Comparison Of Effects Of Amlodipine/Perindopril Combination And Amlodipine Dose Uptitration On Blood Pressure Variability In Hypertension Patients

Objective: Blood pressure variability plays a crucial role in prediction oftarget-organ damage, cardiovascular events and stoke in hypertension patients.Drug combination has been widely used in treatment to hypertension theseyears such as the combination of CCB and ACEI, which is proved byEvidence-based Medicine and recommended by authoritative guidelines. Inthis study, we compared the effects of amlodipine/perindopril combinationwith amlodipine alone on blood pressure variability and endothelium functionsin hypertension patients and found that the former was more beneficial.Meanwhile, we demonstrated that various factors including drugs may affectblood pressure variability.Methods：60primary hypertension outpatients in department ofcardiology of the second hospital affiliated to Hebei Medical University wereenrolled in this study. After administration of amlodipine(5mg/d) for4weeks，patients were randomized in amlodipine/perindopril combination group(Group A) and amlodipine group (Group B). Group B were administratedamlodipine (5mg/d)/perindopril (4mg/d) combination while group A wereadministrated amlodipine (10mg/d) alone.24h ambulatory blood pressures(systolic pressure and diastolic pressure) and levels of blood NO were detectedafter12weeks, using SD and CV as markers for Blood pressure variability.Results:1After12weeks treatment, Group A expressed significantly statisticaldecreases in24hSSD, dSSD, nSSD,24hDSD,24hDCV, dDSD, nDCV (P＜0.05) and showed no significant alterations in24hSCV, dSCV, nSCV, dDCV,nDSD (P＞0.05); Group B expressed significantly statistical decreases in24hSSD,24hSCV, nSCV,24hDSD,24hDCV, nDSD and showed no significant alterations in dSSD, dSCV, nSSD, dDSD, dDCV, nDCV (P＞0.05).Meanwhile, compared with Group A, Group B was found dramatic decreasesin24hSSD,24hSCV,24hDSD (P＜0.05) and showed no significantalterations in nSCV, nDSD, nDCV,dSSD, nSSD,24hDCV, dDSD, dSCV,dDCV (P＞0.05).2Group A and Group B both showed significant increases in blood NO(P＜0.05) while decreases in LVMI (P＜0.05) compared with levels of bloodNO detected12weeks ago. Meanwhile, Group B expressed a more significantincrease in blood NO(F=126.03，t=2.34，P=0.01，P＜0.05) and decreases inLVMI （F=17.65，t=2.45，P=0.01，P＜0.05）than group A.3Factors of NO and LVMI affected systolic blood pressure variability,Multivariate linear regression was analyzed with ANOVA, FSSD=2.441,PSSD=0.037, FDSD=2.324and PDSD=0.046were considered statisticallysignificant.Conclusion：Amlodipine/perindopril combination and amlodipine aloneboth contributed to reducing24h blood pressure variability, and the formerwould be more effective compared with the latter. Data during daytimeexpressed no significant alteration, which may due to life styles and activitiesat daytime and respectively small sample size. However, autonomic nerveswere activated at nighttime, resulting in dramatic blood pressure variability.More clinical trails are needed to perform at nighttime. Functions ofendothelium could be improved by amlodipine/perindopril combination andamlodipine alone, with the former being more beneficial. Factors of NO andLVMI affected systolic blood pressure variability.