Effects Of The Longxi,Gansu Astragalus Mongholicus On Protection Of Peripheral Artery And Mechanism In Hypertensive Patients With Metabolic Syndrome

Objective To study the effect and mechanism of Astragalus Mongholicus on protection of peripheral artery in hypertensive patients with metabolic syndrome (MetS).Methods In this prospective, randomized, controlled, parallel clinical trial, we assigned148MetS patients (totally210MetS patients were needed, and the period of follow-up examination were twelve months.) to three groups:Control group(n=50), Astragalus Mongholicus group1(10g/d, n=49) and Astragalus Mongholicus group2(5g/d, n=49), then performed different treatments respectively. We employed high-resolution ultrasonography, blood and pulse measuring instrument respectively to detect their carotid intima-media thickness (CIMT), cardio-ankle vascular index (CAVI) and ankle brachial index (ABI).Serum8-hydroxy-2’-deoxyguanosine (8-OHdG) level and angiotensin converting enzyme/angiotensin converting enzyme2(ACE/ACE2) protein expression levels of human peripheral blood lymphocyte were examined by Elisa and Western-blot. In this paper, intermediate period (six months) data was analyzed.The changes of these indexes were observed, SPSS17.0software was used to statistical analysis the data.Results1. Compared with control(n=29), expression level of ACE2in Astragalus Mongholicus group1(n=28) and Astragalus Mongholicus group2(n=29) were significantly upregulated (p=0.000), and the expression level of ACE were significantly downregulated (p=0.000) in six month later, but expression level of ACE and ACE2were similar between the Astragalus Mongholicus group1and the Astragalus Mongholicus group2(p=0.972);2. Compared with baseline, the Astragalus Mongholicus group1and Astragalus Mongholicus group2showed inferior effect to decreasing the CIMT (p=0.011);4.There was no statistically difference in level of ABI, CAVI and serum8-OHdG among these three groups(p>0.05).Conclusion The Astragalus Mongholicus of Longxi, Gansu Province, may protect the peripheral artery function partly in hypertensive patients with MetS, and its possible mechanism is that Astragalus Mongholicus might regulate the expression level of ACE and ACE2. Because these data are just middle term results, sample size and intervention time do not meet design requirements. Thus, whether Astragalus Mongholicus has function of vascular protection is still not definite. This study still needs improving the terminal results which should be observed to provide more reliable evidence. Purpose A meta-analysis was carried out to compare the effect of calcium channel blockers(CCBs) and angiotensin-converting enzyme inhibitors (ACE-Is) alone and their combination on the reversion of left ventricular hypertrophy(LVH) in Chinese hypertensive patients.Methods Retrieved relevant medical database, including Cochrane Library (the seventh issue of2011), PubMed (1980～2011), EMBASE (1980～2011), Chinese Biomedical Literature Database (1978～2011), Chinese Scientific Journals Full-text Database (1994～2011), Chinese Journal Full-text Database (1989～2011) and Wanfang Database (1998～2011). Selected clinical studies were according to predefined inclusion and exclusion criteria, evaluated the quality of included studies.The RevMan5.1software was used to analysis the data.Results Ten studies, total859patients were identified. There were statistically significant in SBP (MD=-6.49,95%CI:-10.55,-2.43),DBP (MD=-4.48,95%CI:-6.76,-2.21), left ventricular mass index (LVMI)(MD=-5.31,95%CI:-8.43,-2.19), interventricular septal thickness (IVST)(MD=-1.33,95%CI:-2.00,-0.66) and left ventricular posterior wall thickness (LVPWT)(MD=-0.87,95%CI:-1.41,-0.33) in CCBs and ACE-Is combination versus CCB monotherapy (P<0.05). In addition, compared with ACE-Is monotherapy, the combination treatment showed prior effect on the decreasing of LVMI (MD=-11.54,95%CI:-15.06,-8.01), IVST (MD=-0.76,95%CI:-1.25,-0.27). and LVPWT(MD=-0.80,95%CI:-1.01,-0.59)(P<0.05). The left ventricular end diastolic diameter (LVDd), fraction shortening (FS) and ejection fractions(EF) were no difference in CCBs or ACE-Is mono-therapy and their combination (P>0.05). Conclusion The combination therapy with CCBs and ACE-ls is more superior than individual agents in regression of left ventricular hypertrophy. Because of the low methodological quality, further high quality,large, multicenter, RCTs are required to explore the effects of CCBs and ACE-Is combination on LVH in Chinese hypertensive patients.