硝苯地平控释片对动脉脉搏波传导速度增高的轻度高血压患者的早期干预

发布时间：2017-12-27 17:20

本文关键词：硝苯地平控释片对动脉脉搏波传导速度增高的轻度高血压患者的早期干预　出处：《河北医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:高血压是最常见的慢性病,也是心脑血管病最主要的危险因素,严重危害人类的健康。治疗高血压的主要目的是最大限度的降低心脑血管并发症的发生和死亡的总体风险。因此,应在控制血压值的同时,对检出的血管病变等亚临床靶器官损害进行有效干预,让患者的远期预后得到改善。动脉脉搏波传导速度(pulse wave velocity,PWV)是动脉僵硬度的良好指示器,年龄、性别、血压等都是PWV的决定因素。在对高血压进行积极干预,尤其是早期干预时,可通过这个指标检测以及评估药物干预血管病变的效果。很多研究表明,明确增加动脉顺应性的药物有钙通道阻滞剂、血管紧张素转换酶抑制剂、血管紧张素II受体拮抗剂和硝酸酯类,但降压药物的机制不同,对心血管的保护作用也不同。近20年来,钙通道阻滞剂(calcium channel blockers,CCB)作为阻滞细胞膜钙通道来降压的化学制剂,广泛应用于高血压的降压治疗,通过有效降压可显著降低冠心病患者心肌梗死、卒中和心源性死亡等心血管不良事件的发生率。近来研究表明,钙通道阻滞剂可以重塑血管内皮,改善血管动脉硬化,并且在将患者血压降至平稳后仍有改善动脉硬化的作用,这说明钙通道阻滞剂有不依赖降压作用的改善动脉僵硬度的作用。二氢吡啶类的钙通道阻滞剂硝苯地平控释片因为其有效降压作用和良好的耐受性已用于心血管疾病临床治疗多年,既往有小样本研究表明硝苯地平在降压时显著降低PWV的水平,但大规模的临床研究国内还未见报道。本课题选取60例新诊断为轻度高血压合并PWV增高的18到75岁患者,给予患者硝苯地平控释片降压治疗,共随访24周,期间监测血压、心率、臂-踝动脉脉搏波传导速度(brachial-ankle pulse wave velocity,ba PWV)等指标。目的是评价硝苯地平控释片在高血压病程早期对动脉僵硬度的干预情况,以及是否存在不依赖于降压作用的改善PWV的效果,以用于指导目前高血压的诊断与治疗。方法:研究对象为2013年12月至2014年12月于河北医科大学第二医院新诊断为轻度高血压合并PWV增高的60名患者。本研究为单中心、单组、前瞻性、IV期临床研究。研究开始给予患者硝苯地平控释片(30mg 1/日)治疗4周,若血压降至140/90mm Hg以下,则维持该剂量;若血压未达标,则剂量倍增,予硝苯地平控释片60mg 1/日治疗,若硝苯地平控释片60mg1/日治疗8周后后仍未达标,治疗医生可根据临床常规进行治疗。在基线、2周、4周、8周、12周、18周及24周进行随访,测量患者的血压、心率,直至试验结束。在基线、4周、12周和24周时测量患者的臂-踝动脉脉搏波传导速度(ba PWV)。数据采用SPSS17.0进行统计分析。计量资料服从正态分布时用均数?标准差(x±s)表示,计数资料采用百分数率表示,基线、4周、12周、24周测量的ba PWV、血压各自之间用重复测量方差分析比较,两者之间做双变量直线相关分析(Person相关分析),治疗4周后ba PWV的变化与血压的变化同样做双变量直线相关分析,与吸烟、饮酒、胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、血糖、BMI、年龄、性别做多元线性回归分析。P0.05认为有统计学差异。结果:1降压治疗后SBP、DBP、HR、MAP、PP变化:(1)治疗24周后24小时动态血压较基线比有明显降低(P0.001);降压治疗4周、12周、24周后SBP、DBP、MAP、PP均较治疗前明显降低(P0.001),均有统计学意义;(2)降压治疗12周、24周后的SBP、DBP、MAP、PP较降压治疗4周时无明显变化(P0.05);(3)降压治疗4周、12周、24周时HR较治疗前均未见明显变化(P0.05)。2降压治疗前后ba PWV的变化:(1)硝苯地平控释片降压治疗4周12周、24周后ba PWV较治疗前均可见明显降低(P0.001);(2)治疗12周较治疗4周时及治疗24周时较12周时ba PWV无明显变化(P0.05)。3 ba PWV与血压的相关性分析:基线、4周、12周、24周的ba PWV与SBP的相关系数为0.99,P=0.01;与DBP的相关系数为0.987,P=0.013;与MAP的相关系数为0.992,P=0.008,均有统计学意义,与PP的相关系数为0.943,P=0.057,无统计学意义。4△ba PWV0的相关因素分析:△ba PWV0与△SBP0的相关系数为0.327,P=0.008;与△DBP0的相关系数为0.347,P=0.005;与△MAP0的相关系数为0.388,P=0.002,均有统计学意义。△ba PWV0与△PP0、吸烟、饮酒、胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、血糖、BMI、年龄、性别等因素做多元性线性回归分析均无相关性(P0.05)。结论:硝苯地平控释片对于轻度高血压合并ba PWV增高的患者,在有效降压的同时,能显著降低ba PWV,使动脉硬化改善;而且ba PWV的降低与其降压作用相关,这种降低ba PWV的作用在用药早期(4周内)即可出现,并与收缩压、舒张压、平均压的降低相关。未观察到除降压外改善PWV的作用。
[Abstract]:Objective: hypertension is the most common chronic disease, and it is also the most important risk factor of cardiovascular and cerebrovascular disease, which seriously endangers human health. The main purpose of the treatment of hypertension is to minimize the overall risk of the occurrence and death of cardiovascular and cerebrovascular complications. Therefore, while the blood pressure is controlled, the subclinical target organ damage, such as the detected vascular lesions, should be effectively intervened and the long-term prognosis of the patients should be improved. Pulse wave velocity (pulse wave, velocity, PWV) is a good indicator of arterial stiffness, age, gender, blood pressure are important determinants of PWV. Active intervention in hypertension, especially early intervention, can be used to detect and evaluate the effects of drug intervention on vascular lesions. Many studies have shown that drugs that increase arterial compliance include calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists and nitrates. However, the mechanisms of antihypertensive drugs are different in cardiovascular protection. In the past 20 years, calcium channel blockers (calcium channel, blockers, CCB) of chemical agents as blocking calcium channel in cell membrane to buck, Buck widely used in the treatment of hypertension, through effective antihypertensive therapy can significantly reduce the incidence of cardiovascular disease in patients with myocardial infarction, stroke and cardiac death and other adverse events. Recent studies have shown that calcium channel blockers can remold vascular endothelium, improve vascular atherosclerosis, and improve arteriosclerosis after lowering blood pressure to patients. This indicates that calcium channel blockers have no effect on arterial stiffness. Calcium channel blockers Nifedipine Controlled Release Tablets two dihydropyridine because of its effective antihypertensive effect and good tolerance has been used in clinical treatment of cardiovascular disease for many years, with a history of small sample studies show that nifedipine significantly reduced levels of PWV in the buck, but large-scale clinical research has