İki farklı antihipertansif tedaviye eklenmiş statin tedavisinin kardiyovasküler ve biyokimyasal parametreler üzerine etkisi
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Tarih
2009
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Hatay Mustafa Kemal Üniversitesi
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info:eu-repo/semantics/openAccess
Özet
AMAÇ: Literatür taramasında zofenopril ve statin kombinasyon tedavisinin hipertansif hastalarda kardiyovasküler sistem ve biyokimyasal parametreler üzerine etkisi araştırılmamıştır. Bu çalışmanın amacı; zofenopril-statin kombinasyonunu, faydalı etkileri gösterilmiş olan amlodipin ve statin kombinasyonu ile karşılaştırmaktır.MATERYAL/METOD: JNC 7 kriterlerine göre evre I-II hipertansif ve NCEP ATP 3 kriterlerine göre sınırda yüksek hiperlipidemik 64 hasta çalışmaya alındı. Bu hastalar rastgele yöntem ile zofenopril (n=32) ve amlodipin (n=32) gruplarına ayrıştırıldı. Bir gruba 30 mgr/gün zofenopril, diğer gruba ise 5-10 mgr/gün amlodipin tedavisi 3 ay süre ile başlandı. 3 ay sonunda her iki gruba atorvastatin 10-20 mg/gün ilave edildi. Bazal biyokimyasal, FMD, CİMT, EKO parametreleri alındı, 3 ve 6. aylarda gruplar arasında ve içinde yüzde değişimler karşılaştırıldı.BULGULAR: İlk 3 aylık süreçte amlodipinle karşılaştırıldığında FMD'deki artış zofenopril grubunda istatiksel olarak anlamlıydı (% 74,5 ± 40,2; % 28,3 ± 12,2: p=0,001). Her iki gruba statin eklendikten sonra FMD artışında gruplar arasında fark saptanmadı (% 12,5 ± 5,0 ; % 12,2 ± 4,2 ; p: 0,34) . hsCRP düzeylerinde zofenopril grubunda ilk 3 ayda (% 44,3 ± 3,1 ;% 28 ± 3 ; p: 0,02) ve atorvastatin eklendikten sonraki 3 ayda (% 10 ± 3,1 ; % 3,0 ± 1,0 ; p:0,02) amlodipin grubuna göre istatiksel olarak anlamlı azalma oluştu. Ürik asit düzeylerinde zofenopril grubunda amlodipin grubuyla karşılaştırıldığında ilk 3 ayda ( % 1,0 ± 0 ; % 3 ± 1,0 ; p: 0,6 ) istatiksel olarak anlamlı olmayan azalma olurken, ikinci 3 ayda istatiksel olarak anlamlı düşme oldu ( % 5,0 ± 0,8 ; % 0 ± 0,1 p: 0,037 ). Oksidatif stres parametreleri değerlendirildiğinde, ilk 3 aylık süreçte amlodipin grubuyla karşılaştırıldığında zofenopril grubunda NO düzeyi istatiksel olarak anlamlı şekilde artmıştı (% 110 ± 10 ; % 37 ± 5,0 ; p : 0,006), tedaviye atorvastatin eklendikten sonraki artış iki grup arasında benzerdi (% 22,0 ± 4,1 ; % 12,0 ± 3,1:p;0,47). MDA azalması, zofenopril grubunda amlodipin grubuyla karşılaştırıldığında ilk 3 ayda (% 38 ± 5,0 ; % 9,1 ± 2,1 ; p : 0,001) ve atorvastatin eklendikten sonraki 3 ayda ( % 23 ± 2,2 ; % 17 ± 2,1 ; p : 0,05 ) istatiksel olarak anlamlı tespit edildi. SOD artışı, zofenopril grubunda amlodipin grubuyla karşılaştırıldığında ilk 3 ayda ( % 100,1 ± 10,0 ; % 11,0 ± 2,1 ; p : 0,001) ve atorvastatin eklendikten sonraki 3 ayda (% 37,2 ± 3,1 ; % 23,1 ± 2,0 ; p : 0,034) istatiksel olarak anlamlı tespit edildi. Katalaz artışı zofenopril grubunda, amlodipin grubuyla karşılaştırıldığında ilk 3 ayda ( % 69 ± 5,1 ; % 13 ± 3,2 ; p : 0,01) ve atorvastatin eklendikten sonraki 3 ayda (% 25 ± 2,1 ; % 5,0 ± 1,1 ; p : 0,01 ) istatiksel olarak anlamlı tespit edildi.SONUÇ: Zofenopril hem tek başına, hemde atorvastatinle kombine edildiğinde, amlodipin atorvastatin kombinasyonuna göre inflamatuar parametreleri, oksidatif stres parametrelerini ve endotel bağımlı vazodilatasyonu daha fazla olumlu etkilemiştir.
