Effects Of Mongolia Astragalus Originating In Longxi Of Gansu On Cardiac And Nephritic Function In Hypertensive Patients With Metabolic Syndrome

Objective To investigate the effect of Mongolia Astragalus originating in Longxi of Gansu on protection of cardiac and nephritic function in hypertensive patients with metabolic syndrome (MetS).Methods This study was designed as a prospective, open, parallel randomized controlled trial, and planned to enroll two hundred and ten hypertensive patients with MetS and follow up for one year. The objects came from Outpatient and Inpatient in Department of Cardiology. Department of Endocrinology, Number One Department of Diabetes and Number Two Department of Diabetes in Lanzhou University Second Hospital and surrounding communities. One hundred and forty-eight hypertensive patients with MetS were selected over the age of18years who consistent with the modified United States National Cholesterol Education Program Adult Treatment Panel III (NECP/ATPⅢ) diagnosis criteria. Then the patients were randomly assigned to control group. Astragalus group1and Astragalus group2. After six months, the changes of related indicators of cardiac and nephritic function were compared between pre-treatment and post-treatments. Cardiovascular High-resolution Ultrasonography was used in this study. The anatomy structure of the cardiac, cardiac diastolic function, and the cardiac systolic function were evaluated by M-mode echocardiography, two-dimensional echocardiography and Doppler echocardiographic determination. The levels of microalbuminuria (MAU) and angiotensin Ⅱ (Ang Ⅱ) were evaluated by radioimmunoassay, and angiotensin converting anzyme/angiotensin converting anzyme2(ACE/ACE2) the levels of protein expression in human peripheral blood lymphocyte were examined by Weston Blot. In addition, we calculated Estimated Glomerular Filtration Rate (eGFR) were calculated by the modified MDRD fumular. The changes of these indexes were observed, SPSS17.0software was used to statistical analysis the data.Results①The abnormal metabolism related indicators, among the three groups pre-treatment comparing with post-treatments, waist circumference had no significant differences (P=.932,P=0.499,P=0.589). Body mass index (BMI) had no significant differences (P=0.792, P=0.477,P=0.184). Systolic blood pressure (SBP) had no significant differences (P=0.233, P=0.696,P=0.299). Diastolic blood pressure (DBP) had no significant differences (P=0.47, P=0.535,P=0.889). The changes values of triglyceride (TG) between Astragalus group1and Astragalus group2had significant difference (P=0.038). While between the control group and Astragalus group1, and the control group and Astragalus group2, there was no significant difference (P=0.163, P=0.590). High-density lipoprotein cholesterol (HDL-c) had no significant differences (P=0.615,P=0.373,P=0.168). Low-density lipoprotein cholesterol (LDL-c) had no significant differences (P=0.836,P=0.999,P=0822). Fasting plasma glucose (FPG) had no significant differences (P=0.393,P=0.539,P=0.740).②The anatomy structure of the cardiac and the cardiac systolic function indicators, among the three groups pre-treatment comparing with post-treatments, left ventricular end-diastolic volume (LVEDV) had no significant differences (P=0.190,P=0.920,P=0.150). Ejection fraction (EF) had no significant differences (P=0.451, P=0.548,P=0.867). Left ventricular end-systolic volume (LVESV) had no significant differences (P=0.183,P=0.962,P=0.100). Fractional shortening (FS) had no significant differences (P=0.109,P=0.521,P=0.260). Left ventricular end-diastolic dimension (LVEDd) had no significant differences (P=0.870,P=0.840,P=0.660). Left ventricular end-systolic volume (LVESd) had no significant differences (P=0.132,P=0.150,P=0.867). Stroke volume (SV) had no significant differences (P=0.502,P=0.752,P=0.232). Interventricular septal diastolic thickness (IVSDT) had no significant differences (P=0.122,P=0.130,P=0.998). Left atrium diameter (LAD) had no significant differences (P=0.462,P=0.387,P=0.869). Left ventricular diastolic posterior wall thickness (LVPWT) had no significant differences (P=0.454,P=0.278,P=0.678). Left ventricular mass (LVM) had no significant differences (P=0.446,P=0.240,P0.613). Left ventricular mass index (LVMI) had no significant differences (P=0.425, P=0.460,P=0.918).