摘要
目的 探讨泻肺利水方联合硝苯地平控释片对原发性高血压疗效、不良心血管事件及肾素-血管紧张素-醛固酮系统的影响.方法 前瞻性选择2018年1月至2022年12月滁州市中西医结合医院收治的70例原发性高血压患者作为研究对象.按照随机数字表法将其分为对照组和观察组,每组各35例.对照组给予硝苯地平控释片,观察组在硝苯地平控释片基础上加用泻肺利水方治疗,两组患者均治疗12周.比较两组治疗效果,治疗前、治疗12周后的收缩压、舒张压水平、中医症候积分、心功能情况[舒张末期容积、收缩末期容积、射血分数、二尖瓣舒张早期与晚期血流峰值的比值(E/A)]、血浆肾性活素、血管紧张素Ⅱ、血浆醛固酮水平,并比较两组不良心血管事件及不良反应发生情况.结果 观察组的治疗总有效率为94.29％,明显高于对照组(77.14％),差异有统计学意义(P＜0.05).治疗12周后,观察组收缩压和舒张压水平分别为(124.22±10.23)、(80.24±9.89)mmHg,均低于对照组[(140.33±13.24)、(93.11±9.34)mmHg],差异均有统计学意义(P＜0.05).治疗12周后,观察组眩晕、头痛、暴躁易怒、心悸、失眠评分分别为(1.21±0.20)、(0.23±0.05)、(0.42±0.08)、(0.43±0.07)、(0.34±0.06)分,均低于对照组[(1.81±0.23)、(1.10±0.15)、(1.04±0.21)、(1.09±0.19)、(0.89±0.15)分],差异均有统计学意义(P＜0.05).治疗 12 周后,观察组的舒张末期容积、收缩末期容积均低于对照组,射血分数、E/A值均高于对照组,差异均有统计学意义(P＜0.05).治疗12周后,观察组血浆肾性活素、血管紧张素Ⅱ、血浆醛固酮水平分别为(3.02±0.43)μg·L-1·h-1、(65.23± 4.89)pg/mL、(150.45±28.79)mmHg,均低于对照组[(3.89±0.65)μg·L-1·h-1、(79.99±7.34)pg/mL、(180.88± 27.89)mmHg],差异均有统计学意义(P＜0.05).观察组总不良心血管事件发生率为2.86％,低于对照组(14.28％),但两组比较差异无统计学意义(P＞0.05).观察组总不良反应发生率为5.72％,稍高于对照组(2.86％),但两组比较差异无统计学意义(P＞0.05).结论 泻肺利水方联合硝苯地平控释片治疗可提高原发性高血压的疗效,改善中医症状评分、心功能,降低不良心血管事件发生率,其机制可能与泻肺利水方可调节肾素-血管紧张素-醛固酮系统有关.
Abstract
Objective To investigate the effects of Xiefei Lishui Prescription combined with nifedipine controlled-release tablets on es-sential hypertension,adverse cardiovascular events and renin-angiotensin-aldosterone system.Methods Seventy patients with primary hyper-tension advited to Chuzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to December 2022 were prospec-tively selected as the study subjects,and divided them into the control group and the observation group using the random number table method,with 35 cases in each group.The control group received nifedipine controlled-release tablets,and the observation group added Xiefei Lishui Pre-scription on the basis of nifedipine controlled release tablets.Both groups of patients were treated for 12 weeks.The therapeutic effects of two groups were compared,the levels of systolic and diastolic blood pressure,TCM syndrome points,cardiac function[end diastolic volume,end sys-tolic volume,ejection fraction,ratio of peak blood flow in early and late diastolic phase of mitral valve(E/A)],plasma renal valin,angiotensinⅡ and plasma aldosterone,and adverse cardiovascular events and adverse reactions of the two groups were compared.Results The total effective rate of treatment in the observation group was 94.29％,which was significantly higher than that in the control group(77.14％),the difference was statistically significant(P＜0.05).After 12 weeks of treatment,the average systolic and diastolic blood pressure in the observation group were(124.22±10.23),(80.24±9.89)mmHg,respectively,which were lower than those in the control group[(140.33±13.24),(93.11± 9.34)mmHg],and the differences were statistically significant(P＜0.05).After 12 weeks of treatment,the scores of dizziness,headache,irritability,palpitations,and insomnia in the observation group were(1.21±0.20),(0.23±0.05),(0.42±0.08),(0.43±0.07),(0.34 ±0.06)points,respectively,which were lower than those in the control group[(1.81±0.23),(1.10±0.15),(1.04±0.21),(1.09± 0.19),(0.89±0.15)points],and the differences were statistically significant(P＜0.05).After 12 weeks of treatment,the end diastolic vol-ume and end systolic volume of the observation group were lower than those of the control group,and the ejection fraction and E/A value were high-er than those of the control group,and the differences were statistically significant(P＜0.05).After 12 weeks of treatment,the average levels of plasma renin,angiotensin 11,and plasma aldosterone water in the observation group were(3.02±0.43)µg·L-1·h-1,(65.23±4.89)pg/mL,(150.45±28.79)mmHg,respectively,which were lower than those in the control group[(3.89±0.65)μg·L-1·h-1,(79.99± 7.34)pg/mL,(180.88±27.89)mmHg],and the differences were statistically significant(P＜0.05).The total incidence of adverse cardio-vascular events in the observation group was 2.86％,which was lower than that in the control group(14.28％),but the difference was not statis-tically significant(P＞0.05).The incidence of adverse reactions in the observation group was 5.72％,which was slightly higher than that in the control group(2.86％),but there was no statistically significant difference(P＞0.05).Conclusion Xiefei Lishui Prescription combined with nifedipine controlled-release tablets can improve the therapeutic effect,improve the symptom score of traditional Chinese medicine,improve the heart function,and reduce the incidence of adverse cardiovascular events.The mechanism may be related to the fact that Xiefei Lishui Prescription can regulate the renin angiotensin aldosterone system.
基金项目
安徽省中医药传承创新科研项目(2020ccyb27)
NETL
NSTL
维普
万方数据