14 Journal of Hainan Medical University 2017; 23(20): 14-18

Journal of Hainan Medical University

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Effects of telmisartan combined with nifedipine controlled release

tablet on inflammatory factors, vascular endothelial function and left
ventricular function in patients with coronary heart disease with mild to
moderate hypertension
Feng Guo1, Bao-Wei Zhang2, Zheng-Yan Zhu1
1.
Department of Cardiology, Shunyi Hospital, Beijing 101300, China
2.
Department of Cardiology, No.1 Hospital of Peking University, Beijing 100034, China

ARTICLE INFO ABSTRACT

Article history: Objective: To investigate the effect of telmisartan combined with Nifedipine Controlled
Received 11 Oct 2017
Received in revised form 15 Oct 2017
Release Tablet on inflammatory factors, vascular endothelial function and left ventricular
Accepted 18 Oct 2017 function in patients with coronary heart disease with mild to moderate hypertension. Methods:
Available online 28 Oct 2017 A total of 92 cases of patients with coronary heart disease with mild to moderate hypertension
were selected as the object of observation, according to the random data table, they were
Keywords: divided into the control group (n=46) and observation group (n=46), and patients in the
Coronary heart disease with mild to control group were treated with Nifedipine Controlled Release Table therapy, on this basis,
moderate hypertension the observation group patients were given telmisartan treatment, two groups were treated
Telmisartan for 6 months. The levels of the blood pressure, inflammatory factors, vascular endothelial
Nifedipine Controlled Release Table function and left ventricular function compared between the two groups before and after
Inflammatory factors
Vascular endothelial function treatment. Results: There were no significant differences in the levels of SBP, DBP, hs-CRP,
Left ventricular function TNF-α, NO, ET-1, LVEF, LVEDD and LVESD in the two groups before treatment. After
treatment, two groups of SBP, DBP, hs-CRP, TNF-α, ET-1, LVEDD and LVESD levels
were significantly lower than those in the same group before treatment, and after treatment,
the levels of SBP, DBP, hs-CRP, TNF-α, ET-1 and LVESD in the observation group were
significantly lower than those in the control group, while there were no significant difference in
the level of LVEDD between the two groups after treatment; Compared with level in the group
before treatment, the levels of NO and LVEF in the two groups were significantly increased,
and the observation group [(82.13±19.01) µmol/L, (52.83±7.45)%] was significantly higher
than the control group [(67.37±13.08) µmol/L, (49.47±6.96)%]. Conclusion: Telmisartan
combined with Nifedipine Controlled Release Table in treating coronary heart disease with
mild to moderate hypertension, can effectively control blood pressure, reduce the inflammatory
stress, improve vascular endothelial function and left ventricular function of patients, has an
important clinical value.

pointed out that coronary heart diseases related to hypertension

1. Introduction closely. As one of the important pathogenic factors, hypertension
participates in and promotes the development and progression
Coronary heart disease (CHD) is a common disease in of coronary atherosclerosis. According to incomplete statistics,
cardiovascular and cerebrovascular diseases. The incidence of 60%-70% patients with coronary heart disease accompany by
coronary heart disease in China is increasing year by year, which hypertension. Nearly 69% of hypertensive death patients have severe
causes serious harm to the patient's life safety. Some studies have coronary heart disease[1-3]. Nifedipine Controlled Release Tablets


