| Objective: Essential hypertension is closely related to the incidenceand mortality of cardiovascular events, cardiovascular and cerebrovascular events have seriously affected the quality of human life. Many studies show that essential hypertension can lead to and increased endothelialdysfunction, and hypertension can accelerate the development endothelial dysfunction, then they form a vicious circle. So improving endothelialfunction status more attention in the treatment of essential hypertension.Numerous clinical trials have certified that atorvastatin calcium not only has slowed lipid effects, but also has improved endothelial function, anti-inflammatory and antioxidant function. The ezetimibe as a new lipidlowering drugs, whether has the function of improving endothelial, anti-inflammatory lipid external action, which is currently rarely reported. This study aimed to view atorvastatin calcium combined with ezetimibe whether can be further improve endothelial function in patients with essential hypertension.Methods: Choose60patients diagnosed as hypertension in SecondHospital of Hebei Medical University from January2013to August2013.Inclusion criteria：hypertension diagnostic criteria in line with2005Chinese Hypertension Prevention Guide recommended method: blood pressure≥140/90mmHg (1,2-level selected patients with hypertension).Exclusion criteria:①liver, kidney dysfunction or heart failure.②severe gastrointestinal disease may affect the absorption of the drug in patient.③on statins and ezetimibe allergies.④creatine kinase>2times the upperlimit of normal.⑤diagnosis of secondary hypertension,coronary heart disease, diabetes and other serious diseases organic systems.⑥The patien t who is failing to medication and cannot regularly visit.The60patientsmet the inclusion criteria were randomly divided into two groups.Bothgroups have30patients. Group A(monotherapy group):given levamlodipine lesylate tablets2.5mg1/QD,atorvastatin calcium20mg1/QN;Group B(combination group):given levamlodipine lesylate tablets2.5mg1/QD,atorvastatin20mg1/QN and ezetimibe tablets10mg/QD, diet and lifestyle is same as before medication during treatment.All enrolled patients were obtained fasting blood samples before treatment and after4weeks oftreatment, which is used to evaluate the level plasma lipids,NO,ET-1,Hs-CRP levels, liver and kidney function. The statistics of Hs-CRP,NO,ET-1was observed before and after treatment.The experimental data will be dealed with by using SPSS13.0software for statistical analysis.“P <0.05”is considered statistically significant. Measurement data were expressed as mean±standard deviation.While between the two groups were compared using t test. Count datawas expressed as a percentage.Results:1,the general condition of enrolled patientsBasic information (age,gender,body mass index,smoking rates,drinking rates,family history,blood lipids,blood pressure levels) in patients doesnot have statistically significant difference between two groups (P>0.05).2,the changes of liver and kidney function in the two groups，patientsbefore and after treatment:The level of ALT and Scr in Two groups’ patients has no significant difference in baseline. Within groups: two groups of patients after treatment had varying degrees of elevated ALT, and then gradually declined (P<0.05);Scr levels showed no significant change in each period. Between the two groups:ALT and Scr patients in each group at different times pair wise comparisons showed no significant difference.3, the changes of Hs-CRP before and after treatment:Within the group:Hs-CRP concentrations in two groups(mg/L) were a s follows before and after treatment:pre-treatment, groupA3.32±1.25; groupB2.90±1.68;4weeks, group A2.45±1.41,group B2.10±0.71;4weeks compared with before treatment, groupA dropped△da=0.48±0.45（P<0.05）,groupB fell△db=1.21±0.68(P<0.05);therefore can be summarized as follows:Hs-CRP in two groups appear lower since the application of the drug in patients, while the difference has statistically significant.Between the two groups: two groups before and after treatment compared△d, groupA dropped△da=0.48±0.45(P<0.05), groupB fell△db=1.21±0.68(P<0.05),it can be summed up as, in atorvastatin calcium combinedwith ezetimibe group Hs-CRP is lower magnitude more obvious, whichhas statistically significant.4, the changes of vascular endothelial function before and after treatment:Within the group:ET-1concentrations in two groups (mg/L) beforeand after treatment were as follows:before treatment, group A68.23±6.70, GroupB71.68±6.62;4weeks,groupA62.90±5.88, groupB61.62±6.79;4weeks compared with before treatment, groupA drop△da=5.32±3.88(P<0.05), groupB fell△db=9.94±5.68(P<0.05); therefore it can be summarized as that: ET-1in two groups appear lower since the application