低剂量联合降压对原发性高血压合并代谢综合征患者的疗效观察

Therapeutic effect of low-dose combination regimen in hypertensive patients with metabolic syndrome

目的比较以氨氯地平为基础的两种联合降压方案对原发性高血压合并代谢综合征患者的疗效及不良反应。方法研究对象来源于中国高血压综合干预研究项目,本地区纳入的251例原发性高血压患者中符合代谢综合征的共102例。采用多中心、随机对照、盲终点评估临床试验方法,观察初始小剂量氨氯地平(2.5 mg/d)加复方阿米洛利组(含阿米洛利1.25 mg,氢氯噻嗪12.5 mg,A组,n=46)和小剂量氨氯地平(2.5 mg/d)加替米沙坦组(40 mg/d,B组,n=56)1年内的降压疗效和不良事件。结果治疗1年时,血压达标率B组高于A组,分别为89.3%和78.3%(P=0.002)。B组降压作用优于A组,1年时舒张压下降幅度分别为(13.1±7.4)mm Hg和(9.5±9.9)mm Hg(P=0.047)。结论低剂量氨氯地平联合替米沙坦能更安全有效地控制原发性高血压合并代谢综合征患者的血压。

Objective To compare the therapeutic effect and adverse events of amlodipine - based antihypertensive combination regimen in the treatment of hypertensive patients with metabolic syndrome. Methods There were 102 hypertensive patients with metabolic syndrome from the CHIEF （ Chinese Hypertension Intervention Efficacy Study ） which enrolled a total of 251 hypertensives. This project was a multi - centre, randomized, controlled and blind - endpoint trial. Patients randomly assigned to low - dose Am- lodipine and diuretics （ group A, n = 46 ） or Amlodipine and Telmisartan （ group B, n = 56 ）. Therapeutic effect and adverse events were observed for one year. Results There was significant difference （ P = 0. 002） of the control rate between group A（ 78.26% ） and group B（ 89.29% ）. The antihypertensive effect of group B is better than group A, and the reducing range in diastolic blood pressure of two groups have significant differences after 1 year of treatment （ 13. 1 ±7.4 mmHg VS 9. 5 ±9.9 mmHg , P =0. 047） . 3. One case of stroke event occurred in group A due to the hypopiesia. Conclusion Low -dose Amlodipine combined with Telmisartan had better clinical efficacy and safety in the treatment of hypertensive patients with metabolic syndrome. Instructional importance of self - test blood pressure and 24 - hour ambulatory blood pressure should be attached to lower blood pressure effciently in high - risk hypertensives.