had better effect than yin deficiency with yang hyperactivity patients in Chinese medicine group or west medicine group(P＜0.05).Jiangya capsule or combined with Nimodipine could decrease 24h and daily systolic blood pressure(P＜0.05),and the combination group could also decrease night systolic blood pressure(P＜0.05).Jiangya capsule or combined with Nimodipine could improve clinical symptom integral,and the effect on yin deficiency with yang hyperactivity patients was superior to that of west medicine group.Jiangya capsule could improve integral of 7 dimensions of SF-36 measuring scale on quality of life(P＜0.05),and was superior to west medicine group in 5 dimensions(P＜0.05).Combination group could improve integral of 8 dimensions,and was superior to west medicine group in all dimensions(P＜0.05).Jiangya capsule or combined with Nimodipine could reduce mALB andβ₂-MG in urine(P＜0.05),and the combination group was superior to Chinese medicine group or west medicine group in reducing mALB.Jiangya capsule or combined with Nimodipine could improve NO,ET-1,TXB2,6-Keto-PGF_1α,hs-CRP levels in plasma(serum),and combination group was superior to Chinese medicine group or west medicine group in decreasing TXB₂(P＜0.05).(3) After 8 weeks of treatment,Jiangya capsule or combined with Nimodipine could decrease systolic pressure in SHR model(P＜0.05,P＜0.01),only Jiangya capsule of high dose combined with Nimodipine group could decrease systolic pressure in SHR model after 4 weeks of treatment.Jiangya capsule of high dose or combined with Nimodipine group could reduce the weight of left ventricular and its index(P＜0.05);at the same time,ET-1,Angâ…¡reduced and CGRP elevated in the 2 groups,and was superior to that of Nimodipine group(P＜0.05).In addition,Jiangya capsule or also inhibit protein and mRNA expression of AT1 receptor in myocardium(P＜0.05,P＜0.01);and the effect of Jiangya capsule combined with Nimodipine was superior to west medicine group or TCM group(P＜0.05).Conclusion:Jiangya capsule has good effect on EISH patients,and its mechanism might relate to improving endothelial function,anti-inflammation,and inhibiting protein and mRNA expression of AT1 receptor.Jiangya capsule combined with Nimodipine which belongs to integration of disease and syndromes therapeutic mode has synergistic effect in treating EISH patients,deserves to be popularized and applied.