Effect Of Enalapril Maleate Folic Acid Tablets Combined With Simvastain Tablets On Imflammatory Factors Of The Patients With H-hypertension

objective To investigate the effects of enalapril maleate folic acid tablets combined with simvastatin tablets on blood pressure,serum homocysteine(Hcy),Tumor necrosis factor alpha(TNF-?),interleukin-6(IL-6),high-sensitive C-reactive protein(hs-CRP)in patients with H-hypertension.To explore the correlation factors of serum homocysteine.At the same time,searching for possible risk factors may lead to the increase of serum homocysteine.Methods From April 2017 to October 2017,108 patients with H-hypertension were selected from cardiovascular department of Mianyang Third People's Hospital.According to the inclusion and exclusion criteria to determine whether the patient is included.The subjects were divided into observation group(53 cases)and control group(55 cases)by random number table method,and the clinical and biochemical data of patients in the group were recorded.At the start of the trial,the control group received 1 tablet of enalapril maleate folic acid tablet(specification: 10 mg: 0.8 mg/tablet)daily for 8 weeks.And the observation group were given 1 tablet of enalapril maleate folic acid tablet(specification: 10 mg: 0.8 mg/tablet)daily and 1 tablet of simvastatin tablet(specification: 10 mg/tablet)daily for 8 weeks.The subjects were followed up by telephone every two weeks during the medication.All the subjects were examined for blood pressure,Hcy,hs-CRP,TNF-?,IL-6 in the outpatient clinic after 4 and 8 weeks of medication.After 4 weeks of treatment,subjects whose blood pressure was still not controlled within the target range were given levamlodipine besylate tablets 1 tablet each day(specification:2.5 mg/tablet).Finally,the recorded experimental data were sorted out and the statistical analysis was completed.Results1.There was no significant difference in sex,age,smoking index,BMI,hypertension course,blood pressure,total weekly exercise time,resting heart rate,Hcy,TNF-?,IL-6,hs-CRP,TC,LDL,HDL between the two groups(p>0.05).2.The results of Pearson correlation analysis showed that serum Hcy was correlated with age(r=0.45,P<0.01),the course of hypertension(r=0.63,P<0.01),the smoking index(r=0.39,P<0.01),the body mass index(r=0.20,P =0.04),total cholesterol(r=0.75,P<0.01),Low density lipoprotein(r=0.69,P<0.01),cystatin(r=0.56,P<0.01),systolic blood pressure(r=0.47,P<0.01),diastolic blood pressure(r=0.20,P =0.04),and there was a negative correlation with the total weekly exercise time(r=-0.47,P<0.01)and the glomerular filtration rate(r=-0.48,P<0.01).Multiple linear regression analysis showed that the risk factors of Hyperhomocysteinemia included age(t=2.19,P<0.05),the course of hypertension(r=2.89,P<0.01),smoking index(t=2.38,P<0.05),TC(r=2.23,P<0.05),SBP(r=2.63,P<0.05),and hs-CRP(r=3.86,P<0.01).3.In the change of blood pressure,the blood pressure level of the two groups decreased significantly after 4 and 8 weeks of treatment,and the difference was significant comparison with baseline(P<0.05).Comparison between groups: there was no significant difference in blood pressure level and effective rate of lowering blood pressure between the two groups at 4 weeks after treatment(p>0.05),but after 8 weeks of treatment,compared with the control group,the blood pressure in the observation group decreased significantly(p<0.05)[SBP(130.96�9.01)VS.(134.94�8.45),P=0.025;DBP(66.82�7.90)VS.(71.82�7.70),P=0.002],and the effective rate of lowering blood pressure of the observation group was significantly better than that of the control group(p<0.05).In terms of blood pressure compliance rate,no matter 4 weeks or 8 weeks after treatment,there was no significant difference in blood pressure compliance rate between the two groups(p>0.05).4.In the change of Hcy level,the levels of Hcy in both groups decreased significantly after 4 weeks and 8 weeks of treatment,and there was significant difference compared with that before treatment(p<0.05).Comparison between groups showed that the effective rate of reducing Hcy in observation group was better than that in control group [44(88%)vs.36(72%),p=0.04] only after 8 weeks of treatment(p<0.05).However,there was no significant difference in Hcy level and compliance rate of Hcy reduction between the two groups after treatment no matter 4 weeks or 8 weeks(p>0.05).5.In terms of reducing inflammatory markers,after 4 weeks and 8 weeks of treatment,compared with baseline,the levels of IL-6,TNF-? and hs-CRP were significantly reduced(p<0.05).Comparison between the two groups showed that after 4 weeks of treatment,compared with the control group,IL-6 [(5.68�2.04)vs.(7.02�2.37),p=0.003],TNF-?[(8.66�2.55)vs.(10.42�2.91),p=0.002],hs-CRP[(2.66�1.01)vs.(3.16�1.01),p=0.016] in the observation group were significantly reduced,and the difference was statistically significant(p<0.05).After 8 weeks of treatment,IL-6[(5.04�1.86)vs.(6.00� 2.25),p=0.02],TNF-?[(7.91�2.17)vs.(9.5�2.59),p=0.001],hs-CRP[(2.20�0.85)vs.(2.73�0.97),p=0.005] in the observation group were significantly lower than those in the control group(p<0.05).Conclusion1.Hcy is closely related to age,course of hypertension,smoking index,SBP,hs-CRP.2.The combination of simvastatin and enalapril folic acid tablets for 8 weeks had synergistic hypotensive effect,and could improve the effective rate of blood pressure reduction.3.Compared with enalapril maleate folic acid tablets alone,enalapril maleate folic acid tablets combined with simvastatin tablets could significantly reduce vascular inflammatory response.