氢氯噻嗪和雷米普利联合治疗非杓型高血压的临床研究

Effects of Hydrochlorothiazide and Hydrochlorothiazide Plus Ramipril on the Circadian Rhythmof Blood Pressure in Non-Dipper Essential Hypertension

目的 探讨非杓型高血压的形成机制及理想治疗方法。方法 通过动态血压监测筛选出非杓型原发性高血压 5 2例 ,随机分为两组 ,分别给予氢氯噻嗪 2 5mg/d、氢氯噻嗪 2 5mg/d合用雷米普利 2 .5～ 5mg/d ,治疗 4周。治疗前后做动态血压监测及检测肾素 血管紧张素Ⅱ 醛固酮。结果 两组治疗前后及两组间昼、夜收缩压 (dSBP ,nSBP)和舒张压 (dDBP ,nDBP)比较均差异有显著性 (P <0 .0 1,P <0 .0 5 ) ;治疗前后及两组夜间血压下降率均差异有显著性 (P <0 .0 1,P <0 .0 5 )。结论 两组治疗后均使血压的昼夜节律从非杓型转为杓型 ,合用组的降压作用优于单用氢氯噻嗪组 ,对夜间血压的降压作用更大 ,且可使血管紧张素Ⅱ和醛固酮水平明显降低。

Objective To investigate the development mechanism and to seek the optimal treatment of non-dipper essential hypertension.Methods Fifty-two patients with mild to moderate (class Ⅰ-Ⅱ) non-dipper essential hypertension were randomized into 2 groups.After 4 weeks treatment with hydrochlorothiazide (25 mg daily) and hydrochlorothiazide(25 mg daily) plus ramipril(2.5～5 mg daily,twenty-four hour ambulatory blood pressure was monitored and blood plasma rennin activity (PRA),angiotensinⅡ and aldosterone were determined before and after the treatment.Results Significant differences in the diurnal SBP,nocturnal SBP and the diurnal DBP,nocturnal DBP and the NRR existed before and after the treatment(P<0.01) and between the two groups after treatment(P<0.01).Conclusion Both hydrochlorothiazide and hydrochlorothiazide plus ramipril therapies can restore nocturnal blood pressure decline and can transform the circadian rhythm of blood pressure from non-dipper to dipper in patients with non-dipper essential hypertension.The antihypertensive effects of hydrochlorothiazide plus ramipril are greater than that of hydrochlorothiazide alone.And has an even greater antihypertensive effect on the nocturnal BP,and the plasma angiotensinⅡ and plasma aldosterone decreased significantly (P<0.01) by the treatment of hydrochlorothiazide plus ramipril.