Impact of metoprolol's quadruple therapy on serum inflammatory cytokines and vascular endothelial function in patients with refractory hypertension
Objective To observe the impact of metoprolol's quadruple therapy on serum inflammatory cytokines and vascular endothelial function in patients with refractory hypertension,and to investigate its clinical efficacy and safety.Methods Totally 125 patients with refractory hypertension were diagnosed and treated in Mudanjiang Cardiovascular Hospital from July 2021 to December 2022,and were randomly divided into observation group(n=63)and control group(n=62).In addition to the healthy living intervention,control group was given irbesartan,hydrochlorothiazide and amlodipine therapy,and observation group was given metoprolol's quadruple therapy besides the therapy in control group.Both two groups were treated for 3 months.Before and after 3-month therapy,all patients were measured the systolic blood pressure(SBP),diastolic blood pressure(DBP),serum inflammatory cytokines[high-sensitivity C-reactive protein(hs-CRP),interleukin(IL)-6,IL-10,tumor necrosis factor-α(TNF-α)],and vascular endothelial function indicators[endothelin-1(ET-1),nitric oxide(NO),calcitonin gene-related peptide(CGRP),vascular endothelial growth factor(VEGF)].The 3-month clinical efficacy was evaluated,and the adverse reactions were recorded.Results The SBP and DBP were lower in observation group[(130.45±8.12),(81.28±6.12)mmHg]than those in control group[(136.23±8.45),(85.25±6.54)mmHg]after therapy(t=3.225,P=0.002;t=3.505,P=0.001),were lower in both group after therapy than those before therapy(P＜0.05),and showed no significant differences between two groups before therapy(P＞0.05).The serum levels of hs-CRP,IL-6,TNF-α and ET-1 were lower in observation group[(3.20±0.75)mg/L,(84.28±12.36)ng/L,(25.12±4.41)ng/L,(60.23±8.15)μg/L]than those in control group[(4.16±0.80)mg/L,(92.36±15.31)ng/L,(30.25±4.56)ng/L,(71.36±8.42)μg/L](P＜0.05),were lower after therapy than those before therapy in both two groups(P＜0.05),and showed no significant differences between two groups before therapy(P＞0.05).The levels of IL-10,NO,CGRP and VEGF were higher in observation group[(24.26±4.34)ng/L,(81.25±6.45)μmol/L,(72.36±9.15)ng/L,(43.26±6.12)ng/L]than those in control group[(20.45±4.26)ng/L,(74.36±6.52)μmol/L,(66.82 士 9.06)ng/L,(38.64±6.24)ng/L]after therapy(P＜0.05),were higher after therapy than those before therapy in both two groups(P＜0.05),and showed no significant differences between two groups before therapy(P＞0.05).The total 3-month effective rate was higher in observation group(92.06％)than that in control group(77.42％)(x2=5.199,P=0.023),and the incidence of total adverse reactions was lower in observation group(9.52％)than that in control group(24.19％)(x2=4.811,P=0.028).Conclusion The administration of metoprolol in additional to irbesartan,hydrochlorothiazide and amlodipine can control blood pressure,reduce inflammatory response,improve vascular endothelial function and reduce adverse reactions in patients with refractory hypertension.
refractory hypertensionmetoprololquadruple therapyinflammatory cytokinesvascular endothelial function
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