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目的探讨氨氯地平与地尔硫卓缓释片联用对原发性高血压(EH)患者血管内皮功能的影响。方法初诊轻中度EH患者111例随机分为氨氯地平(5～10 mg,1次/d)与地尔硫卓缓释片(90 mg,1次/d)联合治疗组(联合组,n=56)或氨氯地平单用组(氨氯地平组,5～10 mg,1次/d,n=55),随防12月。采用高分辨率超声技术检测治疗前后的血流介导的肱动脉内皮依赖性血管舒张功能(FMD);检测治疗前后血清内皮素1和一氧化氮的变化。结果随访12月后,与同组治疗前比较,两组患者的血压下降,联合组血压下降幅度为-36 mmHg,单用组为-22 mmHg,两组相比较差异有统计学意义(P<0.05)。两组在治疗后FMD提高[氨氯地平组,治疗前(7.3±1.9)%比治疗后(9.6±2.2)%;联合组,治疗前(7.4±2.0)%比治疗后(11.1±2.3)%],一氧化氮升高,内皮素1降低(均P<0.05);与氨氯地平组比较,联合组降低血压,增加一氧化氮水平,降低内皮素1,改善肱动脉的血管内皮功能都较明显(P<0.05)。多元线性逐步回归显示,校正年龄、血压、血脂、血糖等因素后,内皮素1和一氧化氮是FMD的影响因素(均P<0.05)。结论氨氯地平与地尔硫卓缓释片联合治疗改善EH患者的血管内皮功能,可能与降低血压、减少内皮素1分泌、增加一氧化氮水平有关。
Objective To investigate the effect of amlodipine combined with diltiazem on vascular endothelial function in patients with essential hypertension (EH). Methods One hundred and eleven patients with newly diagnosed mild to moderate EH were randomly divided into amlodipine (n = 5, 10 mg once a day) and diltiazem (90 mg once a day) ) Or amlodipine alone group (amlodipine group, 5 ~ 10 mg, 1 time / d, n = 55), with anti-December. Blood flow-mediated brachial artery endothelium-dependent vasodilation (FMD) was measured by high resolution ultrasound before and after treatment. Changes of serum endothelin-1 and nitric oxide were detected before and after treatment. Results After 12 months of follow-up, compared with the same group before treatment, the blood pressure of the two groups decreased, the decrease of blood pressure in the combination group was -36 mmHg and -22 mmHg in the combination group, the difference was statistically significant (P < 0.05). FMD was improved in both groups (amlodipine group, 7.3 ± 1.9% vs 9.6 ± 2.2% before treatment and 7.4 ± 2.0% vs 11.1 ± 2.3%, respectively) %], Nitric oxide increased, endothelin 1 decreased (all P <0.05); Compared with amlodipine group, the combination group decreased blood pressure, increased nitric oxide levels, decreased endothelin 1, improved endothelial function of the brachial artery Are more obvious (P <0.05). Multivariate linear stepwise regression showed that endothelin 1 and nitric oxide were the influencing factors of FMD (all P <0.05) after adjusting for age, blood pressure, blood lipids, blood glucose and other factors. Conclusion Combination of amlodipine and diltiazem sustained-release tablets can improve endothelial function in patients with EH, which may be related to lowering blood pressure, decreasing endothelin-1 secretion and increasing nitric oxide.