③The cardiac diastolic function indicators, among the three groups pre-treatment comparing with post-treatments, deceleration time (DT) had no significant differences (P0.810,P=0.640, P=0.401). Ratio of early to late diastolic peak flow velocity (E/A) had no significant differences (P=0.414,P=0.465,P=0.939). Ratio of early diastolic mitral annular velocity to late diastolic velocity of tricuspid annulus (E/e’) had no significant differences (P=0.362,P=0.432,P=0.919). Atrial systolic pulmonary venous reflux speed (Ar) had no significant differences (P=0.788, P=0.450,P=0.560). Mitral flow velocity (Vp) had no significant differences (P=0.906,P=0.578, P=0.544).④Nephritic function indicators, among the three groups pre-treatment comparing with post-treatments, estimated glomerular filtration rate (eGFR) had no significant differences (P=.660,P=0.372,P=0.152). Uric acid (UA) had no significant differences (P=0.652,P=1.000, P=0.662). The changes values of Urinary miemalbumin (MAU) between Astragalus group1and Astragalus group2had significant difference (P=0.041), and the changes between the control group and Astragalus group1had significant difference (P=0.042). While between the control group and Astragalus group2, there was no significant difference (P=0.662)⑤The renin-angiotensin system (RAS) related index, when compared the level of ACE beford and after treatment, there was statistical significance between control group and Astragalus group1, control group and astragalus group2(P=0.000,P=0.000), but the difference between Astragalus group1and Astragalus group2was not statistically significant (P=0.293). Moreover, compared the level of ACE beford and after treatment, there was statistical significance between control group and Astragalus group1, control group and astragalus group2(P=0.001,P=0.000), but the difference between Astragalus group1and Astragalus group2was not statistically significant (P=0.325). However, Ang Ⅱ had no significant difference among the three groups (P=0.733,P=0.803, P=.532).Conclusions Interim analysis results show that, Astragalus combined with basic treatment for six months, compared with simple basic treatment on patients with MetS, the cardiac structure, left ventricular systolic function and left ventricular diastolic function has no significantly protective effect. While had significantly protective effect on nephritic function in patients with early nephtitic changes in MetS, and high dose of Astragalus had significantly protective effect than the low dose group. However, all the results above were the interim results, the statistical results of the indicators are for reference only. Objective To evaluate the clinical efficacy and safety of telmisartan in the treatment of metabolic syndrome MS.Methods We searched The Cochrane Library, PubMed, EMBASE, Chinese Biomedical Literature Database, Chinese Scientific Journals Full-text Database, and Chinese Journal Full-text Database up to September2010to identify randomized controlled trials (RCTs) comparing telmisartan with other drugs for MS.We evaluated the quality of the included studies and analyzed data by Cochrane Collaboration’s RevMan5.0software.Results Ten RCTs involving724patients were included.The results of meta analysis suggested that there were significant differences between telmisartan and valsartan in systolic blood pressure(MD=1.79,95%CI:0.91-2.67) and Low-density lipoprotein (MD=-10.10.95%CI:-13.02--7.18).Telmisartan was statistically significantly greater reductions compared with losartan,which was (MD=6.20,95%CI:1.80-10.60) and (MD=10.72,95%CI:1.05-20.39) for systolic blood pressure and fasting plasma glucose respectively.Telmisartan significantly lower diastolic blood pressure(MD=1.00,95%CI:0.06-1.94) and fasting plasma glucose(MD=14.00,95%CI:10.95-17.05) more than irbesartan.The high sensitivity C-reactive protein(MD=0.25,95%CI:0.19-0.31) were all decreased in telmisartan group compared with those in benazepril group. Comparing with ramipril, telmisartan can reduce blood pressure within24hours. Telmisartan was associated with a increase in the insulin resistance index (MD=0.60,95%CI:0.04-1.16),and the difference between the two group were significant. There were significant differences between telmisartan and amlodipine in lowering insulin resistance index(MD=1.36,95%CI:0.26-2.46).Conclusion The results of meta-analysis indicate that telmisartan have significant effects in treatment of the patients of MS, but due to the limitation of sample sight,and the quality of original studys,and the publication bias,the effects of telmisartan on MS need to be confirmed by large mullicenter randomized controlled trials.