and telmisartan are commonly used antihypertensive drugs in clinic.
Corresponding author: Feng Guo, Department of Cardiology, Shunyi Hospital,
Beijing 101300, China. The combination of these two drugs can effectively control blood
E-mail: guofeng2965@163.com
Fund Project: Sustentation fund from Beijing Municipal Health Bureau (Num: pressure and improve left ventricular function[4-5]. At present, there
201712344)
 Feng Guo et al./ Journal of Hainan Medical University 2017; 23(20): 14-18
15
are relatively few studies on the effects of two drugs on biochemical
indexes, hence, the following studies were conducted to investigate 2.2. Therapeutic method
the efficacy of combined therapy.
Basic treatment of coronary heart disease and hypertension was
given in two groups of patients. Based on this, patients in the
2. Data and methods control group were treated with Nifedipine Controlled Release
Tablets (Adalat, Germany bayer medical care co. LTD., lot number
2.1. Clinical data 050109, specification 30 mg/s) 30 mg/time, 1 time/day; Patients
in the observation group were treated with telmisartan (micardis,
A total of 92 cases of patients with coronary heart disease with producted by Boehringer Ingelheim, product batch number 050118,
mild to moderate hypertension from our hospital were selected as specification 80 mg×7 s). The initial dose is 40 mg/time, 1 time/
the object of observation. All patients met the relevant criteria in d, under dinner or after meals, According to the patient's blood
the 2007 guidelines for the diagnosis and treatment of coronary pressure, the dosage range was 20-80 mg, Nifedipine Tablets were
artery disease[6]. It is also consistent with the diagnostic criteria given at the same time as the control group. Two groups of patients
of the diagnosis and treatment of hypertension set by mild and were treated by this way for 6 months.
moderate hypertension guidelines in Chinese[7]. The contents and
processes involved in this study are in line with the standards of the 2.3. Observational indexes
ethics committee of this hospital, and approved by the committee.
According to the random data table, all the patients divided into the The blood pressure [systolic blood pressure (SBP) and diastolic
control group and observation group (each of 46 cases). In control blood pressure (DBP)] were measured before and after treatment. At
group, there were 28 males and 18 females, with ages of 42-70 the same time, 5 mL the fasting peripheral venous blood of patients
years. In observation group, there were 26 males and 20 females, were extracted and the serum were separated by centrifugation,
with ages of 40-70 years. All patients excluded: (1) Patients suffering the related indexes were detected. Serological indicators include
from severe liver and kidney dysfunction, acute and chronic inflammatory factors [high sensitivity C reactive protein (hs-CRP),
infection, metabolic diseases and autoimmune diseases; (2) Pregnant tumor necrosis factor alpha (TNF-)] and vascular endothelial
or lactating pregnant and lying in women; (3) Patients suffer from function [nitric oxide (NO), endothelin -1 (ET-1)]. Hs-CRP and
mental illness and could complete treat according to doctor's orders; ET-1 levels were detected by radioimmunoassay, detection kit
(4) Allergic to the study of active ingredients of drugs; (5) Patients from Shanghai Harling Biological Technology Co., TNF- levels
with biliary obstructive diseases; (6) Patients who have been treated were measured by ELISA and NO levels were measured by nitrate
with related drugs have been treated; (7) Patients with poor treatment reductase assay. TNF-α and NO kits were provided by Shanghai

compliance, could not complete the course of treatment of patients; Enzyme Biotechnology Co., ltd. All laboratory procedures strictly
followed the kit instructions. Meanwhile, doppler ultrasound were
(8) Patients do not want to participate in the study. There was no
used to recorded and calculated left ventricular ejection fraction
significant difference between the two groups in terms of age and
(LVEF), left ventricular end systolic diameter (LVESD), left
sex (P>0.05). All patients informed and agreed on the content of the
ventricular end diastolic diameter (LVEDD) of patients before and
study.
after treatment in two groups.
Table 1.
Comparison of SBP and DBP levels before and after treatment.
Groups n Time SBP (mmHg) DBP (mmHg)
Control group 46 Before treatment 164.94±13.58 110.22±9.67
After treatment 140.68±11.19* 84.56±8.01*
Observation group 46 Before treatment 163.68±13.05 110.86±9.55
After treatment 124.13±9.93*＃ 78.21±6.78*＃
Note：* Compared with that before treatment,＃Compared with the control group after treatment, P<0.05.
Table 2.
Comparison of inflammatory factors before and after treatment.
Groups n Time hs-CRP (mg/L) TNF-α(ng/L)
Control group 46 Before treatment 11.07±2.12 58.79±13.69
After treatment 8.99±1.27* 51.28±8.37*
Observation group 46 Before treatment 10.84±2.23 59.02±14.38
After treatment 6.31±0.87*＃ 39.37±9.84*＃
Note：* Compared with that before treatment, ＃＃Compared with the control group after treatment, P<0.05.
16 Feng Guo et al./ Journal of Hainan Medical University 2017; 23(20): 14-18

Table 3.
Comparison of vascular endothelial function in two groups.
Groups n Time NO (µmol/L) ET-1 (ng/L)
Control group 46 Before treatment 47.44±12.78 101.46±23.74
After treatment 67.37±13.08* 68.35±14.36*
Observation group 46 Before treatment 47.33±12.70 102.17±23.49
After treatment 82.13±19.01*＃ 51.38±12.65*＃
Note：* Compared with that before treatment, ＃Compared with the control group after treatment, P<0.05.
Table 4.
Comparison of cardiac function indexes before and after treatment.
Groups n Time LVEF (%) LVEDD (mm) LVESD (mm)
Control group 46 Before treatment 44.01±6.50 57.68±6.98 51.13±7.64
After treatment 49.47±6.96* 54.12±5.88* 46.41±6.94*
Observation group 46 Before treatment 43.88±6.37 58.40±6.69 51.58±7.52
After treatment 52.83±7.45*＃ 52.42±6.12* 43.12±6.96**＃
Note：* Compared with that before treatment, ＃Compared with the control group after treatment, P<0.05.