BACKGROUND: Antiinflammatory and beneficial antioxidant effects of statins and zofenopril have been reported. The aim of this research is to compare the combination of zofenopril-statin which beneficial effects have been shown yet, and combination of amlodipine-statin.MATERIAL/ METHODS: 64 patients with grade I ? II hypertension according to JNC 7 criteria and mild hyperlipidemia according to NCEP ATP 3 criteria were enrolled to the study. Patients were randomly assigned into zofenopril (n=32, group I) and amlodipin (n=32, group II ) groups. Group I received 30 mg/day zofenopril, group II received 5 ? 10 mg/day amlodipin for 3 months. After 3 months of monotherapy 10- 20 mg/day atorvastatin was added to the regimen. Basal Biochemical measurements, FMD, carotis intima media thickness, and echocardiographic measurements were performed and recorded and were repeated after 3 and 6 months (table14).RESULTS: Both monotherapy regimens increased FMD values significantly but the increase in the zofenopril group was significantly higher in the amlodipine group ( % 74,5 ±40,2; % 28,3±12,2: p: 0,001)(table18). Statin combination increased the FMD levels similarly in both groups (% 12,5±5,0 ; % 12,2±4,2 ; P: 0,34). The decrease rate in the hsCRP levels were significantly higher in zofenopril group after 3 months(% 44,3 ± 3,1 ;% 28 ± 3 ; p: 0,02) and the decrease continued to be more significant in the zofenopril group after combination with atorvastatin after 3 months(% 10 ± 3,1 ; % 3,0 ± 1,0 ; p:0,02) (6. month). The decrease rate in the uric acid levels were not significantly higher in zofenopril group after 3 months ( % 1,0 ± 0 ; % 3 ± 1,0 ; p: 0,6 ) but the decrease to be significant in the zofinopril group after combination with atorvastatin after 3 months( % 5,0 ± 0,8 ; % 0 ± 0,1 p: 0,037 ) (6. month). Nitric oxide levels increased more significantly in the zofenopril group after 3 months(% 110 ± 10 ; % 37 ± 5,0 ; p : 0,006). Adding statin to the groups increased nitric oxide levels similarly in both groups(% 22,0 ± 4,1 ; % 12,0 ± 3,1:p;0,47). The decrease rate in the MDA levels were significantly higher in zofenopril group after 3 months (% 38 ± 5,0 ; % 9,1 ± 2,1 ; p : 0,001) and the decrease continued to be more significant in the zofenopril group after combination with atorvastatin after 3 months ( % 23 ± 2,2 ; % 17 ± 2,1 ; p : 0,05 ) (6. month). The increase rate in the SOD levels were significantly higher in zofenopril group after 3 months ( % 100,1 ± 10,0 ; % 11,0 ± 2,1 ; p : 0,001) and the increase continued to be more significant in the zofenopril group after combination with atorvastatin after 3 months (% 37,2 ± 3,1 ; % 23,1 ± 2,0 ; p : 0,034) (6. month). The increase rate in catalase levels were significantly higher in zofenopril group after 3 months ( % 69 ± 5,1 ; % 13 ± 3,2 ; p : 0,01) and the increase continued to be more significant in the zofenopril group after combination with atorvastatin after 3 months (% 25 ± 2,1 ; % 5,0 ± 1,1 ; p : 0,01 ) (6. month).CONCLUSION: In the present study we found that zofenopril monotherapy and combination of zofenopril with atorvastatin had significantly more beneficial effects on inflammatory, oxidative stres parameters and endothelial mediated vasodilation.
