Zhao Feng, Li Jian-ping, Wang Shu-yu, Guan De-ming, Ge Jun-bo, Hu Jian, Wang Yan-ni, Zhang Fu-min, Huo Yong
Department of Cardiology, Peking University First Hospital, Beijing 100034, China.
Zhonghua Yi Xue Za Zhi. 2008 Nov 18;88(42):2957-61.
To investigate the effect of baseline homocysteine (Hcy) level on the efficacy of enalapril maleate and folic acid tablet in lowering blood pressure and plasma Hcy in patients with mild or moderate essential hypertension.
456 patients with mild or moderate essential hypertension were from 7 hospitals in Southern and Northern China, 196 males and 260 females, aged 18-75, were randomly assigned to one of the 3 groups: Group 1 treated with enalapril 10 mg (n=153); Group 2 treated with enalapril maleate and folic acid tablet at the ratio of 10/0.4 (n=151); and Group 3 treated with enalapril maleate and folic acid tablet at the ratio of 10/0.8 (n=152). Blood pressure was measured every 2 weeks and plasma Hcy level was measured before the experiment, 4 weeks after the beginning of experiment, and by the end of experiment.
Compared with the baseline levels, the blood pressures of the 3 groups were all well controlled (all P<0.01). There was no significant difference among the 3 groups in the efficacy in lowering blood pressure, even after stratification by the baseline Hcy level. 75% of all the subjects had elevated plasma Hcy level (>or=10 micromol/L). The blood pressure and Hcy lowering rates of the subjects with hyperhomocysteinemia in Groups 2 and 3 were 70.9% and 67.0% respectively, both significantly higher than that of Group 1 [45.6%, OR(95%CI): 3.0 (1.7-5.5), P=0.000 and OR=3.3 (1.8-5.9), P=0.000], and in lowering Hcy [OR(95%CI): 7.5 (2.6-21.2), P=0.000 and 3.5 (1.4-8.7), P=0.007] subjects with hyperhomocy steinemia. The Hcy lowering efficacy in the patients without hyperhomocysteinemia of Group 3 was significantly higher than that of Group 1 (P=0.016).
Hyperhomocysteinemia is s extremely common in Chinese hypertensive patients. Enalapril maleate combine with folic acid tablet shows better efficacy in lowering either blood pressure or Hcy in hypertensive patients with hyperhomocysteinemia.
探讨基线同型半胱氨酸（Hcy）水平对马来酸依那普利叶酸片降低轻、中度原发性高血压患者血压及血浆Hcy疗效的影响。
选取来自中国南北7家医院的456例轻、中度原发性高血压患者，其中男性196例，女性260例，年龄18 - 75岁，随机分为3组：1组服用依那普利10 mg（n = 153）；2组服用马来酸依那普利叶酸片，比例为10/0.4（n = 151）；3组服用马来酸依那普利叶酸片，比例为10/0.8（n = 152）。每2周测量血压，在实验前、实验开始后4周及实验结束时测量血浆Hcy水平。
与基线水平相比，3组血压均得到良好控制（均P < 0.01）。即使按基线Hcy水平分层，3组在降低血压疗效方面无显著差异。所有受试者中75%血浆Hcy水平升高（≥10 μmol/L）。2组和3组高同型半胱氨酸血症患者的血压和Hcy降低率分别为70.9%和67.0%，均显著高于1组[45.6%，OR(95%CI)：3.0(1.7 - 5.5)，P = 0.000；OR = 3.3(1.8 - 5.9)，P = 0.000]，在降低Hcy方面[OR(95%CI)：7.5(2.6 - 21.2)，P = 0.000；3.5(1.4 - 8.7)，P = 0.007]，3组非高同型半胱氨酸血症患者的Hcy降低疗效显著高于1组（P = 0.016）。
高同型半胱氨酸血症在中国高血压患者中极为常见。马来酸依那普利联合叶酸片在降低高同型半胱氨酸血症高血压患者的血压或Hcy方面显示出更好的疗效。