(P> 0.05). After treatment, the levels of hs-CRP and TNF-α in control
2.4. Statistical analysis group and observation group were (8.99±1.27) mg/L, (51.28±8.37)
ng/L, (6.31±0.87) mg/L and (39.37±9.84) ng/L, respectively, which
SPSS 17.0 statistical package was conducted for statistical analysis. were significant lower than these before treatment in groups, and the
The levels of blood pressure, inflammatory factors, vascular hs-CRP and TNF-α levels in observation group were significant
endothelial function and cardiac function indexes in this study were lower than these in control group (P<0.05).
in line with the normal distribution, which were described as (Mean
± SD). t test was conducted to comparison the indexes between 3.3 Comparison of vascular endothelial function before and
two groups before and after treatment as well as between the group after treatment
after treatment, values of P<0.05 were considered to be statistically
significant. NO and ET-1 levels before and after treatment in two groups
are shown in Table 3. Before treatment, there was no significant
difference in NO and ET-1 levels between the two groups (P> 0.05).
3. Result After treatment, the levels of NO in control group and observation
group were (67.37±13.08) µmol/L and (82.13±19.01) µmol/
3.1. Comparison of SBP and DBP levels before and after L, respectively, which were significant higher than these before
treatment treatment in groups. Compared with that before treatment, the ET-1
levels in two group were significant decreased, and the levels after
SBP and DBP levels before and after treatment in two groups are treatment in observation group (51.38±12.65) ng/L were significant
shown in Table 1. As shown in Table 1, before treatment, there was lower than that in control group (68.35±14.36) ng/L.
no significant difference in SBP and DBP levels between the two
groups (P> 0.05). The levels of SBP and DBP in control group 3.4 Comparison of cardiac function indexes before and after
were (140.68±11.19) mmHg and (84.56±8.01) mmHg, respectively, treatment
which were significant lower than these before treatment. The levels
of SBP and DBP in observation group were (124.13±9.93) mmHg LVEF, LVEDD and LVESD levels before and after treatment
and (78.21±6.78) mmHg, respectively, which were significant lower in two groups are shown in Table 4. Before treatment, there was
than these before treatment as well as in control group. There was no significant difference in LVEF, LVEDD and LVESD levels
significant difference between the two groups (P<0.05). between the two groups (P> 0.05). After treatment, the levels of
LVEF, in control group and observation group were (49.47±6.96)%
3.2 Comparison of inflammatory factors before and after and (52.83±7.45)%, respectively, which were significant higher
treatment than these before treatment in groups. And the levels of LVEF in
observation group were ere significant higher than that in control
hs-CRP and TNF-α levels before and after treatment in two groups group. The LVEDD and LVESD levels in two group after treatment
are shown in Table 2. Before treatment, there was no significant were significant lower than that before treatment in groups, and the
difference in hs-CRP and TNF-α levels between the two groups levels of LVESD in observation group were significant lower than
 Feng Guo et al./ Journal of Hainan Medical University 2017; 23(20): 14-18
17
that in control group (P<0.05). There was no significant difference in serum were significantly increased in patients with coronary heart
LVEDD levels between the two groups after treatment (P> 0.05). disease, hypertension and diabetes mellitus. As the main markers
of inflammation, the levels of CRP and TNF-α were significantly
correlated with the severity of the disease. In addition, hs-CRP could
predict the stability ofcoronary plaque. TNF-α is mainly involved in
4. Discussion
vascular structure and function damage mechanism[19,20]. The results
of this study indicated that after combined with telmisartan, the level
Coronary heart disease is the world's leading cause of death.
of hs-CRP and TNF- in patients were further decreased, and the
Coronary artery stenosis caused by atherosclerosis can lead to
extent of reduction were significantly better than that in the control
myocardial ischemia hypoxia, hypertension, chronic inflammation,
group. The results showed that telmisartan had anti-inflammatory
endothelial dysfunction and lipid metabolism disorder, which are
effects, and the reason may be that telmisartan can activate the
important risk factors for the onset and development of disease[8,9]. peroxisome proliferator activated receptor gene, thereby inhibiting
Epidemiological studies have pointed out that the mortality rate of the synthesis, release and signal transduction of inflammatory
coronary heart disease in hypertensive patients is 5 times as many factors, so as to exert its anti-inflammatory effects[21].
