拉西地平的时间药理学对老年非杓型高血压患者的治疗作用

The therapeutic effects of chronopharmacology of lacidipine on non-dipper hypertension in elderly patients

目的探讨不同时间服用钙拮抗剂拉西地平对老年非杓型高血压患者血压的影响。方法筛选出未使用二氢吡啶类钙拮抗剂≥4周的老年非杓型高血压患者66例,随机分为拉西地平晨起服药组(32例)和晚上服药组(34例),4 mg/d,共治疗48周。患者治疗前后分别进行24 h动态血压监测的检查。结果晨起服药组患者昼间收缩压迭标率为46.9%,晚上服药组为38.2%,两组比较差异无统计学意义(P>0.05)。晨起服药组患者夜间收缩压达标率为28.1%,晚上服药组为67.6%,两组比较差异有统计学意义(P<0.01)。晨起服药组患者由非杓型纠正为杓型18.8%,晚上服药组47.1%,两组比较差异有统计学意义(P<0.01)。结论对于非杓型老年高血压患者,拉西地平可以较好地纠正夜间的高负荷血压,提高夜间血压达标率。

Objective To investigate the effect of calcium antagonist lacidipine administered at different time on blood pressure（BP） in elderly non-dipper hypertensive patients. Methods Sixty six elderly patients with non-dipper hypertension treated with dihydropyridines（calcium antagonists） for ≥4 weets were divided randomly into 2 groups：lacidipine（4 rag/d） morning dosing group（32 patients） and evening dosing group（34 patients） , and treated for 48w. Results 46. 90/00 of the morning group achieved the target day-time SBP,while 38.2% of the evening group achieved the target SBP, with no significant difference between the two groups （P 〉 0. 05）. The morning group achieved the target night-time SBP in 28.1 % of the patients,while evening group achieved the target SBP in 67.6% ,with significant difference between the two groups （P 〈 0.01）. Change of circadian rhythm from non-dipper to dipper was found in 18. 8% in morning group versus 47.1% in the evening group,and there was significant difference between the two groups （P〈0.01）. Conclusion Compared with morning program,evening program might be more effective in decreasing the high night BP load and changing non-dipper to dipper pattern.