| Objective: At present,in addition to traditional chemotherapy drugs,targeted anti-tumor drugs have gradually become a major trend of anti-tumor therapy.The drug that inhibits vascular endothelial growth factor(VEGF)is one of the currently widely used targeted anti-tumor drugs.However,clinical and experimental research in vascular endothelial growth factor inhibitors have been found it can induce the occurrence of high blood pressure easily at the same time of targeted anti-tumor,and the severities of hypertension varies of each other,they can be controlled in clinical practice,but some cancer patients have to interrupt anti-tumor treatment because of hypertension,and even have serious and life-threatening complications.Bevacizumab is a widely used VEGF inhibitor in clinical practice,and its induced hypertension is also more common.Currently,there is no international guidelines for the treatment of hypertension induced by vascular endothelial growth factor inhibitors.Therefore,this study observed the clinical efficacy of amlodipine besylate tablets and telmisartan in the treatment of patients with hypertension induced by bevacizumab,providing help for the clinical standard diagnosis and treatment.Methods: Among the tumor patients treated in our hospital from June 2017 to October 2018,40 cases were randomly selected.The selected patients should be those who are currently being treated with bevacizumab anti-tumor therapy and who were diagnosed with hypertension during the application of bevacizumab.They were randomly divided into group A(amlodipine besylate 2.5mg/d)and group B(telmisartan 40mg/d)with 20 patients each.Office blood pressure monitoring(OBPM)was performed before,4 and 8 weeks after the treatment,and blood pressure and heart rate were recorded;At week 4,the drug dose was doubled for patients whose blood pressure was not up to standard;Ambulatory blood pressure monitoring(ABPM)was given before and after 8 weeks of medication,and systolic blood pressure(SBP)/diastolic blood pressure(DBP),mean arterial pressure(MAP),heart rate and nocturnal blood pressure drop rate were observed and analyzed at 24 h,daytime and nighttime,and adverse reactions were recorded respectively.Results:(1)There was no significant difference in baseline data between group A and group B(P>0.05).(2)After 4 weeks of treatment,the office blood pressure values of group A and group B decreased from 162.00±10.42 /96.25±8.53 and 163.60±11.52/95.95±8.52 before treatment to 138.70±9.12/ 88.30±7.81 and 138.35±8.92/88.00±7.41,respectively.After 8 weeks of treatment,the office blood pressure values of group A and group B continued to decreased to 136.20±8.51/83.55±5.70 and 135.75±8.12/83.05 ±6.21.The blood pressure of the two groups after treatment was significantly lower than that before treatment(P<0.05),while there was no significant difference between the two groups(P>0.05).(3)After 4 weeks of treatment,there were 5 cases in group A,and 4 cases in group B did not reach the standard of blood pressure,the rate of reaching the standard was 75% and 80% respectively;after 8 weeks,the efficacy of group A and group B was compared: the marked effective rate was 75% vs 80%,the effective rate was 20% vs 15%,the ineffective rate was 5% vs 5%,and the total effective rate was 95% vs 95%.There was no significant difference in the above indicators between group A and group B(P>0.05).(4)The changes of SBP/DBP mean value in AB group after treatment: group A:24h mean SBP/DBP(156.21±9.80/88.57±8.35 decrease to 128.76±7.92/79.26±7.08),daytime mean SBP/DBP(161.26±10.09 /90.50±8.57 decrease to 133.82±8.16/81.90±7.21),nighttime mean SBP/DBP(142.08±9.07/83.20±8.01 decrease to 114.61±7.74/71.88±7.00),group B: 24 h mean SBP/DBP(157.00±9.20/89.00±8.04 decrease to 129.73±8.54/78.51± 7.02),daytime mean SBP/DBP(161.74±9.51/90.91±8.14 decreased to 134.98 ±8.77/81.36±7.20),nighttime mean SBP/DBP(143.70±8.54/83.64±7.87 decreased to 115.04±8.12/70.53±6.76),The mean SBP/DBP of the two groups at 24 h,day and night after medication was significantly lower than that before medication(P<0.05);there was no significant difference between the two groups(P>0.05).The Changes of MAP values at 24 h,daytime and nighttime after treatment in group A and B: group A: 24hMAP(111.12±8.50 decrease to 95.76±6.91),daytime MAP(114.08±8.69 decrease to 99.21±7.05),nighttime MAP(102.82±8.07 decrease to 86.12±6.66);group B:24hMAP(111.66±8.12 decrease to 95.59±7.32),daytime MAP(114.52±8.27 decrease to 99.24±7.50),nighttime MAP(103.66±7.81 decrease to 85.37±6.95),The MAP was significantly lower in the two groups at 24 h,daytime and nighttime after treatment than before treatment(P<0.05),and there was no significant difference between the two groups(P>0.05).(5)The Changes of SBP/DBP nocturnal drop rate after 8 weeks medication in group A and B: group A(11.89±1.02/8.06±2.50 rise to 14.35±2.31/12.27±2.73),group B(11.15±1.35/ 8.03±1.73 rise to 14.79±1.65/13.33±2.59),there were significant differences between after and before treatment in two groups(P<0.05),but there was no significant difference between the two groups(P>0.05).(6)There was no significant difference in the two groups in the mean heart rate before and after treatment,and there was no significant difference between the two groups(P>0.05).(7)After 8 weeks,compared with that before the treatment,there was no significant difference in liver and kidney function,fasting blood glucose,blood lipids and electrolytes Etc.in the two groups(P>0.05);Only one patient in group A developed mild lower extremity edema,the symptoms were mild and no special treatment was given.The remaining patients had no obvious adverse reactions.Conclusion :(1)Both amlodipine besylate and telmisartan can effectively reduce the blood pressure of patients with hypertension induced by bevacizumab without affecting the heart rate,and the efficacy is equivalent.(2)Both amlodipine besylate and telmisartan can improve the nocturnal blood pressure drop rate in patients with hypertension induced by bevacizumab,maintain the circadian rhythm of normal blood pressure,and the efficacy is equivalent.(3)Amlodipine besylate and telmisartan have less adverse reactions in the treatment of hypertension induced by bevacizumab with good safety. |
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