【摘要】 目的观察氨氯地平/阿托伐他汀复方制剂对初发高血压合并边缘高胆固醇血症患者的血管内皮和动脉壁功能与解剖,以及Framingham心血管发病风险的影响。方法前瞻性入选2012年2~12月在北京大学第三医院心内科门诊就诊的57例初发1~2级高血压合并边缘高胆固醇血症的患者,予以氨氯地平/阿托伐他汀钙片5 mg/10 mg治疗,剔除治疗4周后血压仍≥140/90 mmHg的患者,最终40例患者入选。观察治疗对血压及常规生化指标、双侧颈动脉内膜中层厚度、肱踝脉搏波速度及踝臂指数和血管内皮功能标志物一氧化氮(NO)、一氧化氮合酶(eNOS)和内皮素1水平的影响。结果患者年龄26~65岁,平均(48.5±9.5)岁,男性25例(62.5%)。1级高血压患者30例(75%),2级10例(25%)。与基线相比,氨氯地平/阿托伐他汀5 mg/10 mg复方制剂治疗12周和24周时的收缩压[(127.54±10.02)mmHg和(124.21±9.50)mmHg比(141.74±11.64)mmHg,均为P<0.01],舒张压[(77.50±10.78)mmHg和(75.16±8.23)mmHg比(89.63±6.12)mmHg,P=0.02,0.00],TC[(4.17±0.64)mmol/L和(4.37±0.66)mmol/L比(5.46±0.69)mmol/L,均为P<0.01],LDL-C[(2.46±0.57)mmol/L和(2.47±0.58)mmol/L比(3.46±0.66)mmol/L,均为P<0.01],TG[(1.57±0.77)mmol/L和(1.62±0.90)mmol/L比(2.04±1.50)mmol/L,P=0.07,0.01],高敏C反应蛋白[(2.14±2.11)mg/L和(2.11±1.36)mg/L比(4.17±3.18)mg/L,P=0.03,0.00]均有明显下降。随治疗时间的延长(0周,4周,12周,24周),血清NO[(19.00±1.57)nmol/ml,(20.78±1.35)nmol/ml,(22.67±1.37)nmol/ml,(25.23±1.42)nmol/ml],eNOS[(17.70±1.67)U/ml,(19.04±1.19)U/ml,(24.06±1.68)U/ml,(25.61±1.70)U/ml]水平逐渐升高,内皮素1[(94.73±3.74)pg/ml,(87.74±0.56)pg/ml,(76.89±8.15)pg/ml,(66.71±8.39)pg/ml]水平逐渐下降,各时间点间差异有统计学意义(均为P<0.01)。治疗24周时颈动脉内膜中层厚度[右侧:(0.71±0.15)mm比(0.83±0.22)mm,P<0.01;左侧:(0.76±0.18)mm比(0.84±0.23)mm,P=0.02],肱踝脉搏波速度[右侧:(1 319±241)m/s比(1 572±295)m/s,P<0.01;左侧:(1 316±208)m/s比(1 574±256)m/s,P<0.01]较基线值也有显著下降,但双侧踝臂指数没有明显改变。此外,治疗24周后,再次评估Framingham 10年心血管病风险显著下降(5.8%±6.5%比10.0%±10.1%,P<0.01)。结论初发1~2级高血压患者接受联合降压调脂治疗,可能有助于改善血管内皮功能,延缓动脉粥样硬化进展。更多还原

【Abstract】 Objective To observe the influence of amlodipine/atorvastatin( AML/ATO) single-pill therapy in patients with newly diagnosed hypertension and edge of hypercholesterolemia on vascular endothelial function,the function and anatomy of artery wall and Framingham cardiovascular risk. Methods From February to December in 2012 at Peking University Third Hospital Cardiology Clinic,57 patients who were newly diagnosed grade 1 to 2 hypertension and the edges of hypercholesterolemia were prospectively enrolled. All patients were prescribed AML / ATO( 5 mg /10 mg). 4 weeks later,patients with blood pressure more than 140 /90 mmHg were removed. Finally 40 patients completed the follow-up. We observed the impact of therapy on blood pressure,routine biochemical indicators,bilateral carotid artery intima-media thickness( IMT),bilateral brachial-ankle pulse wave velocity( baPWV),bilateral ankle-brachial index( ABI) and biomarkers of endothelial function including nitric oxide( NO),nitric oxide synthase( eNOS) and endothelin-1( ET-1). Results The mean age of patients was 48. 