A Prospective Study Of Different Interventions On Prehypretensives (Pre-HT Stage2) Associated With At Least One Cardiovascular Risk Factor

Objective: To assess the effect of non pharmacologic therapy andpharmacologic therapy on blood pressure control and body mass index (BMI),Low-density lipoprotein cholesterol (LDL-c), Fasting plasma glucose(FPG),Oral glucose tolerance test(OGTT) in prehypretensives which is associatedwith at least one cardiovascular risk factor. To compare the effect of differentantihypertensive ways on new-onset diabetes, hypertension and cardiovascularevents.Methods:104cases with mean blood pressure130～139／85～89mmHg, age from50to79years old as well as with at least onecardiovascular risk factor were randomly divided into3groups：lifestyle andoral telmisartan intervention group(A group， n=26), lifestyle and oralindapamide intervention group(B group，n=26)，simple lifestyle interventiongroup(C group，n=50). Subjects with coronary artery bypass grafting(CBG) orPercutaneous coronary intervention(PCI) and those with hepatic dysfunction,renal insufficiency, myocardial infarction，diabetes，hypertension, cerebralapoplexy，stroke，atrial fibrillation，cancer, hyperkalemia，hypokalemia wereexcluded. Blood and urine samples were drawn after8h of fasting, serumcreatinine(Scr), uric acid(UA), fasting plasma glucose(FPG), total cholesterol(TCH), triglycerides (TG) high-density lipoprotein-cholesterol (HDL-C) andother biochemical indicators were measured. Meanwhile height, weight, waistcircumference, hip circumference were also recorded. And blood pressure(BP),heart rate (HR)were both recorded as well at1,3,6,9,12,13month follow-up.Health education was encouraged. SPSS13.0software pack was used to makeStatistical analyses.All the numerical data was shown as mean±standarddeviation. T test was used to analysis of unpaired data. ANOVA and Kruskal-Wallis H test was used for analysis of more than two groups ofnumerical data, SNK test was used for analysis of two groups of numericaldata, we take P <0.05as statistic significance level.Results:1Comparison of baseline date: There was no significant difference among age,gender, Scr, HDL-c, LDL-c, TG, UA, BMI, FBG, OGTT, TCH, W/H, systolicblood pressure(SBP) and diastolic blood pressure(DBP) in3groups inbaseline.2General parameters and blood biochemical indicators compared withbaseline: Compared with0month, at12nd months：①In group A, SBP, DBP,BMI, TCH and TG decreased significantly (P <0.01);W/H, LDL-C, UA,FPG were also lower (P <0.05); there was no significant difference in HDL-C,Scr and OGTT.②In group B,SBP, DBP, BMI, TCH, LDL-C decreasedsignificantly (P <0.01, P <0.05)；there was no significant difference in TG,FPG, UA, HDL-C, OGTT, W/H and Scr.③While in group C, SBP, DBP, W/H and BMI decreased significantly (P <0.05); OGTT2h PG increasedsignificantly (P <0.01); there was no significant difference in FPG, TCH, TG,HDL-C, LDL-C, Scr and UA.3The levels of blood pressure with time:(1)12months later:①Compared withbaseline, blood pressure decreased9.069±4.442/4.977±2.381mmHg ingroup A (P<0.01),7.309±3.623/4.412±2.380mmHg in group B (P<0.01),3.448±3.413/2.591±2.827mmHg down in group C (P<0.01).②Betweengroups：there was no significant difference between group A and B, but whencompared with group C respectively, group A and B both decreasedsignificantly (P <0.05).(2)13months later:①Compared with12months,Other than the effect of drug itself on blood pressure, follow-up blood pressuremeasurement was Similar to that of one month earlier. Only blood pressure ofgroup B increased1.31±2.54/0.89±1.77mmHg (P <0.05). There was nostatistical difference in both group A and C.②Between groups：The meanvalue of SBP, DBP was lower in group A than in the other two groups (P<0.05). Compared with group C, SBP of group B statistically decreased (P <0.05).4The levels of heart rate (HR) with time:(1)Compared with baseline,12months later, In group A, HR decreased significantly(P <0.05).But there wasno significant difference on HR in group B and group C.(2)While13monthslater, there was no significant difference on HR in the three groups comparedwith0month.In group B, HR was the highest among three groups (P <0.05).5Comparison of other parameters at12nd month:(1) Non participator ingroup A developed into diabetes or hypertension; the positive rate of impairedglucose tolerance （IGT）decreased from38.46%to34.61%; rate of impairedfasting glucose(IFG) decreased from38.46%to26.92%;61.54%reached thestandard of high-normal blood pressure Stage1（Pre-HT stage1）;7.69%withideal blood pressure.(2) In group B3.85%developed into hypertension;3.85%developed into diabetes mellitus(DM); the rate of IGT remained34.61%; the rate of IFG increased from26.92%to30.07%;46.15%reachedPre-HT stage1level;3.85%with ideal blood pressure.(3) In group C7.69%became hypertensives,5.76%with new-onset diabetes, the rate of IGTincreased from40.38%to48.08%, the rate of IFG increased from26.92%to28.85%,13.46%with Pre-HT stage1；no one normotensive.Conclusions:1With improved Lifestyle, blood lipid, blood glucose levels are the keys toreduce the incidence of prehypertension and target organ damage. Andlifestyle intervention can partly prevent the prehypertensives from developinginto hypertensives，but has no impact on IGT and/or IFG.2Based on lifestyle plus small doses antihypertensive drugs intervention astelmisartan or indapamide can be safe and effective.This two treatmentsreduced the high-normal blood pressure, lipid levels and prevented early stagetarget-organ damage better. The effect of indapamide on lowering bloodpressure is similar to telmisartan.3Maybe lifestyle plus oral telmisartan therapy has greater advantage inpreventing new-onset diabetes mellitus, in the improvement of circadianrhythm，in reducing the level of BP, OGTT, FPG, BMI，TCH,TG and LDL-c than the other two groups. This therapy may be a better choice forprehypertensives with IGT or IFG.