| Objective: Since1988found that endothelin (ET), vascular endothelialsystem gradually become a hot research topic. And impaired endothelialfunction as "endothelial-high blood pressure-cardiovascular events" chainof factors and the carrier, in the development of the occurrence of primaryhypertension plays an extremely important role. A large number of researchdata show that the primary hypertension, endothelial markers level changes inplasma, nitric oxide (NO) and superoxide dismutase (sod) decreasedproduction, endothelin-1(ET-1), false von willebrand factor (VWF), reactiveoxygen species and inflammatory factor C-reactive protein (hs-CRP) levels,such as causing endothelium-dependent relaxing function obstacle. So earlydetection, early intervention, and delay the injury of endothelial function hasbecome one of the hot problem in the study on the treatment of hypertension.There have been many studies have shown that statins can through themobilization of endothelial progenitor cells (EPCS), enhance the level of NOand reduce ET and hs-CRP concentration of indirect influence endothelialdiastolic dysfunction, and this effect is independent of the lipid, statins havebeen regarded as one of drugs for the treatment of essential hypertension.Trimetazidine hydrochloride as applied to myocardial metabolism of drugs inthe clinical treatment of coronary heart disease (CHD), with related studieshave shown that trimetazidine besides having save the energy metabolism ofischemia in cells, prevent the intracellular ATP levels drop, stable environmentin the cell, and other functions, can also lead to an elevated plasma NO and ET-1drop, flow mediated endothelial diastolic function enhanced, so as to havethe effect of improving endothelial function, but trimetazidine hydrochlorideas main drug application in the treatment of hypertension reported very little. As for lipid statin drugs in combination with trimetazidine hydrochloride andseparate application tiaozhi statin drugs can compare earlier better and moresignificantly improve endothelial function in patients with essentialhypertension and increase the drug side effects, not yet reached a consensus.This study aims to test related to the change of level of the serum markersbefore and after medication observation trimetazidine hydrochloride withstatins combined influence on endothelial function in patients with primaryhypertension, to provide basis for clinical treatment.Methods:01,2013-08,2013in the second hospital, HEBEI medicaluniversity (including inpatient and outpatient service) in the diagnosis ofprimary hypertension (conform to the2005China hypertension treatmentguidelines of the diagnostic criteria of primary hypertension, namely≧bloodpressure140/90MMHG) of the patients, adopt l benzene sulfonic acidamlodipine treatment. Inclusion criteria: the selection of level1,2patientswith essential hypertension (eh). Exclusion criteria: secondary causes of highblood pressure, blood pressure≧180/110MMHG, angina pectoris, acute orchronic myocardial infarction, diabetes, and other severe systemic diseasehistory; Poor patient compliance, drug or not according to stipulations cannotvisit; Unable to determine efficacy or incomplete information affect curativeeffect and safety judgement. Meet the criteria for the patients (60cases) wererandomly divided into two groups according to their clinic priorities (group Aand group B), each group30cases. Group A: given atorvastatin calcium20mg/night; Group B: given atorvastatin calcium20mg/night plus trimetazidinehydrochloride (great force, France ShiWeiYa pharmaceutical factory)60mg/day. Both groups of continuous evaluation of therapeutic effect aftertreatment of4weeks. Before drug treatment during the diet and living habits.All the patients before and4weeks after the treatment respectively to extractthe morning fasting venous blood, the determination of plasma ET-1, hs-CRP,serum NO, blood lipid and indexes of liver and kidney function. Before and4weeks after the treatment respectively measured blood pressure. Two groupsof indicators before and after the treatment were compared. All the experimental data with SPSS18.0software processing.Measurement data using mean+/-standard deviation. In comparison withpaired t test measurement data set. Comparison between the measurement dataset group t test. Count data expressed as a percentage. P <0.05statisticallysignificant.Result:1The two groups of patients with general data contrastProportion of two groups of patients age, sex, body mass index, smoking,drinking, family history were no statistically significant difference (P>0.05).2The detection index changes2.1The two groups of patients before the treatment, plasma ET-1hs-CRP, NO,blood fat, liver and kidney function and blood pressure levels had nosignificant difference(P>0.05).2.2Compared the two groups of patients before and after the treatment of liverand kidney function2.2.1ALT in the concentration of the two groups before and after the treatment(U/L), respectively:Group A:26.26±7.34before the treatment, the treatment of4weeks28.95±7.83; Group B:27.01±6.88before the treatment,4weeks treatmentwas28.02±9.09. ALT levels after the treatment in both groups compared withbefore the treatment had no significant difference (P>0.05). Before and afterthe treatment between the two groups of patients with ALT concentration bothtwo comparison there was no significant difference (P>0.05).2.2.2Scr in the concentration of the two groups before and after the treatment(umol/L), respectivelyGroup A:72.91±13.88before the treatment, the treatment of4weeks71.21±14.60; Group B:73.22±14.59before the treatment,4weekstreatment was74.21±14.20. Scr concentration after the treatment in bothgroups compared with before treatment had