氨氯地平联合厄贝沙坦不同给药时间对原发性高血压病人血压变异性和血压晨峰现象的影响

Effect of different administration time of amlodipine combined with irbesartan on blood pressure variability and morning blood pressure peak in patients with essential hypertension

目的比较氨氯地平和厄贝沙坦联合用药治疗原发性高血压病人不同服药时间的血压变异性、血压晨峰控制效果。方法回顾性选取符合要求的于2014年2月至2017年12月来上海交通大学医学院附属瑞金医院诊治的84例轻中度原发性高血压,A组于06:30服用苯磺酸氨氯地平片5 mg、厄贝沙坦片150 mg;B组于18:30服用苯磺酸氨氯地平片5 mg、厄贝沙坦片150 mg,持续治疗10周。治疗后开展随访工作,记录不良事件发生情况,通过DMS-ABP动态血压监测仪测量出所有研究对象的24 h、日间、夜间的平均舒张压(DBP)和收缩压(SBP),并计算出血压变异系数以及血压晨峰情况。结果(1)A组治疗后随访临床不良事件发生率(5.00%)低于B组(27.27%)(χ2=7.48,P=0.006)。(2)经过治疗后,B组病人的24 h、日间、夜间的平均DBP和SBP低于A组(tDBP=6.154、1.941、2.099,tSBP=5.629、2.518、2.688,均P<0.05)。(3)经过治疗后,B组血压变异系数低于A组(tDBP=1.812、2.938、2.598,tSBP=4.577、2.938、12.642,均P<0.05)。(4)经过治疗后,B组血压晨峰值低于A组(t=6.732,P<0.001)。结论氨氯地平与厄贝沙坦联合用药,晚间同时服用的血压变异性和血压晨峰控制效果优于早晨同时服用。

Objective To compare the blood pressure variability and the control effect of morning blood pressure surge in patients with essential hypertension treated with amlodipine and irbesartan at different time.Methods Eighty-four patients with mild to moderate essential hypertension who met the inclusion criteria and came to Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine for treatment from February 2014 to December 2017 were selected retrospectively.Group A received 5 mg amlodipine besylate tablets and 150 mg irbesartan tablets at 06:30 and group B received 5 mg amlodipine besylate tablets and 150 mg irbesartan tablets at 18:30 for 10 weeks,respectively.Follow-up was carried out after treatment,and adverse events were recorded.The mean diastolic blood pressure(DBP)and systolic blood pressure(SBP)of all subjects at 24 h,daytime and night were measured by DMS-ABP dynamic blood pressure monitor,and the coefficient of variation of blood pressure and the morning blood pressure surge were calculated.Results The incidence of adverse events in group A(5.00%)after treatment was lower than that in group B(27.27%)(χ2=7.48,P=0.006).After treatment,the average DBP and SBP at 24 h,day and night in group B were lower than those in group A(tDBP=6.154,1.941,2.099,tSBP=5.629,2.518,2.688,all P<0.05).After treatment,the coefficient of variation of blood pressure in group B was lower than that in group A(tDBP=1.812,2.938,2.598,tSBP=4.577,2.938,12.642,all P<0.05).After treatment,the morning blood pressure surge in group B was lower than that in group A(t=6.732,P<0.001).Conclusion The combined use of amlodipine and irbesartan in the evening has better control effect on blood pressure variability and morning blood pressure surge than the combined use of amlodipine and irbesartan in the morning.