| IntroductionHypertension is an independent risk factor for ischemic cardiovascular and cerebrovascular disease, because of the high incidence. Good blood pressure control can decrease patient mortality and morbidity, in order to reduce the burden on society and the family. In recent years, a large number of experimental and clinical study has confirmed the renin - angiotensin system in the occurrence of atherosclerosis plays an important role in the development, thus blocking RAS system to prevent and treat atherosclerosis an important target. ARB is currently found in the blood pressure lowering drugs at the same time, there is also independent of blood pressure in addition to the benefits that may affect the process of atherosclerosis, thereby reducing the occurrence of cardiovascular and cerebrovascular events. This study by two, and two or more hypertensive patients with ARB class antihypertensive drugs compared with other antihypertensive drugs on blood pressure, under the premise of compliance was observed ARB class of antihypertensive drugs in patients with serum C-reactive protein and carotid artery intima-media thickness, and to explore its possible mechanism and on the clinical significance.MethodPatients will be selected randomly were divided into two groups: Experimental group were given telmisartan (Micardis, produced by Boehringer Ingelheim of German) 80mg daily and nifedipine controlled-release tablets (Adalat, produced by Bayer of German) 30mg daily. Control group were given hydrochlorothiazide 12.5mg daily and adalat 30mg daily. After the follow-up monitoring of blood pressure medication on a regular basis, target blood pressure is below 140/90mmHg. Each of the two drugs were combined treatment is still not compliance, coupled withβ-blockers and other antihypertensive drugs. Normal blood pressure and heart rate monitor to record self-test mode. Two groups of subjects were on medication before and after treatment 3 months, 6 months, 12 months, 24 months to call prompt follow-up of the way to the hospital, measurement of blood pressure, heart rate changes and serum high-sensitivity C-reactive protein (Hs -CRP) and color Doppler ultrasound measurement of carotid IMT. Medication before and after treatment in 12 months, 24 months, measuring fasting blood glucose (Glu), blood lipids (TC, TG, HDL-C, LDL-C).ResultsExperimental group, biochemical Glu, TC, TG, HDL-C, LDL-C before and after treatment, compared with the control group there was no1 .statistical difference.2.The serum hs-CRP after treatment 12 months 1.96±0.28 mg / L, 24 months 1.27±0.33 mg / L, with the pre-treatment 3.43±0.21 mg / L There was a significant statistical difference (P~*<0.05); With the control group after treatment for 12 months 3.02±0.41 mg / L, 24 months, 3.12±0.36 mg / L comparisons statistically significant difference (P~*<0.05).3. IMT experimental group 12 months after treatment 0.87±0.32mm, 24 months 0.85±0.31mm, and 0.92±0.10mm pre-treatment was no statistically significant difference (P > 0.05), with the control group 12 months, 0.86±0.12 mm, 24 months, 0.87±0.26mm comparisons are also no significant difference (P > 0.05).DiscussionTelmisartan is a new angiotensin II receptor antagonists. It is not only outside the ARB or the peroxisome proliferator-activated receptorγ(PPARγ) agonists, and is the only conventional treatment doses that the ARB has the role of PPARγdrugs. PPARγagonists known as insulin-sensitizing agent, in the vascular wall cells have anti-inflammatory effects, can reduce the atherosclerosis lesions. In addition, telmisartan is a selective PPARγmodulator, it does not gain weight, but can also activate the RAS reflex caused by sodium and water retention.In recent years, studies have shown that, CRP is not only a marker of vascular inflammation, but also in the process of vascular injury plays a direct role. Therefore, CRP is actually occurring with atherosclerosis and progress of the pro-inflammatory factors. Ample evidence that, hs-CRP is a response to Cardio-cerebral vascular diseases, independent predictors of risk, and may according to the different levels of serum CRP to cardiovascular and cerebrovascular diseases for low, medium and high-risk sexual risk stratification. The study found that the two groups at each time point after treatment no significant difference in blood pressure levels under the premise of telmisartan group compared with the concentration of serum C-reactive protein before treatment significantly decreased, especially in the drug after 12 months and 24 months months, group, and were statistically significant difference between the two groups, showing a good buck out of telmisartan organs other than the protective effect. Val-MARC study confirmed the ARB class of drugs has anti-inflammatory effect. The study, which took longer follow-up found that telmisartan group on the basis of compliance and effective blood pressure, serum hs-CRP levels significantly lower than the control group, but its role in anti-atherosclerosis are still to be confirmed.IMT of caroid is a noninvansive indicator of reflecting early atherosclerosis, the change of IMT is prior to the production of plaques, ultrasonic testing carotid is better noninvasive,cheap method. The atherosclerosis of common caroid artery which is displayed by ultrasound is only a part of atherosclerosis, IMT of common caroid artery must be accompanying the thickening of systemic main and medium arteries including coronay arteries, the increasing of IMT may be as independent risk factor of forecasting cardiovascular morbidity and mortality. Angiotension II may phosphosphate NF-kB by inhibiting it, consequently start up secretion of various promoting-inflammatory factors. The commonness of ARBs is to delay atherosclerosis by preventing inflammation and oxidative stress mediated by Angiotension II .Though there is no significant statistic difference between two groups, if we can insist on following up and enlarge sampling, the possibility is theoretical that telmisartan can delay or reverse IMT on the basis of decreasing hs-CRP. If the chosen patients can be followed up for long period, they can benefit greater.Conclusion1. Two groups of subjects were used in combination of two antihypertensive drugs can be a good control of blood pressure, blood pressure compliance, and well tolerated.2.Telmisartan group can significantly reduce C-reactive protein concentration, there is slow carotid artery intima-media thickness of the progress trend.3. Telmisartan could inhibit the role of inflammatory response in vivo, and non-blood pressure-dependent, suggesting the existence of organs other than the protective effect of blood pressure.
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