硝酸酯类对老年单纯收缩期高血压的影响

Efficacy of Isosorbide Mononitrate in the Treatment of Elderly Patients with Isolated Systolic Hypertension

目的比较依那普利和氢氯噻嗪加用与不加用单硝酸异山梨酯(ISMN)两种方案对老年单纯收缩期高血压(ISH)的降压疗效及安全性。方法110例轻、中度老年ISH患者,随机分为A组60例,给予ISMN缓释片(40mg/d)、依那普利(10mg/d)、氢氯噻嗪(12.5mg/d),晨顿服;B组50例,给予依那普利(10mg,每日2次),氢氯噻嗪(25mg/d),均治疗8周。治疗前后测动态血压、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%,动态血压为86.12%;B组分别为80.00%和74.29%。24h昼夜平均收缩压下降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:0.75,0.59;平滑指数:0.86,0.65)。两组比较差异有统计学意义(P<0.05)。结论硝酸酯等三药联用,可以24h平稳降低轻、中度老年ISH患者的血压,好于常规两药联用,安全性良好。

Objective Evaluate the efficacy and safety of mononitrate combined with conventional anti-hypertensive treatment for elderly patients with isolated systolic hypertension（ISH）. Methods 110 elderly patients with mild-to-moderate ISH were randomly divided into 2 groups. Patients in group A（ n = 60 ） were given isosorbide mononitrate 40 mg/d, enapril 10 mg/d hydrochlorothiazide 12.5 mg/d in the morning. Patients in group B（ n = 50） were given enapril 10 mg twice per day 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. Resuits The effective ratios of two groups were 91.67% and 80.00% respectively for CBP, and 86.12% and 74.29% respectively for ABPM, both P 〈 0.05. Patients in group A had higher T/P ratios and smoothness indexes for systolic blood pressure （SBP） than those in group B （0.75 vs. 0.59 ; 0.86 vs. 0.65 respectively, both P 〈 0.05 ）. Conclusion Isosorbide mononitrate with enapril and hydrochlorothiazide had good efficacy and safety in elderly patients with ISH,better than double doses of enapril and hydrochlorothiazide.