no significant difference (P>0.05). Before and after treatment between the two groups of patients with Scrconcentration both two comparison there was no significant difference (P> 0.05).2.3The two groups of patients before and after the treatment of blood pressurelevelsBlood pressure value of the two groups before and after the treatment(mmHg), respectively: before the treatment of group A SBP, DBP,153.87±8.4396.57±6.12, the treatment of4weeks SBP, DBP，140.57±8.1186.37±6.02, compared with before the treatment, after the treatment of SBP andDBP were down, there are significant differences (P <0.05); before thetreatment of group B SBP, DBP153.93±9.2496.97±6.55, the treatment of4weeks SBP, DBP141.33±6.5587.30±5.86,after the treatment comparedwith before the treatment, SBP and DBP were down, there are significantdifferences (P <0.05). Before and after the treatment between the two groupsof patients with blood pressure values both two comparison there was nosignificant difference (P>0.05).2.4Compared the two groups of patients with blood lipid levels before andafter the treatmentBefore and after the treatment in the two groups of TC concentration(tendency/L) are:Group A4.39±1.26before the treatment, the treatment0f4weeks was3.52±1.00, compared with before the treatment TC decreasedsignificantly after the treatment (P <0.05); Group B4.28±1.30before thetreatment,4weeks after the treatment3.45±1.08, compared with before thetreatment TC decreased significantly (P <0.05). Before and after the treatmentbetween the two groups of patients with TC concentration both twocomparison there was no significant difference (P>0.05).In the two groups before and after the treatment of LDL-C concentration(tendency/L) are: Group A1.86±1.12before the treatment,1.54±0.944weeks after the treatment,after the treatment treatment compared with beforethe treatment of LDL-C decreased significantly (P <0.05);Group B2.01±1.05before the treatment,1.61±0.77the treatment of4weeks,after thetreatment compared with before the treatment of LDL-C decreasedsignificantly (P <0.05). Before and after the treatment between the two groups of patients with LDL-C concentration both two comparison there was nosignificant difference (P>0.05).2.5Drug clinical curative effect2.5.1The changes of ET-1Comparison in groups:ET-1in the concentration of the two groups beforeand after the treatment (ng/L) are: Group A68.23±6.71before the treatment,the treatment of4weeks was62.90±5.88, compared with before thetreatment, after the treatment ET-1concentration decreased (P <0.05);GroupB before the treatment70.64±6.13,61.48±6.22, the treatment of4weeks,after the treatment compared with before the treatment, ET-1concentration decreased (P <0.05). The two groups after the treatment inpatients with ET-1concentration compared with before the treatment weredecreased, the difference was statistically significant (P <0.05).Comparison between groups: ET-1in the two groups before and after thetreatment of decline (delta d), respectively: Group A delta da=5.32±0.83,Group B delta db=7.48±0.58, the two groups of ET-1concentration reductionof comparison, group B than in group A, the difference was statisticallysignificant (P <0.05).2.5.2The changes of hs-CRPComparison in groups: the hs-CRP in the concentration of the two groupsbefore and after the treatment respectively (mg/L): Group A2.91±1.69before the treatment,2.46±1.41the treatment of4weeks,compared withbefore the treatment, after the treatment the hs-CRP were decreased (P <0.05);Group B3.01±1.48before the treatment,2.37±1.19the treatment of4weeks, after the treatment compared with before the treatment, the hs-CRPwere decreased (P <0.05). Hs-CRP concentrations after the treatment in bothgroups compared with before the treatment were decreased, the difference wasstatistically significant (P <0.05).Comparison between groups: hs-CRP in the two groups before and aftertreatment of decline (delta d), respectively: group A delta da=0.45±0.27,Group B delta db=0.44±0.29, the two groups of hs-CRP concentration reduction of comparison, group B than in group A, the difference wasstatistically significant (P <0.05).2.5.3The changes of NO:Comparison in groups: the concentration of NO in the two groups beforeand after the treatment (umol/L): Group A52.28±5.45before the treatment,57.26±5.92the treatment of4weeks,after the treatment compared withbefore the treatment, NO concentration increased (P <0.05);Group B51.92±5.30before the treatment,58.26±5.73the treatment of4weeks,after thetreatment compared with before the treatment, NO concentration increased (P<0.05). The two groups of patients after the treatment compared with beforethe treatment were NO concentration increased, the difference was statisticallysignificant (P <0.05).Comparison between groups: NO increase in the two groups before andafter the treatment (delta d), respectively: Group A delta da=4.99±3.89,Group B delta db=6.34±4.59,NO concentration increased amplitudecomparing the two groups, group B than in group A, the difference wasstatistically significant (P <0.05).Conclusion:1The primary hypertension using atorvastatin calcium, can reduce thehs-CRP, ET-1, rise the NO, show that atorvastatin calcium can effectivelyimprove endothelial function in patients with essential hypertension.2The primary hypertension combined use of atorvastatin calcium withtrimetazidine hydrochloride make the hs-CRP, ET-1reduced and make the NOrised more significantly, showed that combined with trimetazidinehydrochloride can more effectively improve endothelial function in patientswith essential hypertension.3Combined with trimetazidine hydrochloride is not increased in patientswith liver and kidney toxicity. |
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