单硝酸异山梨酯对老年人单纯收缩期高血压治疗的影响

Isosorbide mononitrate in the treatment for elderly patients with isolated systolic hypertension

目的比较卡托普利和氢氯噻嗪加用或不加用单硝酸异山梨酯两种降压方案治疗老年单纯收缩期高血压(ISH)的降压疗效及安全性。方法 142例轻、中度老年ISH患者,随机分为A组(加用单硝酸异山梨酯组)72例,给予单硝酸异山梨酯缓释片(40 mg)、卡托普利(25 mg)、氢氯噻嗪(12.5 mg),晨顿服;B组(不加用单硝酸异山梨酯组)70例,给予卡托普利(25 mg,2次/d),氢氯噻嗪(25mg/d),均治疗8周。治疗前后测定动态血压、诊室血压、心率及生化指标。结果 A组总有效率在诊室血压为91.67%,在动态血压为86.12%;B组分别为80.01%和74.29%。24 h、白昼和夜间平均收缩压下降A组大于B组;收缩压谷/峰比及平滑指数A组高于B组(谷/峰比:0.73、0.58;平滑指数:0.87、0.62)。两组结果相比差异均有统计学意义(均为P<0.05)。心率及生化指标改变无统计学意义。结论硝酸酯三药联用晨服1次,能24 h平稳降低轻中度老年ISH患者的血压,降压效果大于常规二药联用,且安全性良好。

Objective To evaluate the efficacy and safety of mononitrate combined with conventional antihypertensive treatment for elderly patients with isolated systolic hypertension （ISH）. Methods A total of 142 elderly patients with mild-to-moderate ISH were randomly divided into 2 groups. Patients in group A （n = 72 ） were given isosorbide mononitrate 40 mg, captopril 25 mg and hydrochlorothiazide 12. 5 mg once daily in the morning. Patients in group B （ n = 70） were given captopril 25 mg twice daily and hydrochlorothiazide 25 mg once daily. All the patients were treated for 8 weeks. Ambulatory blood pressure monitering （ ABPM ）, pulse pressure, heart rate, clinic blood pressure （CBP） and blood biochemistry tests were examined at baseline and 8 weeks after treatment. Results The rate reached the target blood pressure in group A and B were 91.67% and 80.01% respectively for CBP, and 86. 12% and 74. 29% respectively for ABPM, both P 〈 0. 05. Patients in group A had higher T/P ratio and smoothness index for systolic blood pressure （SBP） than those in group B （0. 73 vs. O. 58; and 0. 87 vs. O. 62 respectively, both P〈0. 05）. Conclusions Isosorbide mononitrate, combined with low dose captopril and hydrochlorothiazide has good efficacy and safety in elderly patients with mild-to-moderate ISIt, and the efficacy is better than double doses of captopril and hydrochlorothiazide.