| Prehypertension is a special stage between normal blood pressure andhypertension, and the backup for development of hypertension. Prehypertensivescombined with a higher risk of cardiovascular disease than normal individuals, andhave already exist the target organ damage. Recently, the research at home and abroadon the effect of antihypertensive drugs in prehyertensives had been carried out. Andseveral researches have demonstrated that the appropriate antihypertensive drugs takeeffect to postpone the progress from prehypertension into hypertension. Ambulatoryblood pressure monitoring(ABPM), a valuable non-invasive method of measuringblood pressure change, plays an important role on the diagnosis of hypertension and theevaluation of antihypertensive drugs. ABPM is closely related to the cardiovascularevents, and is a better predictor of cardiovascular risk than casual blood pressuremonitoring (CBPM). At present, using ambulatory blood pressure parameters toevaluate the effect of antihypertensive drugs in prehypertension has rarely beenreported. The aim of the study was to evaluate the hemodynamic effects ofantihypertensive drugs with ambulatory blood pressure parameters including the meanblood pressure, circadian rhythm and blood pressure variability, further to provide thetheoretical basis for prevent and control of prehypertension.【Objective】⑴To observe the characteristics of different circadian rhythm type individuals inprehypertensives.⑵To explore the relationship between ambulatory blood pressure parameters andarterial elasticity in prehypertensives. ⑶To observe the effect of different antihypertensive agents on the average bloodpressure, circadian rhythm and blood pressure variability in prehypertensives.⑷To observe the effect of different antihypertensive agents on the new cases ofhypertension and cerebro-cardiovascular events in prehypertensives.【Methods】360prehypertensives aged from40to70years old with cardiovascular risk factorswere enrolled, they were randomized into three treatment groups, namely, telmisartangroup120cases, indapamide group120cases, control group120cases. At the baselineand the end of study, general clinical data of all subjects such as weight, waist and hipcircumference were measured; blood biochemical indexes such as fasting plasmaglucose and serum lipids were examined;24hour ambulatory blood pressure weremeasured using non-invasive portable ambulatory blood pressure monitoring (ABPM),then calculated the parameters involving circadian rhythm and blood pressurevariability. Carotid-radial pulse wave velocity (crPWV) were performed using theSphygmoCor device. Carotid intima-media thickness (IMT) was obtained using GEvivid i ultrasonography. Participants were visit at baseline and every3monthsthereafter until the24-month visit. During each subsequent clinical visit, drugs weredistributed and recycled. Clinical data such as blood pressure and heart rate werecollected by specialized persons. The new cases of hypertension and cerebro-cardiovascular events were collected and recorded.【Results】⑴Non-dipper circadian rhythm individuals accounted for41.4percent inprehypertensive participants. Nighttime systolic blood pressure(nSBP), nighttimediastolic blood pressure(nDBP) in non-dipper type group were higher than that indipper type group, while systolic blood pressure falling (SBPF) in non-dipper typegroup were lower than that in dipper type group (P<0.01); low density lipoproteincholesterol (LDL-C) in non-dipper type group are higher than that in dipper type group(P<0.05); crPWV and IMT in non-dipper type group are higher than that in dipper typegroup (P<0.05). ⑵Taking crPWV as dependent variable, crPWV is negative correlation withsystolic blood pressure falling, and positive correlation with24-hour systolic bloodpressure, daytime systolic blood pressure, nighttime systolic blood pressure, age, totalcholesterol, triglyceride, and fasting plasma glucose; Multiple liner regression showedthat: crPWV (m/s)=8.308+0.03×nSBP(mmHg)+0.054×TC(mmol/L)-0.139×SBPF,nSBP, TC and SBPF were risk factors for crPWV.⑶Taking IMT as dependent variable, IMT is negative correlation with systolicblood pressure falling, and positive correlation with24-hour systolic blood pressure,daytime systolic blood pressure, nighttime systolic blood pressure, age, total cholesteroland low density lipoprotein cholesterol; Multiple liner regression showed that: IMT(m/s)=0.460+0.024×24hSBP(mmHg)+0.051×LDL-C(mmol/L)-0.007×SBPF,24hSBP,LDL-C and SBPF were risk factors for IMT.⑷At the end of treatment, total cholesterol, LDL-C, fasting plasma glucose aresignificant decreased in telmisartan group (P<0.05). While no significant difference inindapamide group.⑸At the end of treatment,24-hour systolic and diastolic blood pressure, daytimesystolic and diastolic blood pressure, nighttime systolic and diastolic blood pressure aredecreased in the two treatment groups (P<0.01). Non-dipper circadian rhythm rate aredecreased meanwhile SBPF are increased in telmisartan group (P<0.05). While nosignificant difference in indapamide group.⑹At the end of treatment,24-hour systolic blood pressure standard deviation aredecreased in indapamide group (P<0.05). While no significant difference in telmisartangroup.⑺At the end of treatment, crPWV and IMT are significant decreased intelmisartan group (P<0.05). While no significant difference in indapamide group.⑻Compared with control group, the new cases of hypertension in telmisartangroup and indapamide group are significant decreased (P<0.01). The cases of clinicalcerebro-cardiovascular events are no significant difference in the three groups. 【Conclusion】⑴In prehypertensive participants, non-dipper circadian rhythm individuals havehigher risk factors of cardiovascular disease, and more severe arteriosclerosis than thedipper individuals.⑵In prehypertensives, systolic blood pressure falling is closely related toarteriosclerosis, and is one of the important influence factors for arterial elasticity.⑶Telmisartan and indapamide were significantly reduced24-hour, daytime,nighttime systolic and diastolic blood pressure.⑷Telmisartan is conducive to improve the non-dipper circadian rhythm, andbetter protect the arterial function and structure.⑸Indapamide is less effective to improve the non-dipper circadian rhythm butsignificantly reduced24-hour systolic blood pressure variability.⑹Two antihypertensive drugs effectively reduce the new cases of hypertension,but no significant statistical significance on reducing cerebro-cardiovascular events. |
PDF Full Text Request