晨起与夜间服用依那普利叶酸片辅助治疗老年H型高血压患者效果及对Hcy水平影响的比较

Curative effect comparison of enalapril folic acid tablets taken in the morning and at night in the adjuvant treatment of elderly patients with type H hypertension and its impact on Hcy level

目的比较晨起与夜间服用依那普利叶酸片辅助治疗老年H型高血压患者的效果及对同型半胱氨酸(Hcy)水平的影响。方法选取2019年1月—2022年1月吴川市人民医院收治的老年H型高血压患者200例,按照计算机分组法将患者分为夜间组(n=101)和晨间组(n=99)。患者均采用马来酸依那普利叶酸片治疗,夜间组于夜间(19:00~20:00)服用,晨间组于晨间(7:00~8:00)服用,2组均持续治疗6个月。比较2组临床疗效,治疗前及治疗6个月后血浆Hcy水平、血管内皮功能指标[内皮素-1(ET-1)、血管性假血友病因子(VWF)抗原、一氧化氮(NO)、血流介导的血管扩张功能(FMD)]、24 h动态血压[白昼平均收缩压(dSBP)、白昼平均舒张压(dDBP)、夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP)及24 h收缩压(SBP)、24 h舒张压(DBP)],不良反应。结果夜间组与晨间组总有效率比较,差异无统计学意义(92.08%vs.90.91%,χ^(2)=0.088,P=0.767)。治疗6个月后,夜间组、晨间组血浆Hcy水平低于治疗前,且夜间组低于晨间组(P<0.01)。治疗前及治疗6个月后,2组ET-1、VWF抗原、NO、FMD及dSBP、dDBP、nSBP、nDBP、24 hSBP、24 hDBP比较,差异无统计学意义(P>0.05);治疗6个月后,2组ET-1、VWF抗原、NO、FMD及dSBP、dDBP、nSBP、nDBP、24 hSBP、24 hDBP低于治疗前(P<0.01)。夜间组不良反应总发生率与晨间组比较,差异无统计学意义(6.93%vs.9.09%,χ^(2)=0.317,P=0.573)。结论晨间、夜间服用依那普利叶酸片治疗老年H型高血压患者的疗效相当,均可有效调节其24 h异常血压变化,改善血管内皮功能,但夜间服用在降低血浆Hcy水平上效果更佳,且不增加不良反应。

Objective To compare the curative effect of enalapril folic acid tablets taken in the morning and at night in the adjuvant treatment of elderly patients with type H hypertension and its impact on Hcy level.Methods A total of 200 cases of elderly patients with type H hypertension were selected from January 2019 to January 2022 in Wuchuan People′s Hospital,and they were divided into the night group with 101 cases and the morning group with 99 cases according to the computer grouping method.Patients were given enalapril folic acid tablets,the night group was taken drugs at night(19:00-20:00),and the morning group was taken drugs in the morning(7:00-8:00),both groups were taken for 6 months.Clinical effect,plasma Hcy level,vascular endothelial function indexes(ET-1,VWF antigen,NO,FMD),24 h ambulatory blood pressure(dSBP,dDBP,nSBP,nDBP,24 hSBP,24 hDBP)before and after 6 months of treatment,incidence of adverse reactions of the two groups were compared.Results There was no significant difference of the total effective rate between the night group and the morning group(92.08%vs.90.91%,χ^(2)=0.088,P=0.767).After 6 months of treatment,plasma Hcy level of the two groups was lower than that before treatment,and plasma Hcy level of the night group was lower than that of the morning group(P<0.01).There was no significant difference of ET-1,VWF antigen,NO,FMD,dSBP,dDBP,nSBP,nDBP,24 hSBP or 24 hDBP before and after 6 months of treatment between the two groups(P>0.05);After 6 months of treatment,ET-1,VWF antigen,NO,FMD,dSBP,dDBP,nSBP,nDBP,24 hSBP and 24 hDBP of the two groups were lower than those before treatment(P<0.01).There was no significant difference of the incidence of adverse reactions between the night group and the morning group(6.93%vs.9.09%,χ^(2)=0.317,P=0.573).Conclusion The effect of enalapril folic acid tablets taken in the morning and at night are similar in the treatment of elderly patients with type H hypertension,which can effectively regulate their 24 h abnormal blood pressure changes and improve vascular endothelial function,but the effect of enalapril folic acid tablets taken at night is better in reducing the level of Hcy,and does not increase the incidence of adverse reactions.