Abstract:

Objective　To observe the effects of sacubitril valsartan sodium tablets combined with folic acid on glucose and lipid metabolism, blood pressure and vascular endothelial function in patients with H-type hypertension. Methods　This study is a randomized controlled trial. Eighty-eight patients with H-type hypertension who were admitted to Tongchuan People's Hospital from April 2022 to April 2024 were selected as the study subjects. Using the random number table method, the patients were divided into the control group and the experimental group, with 44 cases in each group. There were 25 males and 19 females in the control group, aged 45-74 (53.30±7.87) years, body mass index (BMI) 22.87-29.65 (24.85±2.83) kg/m². There were 28 males and 16 females in the experimental group, aged 41-75 (54.68±8.01) years, BMI 22.57-29.41 (24.71±2.43) kg/m². The control group was treated with sacubitril valsartan sodium tablets, while the experimental group was treated with folic acid in addition to the treatment of the control group. Both groups received continuous treatment for 4 months. The glucose and lipid metabolism indicators [fasting blood glucose (FPG), glycosylated hemoglobin (HbAlc), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA1)], blood pressure and Hcy levels, vascular endothelial function [vascular dilation function (FMD), intercellular adhesion molecule-1 (ICAM-1), endothelin-1 (ET-1)] were compared before and after treatment in the two groups, as well as clinical efficacy and adverse reactions. Independent sample t test, paired t test, Mann-Whitney U test, χ² test, corrected χ² test, and rank sum test were used for statistical analysis. Results　After treatment, the levels of FPG, HbAlc, TC, TG, and LDL-C in the experimental group were all lower than those in the control group [(4.34±0.89) mmol/L vs. (4.77±0.98) mmol/L, (4.11±0.92)% vs. (4.49±0.81)%, (3.98±0.97) mmol/L vs. (4.42±1.03) mmol/L, 1.03 (1.04, 2.18) mmol/L vs. 1.24 (1.06, 2.16) mmol/L, (2.24±0.71) mmol/L vs. (2.54±0.63) mmol/L], while the levels of HDL-C and ApoA1 were higher than those in the control group [(1.39±0.37) mmol/L vs. (1.22±0.35) mmol/L, (154.69±31.15) mmol/L vs. (135.77±38.11) mmol/L] (all P<0.05); the systolic blood pressure, diastolic blood pressure, and Hcy levels in the experimental group were all lower than those in the control group [(142.27±14.14) mmHg (1 mmHg=0.133 kPa) vs. (148.86±13.07) mmHg, (84.05±9.96) mmHg vs. (89.91±9.98) mmHg, (10.95±2.16) μmol/L vs. (12.32±2.99) μmol/L] (all P<0.05); the FMD level in the experimental group was higher than that in the control group [(5.67±0.74)% vs. (5.09±0.87)%], and the levels of ICAM-1 and ET-1 were lower than those in the control group [(114.63±27.74) μg/L vs. (130.01±31.55) μg/L, (2.23±0.64) ng/L vs. (2.61±0.52) ng/L] (all P<0.05). The total effective rate of treatment in the experimental group was higher than that in the control group [88.64% (39/44) vs. 70.45% (31/44)] (P<0.05); the distribution of treatment effect grades in the experimental group was better than that in the control group (P<0.05). There was no statistically significant difference in the total incidence of adverse reactions between the two groups (P>0.05). Conclusion　The combination of sacubitril valsartan sodium tablets and folic acid in the treatment of patients with H-type hypertension has a better effect. It can improve glucose and lipid metabolism, vascular endothelial function, lower blood pressure, and has good safety.

Key words: H-type hypertension,  , sacubitril valsartan sodium tablets,  , folic acid,  , glucose and lipid metabolism,  , blood pressure,  , vascular endothelial function

摘要：

目的　观察沙库巴曲缬沙坦钠片联合叶酸对H型高血压患者糖脂代谢、血压及血管内皮功能的影响。方法　本研究为随机对照试验。选取2022年4月至2024年4月铜川市人民医院收治的88例H型高血压患者作为研究对象。采用随机数字表法，将患者分为对照组和试验组，各44例。对照组男25例，女19例；年龄45～74（53.30±7.87）岁；体重指数（BMI）22.87～29.65（24.85±2.83）kg/m²。试验组男28例，女16例；年龄41～75（54.68±8.01）岁；BMI 22.57～29.41（24.71±2.43）kg/m²。对照组采用沙库巴曲缬沙坦钠片治疗，试验组在对照组基础上联合叶酸治疗。两组均连续治疗4个月。比较两组治疗前后糖脂代谢指标［空腹血糖（FPG）、糖化血红蛋白（HbAlc）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白A1（ApoA1）］、血压及Hcy水平、血管内皮功能［血管扩张功能（FMD）、细胞间黏附分子-1（ICAM-1）、内皮素-1（ET-1）］，临床疗效和不良反应。采用独立样本t检验、配对t检验、Mann-Whitney U检验、χ²检验、校正χ²检验和秩和检验进行统计学分析。结果　治疗后，试验组FPG、HbAlc、TC、TG、LDL-C水平均低于对照组［（4.34±0.89）mmol/L比（4.77±0.98）mmol/L、（4.11±0.92）%比（4.49±0.81）%、（3.98±0.97）mmol/L比（4.42±1.03）mmol/L、1.03（1.04，2.18）mmol/L比1.24（1.06，2.16）mmol/L、（2.24±0.71）mmol/L比（2.54±0.63）mmol/L］，HDL-C、ApoA1水平均高于对照组［（1.39±0.37）mmol/L比（1.22±0.35）mmol/L、（154.69±31.15）mmol/L比（135.77±38.11）mmol/L］（均P<0.05）；试验组收缩压、舒张压及Hcy水平均低于对照组［（142.27±14.14）mmHg（1 mmHg=0.133 kPa）比（148.86±13.07）mmHg、（84.05±9.96）mmHg比（89.91±9.98）mmHg、（10.95±2.16）μmol/L比（12.32±2.99）μmol/L］（均P<0.05）；试验组FMD水平高于对照组［（5.67±0.74）%比（5.09±0.87）%］，ICAM-1、ET-1水平均低于对照组［（114.63±27.74）μg/L比（130.01±31.55）μg/L，（2.23±0.64）ng/L比（2.61±0.52）ng/L］（均P<0.05）。试验组治疗总有效率高于对照组［88.64%（39/44）比70.45%（31/44）］（P<0.05）；试验组治疗效果等级分布优于对照组（P<0.05）。两组不良反应总发生率比较，差异无统计学意义（P>0.05）。结论　沙库巴曲缬沙坦钠片联合叶酸治疗H型高血压患者的效果较好，可改善糖脂代谢及血管内皮功能，降低血压，且安全性较好。

关键词:

H型高血压, 沙库巴曲缬沙坦钠片, 叶酸, 糖脂代谢, 血压, 血管内皮功能