| Objective: The rising of isolated systolic blood pressure and pulse pressure of arteries and veins are the most common types of hypertension for big old people , especially for senior patients.The main pathological changes are the vascular sclerosis, the decreasing of vascular compliance and flexibility as well as the increase of vascular stiffness, which in combination result in the loss of buffering of systolic and diastolic pressure .It is in this case that the systolic pressure keeps rising and the diastolic pressure is lower for common old people ,resulting the widening of pulse pressure . In recent years a number of studies have proved that the rising pulse pressure is an independent risk factor for heart attack in the old patients with hypertension.Its predictive and prognosis function is far greater than systolic blood pressure and diastolic blood pressure. The baseline pulse pressure is in positive correlation with total death ,cardiovascular death, stroke and coronary heart disease. Although the control of systolic blood pressure is of high significance in reducing the incidence of heart attack and stroke, it is also clear that in the antihypertensive therapy for isolated systolic hypertension patients we are facing the predicament that the diastolic pressure may drop even greater than systolic pressure itself which likely leads to the occurrence of heart attack and stroke. Studies have found that pulse pressure is an powerful indication for .The function of vessel endothelium is closely related with the arterial stiffness.It is for this reason that we should prevent the occurrence of vascular lesions, reduce artery stiffness, and narrow the pulse pressure in our process of reducing peripheral vascular resistance ,which has become the priorities for the aged isolated systolic hypertension patients. Because of the degeneration of juxtaglomerular apparatus for the elderly and the gradual decrease of chemical activity of vascular renin, the preferable treatment for older isolated systolic hypertension patients is long-term calcium antagonists and diuretics. Nitrates has been an effective treatment for acute heart failure and angina for years,the mechanism of which is their combination with cellular SH base in vascular smooth cells ,producing nitric oxide(NO) and later activating guanylyl cyclase-C(cGMP). The booming of cGMP is able to retard the inflow of calcium to the vascular smooth cells and ultimately contribute to the relaxation of vascular smooth muscle especially the small ones. With this process comes the dilation of peripheral vascular and the decrease of peripheral resistance. Meanwhile the blood return is lowered ,and the heart load is reduced ,which is a low-oxygen-consuming state.The effectiveness of Nitrates is evaluated indirectly by the improvement of myocardial ischemia symptoms and the exercise tolerance. Recent studies have shown that nitrates are able to adjust arterial stiffness by means of the production of nitric oxide, greatly improving the artery elasticity for elderly patients with hypertension. They can be a supplementary treatment for simple contractile hypertension.They have shown their specific advantages in reducing pulse pressure a, but researches on this aspect is still in scarity.This research focuses on the comparative antihypertensive efferct in groups of ammonia chloride and hydrochlorothiazide with or without 5-isosorbide mononitrate sustained release tablets in the treatment of elderly isolated systolic hypertension (ISH). This paper will discuss the antihypertensive effect of 5-isosorbide mononitrate sustained release tablets on the blood pressure in ISH patients.Methods: In this experiment we choose 60 cases with ISH admitted in our hospital with 38 male and 22 female,aged 68 ~ 82 years old and 66 ~ 85years old respectively.Patients were randomly divided into the experimental group and the control groups with 30 cases respectively. There is statistical significance between the clinical data in each groups (P > 0.05). The experimental group is administrated with 5-isosorbide mononitratesustained release tablets 60mg/d, amlodipine 5mg/d, and hydrochlorothiazide 25mg/d; the control group with amlodipine 5mg/d, hydrochlorothiazide 25mg/d. In this two-weeks time, the drugs is adminstrated persistently. No other antihypertensive medications, smoking, drinking caffeinated drinks are allowed. Blood pressure measurement is carried out during 8:00-11:00am. Take the average value of 3 measurements. Pulse pressure (PP) = SBP - DBP. All data is processed and statistically analysed in SPSS18.0 software with t-test. Measurement data is expressed in the form of x-±s. P < 0.05 signifies statistical significance.Results: Systolic pressure, diastolic pressure and pulse pressure have all dropped compared with preoperative data in both two groups(P < 0.05). Experimental group: systolic blood pressure drops 30.4±11.0 mmHg, diastolic pressure drops 7.1±6.5 mmHg, pulse pressure drops 23.3±10.9 mmHg; The control group: systolic blood pressure drops 24.8±9.3 mmHg, diastolic pressure drops 10.7±8.9 mmHg, pulse pressure drops 14.1±10.1mmHg . There is statistical significance between the two groups in terms of systolic blood pressure drop (P < 0.05) as well as pulse pressure drop (P < 0.05),but no difference when it comes to diastolic pressure decline (P > 0.05) In other words, systolic blood pressure, diastolic blood pressure and pulse pressure are all lowered after medication in these two groups.However, the additional administration of 5-isosorbide mononitratesustained release tablets has shown extra advantage in reducing pulse pressure ,which is exhibited in experimental group.Conclusion: After continuous administration of medicine for 2 weeks, we can see that both the combination of 5-isosorbide mononitrate sustained release tablets, amlodipine, hydrochlorothiazide and the combination of only amlodipine, hydrochlorothiazide are able to not only reduce the systolic pressure to normal range, but also decrease senile pulse pressure .While calcium channel blockers and diuretic jointly could lower systolic blood pressure and pulse pressure ,it can also reduce diastolic blood pressure, which is not desirable.Our experimental data reveals that the application of additional 5 -isosorbide mononitrate sustained release tablets is able to reduce diastolic pressure to a greater extent without too much lowering of diastolic pressure, making the decreasing of pulse pressure is of obvious significance between the two groups. It is thus confirmed that nitrates can lower systolic without too much diastolic blood pressure changes, thereby shrinking pulse pressure. 5-isosorbide mononitrate sustained release tablet is especially suitable for low ISH diastolic blood pressure patients. It has shown that its combination with amlodipine, hydrochlorothiazide in ISH patients could produce ideal anti-hypertension effect.
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