联合降压治疗对老年高血压合并轻度认知功能障碍患者血压及认知功能疗效的评价

Effect between amlodipine plus irbesartan and amlodipine plus metoprolol regimen on blood pressure and cognitive function in elderly hypertension

目的探讨两种联合降压方法对老年高血压合并轻度认知功能障碍(MCI)患者血压及认知的影响。方法共选取了2018年7月~2021年11月在空军军医大学第一附属医院治疗的老年2级高血压病且合并轻度认知功能障碍患者198例,年龄(65~79)岁,随机分为厄贝沙坦组(苯磺酸氨氯地平片结合厄贝沙坦片,n=98)和美托洛尔组(苯磺酸氨氯地平片结合琥珀酸美托洛尔,n=100)。用药第4周、第8周、第12周及第24周分别检测血压,并于治疗前和疗程后以蒙特利尔认知评估量表(MoCA)进行问卷调查,MoCA<26分定义为MCI,血压<140/90 mmHg(1 mmHg=0.133 kPa)为血压达标标准。结果两组基本信息比较无统计学差异,在第4、8、12与24周比较降压达标率,两组间无统计学意义。与纳入时相比,在第4周、第8周、第12周与第24周两组收缩压和舒张压均降低(均P<0.05),用药间越长,降低数值越大,但两组间的差异没有统计学意义。厄贝沙坦组治疗后MoCA评分较治疗前有显著提高(P<0.01),治疗后MoCA评分较治疗后美托洛尔组MoCA评分有显著提高(P<0.01)。美托洛尔组MoCA评分治疗前后无显著性差异。结论在降压疗效相同的情况下,苯磺酸氨氯地平片联合厄贝沙坦片相较于联合琥珀酸美托洛尔缓释片,能更有效的促进老年高血压患者的认知功能。

AIM To compare the effect of amlodipine plus irbesartan and amlodipine plus metoprolol on blood pressure and cognitive function in elderly hypertension.METHODS A total of 198 elderly patients with grade 2 hypertension and mild cognitive impairment who were treated in the First Affiliated Hospital of Air Force Medical University from 2018 to 2021,aged(65 to 79)years,were randomly divided into irbesartan group(amlodipine besylate combined with irbesartan tablets,n=98)and metoprolol group(amlodipine besylate combined with metoprolol succinate,n=100).The blood pressure was measured at the 4th,8th,12th and 24th weeks of medication,and a questionnaire survey was conducted with the Montreal Cognitive Assessment(MoCA)before and after treatment.MoCA<26 was defined as MCI,and blood pressure<140/90 mmHg(1 mmHg=0.133 kPa)was the standard for blood pressure compliance.RESULTS There was no statistical difference between the two groups in terms of basic information.There was no statistical difference between the two groups in terms of the rate of reaching the antihypertensive goal at the 4th,8th,12th and 24th weeks.Compared with that at the time of inclusion,the systolic and diastolic blood pressure of the two groups decreased at the 4th,8th,12th and 24th weeks.The longer the medication was,the greater the reduction was,both P<0.05,but there was no statistically significant difference between the two groups.MoCA score in irbesartan group was significantly higher than that before treatment(P<0.01),and MoCA score in metoprolol group was significantly higher after treatment(P<0.01).There was no significant difference in MoCA score before and after treatment in metoprolol group.CONCLUSION Amlodipine plus irbesartan or metoprolol for 24 weeks equally reduces blood pressure and the former is superior to the latter on cognitive function improvement in this patient cohort.