The therapeutic effects of valsartan on hypertensive patients according to the classification of Traditional Chinese Medicine constitution

• Main Authors: Tung Chung Po, 董俊伯
• Other Authors: 張芳嘉
• Format: Others
• Language: zh-TW
• Published: 2003
• Online Access: http://ndltd.ncl.edu.tw/handle/18937269621616216391

碩士 === 中國醫藥學院 === 中西醫結合研究所 === 91 === Background Drugs from all six main classes of anti-hypertensive agents are effective in lowering blood pressure, with no substantive differences between drug classes in effects on blood pressure. However, how to choice the best effective drug for hypertensive patients according clinic symptoms are not available. Objectives We tried to research the relativity of the different phenotypes and the traditional Chinese medicine constitution classification of essential hypertensive patients from the viewpoint of the insulin resistance、LV hypertrophy、LV diastolic dysfunction and response to treatment.We also tried to find the most effective anti-hypertensive drug for hypertensive patients according to the traditional Chinese medicine constitution classification of essential hypertensive patients. Subjects and methods A total of 99 never or at least three months un-treatment essential hypertensive patients from Jiannren Hospital were classified into two types, the syndrome of the Yin-Deficiency and Yang-Excess type (type A) and the syndrome of the Phlegm-Dampness abundant type (type B), according traditional Chinese medicine constitution classification and evaluated by recording home blood pressure during the study periods. LV mass and performance were measured by M-mode echocardiography and mitral flow in diastole did by pulsed-wave Doppler. Insulin and C-peptide were assessed for determination of insulin resistance. We also assessed the anti-hypertensive efficacy of valsartan between the two types. Results Type A patients had lower insulin level (7.98 ±4.27 vs 11.39 ±9.54, P=0.033), less insulin resistance, smaller LV mass (187.78±56.82 vs 220.59±74.74, P=0.02), smaller end diastolic (28.99±10.66 vs 35.55±14.35, P=0.01) and end systolic volume (91.62±26.42 vs 104.21±31.79, P=0.03), lower systolic wall tension (2839.61±456.27 vs 3123.66±608.09, P=0.01), shorter E wave deceleration time (0.19±0.04 vs 0.20±0.04, P=0.04), less percentage of diastolic dysfunction, with good control and response rates to valsartan therapy than type B patients. On the other hand, with aging, the possibility of isolated systolic hypertension in type A group was noted more frequently than in type B group. Valsartan therapy for type A hypertensive patients is associated with profound and significant systolic BP (137.02 ± 14.62 mmHg vs 147.43 ± 12.63 mmHg, P=0.001) and diastolic BP (85.88 ± 8.99 mmHg vs 91.29 ± 10.43 mmHg, P=0.012) reduction at 4 weeks treatment. Conclusions We concluded that according to the traditional Chinese medicine constitution classification, hypetensive patients can be divided into two groups. They have different insulin level, LV mass, hemodynamic pattens, and even have different control and response rates of valsartan therapy. Valsartan therapy for type A hypertensive patients is associated with significant BP reduction at 4 weeks treatment, with good control and response rates, and should therefore be preferred as first line antihypertensive drug in the groups. In contrast, Valsartan therapy for type B hypertensive patients has poor control and response rates and it will not be suggested.