降压药物对老年高血压患者血浆脂联素和视黄醛结合蛋白4含量的影响

摘要

目的 观察老年高血压患者应用氨氯地平、培哚普利、缬沙坦3种药物降压治疗前后的血浆脂联素和血浆视黄醛结合蛋白含量的变化. 方法 选择2007年3月至2010年7月年在我院住院的老年高血压患者238例,完成研究1 93例,数字抽签随机分为3组,分别用氨氯地平、培哚普利、缬沙坦治疗,1 2周后观察血压、心率、身高、体质量、腹围、腰围、血脂、血浆脂联素及视黄醛结合蛋白水平等改变. 结果 氨氯地平组、培哚普利组、缬沙坦组治疗后血压均较治疗前下降(均P＜0.01)；治疗后3组血压比较,差异无统计学意义(均P＞0.05).治疗前、后血浆脂联素水平培哚普利组(7.4±1.8)μg/L与(8.3±1.8)μg/L、缬沙坦组(7.5±1.7)μg/L与(8.4±1.9)μg/L较治疗前升高(均P＜0.01)；治疗后培哚普利组、缬沙坦组血浆脂联素水平高于氨氯地平组(7.6±1.8)μg/L(均P＜0.05).治疗后培哚普利组、缬沙坦组血浆视黄醛结合蛋白水平较治疗前降低(P＜0.01).氨氯地平组较治疗前血浆视黄醛结合蛋白水平降低,但差异无统计学意义(P＞0.05).血浆视黄醛结合蛋白水平治疗后培哚普利组(36.6±14.2) mg/L、缬沙坦组(36.3±14.1)mg/L低于氨氯地平组(42.7±13.8)mg/L,差异有统计学意义(均P＜0.01). 结论 培哚普利、缬沙坦能提高老年高血压病患者血浆脂联素水平,降低血浆视黄醛结合蛋白水平,从而起到降压作用以外的心血管保护作用.%Objective To explore the effects of amlodipine,perindopril and valsartan on plasma adiponectin and retinol binding protein 4 in elderly patients with essential hypertension.Methods From March 2007 to July 2010,238 elderly patients with essential hypertension were selected and 193 cases completed this study.Patients were randomly divided into 3 groups:amlodipine group (n=68),perindoprilgroup (n=60) and valsartan group (n=65).Patients in each group were treated with amlodipine,perindopril and valsartan respectively for at least 12 weeks.The changes in blood pressure,heart rate,body height,body mass index (BMI),abdominal circumference,waist circumference (WC),levels of blood lipids,plasma adiponection and retinol binding protein 4 were observed before and after treatment.Results Compared with pre-treatment,systolic blood pressure in 3 groups were significantly decreased after treatment (all P＜0.01).There were no significant differences in blood pressure among 3 groups after treatment (all P＞0.05).Compared with pre treatment,plasma adiponectin level was significantly increased in perindopril group and valsartan group after treatment [(7.4±1.8) μg/L vs.(8.3± 1.8) μg/L,(7.5±1.7) μg/L vs.(8.4±1.9)μg/L,both P＜0.01].Plasma adiponectin level was higher in perindopril group and valsartan group than in amlodipine group after treatment [(8.3±1.8) μg/L vs.(7.6±1.8) μg/L,(8.4±1.9) μg/Lvs.(7.6±1.8) μg/L,both P＜0.05].Compared with pretreatment,plasma retinol binding protein 4 level in 3 groups were all decreased after treatment,and the decrements had significant differences in perindopril group and valsartan group (both P＜0.01) but had no difference in amlodipine group (P＞0.05).Plasma adiponectin retinol binding protein 4 levels were lower in perindopril group and valsartan group than in amlodipine group after treatment[(36.6± 14.2) μg/L vs.(42.7± 13.8) μg/L,(36.3±14.1) μg/L vs.(42.7±13.8) μg/L,respectively,both P＜0.01].Conclusions Perindopril and valsartan play important roles in cardiovascular protection beyond the antihypertensive effects by increasing plasma adiponection level and decreasing plasma retinol binding protein 4 level in elderly patients with hypertension.