目的 观察降压和调脂联合治疗对高血压动脉粥样硬化的影响。方法 选取2012-06至2013-06在河北大学附属医院心内科门诊就诊的高血压,且颈动脉内膜中层厚度(intima-media thickness, IMT)≥0.9 mm患者120例,随机分为两组,对照组60例,在健康宣教、低盐低脂饮食、戒烟戒酒等基础治疗上给予贝那普利口服(10 mg/d,1次/d)控制血压;联合组60例,在对照组基础上加用瑞舒伐他汀口服(10 mg/d,1次/晚)。治疗8周,记录两组治疗前后IMT、血压及血脂的变化,并对两组进行比较。结果 治疗前,对照组IMT值为(1.05±0.32)mm,联合组为(1.06±0.29)mm;治疗后,对照组为(0.89±0.17)mm,联合组为(0.58±0.19)mm;两组治疗后IMT均较治疗前减小,差异均有统计学意义(P<0.05);联合组治疗后小于对照组,差异有统计学意义(P<0.05)。两组血压治疗后较治疗前均显著下降,差异有统计学意义(P<0.05),两组之间比较差异无统计学意义;血脂情况,对照组治疗前后血脂水平无统计学差异,联合组治疗后与治疗前相比,血脂水平明显下降,差异有统计学意义(P<0.05),与对照组治疗后相比,联合组治疗后的血脂水平较低,差异有统计学意义 (P<0.05)。结论 贝那普利联合瑞舒伐他汀可以在有效降压及调脂的基础上,对高血压患者颈动脉IMT有良好的逆转作用,进而能够延缓动脉粥样硬化进展。

Objective To evaluate the efficacy of combined antihypertension and cholesterol lowering treatment on atherosclerosis in patients with essential hypertension.Methods 120 patients with high blood pressure were recruited from June 2012 to June 2013 in the Affillated Hospital of Hebei University. By carotid ultrasound examination, all patients showed carotid IMT thickening (IMT value≥0.9 mm), 120 patients were randomly divided into 2 groups by the double blind method. Control group consisted of 60 patients in health education, on regimen of low salt, low fat diet, quitting smoking and smoking were given benazepril orally (10 mg/d, QD). Study group (60 cases, on the basis of the medicament in control group, were given rosuva statin orally (10 mg/d, QN). Treatments lasted for 8 weeks, the blood pressure, IMT and blood fat in the two groups were recorded before and after treatment, and compared between the two groups, and statistical analysis was conducted. Results Before the treatment, the control group showed IMT values (1.05±0.32)mm, the study group (1.06±0.29) mm; after treatment, the control group showed IMT (0.89±0.17) mm, the treatment group (0.58±0.19) mm. Compared with before treatment, IMT were reduced after treatment in both groups, differences were statistically significant (P<0.05). Blood pressure significantly decreased after treatment, with statistically significant difference(P<0.05), but comparison between the two groups had no statistical difference. Blood lipid levels in the control group before and after treatment were not statistically different (P<0.05), the study group showed compared with before treatment, the blood lipid level declined obviously, with statistically significant difference (P<0.05). Compared with the control group after treatment, the study group showed lipid levels dropped significantly after treatment, with statistically significant difference(P<0.05). Conclusions Benazeprilin combined with rosuvastatin in patients with hypertension has good reversal effect on carotid IMT, which can delay the progress of atherosclerosis.