A Study Of The Relationship Between Higher Pulse Press And Inflammatory Factor, Endogenous Ouabain In Elderly Hypertensive Patients

Background: The higher- pulse pressure(H-PP) is an independent risk factor for cardiac and cerebral vascular diseases. The morbility and mortality of cardiac and cerebral vascular diseases in elderly essential hypertensive patients with a higher-pulse pressure are remarkably higher than that in hypertensive patients with normal pulse pressure. It's important to decrease pulse pressure to prevent heart, brain and kidney from damage in elderly essential hypentesive patients who have a higher pulse pressure. The formation of H-PP probably results from AS. Endogenous Ouabain is an endocrine hormone which playes an important role in the modulation of blood pressure, but the relationship between EO and H-PP remains unclear. Atherosclerosis (AS) is a specific kind of inflammation in terms of pathophysiology. But whether inflammatory factor plays a role in the formation of H-PP is not clear up to date.Aim: To study the relationship between higher PP and atherosclerosis and the effects of inflammation and EO in the formation of higher PP so as to provide new ideas in the higher PP treatment. To study the effects of amlodipine independant of blood pressure decreasing to provide new evidences of hypertension treatment.Method: Sixty-five hypertensive patients ( 32 males, 33 females) were selected. The mean age was 69.6±4.3 years old. After medicine elution, the subjects were divided into 2 groups according to the average ambulatory pulse pressure of 24h. One group included the patients whose PP was equal to or higher than 60 mmHg(n=31), the other group have the patients with PP<60mmHg (n=34). We measured the CCA-IMT,serum C-reactive protein IL-6 and EO of all the cases. And then we treated the patients with PP>60mmHg with amlodipine up to 10 months. All the indexes before and after the therapy were compared. The data were analyzed with spssll.5. Result: 1.The mean CCA-IMT, serum levels of C-reactive protein, IL-6, EO were significantly higher in PP>60mmHg group than that in PP<60mmHg group. 2. The mean CCA-IMT was decreased after ten months of amlodipine therapy. 3.The average 24h ambulatory pulse pressure, serum levels of C-reactive protein, IL-6, EO were significantly lower after treatment with amlodipine.Conclusion: 1. The mean CCA-IMT was increased in PP>60mmHg group than that in PP<60mmHg group. It suggested that the higher-pulse pressure is a useful marker for evaluation of atherosclerosis in elderly essential hypertensive patients. 2. The serum concentration of C-reactive protein, IL-6, EO was significantly higher in PP>60mmHg group. It indicated that the inflammation and EO were probably involved in the development of a higher pulse-pressure. 3. CCA-IMT and PP were remarkably reduced in PP>60mmHg group after ten months of treatment with amlodipine, which showed that in addition to PP-lowering amlodipine might prevent the development of atherosclerosis. The serum concentration of C-reactive protein, IL-6, and EO were significantly lower after treatment with amlodipine. It showed that amlodipine could involved in the inhibition of inflammation and the decrease of the concentration of EO, which may exert beneficial effect to vascular endothelial cell independent of blood pressure reduction.