not been reported at home. This study selected 60 patients with newly diagnosed mild hypertension with PWV increased 18 to 75 years old were treated with Nifedipine Controlled Release Tablets blood pressure, were followed for 24 weeks during the monitoring of blood pressure, heart rate, brachial ankle pulse wave velocity (brachial-ankle pulse wave velocity, BA PWV) and other indicators. Objective to evaluate the intervention of Nifedipine Controlled Release Tablets on arterial stiffness in the early stage of hypertension, and whether there is any effect of improving PWV without lowering blood pressure, so as to guide the diagnosis and treatment of hypertension. Methods: from December 2013 to December 2014, 60 patients with mild hypertension and increased PWV were newly diagnosed at the second hospital of Hebei Medical University. This study is a single center, single group, prospective, IV phase clinical study. The start of the study were given Nifedipine Controlled Release Tablets (30mg 1/) for 4 weeks, if the blood pressure dropped to 140/90mm following Hg, while maintaining the dose; if the blood pressure did not reach, it dose doubled to Nifedipine Controlled Release Tablets 60mg 1/, Nifedipine Controlled Release Tablets 60mg1/, if the treatment, after 8 weeks of treatment, after treatment has not yet reached, doctors may be treated according to the clinical routine. Follow up at baseline, 2, 4, 8, 12, 18, and 24 weeks to measure the patient's blood pressure and heart rate until the end of the test. At baseline, 4 weeks, 12 weeks and 24 weeks were measured brachial ankle pulse wave velocity (BA PWV). The data were analyzed by SPSS17.0. The measurement data obey normal distribution with mean? Standard deviation (x + s), count data using percentage rate, comparative analysis of baseline, 4 weeks, 12 weeks, 24 weeks, their blood pressure measurement of BA PWV by repeated measurement of variance analysis, linear correlation between the two variables do (Person correlation analysis), changes in PWV and blood pressure changes of Ba after 4 weeks to do the same for the analysis of bivariate linear correlation, drinking, smoking, cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, blood glucose, BMI, age and gender do multiple linear regression analysis. P0.05 thinks there is a statistical difference. Results: the changes of SBP, DBP, HR 1, MAP, PP after antihypertensive treatment: (1) after 24 weeks of treatment, 24 hour ambulatory blood pressure was lower than the baseline (P0.001); antihypertensive treatment for 4 weeks, 12 weeks and 24 weeks after SBP, DBP, MAP and PP were significantly lower than those before treatment (P0.001), there was statistically significant; (2) antihypertensive treatment for 12 weeks and 24 weeks after SBP, DBP, MAP, PP with antihypertensive treatment no significant change at 4 weeks (P0.05); (3) antihypertensive treatment for 4 weeks, 12 weeks and 24 weeks HR than before treatment showed no significant change (P0.05). 2, the change of BA PWV before and after treatment: (1) after 4 weeks, 12 weeks and 24 weeks, the BA PWV of Nifedipine Controlled Release Tablets decreased significantly compared with that before treatment (P0.001). (2) there was no significant change in BA PWV at 12 weeks compared with 4 weeks and 24 weeks. Correlation analysis of 3 BA PWV and blood pressure: the correlation coefficient of BA PWV and SBP at baseline, 4 weeks, 12 weeks, 24 weeks was 0.99 P=0.01; and the correlation coefficient DBP is 0.987, P=0.013; the correlation coefficient of MAP was 0.992, P=0.008, were statistically significant, and the correlation coefficient PP was 0.943. P=0.057, no statistical significance. Analysis of related factors of 4 BA PWV0: correlation coefficient of delta BA PWV0 and delta SBP0 is 0.327, P=0.008; the correlation coefficient and DBP0 is 0.347, P=0.005; the correlation coefficient and MAP0 is 0.388, P=0.002, were statistically significant. BA PWV0 and PP0, smoking, drinking, cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, blood glucose, BMI, age, gender and other factors to do multiple linear regression analysis showed no correlation (P0.05). Conclusion: Nifedipine Controlled Release Tablets can significantly reduce BA PWV and improve arteriosclerosis in patients with mild hypertension and BA PWV increase, while the decrease of BA PWV is associated with its antihypertensive effect, which reduces the role of BA PWV in drug use.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R544.1

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