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目的 比较培哚普利与硝苯地平对老年原发性高血压患者纤溶系统及其他血管活性物质的影响。方法 6 8例老年原发性轻、中度高血压患者随机给予培哚普利 (4mg ,1次 /d)或缓释硝苯地平 (2 0mg ,2次 /d)治疗 8周。治疗前后测定血压、心率 ,并测定血组织型纤溶酶原激活物 (tPA)、纤溶酶原激活物抑制剂(PAI) 1、纤维蛋白原 (FIB)、血管紧张素 (Ang)Ⅱ、血管紧张素转换酶 (ACE)及去甲肾上腺素 (NE)浓度。结果 培哚普利和缓释硝苯地平治疗后血压均有所下降 ,收缩压 /舒张压降幅平均为 11 5 / 5 8mmHg和 17 9/6 6mmHg。缓释硝苯地平组收缩压下降更显著 ,心率较前增加 (P <0 0 5 )。两组基线tPA和PAI 1浓度相似 (P >0 0 5 )。血浆PAI 1在培哚普利治疗后下降 2 6 % (P <0 0 5 ) ,而缓释硝苯地平治疗后增加 2 8% (P <0 0 5 ) ,组间比较差异有显著意义 (P <0 0 1)。而对于tPA和FIB ,两组治疗前后差异均无显著意义 (P >0 0 5 )。两组基线血清ACE、AngⅡ和血浆NE浓度差异无显著意义。培哚普利治疗后血清ACE和AngⅡ显著下降 ,组间比较差异有显著意义 (P <0 0 5 ) ;而缓释硝苯地平治疗后血浆NE增加 ,组间比较差异有显著意义 (P <0 0 5 )。结论 同缓释硝苯地平相比 ,培哚普利能降低老年高血压患者PAI 1,增?
Objective To compare the effects of perindopril and nifedipine on fibrinolytic system and other vasoactive substances in elderly patients with essential hypertension. Methods Sixty eight elderly patients with mild to moderate hypertension were randomly assigned to receive either perindopril (4 mg once daily) or extended release nifedipine (20 mg twice daily for 8 weeks). Blood pressure and heart rate were measured before and after treatment. The levels of tPA, PAI 1, fibrinogen (FIB), angiotensin Ⅱ (Angiotensin Ⅱ) Angiotensin converting enzyme (ACE) and norepinephrine (NE) concentrations. Results After perindopril and sustained-release nifedipine treatment, the blood pressure decreased, and the mean systolic / diastolic blood pressure drop was 11 5/58 mmHg and 17 9/6 6 mmHg respectively. Sustained release nifedipine systolic blood pressure decreased more significantly, heart rate increased compared with the previous (P <0 05). Baseline tPA and PAI 1 concentrations were similar between the two groups (P> 0.05). Plasma PAI 1 decreased by 26% (P <0.05) after perindopril treatment, and increased by 28% (P <0.05) after controlled release of nifedipine, with significant difference between the groups P <0 0 1). For tPA and FIB, there was no significant difference between the two groups before and after treatment (P> 0.05). There was no significant difference in serum ACE, AngⅡ and plasma NE concentrations between the two groups. Serum ACE and AngⅡwere significantly decreased after perindopril treatment, with significant difference between the two groups (P <0 05); while plasma NE after prolonged nifedipine treatment increased significantly, with significant difference between the two groups (P < 0 0 5). Conclusion Compared with the sustained-release nifedipine, perindopril can reduce PAI 1 in elderly patients with hypertension,