| Objective：Hypertension is currently the world’s highest incidence of disease, inrecent years, with China’s continuous improvement of living standards, patientswith hypertension have more than100million people, an annual increase of3.5million new patients with hypertension. Hypertension not only to diseaserate, the heart, brain, kidney damage is particularly serious, is the world’s themost common chronic diseases. Hypertension is the most important risk factorfor cardiovascular disease, lowering blood pressure can cause the risk ofcoronary heart disease and stroke incidence to reduce. Hypertensive patientssuffering from atherosclerosis (AS) disease is3-4times higher than normalblood pressure, so effectively inhibit AS in favor of hypertension prevention,treatment and prognosis. Calcium antagonists are the first-line drug of treatinghypertension, of which dihydropyridine calcium antagonists (DHPS) the roleof short duration, administered2-3times a day. DHPS adverse reactions suchas facial flushing, headache, rapid heart rate and other more serious, limit itsclinical application. DHPS caused a dramatic decrease of blood, can lead toreflex sympathetic arousal and renin angiotensin system (RA) activity, in whichthe heart rate and plasma catecholamine concentration, thus predisposing tocardiovascular events. Therefore, having stable sustained vasodilatoryhypotensive effect on myocardial contractility, and does not produce inhibitoryreflex tachycardia, heartbeat and cardiac stimulation effects of drugs areconsidered to be the ideal class CCB drugs. A new generation of long-termDHPS antihypertensive drugs Azelnidipine in recent years introduced the idealof two dihydropyridine calcium channel blockers. Azelnidipine in Japan in 2003, was first listed on (not yet widely used in China), the drug for thelong-acting formulations, orally once a day, onset characteristics of stable,progressive, gradual, to avoid causing the patient’s reflex tachycardia,especially facial flushing and headache incidence is low, so low incidence ofadverse events. Azelnidipine half-life was significantly lower than amlodipineand high lipid solubility characteristics, its relatively rapid onset, duration ofaction is more lasting and more effective to reduce vascular inflammationresponse. This study through the use of azelnidipine or amlodipine besylatetreatment, to compare the antihypertensive efficacy, to observe the influenceof azelnidipine and amlodipine besylate on clinical efficacy and serum levels ofhs-CRP、SOD and6-keto-PGF1α in patients with hypertension.To express theeffectiveness of azelnidipine besylate on realeasing of blood pressure andsuppression the development of AS.Methods:In2010March to September, we collected the outpatient hypertensivepatients met inclusion criteria and hypertensive volunteers to collect theirmedication observation.After two-week drug clearance, blood pressure reachedthe inclusion criteria who entered the study phase, in accordance with thechronological order of enrollment, randomized double-blind divided intoazelnidipine group (24cases) and the amlodipine group (24cases).48patients with HTN were stratified by randomized，contrastive assigned toazelnidipine group(8mg/d~16mg/d of azelnidipine for8weeks), amlodipinegroup (5mg/d~10mg/d of amlodipine besylate for8weeks). Patients werefollowed up every2weeks, measuring seat resting systolic blood pressure,diastolic blood pressure and heart rate. Taking4weekend, if blood pressure <140/90mmHg, maintains the original drug dose change to eighth weekends; ifthe systolic blood pressure is still≥140mmHg and/or diastolic bloodpressure≥90mmHg, drug dose doubling: Azelnidipine tablets (16mg/D) or amlodipine besylate tablets (10mg/D), medication to eighth weekends.Patients before treatment and after treatment of2blood sample collection,some blood samples immediately Determination of biochemical indicators, theremaining blood samples of low-temperature refrigerator, leaving do of SOD,of hs-CRP and6-keto-PGF1α in the determination of specimens collectedafter unified detection.The blood pressure and the serum levels of hs-CRP、SOD and6-keto-PGF1α before and after treatment were detected respectively.The data of different treatment groups were compared.Results:Two groups on the basis of gender, age, the proportion of smoking, theprevalence of diabetes, height, weight, systolic blood pressure, diastolicblood pressure, heart rate, there was no significant difference after8weeks ofazelnidipine or amlodipine besylate treatment, systolic and diastolic bloodpressure decreased significantly. Blood pressure in the total efficiency ofAzelnidipine group was87.5%and amlodipine group was91.7%. Azelnidipinegroup of14cases significantly with the effect,7cases have the effect,3casesof no effect, amlodipine group,18cases have significantly with the effect,4cases have the effect,2cases of no effect, between the two groups compareno significant difference (P>0.05). And Azelnidipine group after treatmentthan before treatment compared with heart rate, decreased significantly (P <0.01). Each biochemical indexes: ALT, AST, UA, BUN, Cr and TC, TG,LDL-C, HDL-C before and after treatment had no significant difference (P>0.05). Compared with before treatment, two groups of hs-CRP, SOD insignificant changes before and after treatment in two groups after the treatment,hs-CRP was significantly decreased (P <0.05), SOD increased significantly (P<0.05). Azelnidipine group6-keto-PGF1α after treatment was significantlyincreased (P <0.05),while no significant changes in the amlodipine group (P>0.05). Conclusion:Azelnidipine, new generation of long-acting of DHPS antihypertensivedrugs for the treatment of patients with essential hypertension, compared withcommonly used drugs amlodipine, not only has good antihypertensive effect,but its still slower heart rate. And azelnidipine reduce plasma levels ofinflammatory mediators in the content of his-CRP, and can improve of thecontent of SOD,6-keto-PGF1α. Azelnidipine reduce direct effect on therelieving target organ damage and inhibit the formation of atherosclerosis anddevelopment. |
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