| As the most important risk factor for stroke, hypertension causes a serious problem to the healthy of elderly people. Hypertension is a disease with high prevalence, low control rate and great danger in China. The reasons for the status quo were manifold, one of the important issues is some extraordinary hypertension types have far from been understood and resolved. H-type hypertension is a kind of extraordinary hypertension type.H-type hyperteinsion is defined as essential hypertension with Hyperhomocysteine(Hhcy), which means homocysteine(Hcy) over 10μmol/L in the human serum. Hcy level is generally high in Chinese. The 75 percent of essential hypertension patients have h-type hypertension. Hhcy have close connection with angiocardiopathy and stroke.Enalapril Maleate and Folic Acid tablet consisted of 10 mg Enalapril Maleate and 0.8mg Folic Acid, is the first drug which be admitted to treat h-type hypertension. Research shows that Enalapril Maleate and Folic Acid tablet lowers Hcy and reduces stroke risk. However, the intervention mechanisms of this decrease are unclear. The relationship among Hcy、hypertension、arterioscierosis、angiocardiopathy and stroke are really not clear. Effects of the reduction in Hcy on blood pressure and arterioscierosis are not aviliable. Whether Enalapril Maleate and Folic Acid tablet is superior to Enalapril Maleatemonotherapy on the effects maybe the point to the question. This research is lacked, need more proof.Before the change of radiological films, arterioscierosis in early period couldn’t be accurately diagnose. Pulse wave velocity(PWV) provide a way to make a diagnosis as arteriosclerosis according to conduction velocity of the pulse wave. ESC 2007 labeled PWV as an important clinical objective index that reflected the degree of arterioscierosis. PWV acted as an important method that marked the level of arterioscierosis in our research.There are some researches show persistent Hhcy maybe induce the increase of rats’ blood pressure and Endoplasmic reticulum stress(ERS) in our lab. This changes caused vascular remodeling aggravated. This study observed the connection among hcy、blood pressure and PWV, effectiveness of Enalapril Maleate and Folic Acid tablet on h-type hypertension and effect of lower Hcy on blood pressure and PWV. Preliminary explore the connection among Hcy、blood pressure and ba PWV, to reveal the mechanism. Provide new therapeutic targets and theoretical basis for the final prevention and treatment of h-type hypertension and arterioscierosis.Materials and methods 1.Patients One hundred and forty patients with H-type hypertension from our out-patient department were included. They were divided into 2 groups(Enalapril Maleate Group, Enalapril Maleate and Folic Acid group) with 70 cases for each group. The selected patients without previous serious heart, lung, circulation, liver, kidney or psychiatric problems. There are no significant difference between the two groups in sex、 age、 BMI、 heart rates、systolic blood pressure(SBP)、 diastolic blood pressure(DBP)、Hcy and ba PWV. 2.Method In Enalapril Maleate Group, 70 h-type hypertension patients were given Enalapril Maleate 10 mg one day. In Enalapril Maleate and Folic Acid group, 70 h-type hypertension patients were given Enalapril Maleate and Folic Acid tablet 10.8mg one day. Observe theblood pressure measured by mercury sphygmomanometer, IBM reckoned by weight(kg)/height2(m2), Hcy tested by nephelometry assay with latex, ba PWV examed by Omron-Colin BP 一 203 RPEl I. Observe: 1. After the 24-weeks treatment, the changes of SBP and DBP in Enalapril Maleate Group and Enalapril Maleate and Folic Acid group. 2. After the 24-weeks treatment, the changes of Hcy levels in Enalapril Maleate Group and Enalapril Maleate and Folic Acid group. 3. The connection among the parents’ Hcy levels in different blood pressure levels and the effectiveness of Enalapril Maleate and Folic Acid tablet. 4. After the 24-weeks treatment, the changes of ba PWV in Enalapril Maleate Group and Enalapril Maleate and Folic Acid group. 5. Before and after treatment, the correlation between Hcy levels and ba PWV.Results: 1.After 12 weeks or 24 weeks treatment, SBP and DBP were significantly lower than that of without treatment in Enalapril Maleate group and Enalapril Maleate and Folic Acid group(all P<0.01). After 24 weeks treatment, SBP and DBP in Enalapril Maleate and Folic Acid group were significantly lower than Enalapril Maleate group(both P<0.05). 2.After treatment, Hcy was significantly lower than without treatment in Enalapril Maleate and Folic Acid group(P<0.01). As treatment went on, Hcy was significantly lower in Enalapril Maleate and Folic Acid group. After 24-weeks treatment, Hcy was significantly lower than after 12-weeks treatment in Enalapril Maleate and Folic Acid group(P<0.01). The differences among without treatment, After 12-weeks and 24 weeks treatment were not significant(P>0.05). 3.In Enalapril Maleate and Folic Acid group as the blood pressure levels decrease, the Hcy levels were significantly higher(P<0.01). After 24 weeks treatment, the Hcy levels in different blood pressure levels had no significantly difference in Enalapril Maleate and Folic Acid group(P>0.05). 4.After 24 weeks treatment, ba PWV was significantly lower than before treatment in Enalapril Maleate group and Enalapril Maleate and Folic Acid group(both P<0.01). After 24 weeks treatment, ba PWV was significantly lower in Enalapril Maleate and Folic Acid group than in Enalapril Maleate group(P<0.05).5. Before the treatment, Hcy and ba PWV were positively correlated in Enalapril Maleate and Folic Acid group(r=0.619)(p<0.01);After 24 weeks treatment, As the Hcy reduced, ba PWV was reducing. In Enalapril Maleate and Folic Acid group, after treatment, Hcy and ba PWV were still positively correlated(r=0.647)(p<0.01).Conclusion: Enalapril Maleate and Folic Acid tablet can efficiently reduce Hcy levels, longtime treatment superior to short time. Enalapril Maleate can’t decrease Hcy. In Enalapril Maleate and Folic Acid group as the blood pressure levels decrease, the Hcy levels were significantly higher. Use Enalapril Maleate and Folic Acid tablet for 24 weeks, the Hcy levels had no difference among different blood pressure levels. This resulut show Hcy close linked blood pressure levels, and Enalapril Maleate and Folic Acid tablet can always efficiently control Hcy levels in every blood pressure levels. Enalapril Maleate and Folic Acid tablet was superior to Enalapril Maleate tablet for SBP、DBP、ba PWV on patients with h-type hypertension. Hcy and ba PWV were positively correlated. Enalapril Maleate and Folic Acid tablet reduced Hcy, caused better clinical outcome in blood pressure and ba PWV. This study provides Hcy maybe take part in the the progression of hypertension and arterioscierosis, Enalapril Maleate can efficiently improve prognosis of h-type hypertension. |
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