The Clinical Effect Of Jiawei Liuwei Dihuang Decoction Combined With Enalapril In The Treatment Of H-type Hypertension With Syndrome Of Kidney Deficiency And Blood Stasis And Its Effect On Homocysteine Level

Objectives: 1.To observe the clinical effect of Jiawei Liuwei Dihuang Decoction(JWLWDHD)in the treatment of H-type hypertension with Syndrome of kidney deficiency and blood stasis(Kidney Yin deficiency predominantly)and its effect on serum homocysteine(Hcy);2.To compare and evaluate the effect of JWLWDHD combined with enalapril and compound of enalapril-folic acid tablets in the treatment of H-type hypertension with Syndrome of kidney deficiency and blood-stasis(Kidney Yin deficiency predominantly),and observe those difference between enalapril tablets alone;3.To comprehensively analyze the clinical effect of the combination of traditional Chinese and western medicine(JWLWDHDcombined with enalapril)in the treatment of H-type hypertension with Syndrome of kidney deficiency and blood stasis(Kidney Yin deficiency predominantly)and the dual advantages of intervention in clinical and Hcy.Methods: Total of 134 patients with H-type hypertension(Syndrome of kidney deficiency and blood-stasis,Kidney Yin deficiency predominantly)who met the inclusion and exclusion criteria were randomly divided into group of enalapril-folic acid tablet(48 cases),group of enalapril combined with Chinese medicine(42 cases)and group of enalapril(44 cases).group of enalapril-folic acid tablet were taken with enalapril maleate folate tablets(specification: enalapril 10mg/folic acid 0.8mg,usage: one piece a day),group of enalapril combined with Chinese medicine were taken enalapril maleate tablets(specification: 10mg/tablet,usage: one tablet a day)and JWLWDHD(usage:one dose per day),group of enalapril were taken enalapril maleate tablets one piece a day.The three groups were treated continuously for 4 weeks.The changes of clinical symptoms,occasional blood pressure,dynamic blood pressure(including all-day mean blood pressure,daytime mean blood pressure,nighttime mean blood pressure,blood pressure load value,blood pressure variability,nocturnal blood pressure drop rate,heart rate etc.),plasma Hcy and adverse reactions of 3 groups before and after treatment were observed,and the difference of treatment effect between 3 groups was compared.Results:(1)Finally,42,35 and 38 cases were completed and 6,7 and 6 cases were terminated due to adverse reactions in group of enalapril-folic acid tablet,group of enalapril combined with Chinese medicine and group of enalapril respectively,and there were no significant difference of baseline among three groups(p>0.05).(2)Efficacy for TCM symptom: The symptoms were improved after treatment in the three groups and with significant differences among the groups(p<0.01),and the symptoms were improved more significantly in group of enalapril combined with Chinese medicine(p<0.017).(3)Efficacy for clinical and test parameter: Whole-day mean blood pressure,daytime mean blood pressure,nighttime mean blood pressure,blood pressure load value,pulse pressure,mean arterial pressure were statistically significant decreased in each group(p<0.05)and the difference among the groups after treatment were statistically significant(p<0.05),Amplitude of blood pressure lowering in group of enalapril combined with Chinese medicine was superior to group of enalapril;There was no significant difference in blood pressure variation coefficient,nocturnal blood pressure drop rate and heart rate before and after treatment in each group(p>0.05);The differences of blood pressure before and after treatment were statistically significant(p<0.05)in three groups,while there was no significant difference in blood pressure between the three groups after treatment(p>0.05);Office systolic blood pressure in the three groups after treatment were higher than the average systolic blood pressure(p<0.05);The rate of reaching the standard of mean blood pressure after treatment was statistically significant(p<0.05)among the three groups,while there was no significant difference in the rate of reaching the standard of Office blood pressure(p > 0.05);The difference of serum Hcy levels before and after treatment were statistically significant decreased in two group(p<0.05)beside group of enalapril.Though there was no significant difference between group of enalapril-folic acid tablet and group of enalapril combined with Chinese medicine in serum Hcy levels(p >0.017),but both of them were significantly lower than group of enalapril(p<0.017).Conclusions:(1)All of the clinical symptoms can be alleviated in H-type hypertensives of three groups however group of enalapril combined with Chinese medicine is better.(2)OBP can be reduced significantly in each group,while the difference between the groups is not obvious.(3)All of the dynamic blood pressure parameters,including mean blood pressure,blood pressure load value,pulse pressure and mean arterial pressure in three groups can be significantly reduced,but group of enalapril combined with Chinese medicine had a better effect.(4)Serum Hcy level were significantly reduced in two group beside group of enalapril.(5)JWLWDHD had no significant effect on the dry cough and other adverse reactions caused by enalapril,and could not improve white coat effect of patient.