as persons with normal blood pressure, among which the prevalence NO and ET-1 are important markers of vascular endothelial
rate of elderly patients and men is relatively high[10]. A large number function, which belong to the important regulating substances of
of clinical studies have confirmed that effective blood pressure cardiovascular system secreted by vascular endothelial cells. NO
control in the normal range can prevent the occurrence of coronary can inhibit the synthesis of ET-1, and the main functions of NO are
heart disease, reduce mortality rate of coronary heart disease [11], dilation blood vessels, inhibition of monocyte adhesion, platelet
hence, the antihypertensive therapy plays an important role in the aggregation and formation of atherosclerotic plaques; ET-1 is the
most potent vasoconstrictor and has the function of maintaining
treatment of coronary heart disease.
vascular tone and homeostasis of the cardiovascular system. The
Nifedipine Controlled Release Tablets is a long-acting calcium
increase of ET-1 level may cause vasoconstriction, spasticity, and
channel antagonist. It is widely used in the treatment of angina
increased blood pressure, which can accelerate hypoxia ischemia[22].
pectoris, hypertension and other diseases. It is pointed out that
The results of this study indicated that both two treatments can
Nifedipine Controlled Release Tablets has a long-lasting hypotensive
effectively reduce the level of ET-1 and raise the level of NO. But in
effect[12]. Telmisartan is a specific angiotensin II receptor antagonist, the group combination with telmisartan, the levels of NO and ET-1
which can increase the content of serum adiponectin, control improved more significantly in the patients, which suggested that
pressure for 24 h, regulate metabolism and inhibit of atherosclerosis telmisartan could improve vascular endothelial function in patients,
function [13]. Related studies have pointed out that, compared with but the cause remains to be explored.
the single use of Nifedipine Controlled Release Tablets, combined Hypertension is one of the major causes of ventricular dysfunction
with telmisartan can further reduce blood pressure, reduce the liver and myocardial remodeling. The related studies pointed out that
cell growth factor and vascular endothelial growth factor in patients, the combination of Nifedipine Controlled Release Table with
also pointed out that telmisartan has a protective effect of on vascular telmisartan can improve left ventricular function in hypertensive
endothelial cell function[14,15]. This study pointed out that, compared patients. The mechanism of Nifedipine Controlled Release Table
is to dilate vessels and decrease ventricular filling. The telmisartan
with the single use of Nifedipine Controlled Release Tablets,
could improve left ventricular function by inhibiting myocardial
combined with telmisartan treatment, the DBP and SBP levels were
remodeling[23]. The results of this study indicated that the level of
further reduced, and the blood pressure control effect is significant,
left ventricular function in the combined telmisartan group is further
which consistent with the previous reports, further confirmed the
improved, compared with the control group. The results of this study
synergistic antihypertensive effect of two pesticides[16,17]. In addition
were consistent with the previous reports, and further confirmed that
to blood pressure, this study also analyzed the levels of inflammatory combination therapy with Nifedipine Controlled Release Tablets
factors, vascular endothelial function and left ventricular function and telmisartan can improve left ventricular function and reverse left
after two treatments, in order to investigate the clinical effect of ventricular hypertrophy[24].
combined therapy. In conclusion, Telmisartan compared with single use of Nifedipine
A large number of domestic and foreign studies have confirmed Controlled Release Table, combined with telmisartan can effectively
that the occurrence and development of coronary heart disease improve the efficacy in treating coronary heart disease with mild
and hypertension were closely related to inflammatory response. to moderate hypertension, also can control blood pressure, reduce
Inflammatory factors play an important role in the formation, the inflammatory stress, improve vascular endothelial function and

rupture and abscission of coronary atherosclerotic plaques[18]. left ventricular function of patients, which has an important clinical

The study indicated that the levels of hs-CRP and TNF-α in value.
18 Feng Guo et al./ Journal of Hainan Medical University 2017; 23(20): 14-18

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patients with coronary artery disease. Hypertension 2015; 65(6): 1372-

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