| Objectives:The purpose of this study was to evaluate the effects of antihypertensive drugs and isosorbide dinitrate on arterial stiffness index (ASI) and pulse pressure (PP) in essential hypertensive patients. Methods: In the first part of this study, 82 patients with grade 1 or grade 2 essential hypertension who had never received antihypertensive drugs before were enrolled and randomly divided into two groups. One group received enalapril (ACEI group), another group received sustained-release nifedipine (CCB group). The ASI was measured in brachial artery by the device made by Si-chuan Yu-Feng Technical Corporation before and after the treatment. The arterial blood pressure was measured in seat position by sphygmomanometer. PP = SBP – DBP. The initial dose of enalapril was 5mg twice a day, and sustained-release nifedipine was 10mg twice a day. The doses of these two drugs could be increased if lowering of blood pressure was not satisfactory. At baseline and after six weeks therapy, SBP, DBP, PP, ASI and HR values were compared between two groups. The differences of these parameters between isolated systolic hypertension group and non-isolated systolic hypertension group were assessed. In the second part of this study, 142 essential hypertension patients who were being treated with ACEI or CCB but their PP was still more than 50mmHg, at random assignment, received either isosorbide dinitrate 5mg, three times daily combined with their original antihypertensive drugs (ISDN group) or only their original antihypertensive drugs (control group). SBP, DBP, PP, ASI and HR values were measured at baseline and after four weeks. The effects of ISDN on blood pressure, PP, and ASI in isolated systolic hypertension subgroup were compared with that in non-isolated systolic hypertension subgroup. Results: 73 patients completed the first part of this study. 38 patients were in ACEI group, and 35 patients were in CCB group. There were no significant differences in mean age, gender, blood pressure, serum cholesterol, triglyceride, baseline PP, ASI and HR between two groups(P>0.05). At the end of 6 week, the mean daily dose of enalapril was 16.32mg and sustained-release nifedipine was 29.14mg. After 6 week treatment, SBP decreased 17.0mmHg and 19.2 mmHg in ACEI group and CCB group respectively, DBP decreased 7.2mmHg and 9.6mmHg, PP decreased 8.6mmHg and 9.8mmHg and ASI decreased 23.7 and 25.4respectively. The effects above did not show any statistical significance between two groups. Heart rate in CCB group increased after treatment (77.1bpm vs 80.1bpm p<0.05), but there was no significant change in ACEI group. The treatment response to drugs was better in non-isolated systolic hypertensive group than that in isolated systolic hypertension group. 129 patients finished the second part of this study. 65 patients were in ISDN group, and 64 patients were in control group. There were no significant differences in mean age, gender, serum cholesterol, blood pressure, baseline PP ASI and HR between two groups (P>0.05). Compared with the baseline, there were significant reduction of SBP (10.5mmHg), PP (7.8mmHg), ASI (11.6) and light reduction of DBP (2.7mmHg) in the ISDN group, these changes had statistical significance, however, no significant changes of above parameters were found in control group. The effects of isosorbide dinitrate in isolated systolic hypertension subgroup were better than that in non-isolated systolic hypertension subgroup. Conclusions: Antihypertensive drugs—enalapril and sustained-release nifedipine could improve arterial compliance while decreasing arterial blood pressure effectively. The effects of two drugs on blood pressure, PP and ASI were similar in this study. The treatment response of these two drugs in ISH subgroup was better than that in non-ISH subgroup.Combined with ACEI or CCB, the effects of ISDN in lowering blood pressure, especially SBP, and improving arterial compliance were demonstrated. The effects of ISDN in ISH subgroup were better than that in non-ISH subgroup.
|
PDF Full Text Request