RAAS相关激素水平与血压调控的相关性及清眩降压汤的临床研究
发布时间：2019-05-28 23:36
【摘要】：高血压是冠心病、脑卒中、心衰、肾脏疾病及大动脉和周围动脉疾病的主要危险因素之一。我国人群高血压患病率呈逐年增长态势,如何有效控制血压,保护靶器官损伤是现代医学的一个挑战。神经-内分泌系统的紊乱,在高血压病发生发展过程中具有重要作用,其中以肾素-血管紧张素-醛固酮系统(RAAS)最为显著。血管紧张素Ⅰ转化酶抑制剂(ACEI)类药物可通过阻断ACE酶抑制AAS过度激活发挥降压疗效。临床研究表明,ACEI对患者具有良好的靶器官保护和心血管终点事件预防作用。但ACEI类降压药物存在刺激性干咳、血钾升高、血管性水肿等副反应,在一定程度上限制其应用。高血压病属中医“风眩”、“眩晕”的范畴,“肝肾阴虚、肝阳上亢”是其主要发病机理。我院陈可冀院士等对高血压病进行系统研究,在长期临床实践的基础上组成清肝热、平肝阳、益肝肾的清眩降压汤,应用临床几十年,显示有良好作用。我们临床观察发现,应用ACEI类药物患者虽可使血管紧张素转换酶(ACE)得到抑制(低于正常水平),但部分患者血压控制并不理想。为此,我们提出如下问题：(1)ACE水平是否越低越好,更低的ACE水平是否可获得更好的血压控制?(2)如果ACE水平不是越低越好,血压控制水平与RAAS相关激素水平存在什么样的关系?(3)清眩降压汤具有调和血脉、平肝潜阳等作用,其疗效是否与RAAS相关激素水平相关?围绕上述问题,我们进行如下研究：研究一、高血压患者ACEI治疗后RAAS激素水平与血压水平相关性的研究目的：研究ACEI治疗后高血压患者RAAS激素水平与血压水平相关性。方法：本研究为回顾性研究,纳入206例中、低危的Ⅰ、Ⅱ级服用ACEI类药物1周以上的门诊或住院高血压患者,根据血压调控的水平分为5组,填写CRF表,收集患者一般资料、24小时动态血压、血管紧张素转换酶、肾素、血管紧张素Ⅱ、醛固酮等RAAS相关激素检测值,比较各组血管紧张素转换酶、肾素、血管紧张素Ⅱ、醛固酮值的差异。然后,跟据血压水平将此206例患者分为控制达标组(140/90mmHg)和控制未达标组(≥140/90mmHg),统计两组血管紧张素转换酶、肾素、血管紧张素Ⅱ、醛固酮的95%的置信区间并进行分析。结果：血压控制达标组血管紧张素转换酶、肾素检测值与控制未达标组比较无统计学差异(P0.05),而血管紧张素Ⅱ、醛固酮值均低于控制未达标组(P0.05)；血压控制未达标组,随血压升高,血管紧张素Ⅱ、醛固酮值也呈明显升高趋势(P0.05)。血压控制达标组血管紧张素Ⅱ、醛固酮值的95%置信区间分别为[3.99,7.14]、[178.9,265.1]。结论：血管紧张素Ⅱ和醛固酮值可作为中、低危的Ⅰ、Ⅱ级高血压患者服用ACEI药物血压控制的参考指标。血管紧张素Ⅱ和醛固酮值分别在[3.99,7.14]和[178.9,265.1]范围内的患者血压控制水平明显优于区间之外患者血压水平。研究二、清眩降压汤对肝阳上亢型高血压病的临床疗效观察及机制探讨目的：观察清眩降压汤对中、低危的Ⅰ、Ⅱ级肝阳上亢型高血压患者的疗效。从血管紧张素转换酶、肾素、血管紧张素Ⅱ、醛固酮等RAAS相关激素水平与血压的关系探讨其降压机制。方法：本研究为前瞻性开放随机对照研究,将172例中、低危的Ⅰ、Ⅱ级肝阳上亢型高血压患者采用简单随机化方法分为治疗组和对照组各86例。对照组口服福辛普利,治疗组在福辛普治疗基础上联合清眩降压汤治疗,分别于治疗后1周、2周比较两组的血压、谷峰值、RAAS相关激素水平、疗效、中医症候积分、副反应及研究一提出的血管紧张素Ⅱ和醛固酮的95%置信区间的人数。结果：治疗1周,治疗组和对照组24小时平均血压、血管紧张素Ⅱ、醛固酮水平均较治疗前明显降低(P0.05),血管紧张素转换酶、肾素值变化虽有降低趋势,但无统计学差异(P0.05)；两组血管紧张素转换酶、肾素、血管紧张素Ⅱ、醛固酮等tAAS相关激素值及谷峰值、总有效率、中医症候积分比较无统计学差异(P0.05)。治疗2周,治疗组和对照组24小时平均血压、血管紧张素Ⅱ、醛固酮水平较治疗1周有进一步降低(P0.05),肾素、血管紧张素转换酶值变化无统计学差异(P0.05)；治疗组24小时平均血压、日间收缩压和血管紧张素Ⅱ、醛固酮水平较对照组有明显降低(P0.05)；治疗组的谷峰值、总有效率、中医症候积分、副反应、血管紧张素Ⅱ和醛固酮的95%置信区间的人数明显优于对照组(P0.05)。结论：清眩降压汤联合ACEI类药物较单用ACEI类药物对中、低危的Ⅰ、Ⅱ级肝阳上亢证高血压患者有更好的降压疗效,治疗组在血管紧张素Ⅱ、醛固酮值的95%置信区间的人数明显多于对照组,进一步支持研究一提出的血管紧张素Ⅱ、醛固酮值的95%置信区间[3.99,7.14]、[178.9,265.1]可作为理想血压的生化值的参考。
[Abstract]:Hypertension is one of the main risk factors for coronary heart disease, stroke, heart failure, kidney disease and arterial and peripheral arterial disease. The prevalence of hypertension in Chinese population is increasing year by year, and how to control blood pressure effectively and to protect target organ damage is a challenge in modern medicine. The disorder of the neuroendocrine system plays an important role in the development of hypertension, in which the renin-angiotensin-aldosterone system (RAAS) is the most significant. Angiotensin I converting enzyme inhibitor (ACEI) can be used to block ACE enzyme to inhibit the activation of AAS. The clinical study shows that ACEI has good target organ protection and cardiovascular end event prevention effect on patients. But the ACEI antihypertensive drugs have the effects of stimulating dry cough, increasing blood potassium and angioedema, and limiting the application to a certain extent. The essential hypertension belongs to the "wind daze" and "Vertigo" of Chinese medicine, and the "yin deficiency of liver and kidney and hyperactivity of liver yang" is its main pathogenesis. In the long-term clinical practice, the Chinese Academy of Sciences, the academician of the Chinese Academy of Sciences, made a systematic study of the hypertension, and made up the Qingxuan blood-lowering soup with the functions of clearing liver heat, calming the liver-yang and benefiting the liver and the kidney on the basis of long-term clinical practice, and has good effect in the clinical decades. Our clinical observations suggest that the application of ACEI in patients with ACEI can inhibit the angiotensin-converting enzyme (ACE) (below the normal level), but the