| Increased blood pressure variability (BPV) directly injures vascular endothelial cell; manifested as irregular tissue perfusion, activates humoral regulation system, inflammation and apoptosis. Unnormal vascular endothelial function exists in most essential hypertension patients, may reflect their severity. After endothelial cells are injured, vascular permeability increases, macromolecules such as various cell growth factors get into vessels; at the same time, the self-regulation system balance, endothelin-1(ET-1)/nitric oxide (NO), is destroyed. Vasodilator substances such as NO, prostacyclin (PGI2) decreases and the release of vasoconstrictor substances such as ET-1, thromboxane A2(TXA2) are increased, leading to the decreased of vascular endothelium-dependent vasodilation, also enhanced it’s contractile function, change the structure of the vessel wall, leading to a further increase in blood pressure ultimately.Chinese medisine pathology of hypertension is deficient root with overdo superficial, liver-kidney Yin deficiency syndrome and liver heat uprush. Therefor, treatments should based on nourishing the liver and kidney. The design of Bushen Qinggan formulae conforms with this rule. By means of calming the liver Yang and nourishing Yin, Bushen Qinggan formulae (granule and decoction) provides superior clinical effectiveness. As which concluded from our clinical observation, this study is designed to research clinical efficacy of Bushen Qinggan granule and decoction in treating hypertension of type of Yang-hyperactivity due to Yin-deficiency.1Objectives::Observe Bushen Qinggan granule and decoction’s clinical efficacy in Hypertension of Type of Yang-hyperactivity due to Yin-deficiency. Focused on blood pressure variability(BPV), endothelial function and comparing efficacy of granule and decoction, so as to provide clinical basis for the diagnosis and treatment of these patients. 2Methods:2.1This study is a randomized, placebo-controlled clinical trial.137mild and moderate hypertensive patients with Yin deficiency and Yang hyperactivity syndrome were enrolled. Each one received24hour Ambulatory blood pressure monitoring (ABPM), and blood pressure mean values, blood pressure variability (BPV) were collected and analyzed.2.2Endothelial function was evaluated by nitric oxide (NO), Endothelin-1(ET-1),nitric oxide/endothelin-1(NO/ET-1),and rein-angiotensin-aldosterone system (RAAS) were tested to explore the mechanisms of action of herb medicine.2.3patients were randomized into granula group, decoction group and control group. All of the patients were treated by amlodipine, in addition, Bushen Qinggan granule was given to the granule group, Bushen Qinggan decoction was given to the decoction group and placebo was given to the control group, respectively. After2months treatment, the differences of average blood pressure, blood pressure variability, endothelial function and RAAS were analyzed, so as to investigate the treatment effects of Bushen Qinggan granule and decoction.3Result:3.1Analysis of Bushen Qinggan formulae’s curative effect of the blood pressure After two months of treatment, only daytime systolic pressure(SBP), declined more in Bushen Qinggan decoction group than in other groups (P<0.05). Compared with each groups,24hSBP, night time SBP,24h diastolic pressure (DBP),daytime DBP and night time DBP not statistically significance,3.2Analysis of Bushen Qinggan formulae’s curative effect of the blood pressure variability (BPV) on hypertensive patients After two months of treatment, the following indexes’declined more in granule and decoction group than in control group:24hSBP SD, daytime SBP SD, night time SBP SD,24hDBP SD,24hDBP CV, daytime DBP, night time DBP SD (P<0.05)3.3Analysis of Bushen Qinggan formulae’s curative effect of endothelial function Analysis of correlation factors of endothelial:compared with control group, granule and decoction group decreased ET-1, elevated NO/ET-1(P<0.05);no significant differences between granule and decoction group (P>0.05)3.4Analysis of Bushen Qinggan formulae’s curative effect of renin-angiolensin-aldosterone system (RAAS) Compared with control group, granule and decoction group decreased angiotensin11(AngⅡ).(P<0.05)4Conclusions:4.1Two different Bushen Qinggan formulations compared with placebo can effectively inhibit the AngⅡ,prompted the possibility of Chinese medicine inhibiting the RAAS system. Compared with the control group, mean blood pressure of granule and decoction group did not significantly affected. Only daytime SBP of decoction group was lower, compared with the control group.Suggesting that observation period should be extended or expanded the sample size.4.2Compared with placebo, granule and decoction group improved blood pressure variability, reduced ET-1, increased NO/ET-1. Increased BPV and endothelial function is closely related.The results of our study suggest that Chinese medicine may protect endothelial function by controlling BPV, in order to achieve its target organ protection effect.4.3Compared with granule group, BPV and endothelial factors of decoction group was no significant difference, suggesting two different Bushen Qinggan formulations has no significant differences in clinical efficacy, about BPV and endothelial function... |
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