Objective To observe the effects of different doses of atorvastatin combined with amlodipine besylate on dynamic blood pressure in patients with essential hypertension complicated with atherosclerosis.Methods A total of 276 patients with essential hypertension complicated with atherosclerosis in the First People's Hospital of Lushi County were selected and divided into control group,observation group 1,observation group 2 and observation group 3,with 69 cases in each group.The patients in the control group were given 5 mg amlodipine besylate orally every day for a period of 24 months.The patients in the observation group 1,2 and 3 were given 5 mg amlodipine besylate orally every day for a period,and then they were given 10,20,30 mg atorvastatin orally every day,the whole treatment course lasted for 24 months.The levels of blood lipid,carotid intima-media thickness (IMT),plaque area and dynamic blood pressure after treatment were compared among the four groups.Results There was no significant difference in blood lipid,IMT,plaque area and dynamic blood pressure among the four groups (P ＞ 0.05).After treatment,the levels of high density lipoprotein (HDL) was significantly higher than that of before treatment,and low density lipoprotein (LDL),total cholesterol (TC),triacylglycerol (TG) and oxidized low-density lipoprotein (Ox-LDL) in the four groups were significantly lower than those of before treatment(P ＜ 0.05).After treatment,the levels of HDL in the observation group 1,2,3 were significantly higher than those in the control group (P ＜ 0.05),and LDL,TC,TG and Ox-LDL in the observation group 1,2,3 were significantly lower than those in the control group(P ＜0.05).The level of HDL in observation group 3 was significantly higher than that in observation group 1 and 2 (P ＜ 0.05),and LDL,TC,TG and Ox-LDL in the observation group 3 were significantly lower than those in the observation group 1 and 2 (P ＜ 0.05).After treatment,the carotid IMT and plaque area in the four groups were significantly smaller than those of before treatment(P ＜ 0.05).The carotid IMT and plaque area in the observation group 1,2 and 3 were significantly smaller than those in the control group (P ＜ 0.05).The carotid IMT and plaque area in the observation group 3 were significantly smaller than those in the observation group 1 and 2 (P ＜ 0.05).After treatment,mean systolic blood pressure,mean diastolic blood pressure and mean arterial pressure of 24 hours,daytime and nighttime in the four groups were significantly lower than those of before treatment (P ＜ 0.05).The mean systolic blood pressure,mean diastolic blood pressure and mean arterial pressure of 24 hours,daytime and nighttime after treatment,in the observation group 1,2 and 3 were significantly lower than those in the control group (P ＜ 0.05),and the levels of them in the observation group 3 were significantly lower than those in the observation group 1 and 2 (P ＜ 0.05).Conclusion The effect of atorvastatin combined with amlodipine besylate on dynamic blood pressure in patients with essential hypertension complicated with atherosclerosis is better than only amlodipine besylate,30 mg · d-1of torvastatin combined with amlodipine besylate has the best clinical effects.%目的 观察不同剂量阿托伐他汀联合苯磺酸氨氯地平治疗原发性高血压合并动脉粥样硬化患者的临床疗效,并对患者的动态血压水平变化进行研究.方法 将2013年1月至2016年1月卢氏县第一人民医院收治的276例原发性高血压合并动脉粥样硬化患者分为对照组、观察1组、观察2组和观察3组,每组69例.对照组患者每日给予5 mg苯磺酸氨氯地平口服,治疗时间为24个月.在对照组治疗的基础上,观察1、2、3组患者分别每日给予10、20、30 mg阿托伐他汀口服,治疗时间为24个月.对4组患者治疗前后的血脂水平、颈动脉内膜中层厚度(IMT)、斑块面积及治疗后动态血压水平进行比较.结果 4组患者治疗前血脂水平、IMT、斑块面积及治疗后动态血压水平比较差异均无统计学意义(P＞0.05).治疗后4组患者高密度脂蛋白(HDL)水平显著高于治疗前,而低密度脂蛋白(LDL)、总胆固醇(TC)、三酰甘油(TG)及氧化低密度脂蛋白(Ox-LDL)水平显著低于治疗前(P＜0.05);治疗后,观察l、2、3组患者的HDL水平显著高于对照组(P＜0.05),而LDL、TC、TG、Ox-LDL水平显著低于对照组(P＜0.05).治疗后观察3组的HDL水平显著高于观察1、2组(P＜0.05),而LDL、TC、TG、Ox-LDL水平显著低于观察l、2组(P＜0.05).4组患者治疗后颈动脉IMT及斑块面积均显著小于治疗前(P＜0.05);治疗后,观察l、2、3组患者的颈动脉IMT及斑块面积均显著小于对照组(P＜0.05);观察3组患者颈动脉IMT及斑块面积均显著小于观察1、2组(P＜0.05).治疗后,4组患者的24 h、昼间、夜间的收缩压、舒张压及平均动脉压均显著低于治疗前(P＜0.05);观察1、2、3组患者的24h、昼间、夜间的收缩压、舒张压及平均动脉压均显著低于对照组(P＜0.05),观察3组患者的24 h、昼间、夜间的收缩压、舒张压及平均动脉压均显著低于观察1、2组(P＜0.05).结论 阿托伐他汀联合苯磺酸氨氯地平治疗高血压合并动脉粥样硬化较单纯采用苯磺酸氨氯地平临床疗效更佳,且30 mg·d-1阿托伐他汀联合苯磺酸氨氯地平口服在控制血压及改善患者临床症状方面效果更明显.
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