control of blood pressure in some patients is not ideal. For this reason, we have the following questions: (1) whether the lower the ACE level is, and whether the lower ACE level is available for better blood pressure control? (2) What is the relationship between the blood pressure control level and the RAAS-related hormone level if the ACE level is not the lower the lower the lower the ACE level is? (3) Qingxuan Blood-lowering Decoction has the effects of regulating blood vessel, calming liver and suppressing yang, and is related to the level of RAAS-related hormone. The purpose of this study was to study the relationship between the level of RAAS and the level of blood pressure in the patients with high blood pressure (ACEI) after ACEI in the study of the relationship between the level of RAAS and the level of blood pressure in the patients with high blood pressure after ACEI treatment. Methods: This study was a retrospective study. In 206 cases, patients with low-risk 鈪，
本文编号：2487459
[Abstract]:Hypertension is one of the main risk factors for coronary heart disease, stroke, heart failure, kidney disease and arterial and peripheral arterial disease. The prevalence of hypertension in Chinese population is increasing year by year, and how to control blood pressure effectively and to protect target organ damage is a challenge in modern medicine. The disorder of the neuroendocrine system plays an important role in the development of hypertension, in which the renin-angiotensin-aldosterone system (RAAS) is the most significant. Angiotensin I converting enzyme inhibitor (ACEI) can be used to block ACE enzyme to inhibit the activation of AAS. The clinical study shows that ACEI has good target organ protection and cardiovascular end event prevention effect on patients. But the ACEI antihypertensive drugs have the effects of stimulating dry cough, increasing blood potassium and angioedema, and limiting the application to a certain extent. The essential hypertension belongs to the "wind daze" and "Vertigo" of Chinese medicine, and the "yin deficiency of liver and kidney and hyperactivity of liver yang" is its main pathogenesis. In the long-term clinical practice, the Chinese Academy of Sciences, the academician of the Chinese Academy of Sciences, made a systematic study of the hypertension, and made up the Qingxuan blood-lowering soup with the functions of clearing liver heat, calming the liver-yang and benefiting the liver and the kidney on the basis of long-term clinical practice, and has good effect in the clinical decades. Our clinical observations suggest that the application of ACEI in patients with ACEI can inhibit the angiotensin-converting enzyme (ACE) (below the normal level), but the control of blood pressure in some patients is not ideal. For this reason, we have the following questions: (1) whether the lower the ACE level is, and whether the lower ACE level is available for better blood pressure control? (2) What is the relationship between the blood pressure control level and the RAAS-related hormone level if the ACE level is not the lower the lower the lower the ACE level is? (3) Qingxuan Blood-lowering Decoction has the effects of regulating blood vessel, calming liver and suppressing yang, and is related to the level of RAAS-related hormone. The purpose of this study was to study the relationship between the level of RAAS and the level of blood pressure in the patients with high blood pressure (ACEI) after ACEI in the study of the relationship between the level of RAAS and the level of blood pressure in the patients with high blood pressure after ACEI treatment. Methods: This study was a retrospective study. In 206 cases, patients with low-risk 鈪，
本文编号：2487459
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