Study Of Related Hormone Of RAAS And Qingxuan Jiangya Decoction On Blood Pressure

Hypertension is one of the major risk factors for coronary heart disease, stroke, heart failure, kidney disease and artery and peripheral arterial disease. The incidence of hypertension in Chinese population is increasing year by year, how to effectively control the blood pressure, protecting target organ is a challenge in modern medicine.Nerve-endocrine disorder plays a critical role in the progression of hypertension, among which the renin-angiotensin-aldosterone system(RAAS) is the most significant. ACEI drugs work by blocking the ACE enzyme and confirmed by the clinical trials that such drugs benefit patients of hypertension for good protection of target organs and against cardiovascular endpoint events. However, for the side effects of ACEI drugs such as irritating cough, arising blood potassium, angioedema, the application of such drugs is limited to a certain extent.Generally, Hypertension belongs to Wind Dizziness and Giddiness with liver and kidney Yin deficiency and hyperactivity of liver Yang as its main pathogenesis. Academician Chen Keji and others in our hospital systematic study on hypertension, in the basis of the long-term clinical practice summarized empirical formula Qingxuan Jiangya Decoction to cleare liver heat, balance liver Yang and tonify the liver and kidney, which has been applied to clinical practice for decades with good clinical efficacy.However, we found some patients blood pressure control is not ideal even ACE has been fully inhibited far below normal levels. So, we ask these questions:The first, whether we can get better clinical curative effect as lower ACE can get? The second, if it is not the lower the better, if there exists relationship between blood pressure control and RAAS related hormone? The third, traditional Chinese medicine can reconciling blood, calming liver and suppressing yang, if the good effect is related to the hormone levels of RAAS? In view of the above questions, we conducted this study.Study one:Study on the relationship between RAAS hormone and blood pressure after hypertensive patients treated with ACEIObjective:To study the correlation between RAAS hormone and blood pressure of hypertensive patients treated with ACEI.Methods:This study is a retrospective study comprise 206 cases with medium or low risk and Ⅰ or Ⅱ grade taking ACEI drugs for more than 1 week of outpatient or hospitalized patients with hypertension, divided them into 5 groups according to the blood pressure levels, filled out the CRF form, collected the patient’s general information,24 hour ambulatory blood pressure and RAAS related hormone values including serum ACE, Renin, ANG-2 and ALD, the differences of ACE, Renin, ANG-2 and ALD in these groups were compared. Then, according to the blood pressure levels, these 206 cases were divided into standard group(<140/90mmHg) and the non-Standard Group(≥140/90mmHg), the 95% confidence intervals of the two groups of ACE, Renin, ANG-2 and ALD were analyzed.Results:There was no difference between the standard group and the non-Standard Group of ACE and Renin (P>0.05), but the ANG-2 and ALD were lower than the non-Standard group(P<0.05);To the non-Standard group, ANG-2 and ALD were also significantly increased with the increase of blood pressure(P<0.05). The 95% confidence interval of the standard group of ANG-2 and ALD were [3.99,7.14] and [178.9265.1].Conclusion:ANG-2 and ALD can be used as the reference index of hypertensive patients with medium or low risk and Ⅰ or Ⅱ grade treated with ACEI. ANG-2 and ALD values of hypertensive patients in the [3.99,7.14] and [178.9265.1] have better blood pressure control than the range outside.Study two:Effect and mechanism of Qingxuan Jiangya Decoction on hypertension patients with liver yang hyperactivityObjective:To figure out the efficacy of Qingxuan Jiangya Decoction on hypertensive patients with medium or low risk and I or II grade and the type of hyperactivity of Liver Yang, furthermore, discussing its antihypertensive mechanism by detecting the RAAS related hormones including serum ACE, Renin, ANG-2 and ALD.Methods:This study is open prospective randomized controlled trial divided 172 hypertensive patients with medium or low risk and I or II grade and the type of hyperactivity of Liver Yang into 2 groups randomly, with each group of 86 patients (n=86). The control group only given fosinopril and the treatment group was given Qingxuan Jiangya Decoction and fosinopril combined treatment, respectively comparing blood pressure, trough/peak ratio, RAAS related hormone levels, efficacy, TCM syndrome score, side effects, ANG-2 and ALD 95% confidence interval number after 1 and 2 weeks.Results:Treatment of 1 week, the treatment group and control group of 24 hours average blood pressure, ANG-2 and ALD levels were significantly decreased compared with those before treatment (P<0.05), there is a decreasing trend of ACE and Renin values, but no significant difference(P>0.05); two groups of RAAS related hormone including ACE, Renin, ANG-2, ALD and trough/peak ratio, the total efficiency, TCM syndrome score have no statistical difference (P>0.05). Treatment of 2 weeks, the treatment group and control group of 24 hours average blood pressure, ANG-2 and ALD levels further reduced then that treated of 1 week(P<0.05), but the change of ACE and Renin had no statistical difference (P>0.05); 24-hour mean blood pressure, daytime accept systolic blood pressure, ANG-2 and ALD levels of treatment group decreased significantly compared with the control group (P<0.05); trough/peak ratio, the total efficiency rate, TCM syndrome integral, side reaction and the number of 95% confidence intervals for ANG-2 and ALD in the treatment group were obviously better than that of the control group.Conclusion:Antihypertensive effect of Qingxuan Jiangya Decoction combined with ACE inhibitor is better than western medicine alone to hypertensive patients with medium or low risk and I or II grade and the type of hyperactivity of Liver Yang. Numbers of treatment group of ANG-2 and ALD values of 95% confidence interval is more than that of the control group, further confirmed that the 95% confidence interval of ANG-2 and ALD can be used as a reference for the regulation of blood pressure.