5 ± 9. 5 years( 26- 65 years old), including 25 males( 62. 5%). There were 30 patients( 75%) diagnosed hypertension of grade 1,10 patients diagnosed hypertension of grade 2. Compared with baseline,after AML / ATO( 5 mg /10 mg) therapy for 12 and 24 weeks,SBP [( 127. 54 ± 10. 02) mmHg and( 124. 21 ± 9. 50) mmHg vs.( 141. 74 ± 11. 64) mmHg,both P < 0. 01],DBP[( 77. 50 ± 10. 78) mmHg and( 75. 16 ± 8. 23) mmHg vs.( 89. 63 ± 6. 12) mmHg,P = 0. 02,0. 00],TC[( 4. 17 ± 0. 64) mmol / L and( 4. 37 ± 0. 66) mmol / L vs.( 5. 46 ± 0. 69) mmol / L,both P < 0. 01],LDL-C[( 2. 46 ± 0. 57) mmol / L and( 2. 47 ± 0. 58) mmol / L vs.( 3. 46 ± 0. 66) mmol / L,both P < 0. 01 ],TG [( 1. 57 ± 0. 77) mmol / L and( 1. 62 ± 0. 90) mmol / L vs.( 2. 04 ± 1. 50) mmol / L,P = 0. 07,0. 01],hs-CRP[( 2. 14 ± 2. 11) mg / L and( 2. 11 ± 1. 36) mg / L vs.( 4. 17 ± 3. 18) mg / L,P = 0. 03,0. 00] were significantly decreased. With the therapy prolonged( 0 week,4 weeks,12 weeks, 24 weeks),the plasma levels of NO [( 19. 00 ± 1. 57) nmol / ml,( 20. 78 ± 1. 35) nmol / ml,( 22. 67 ± 1. 37) nmol / ml,( 25. 23 ± 1. 42) nmol / ml],eNOS [( 17. 70 ± 1. 67) U / ml,( 19. 04 ± 1. 19) U / ml,( 24. 06 ± 1. 68) U/ml,( 25. 61 ± 1. 70) U/ml] were gradually increased and plasma levels of ET-1 [( 94. 73 ± 3. 74) pg/ml,( 87. 74 ± 0. 56) pg/ml,( 76. 89 ± 8. 15) pg/ml,( 66. 71 ± 8. 39) pg/ml] gradually decreased,there were significant difference between every time point( P < 0. 01). Meanwhile, after therapy for 24 weeks,IMT [right side:( 0. 71 ± 0. 15) mm vs.( 0. 83 ± 0. 22) mm,P < 0. 01; left side:( 0. 76 ± 0. 18) mm vs.( 0. 84 ± 0. 23) mm,P = 0. 02],baPWV [right side:( 1 319 ± 241) m / s vs.( 1 572 ± 295) m/s,P < 0. 01; left side:( 1 316 ± 208) m/s vs.( 1574 ± 256) m/s,P < 0. 01] were significantly decreased compared with baseline,but no significant changes in bilateral ABI were observed. In addition,after therapy for 24 weeks,Framingham 10-years cardiovascular risk re-evaluated was significantly decreased( 5. 8% ± 6. 5% vs. 10. 0% ± 10. 1%,P < 0. 01). Conclusions Antihypertensive combined lipid-lowering therapy in patients in moderate and low risk who were newly diagnosed hypertension of grade 1 to 2 may help to improve vascular endothelial function and delay the progress of atherosclerosis.更多还原