BACKGROUND: Antiinflammatory and beneficial antioxidant effects of statins and zofenopril have been reported. The aim of this research is to compare the combination of zofenopril-statin which beneficial effects have been shown yet, and combination of amlodipine-statin.MATERIAL/ METHODS: 64 patients with grade I ? II hypertension according to JNC 7 criteria and mild hyperlipidemia according to NCEP ATP 3 criteria were enrolled to the study. Patients were randomly assigned into zofenopril (n=32, group I) and amlodipin (n=32, group II ) groups. Group I received 30 mg/day zofenopril, group II received 5 ? 10 mg/day amlodipin for 3 months. After 3 months of monotherapy 10- 20 mg/day atorvastatin was added to the regimen. Basal Biochemical measurements, FMD, carotis intima media thickness, and echocardiographic measurements were performed and recorded and were repeated after 3 and 6 months (table14).RESULTS: Both monotherapy regimens increased FMD values significantly but the increase in the zofenopril group was significantly higher in the amlodipine group ( % 74,5 ±40,2; % 28,3±12,2: p: 0,001)(table18). Statin combination increased the FMD levels similarly in both groups (% 12,5±5,0 ; % 12,2±4,2 ; P: 0,34). The decrease rate in the hsCRP levels were significantly higher in zofenopril group after 3 months(% 44,3 ± 3,1 ;% 28 ± 3 ; p: 0,02) and the decrease continued to be more significant in the zofenopril group after combination with atorvastatin after 3 months(% 10 ± 3,1 ; % 3,0 ± 1,0 ; p:0,02) (6. month). The decrease rate in the uric acid levels were not significantly higher in zofenopril group after 3 months ( % 1,0 ± 0 ; % 3 ± 1,0 ; p: 0,6 ) but the decrease to be significant in the zofinopril group after combination with atorvastatin after 3 months( % 5,0 ± 0,8 ; % 0 ± 0,1 p: 0,037 ) (6. month). Nitric oxide levels increased more significantly in the zofenopril group after 3 months(% 110 ± 10 ; % 37 ± 5,0 ; p : 0,006). Adding statin to the groups increased nitric oxide levels similarly in both groups(% 22,0 ± 4,1 ; % 12,0 ± 3,1:p;0,47). The decrease rate in the MDA levels were significantly higher in zofenopril group after 3 months (% 38 ± 5,0 ; % 9,1 ± 2,1 ; p : 0,001) and the decrease continued to be more significant in the zofenopril group after combination with atorvastatin after 3 months ( % 23 ± 2,2 ; % 17 ± 2,1 ; p : 0,05 ) (6. month). The increase rate in the SOD levels were significantly higher in zofenopril group after 3 months ( % 100,1 ± 10,0 ; % 11,0 ± 2,1 ; p : 0,001) and the increase continued to be more significant in the zofenopril group after combination with atorvastatin after 3 months (% 37,2 ± 3,1 ; % 23,1 ± 2,0 ; p : 0,034) (6. month). The increase rate in catalase levels were significantly higher in zofenopril group after 3 months ( % 69 ± 5,1 ; % 13 ± 3,2 ; p : 0,01) and the increase continued to be more significant in the zofenopril group after combination with atorvastatin after 3 months (% 25 ± 2,1 ; % 5,0 ± 1,1 ; p : 0,01 ) (6. month).CONCLUSION: In the present study we found that zofenopril monotherapy and combination of zofenopril with atorvastatin had significantly more beneficial effects on inflammatory, oxidative stres parameters and endothelial mediated vasodilation.
Açıklama
Anahtar Kelimeler
Kardiyoloji, Cardiology, Endotel disfonksiyonu, Hipertansiyon, hiperlipidemi, zofenopril, amlodipin, atorvastatin, oksidatif stres., Endothelial dysfunction, hypertension, hyperlipidemia, zofenopril, atorvastatin, amlodipin
