Effects of nimodipine combined with betahistine on CRP and other inflammatory cytokines and vascular endothelial function in patients with hypertensive cerebral vasospasm

Article type: Research Article

Authors: Liu, Xuanwei^a | Zhao, Na’na^{b; 1} | Zeng, Kexue^c | Xiao, Peng^a | Sheng, Pengjie^b | Luo, Xun^d | Wang, Yulong^{e; *}

Affiliations: [a] Department of Rehabilitation, ShenZhen DaPeng New District NanAo People’s Hospital, Shenzhen, Guangdong, China | [b] Department of Acupuncture and Massage, Shenzhen Luohu District Hospital of Chinese Medicine, Shenzhen, Guangdong, China | [c] Department of Acupuncture and Massage, GuangDong Province Second Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China | [d] Department of Rehabilitation, Shenzhen Sanming Group, Kerry Rehabilitation Medicine Research, Shenzhen, Guangdong, China | [e] Department of Rehabilitation, The First Affiliated Hospital, Shenzhen University, Shenzhen, Guangdong, China

Correspondence: [*] Corresponding author: Dr. Yulong Wang, Department of Rehabilitation, The First Affiliated Hospital, Shenzhen University, 3002 Sungang West Road, Futian District, Shenzhen, 518035, Guangdong, China. Tel.: +86 13923448395; Fax: +86 0755 83366388; E-mail: zengqiangsun226@163.com.

Note: [1] Co-first author.

Abstract: OBJECTIVE:This study aims to investigate the effect of nimodipine combined with betahistine on the levels of CRP and other inflammatory cytokines, as well as vascular endothelial function in patients with hypertensive cerebral vasospasm. METHODS:A total of 80 patients with hypertensive cerebral vasospasm from March 2016 to September 2018 were enrolled and randomly equally divided into two groups. At 1 week before enrollment, the application of all antihypertensive drugs was stopped. Then amlodipine tablets were used in control group, based on which nimodipine tablets were applied in observation group. All the patients included were followed up for 1 month. The changes in the cerebral vasospasm index in the course of treatment as well as inflammatory cytokines and indicators related to vascular endothelial function at 1 month after treatment were measured and compared between the two groups. The correlations of the cerebral vasospasm index with the changes in inflammatory cytokines and vascular endothelial function-related factors in the body were analyzed. Finally, the effective rates of blood pressure regulation and cerebral vasospasm treatment were compared, while the adverse reactions and the overall clinical treatment effect of the two groups were evaluated. RESULTS:The cerebral vasospasm indexes in observation group were significantly lower than those in control group at 3 d, 1 week and 1 month after treatment (p < 0.05). At 1 month after treatment, the levels of inflammatory cytokines such as high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in observation group were significantly reduced compared to those in control group (p < 0.05). As for vascular endothelial function-related indicators, the endothelin-1 (ET-1) level in observation group was markedly lower than that in control group, whereas the level of nitric oxide (NO) was statistically higher than that in control group (p < 0.05). The cerebral vasospasm index was statistically positively correlated with changes in hs-CRP, IL-6, TNF-α and ET-1 (p < 0.05), but negatively correlated with changes in NO (p < 0.05). Besides, the effective rates of blood pressure regulation and cerebral vasospasm treatment in observation group were significantly higher than those in control group (p < 0.05). The overall treatment effective rate in observation group was markedly higher than that in control group (p < 0.05), and there were no significant differences of adverse reactions between the two groups (p > 0.05). CONCLUSION:For the treatment of hypertensive cerebral vasospasm, combined application of betahistine on the basis of nimodipine can effectively reduce the body’s aseptic inflammatory responses, improve vascular endothelial function and increase the cerebral circulation blood flow, which offers a favorable strategy for clinical therapy.

Keywords: Betahistine, hypertension, cerebral vasospasm, inflammatory cytokine, vascular endothelial function, nimodipine

DOI: 10.3233/CH-190589

Journal: Clinical Hemorheology and Microcirculation, vol. 75, no. 3, pp. 279-289, 2020