比索洛尔／氢氯噻嗪复方片对血压晨峰的影响

The Influence of Combined Bisorpolol/hydrochlorothiazide on Morning Blood Pressure Surge in Mild to Moderate Es- sential Hypertension

目的采用动态血压监测(ABPM)观察比索洛尔/氢氯噻嗪复方片对轻、中度原发性高血压患者服药后18～24 h 血压和血压晨峰(MBPS)程度的影响。方法选择90例轻、中度高血压患者[收缩压(SBP)<180mmHg,舒张压(DBP)95～109 mmHg],口服比索洛尔/氢氯噻嗪复方片2.5 mg/6.25 mg,4周后血压不达标者用比索洛尔/氢氯噻嗪复方片5.0 mg/6.25 mg 继续治疗4周,应用 ABPM 评价治疗前后服血压和血压晨峰程度的变化。以起床后2 h 内 SBP 增加≥23 mmHg,DBP≥15 mmHg 为晨峰阳性(MBPS)(+)组,低于以上值为 MBPS(一)组。结果 1)入选84例患者,比索洛尔/氢氯噻嗪复方片(2.5 mg/6.25 mg)治疗4周末,24 h SBP/DBP 降低(10.8±1.7)/(8.6±0.8)mmHg,服药后18～24 h SBP/DBP 降低(10.1±1.5)/(7.6±1.0)mmHg,治疗前后比较,差异有非常显著意义(P 均<0.01)。MBPS(+)和(-)患者的服药后18～24 h SBP/DBP 分别降低(11.1±2.5)/(8.9±1.8)mmHg(n=26)和(9.9±1.5)/(8.0±2.0)mmHg(n=58)(组间比较,P<0.05)。MBPS(+)患者的晨峰程度降低(14.1±2.7)/(10.5±2.5)mmHg(P<0.05),而 MBPS(-)患者的晨峰程度未见明显降低,两组间有显著性差异(P<0.01)。2)59例因血压未达标而给予比索洛尔/氢氯噻嗪复方片(5.0 mg/6.25 mg)继续治疗4周,24 h SBP/DBP 降低(9.9±2.5)/(7.8±1.5)mmHg,服药后18～24 h SBP/DBP 降低(8.8±2.5)/(7.4±1.4)mmHg,治疗前后比较,差异有非常显著意义(P<0.01)。MBPS(+)和(-)患者的服药后18～24 hSBP/DBP 分别降低(10.3±2.2)/(7.9±1.6)mmHg(n=24)和(6.0±2.9)/(4.4±2.4)mmHg(n=35)(组间比较,P<0.01)。MBPS(+)患者晨峰程度降低(17.3±3.3)/(11.0±2.7)mmHg(P<0.01),而 MBPS(-)患者晨峰程度无明显降低,两组比较,差异有非常显著意义(P<0.01)。3)比索洛尔/氢氯噻嗪复方片治疗后,MBPS(+)的患者减少,MBPS(-)的患者增多,治疗前后频数比较,差异有非常显著意义(P<0.01)。结论比索洛尔/氢氯噻嗪复方片不仅有效降低24 h 血压,还能明显降低服药后18～24 h 血压,能够遏制血压晨峰的发生,并降低晨峰程度。

Objective To investigate the influence of combined bisorpolol/hydrochlorothiazide on morning blood pressure surge in mild and moderate essential hypertension using ABPM. Morning surge was defined as increases in SBP≥23 mmHg or DBP≥15 mmHg during 2 h in morning after getting up. Methods After 2 weeks run-in period, if the sitting DBP was 95-109 mmHg and SBP 〈 180 mmHg, the patients were received bisorpolol/hydrochlorothiazide once daily from 2. 5 mg/6.25 mg for 4 weeks to 5.0 mg/6.25 mg for another 4 weeks. ABPM was conducted at the end of placebo baseline and 4th or 8th week. Results 1）After treatment with bisorpolol/hydrochlorothiazide 2.5 mg/6.25 mg once daily for 4 weeks, 24 h SBP/DBP and the 18-24 h after administration SBP/DBP were reduced 10.8 ± 0.7/8.6 ± 0.8 mmHg and 10.1 ± 1.4/7.6 ± 1.0 mmHg separately, compared with the baseline （P〈0.01）. The reductions of the 18-24 h after administration SBP/DBP were 11.1± 2.5/8.9±1.8 mmHg in MBPS （±） group compared with 9.9±1.5/8. 0±2.0 mmHg in MBPS（-） group （P〈 0.05）. Bisorpolol/hydrochlorothiazide 2.5 mg/6.25 mg once daily inhibited morning BP surge for 14.1± 2.7/ 10.5±2.5 mmHg in MBPS（±） group, 9.9±1.5/7.8±2.0 mmHg in MBPB（-） group, with significant inter groups differences（P〈0.01）. 2） Fifty-nine patients not reaching target BP were titrated to bisorpolol/hydrochlorothiazide 5.0/6.25 mg/d for another 4 weeks, reductions SBP/DBP 18-24 h after administration were 10.3 ±2.2/7.9±1.6 mmHg in MBPS（±） group and 6.0±2.9 mmHg in MBPS（-） group（P〈0.01）, The extents of MBPS were reduced for 17.3±3.3/11.0± 2.7 mmHg in MBPS（±） group with little change in MBPS（- ） group showing significant inter groups differences（P〈0.01）. 3） After treatment the patients with MBPS（±） decreased and patients with MBPS（-） increased. Conclusion Bisorpolol/hydrochlorothiazide effectively reduce the 24 h blood pressure essential hypertension, and attenuated the extent of MBPS.