of the drug in patients, while the difference has statistically significant.Between the two groups:two groups before and after treatment compared△da=5.32±3.88(P<0.05),group B fell△db=9.94±5.68(P<0.05),it can besummed up as, in atorvastatin calcium combined with ezetimibe groupET-1is lower magnitude more obvious, which has statistically significant.Within the group: NO concentrations in two groups before and after treatment were as follows:pre-treatment, group A52.28±5.45,group B50.42±4.72:4weeks, groupA56.83±5.92, groupB58.08±5.24;4weeks compared with before treatment,groupA drop△da=-4.55±4.12(P<0.05), group Bfell△db=-7.43±7.77(P<0.05);therefore can be summarized as that: Noun two groups appear lower since the application of the drug in patients, while the difference has statistically significant.Between the two groups: two groups before and after treatment compared△d, groupA dropped△da=-4.55±4.12(P<0.05), groupB fell△db=-7.43±7.77(P<0.05),it can be summed up as, in atorvastatin calcium combined with ezetimibe group NO is lower magnitude more obvious, whichhas statistically significant.5、the changes of blood pressure before and after treatment：Blood pressure within the group:The blood pressure(mmHg) of groupA before and after treatment was as follows: systolic blood pressure before treatment was153.87±8.43,4weeks was140.10±8.15;while diastolic blood pressure before treatmentwas105.00±96.3,4weeks diastolic was84.90±5.44. After treatment, systolic and diastolic blood pressures were both lower, compared with before treatment there were statistically significant differences.Blood pressure (mmHg) of group B Blood pressure before and aftertreatment was: systolic blood pressure before treatment was153.13±8.47,4weeks140.23±7.52;diastolic blood pressure before treatment was105.00±96.3, diastolic blood pressure at4weeks was84.90±5.44. After treatment, systolic and diastolic blood pressures were both lower, comparedwith pre-treatment differences statistically significant.Blood pressure between the two groups:systolic blood pressure drop in two groups:△da=13.77±5.70(P<0.05),△db=12.90±4.55(P<0.05), the magnitude of differences of systolicblood pressure do not exist statistically significant in the two groups.Two diastolic decline:△da=11.4±5.29(P<0.05),△db=9.27±4.08(P<0.05),the magnitude of differences of systolic blood pressure do notexist statistically significant in the two groups.6、the lipid changes of two groups before and after treatment：The level of LDL-C within group: the level of LDL-C concentrations(mmol/L) in two groups before and after treatment were as follows: before treatment, groupA1.99±1.20, group2.33±1.18;4weeks, groupA1.55 ±1.00, groupB1.36±0.56. group A dropped△da=0.44±0.56(P<0.05);groupB fell△db=0.97±0.84(P<0.05). LDL-C was lower in both groupscompared with pre-treatment differences existed statistically significant.The level of LDL-C between groups: the level of LDL-C concentrations (mmol/L) in two groups before and after treatment were as follows:groupA dropped△da=0.44±0.56(P<0.05), groupB fell△db=0.97±0.84(P<0.05). Atorvastatin calcium and ezetimibe reduced LDL-C group magnitude more obviously,differences existed statistically significant.The level of CHOL within group: the level of CHOL concentrations(mmol/L) in two groups before and after treatment were as follows: before treatment, group A4.39±1.26, Group B4.67±0.79;4weeks, groupA3.51±0.10, GroupB3.08±1.01. groupA dropped△da=0.84±0.45(P<0.05); groupB dropped△db=1.47±0.68(P<0.05). CHOL was lower inboth groups compared with pre-treatment differences existed statisticallysignificant.The level of CHOL between groups: the level of LDL-C concentrations (mmol/L) in two groups before and after treatment were as follows:groupA dropped△da=0.84±0.45(P<0.05), groupB dropped△db=1.47±0.68(P<0.05).Atorvastatin calcium ezetimibe group CHOL lower magnitude more obviously,differences existed statistically significant.Conclusions:1,The factors of vascular endothelial inflammatory ET-1,Hs-CRP decreased,NO increased after the patients with essential hypertension taking atorvastatin calcium.Atorvastatin calcium can improve endothelial function in patients with essential hypertension.2,in atorvastatin calcium combined with ezetimibe,Hs-CRP,ET-1decreased more obviously andNO elevated more obviously in the patients with essential hypertension.Combined treatment showed better improvement in endothelial function in essential hypertensive patients with primary aspects.3,The combinationtherapy compared to immunotherapy groups in the patients with essential hypertension.; there is no significant increase in liver and kidney toxicity.4,In atorvastatin calcium combined with ezetimibe,lipid decreased mor e obviously. |
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