Effects of amlodipine combined with atorvastatin on Th17/Treg imbalance and vascular microcirculation in hypertensive patients with atherosclerosis: A double-blind, single-center randomized controlled trial

Abstract

Objective: Helper T cells 17 (Th17) and regulatory T cells (Treg), as CD4+T lymphocyte subsets, play an important role in the process of atherosclerosis. However, there are few studies on the regulation and efficacy of atorvastatin combined with amlodipine on Th17/Treg balance in hypertension combined with carotid atherosclerosis. Therefore, this study aims to verify the efficacy and immunomodulatory effects of atorvastatin combined with amlodipine in the treatment of hypertension combined with carotid atherosclerosis. Methods: A total of 260 patients with hypertension and carotid atherosclerosis were randomly divided into atorvastatin or combined treatment group. Inflammatory factors and Th17 and Treg levels were detected by enzyme-linked immunosorbent assay and flow cytometry. The messenger ribonucleic acid expression of retinoic acid receptor-related orphan receptor gamma and forkhead spiral transcription factor were detected by real-time quantitative polymerse chain reaction. Results: We found that the total effective rate in the treatment group was significantly higher than that in the control group. The levels of whole blood high shear viscosity, whole blood low shear viscosity, plasma specific viscosity and fibrin content in the 2 groups were significantly decreased after treatment, and the combined group was significantly lower than the control group (all P < .05). The improvement of endothelial function in the treatment group was also significantly higher than that in the control group (all P < .05). In addition, we found that there were statistically significant differences in Th17 percentage, Treg percentage and Treg/Th17 between the treatment group and the control group ( P < .05). The messenger ribonucleic acid levels of retinoic acid receptor-related orphan receptor gamma and forkhead spiral transcription factor showed the same trend. Further detection of Th17-related inflammatory factors showed that the expression of interleukin (IL)-17, IL-6, IL-23 and tumor necrosis factor-α in the treatment group was significantly decreased, which was better than that in the control group (all P < .05). Conclusion: These data indicate that amlodipine combined with atorvastatin can improve Th17/Treg imbalance, vascular endothelial function and efficacy in patients with hypertension and atherosclerosis.

Overview of multifunctional Tregs in cardiovascular disease: From insights into cellular functions to clinical implications

“…203 A recent study showed that the anti-hypertensive amlodipine, in combination with atorvastatin, can improve the Th17/Tregs imbalance and ameliorate vascular endothelial function in patients with hypertension and atherosclerosis. 204 In addition, indole propionic acid from the bacterial metabolism of tryptophan has been shown to have an inhibitory effect on fibrosis and inflammation at both the cellular and tissue levels. 205,206 The dietary supplementation of indole propionic acid has been reported to reduce blood pressure in a mouse model of high salt diet-induced hypertension by decreasing pro-inflammatory Th17 cells in the kidney, increasing anti-inflammatory Tregs, and increasing urinary sodium excretion.…”

“…The combination of telmisartan and rosuvastatin has been shown to simultaneously decrease plasma levels of TNF‐α and IL‐1β and increase Tregs cell frequency and FoxP3 mRNA expression in patients with hypertension 203 . A recent study showed that the anti‐hypertensive amlodipine, in combination with atorvastatin, can improve the Th17/Tregs imbalance and ameliorate vascular endothelial function in patients with hypertension and atherosclerosis 204 . In addition, indole propionic acid from the bacterial metabolism of tryptophan has been shown to have an inhibitory effect on fibrosis and inflammation at both the cellular and tissue levels 205,206 .…”