| Objective:Essential Hypertension(EH)is widely recognized as the most relevant risk factor for the incidence and death of cardiovascular diseases,affecting 30%to 50%of the global adult population,and seriously threatening the quality of human life.Poorly controlled blood pressure over a long period of time can increase the risk of damage to target organs such as the heart,brain and kidneys,so it is important to control blood pressure aggressively.The efficacy of the same antihypertensive drug can be observed to be heterogeneous across ethnic groups and even across patients in clinical practice.The use of angiotensin-converting enzyme inhibitors(ACEIs)has been largely endorsed by all major guidelines in the field of hypertension,as they have proven to be effective in lowering blood pressure.In this study,we retrospectively analyzed the antihypertensive efficacy of the same ACEI drug in Dai and Han hypertensive patients,and observed whether there is any clinical efficacy difference of ACEI drugs between different ethnic groups,so as to provide a reference basis for discussing the factors influencing the antihypertensive efficacy in Dai hypertensive patients,and to provide a certain degree of reference for the antihypertensive treatment of Dai hypertensive patients in local areas.Methods:A case-control retrospective research method was used.First of all,through the inclusion and exclusion criteria,325 patients with primary hypertension of the Dai and Han nationalities who attended the Department of Cardiology,Dehong People’s Hospital between August 2017 and September 2019 were included.The patients were divided into Han and Dai groups according to their ethnicity.There were 200 cases in the Han group and 125 in the Dai group.The selected cases are limited to people in Dehong prefecture LuXi region,we used electronic medical record system to collect general data and laboratory data of them.All enrolled patients have treated with ACEI drugs(perindopril or benazepril)for 8 weeks.Patients were followed up at the end of the 2nd,4th and 8th week of dosing,and the clinician made adjustments to the medication dosage based on the reduction in their BP.During the follow-up,the SBP and DBP of the patients were monitored and recorded by fixed personnel.We collected patient’s blood pressure changes and corresponding drug treatment dose,meanwhile,assessed blood pressure and hypertension treatment according to the relevant standards.Moreover,SPSS 23.0 software was used for statistical analysis to compare the blood pressure reduction between Dai and Han patients with hypertension and to observe whether there were differences in the antihypertensive efficacy of ACEI drugs.Finally,the conclusion was drawn.Results:1.Comparison of clinical data:Clinical data was retrospectively analyzed between enrolled Dai and Han hypertension patients in Dehong Luxi area of Yunnan Province,based on age,gender,BMI,heart rate,laboratory data(BUN,Cr,FBG,TG,TC,LDL-C,HDL)had no statistical significance(P>0.05).No statistically significant difference in SBP and DBP between the two groups before treatment(P>0.05).2.Comparison of blood pressure changes:After observing the standard application of ACEI for 8 weeks in the Dai group and the Han group,there remained no difference in SBP and DBP after treatment(P>0.05),but both groups showed a decrease in SBP and DBP.SBP decreased(49.38±22.10)mmHg in Dai group and(44.98±20.37)mmHg in Han group,while DBP decreased(23.05±16.28)mmHg in Dai group and(21.73±19.80)mmHg in Han group,respectively.The decline in either SBP or DBP had no statistical significance between the two groups(P>0.05).After stratified subgroup analysis by age(Age≥60 group and<60 group),there no difference between Dai group and Han group in the antihypertensive amplitude of SBP and DBP(P>0.05).3.To compare the effectiveness of clinical therapy and attainment rates:The total effective rate was 92.8%,significant effective rate was 82.4%,and effective rate was 10.4%in the 125 Dai hypertension patients included in the efficacy analysis.In 200 Han ethic patients,the overall effective rate reached 89.0%,with a significant rate at 75%and an effective rate at 14%.No statistical difference in antihypertensive efficacy between ethnic groups(X2=1.287,P=0.257).In addition,84.4%of Dai hypertension patients and 75.5%of Han hypertension patients reached the blood pressure standard,and there was no statistically difference between the two groups(X2=3.323,P=0.068).The difference in antihypertensive efficacy between patients aged>60 and<60 years was not statistically significant(P>0.05)in a subgroup analysis stratified by age(P>0.05).A statistically insignificant difference in attainment rates between the two groups was observed in patients≥60 years of age(X2=2.213,P=0.137).However,in the<60 age subgroup,the achievement rate of the standard for high blood pressure was obviously higher in the Dai than the Han group(X2=8.955,P=0.003).4.Comparison of medication use after blood pressure control reached the standard:The standard dose is recognized as the dose of ACEI drug when the patient’s blood pressure drops to normal(<140/90mmHg).The Dai group had a much higher proportion of Benadryl 5mg dosage in comparison to the Han group,according to the chi-square test(X2=24.867,P<0.001).The proportion of perindopril 4mg dosage in Dai patients was remarkably higher in comparison to Han patients(X2=16.640,P<0.001).The target dose in both the perindopriya group and the benapriya group was significantly lower than that in the Han group,with statistical significance(P<0.001).5.Comparison of blood pressure control compliance time:The time when the patient’s blood pressure control reaches the standard(<140/90mmHg)is regarded as the standard time.The Mann-Whitney U test results of patients of different ethnic groups showed that the Dai group had significantly shorter reaching time than the Han group,with statistical significance(P<0.001).6.The proportion combined with other drugs:At the end of the fourth week of taking antihypertensive drugs,24(19.2%)patients in the Dai group still had substandard blood pressure and needed to take other antihypertensive drugs together.In the Han group,69(34.5%)patients needed to be combined with other antihypertensive drugs.The difference between the two groups was significant(X2=5.990,P=0.014).Conclusion:It was found that in patients with hypertension from the same region,Dai nationality had less dose demand for ACEIS and shorter time for blood pressure control to reach the standard than Han nationality,but there was no difference in the antihypertensive efficacy and the success rate of ACEIS drugs between the two groups.Dai patients with EH have a higher sensitivity trend to ACEIs,gene polymorphism may still be one of the influencing factors of individual response to drug therapy. |
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