不同服药方法对非杓型高血压患者降压疗效的影响

Effects of different methods of taking medicine in antihypertensive patients with non-dipper hypertension

目的:探讨不同服药方法对非杓型高血压患者降压疗效的影响。方法:60例2级和3级非杓型高血压患者随机分为顿服组30例、分服组30例,顿服组每天7:00服用非洛地平缓释片5mg和厄贝沙坦150mg;分服组每天7:00服用非洛地平缓释片5mg或厄贝沙坦150mg,晚7:00服用厄贝沙坦150mg或非洛地平缓释片5mg。患者均于服药前及服药后4周,采用动态血压监测系统进行血压监测。结果:服药4周后分服组24h平均收缩压下降值、24h平均舒张压下降值和24h平均动脉压下降值大于顿服组(均P<0.05);分服组夜间平均收缩压下降值、平均舒张压下降值和平均动脉压下降值显著大于顿服组(均P<0.01);分服组24h平均收缩压平滑指数、24h动脉压平滑指数显著高于顿服组(均P<0.05);分服组夜间平均收缩压平滑指数、平均舒张压平滑指数和平均动脉压平滑指数显著高于顿服组(均P<0.01)。治疗后分服组有18例昼夜节律由非杓型改变为杓型,显著多于顿服组的4例(P<0.01)。结论:长效降压制剂联合治疗2级和3级非杓型高血压,早晚分次给药与早晨顿服相比,降压效果更好、降压更加平稳,更有利于血压的昼夜节律由非杓型恢复为正常的杓型。

Objective：To investigate effects of different methods of taking medicine in antihypertensive patients with non-dipper hypertension.Method：60patients with stage 2or stage 3non-dipper hypertensive were randomly divided into two groups.Patients in group A（n=30）take felodipine sustained release tablet（Plendil）5mg qd and irbesartan 150mg qd at 7o＇clock.Patients in group B（n=30）take Plendil 5mg qd（or irbesartan 150mg qd）at 7 o＇clock and irbesartan 150mg qd（or Plendil 5mg qd）at 19o＇clock.All patients were checked blood pressure with ambulatory blood pressure monitoring before and 4weeks after medication.Result：The decrease in value of mean systolic blood pressure,mean diastolic blood pressure and mean arterial pressure in group B were significantly larger than the values in group A 4weeks after medication（P0.05）.The decrease in value of mean systolic blood pressure,mean diastolic blood pressure and mean arterial pressure at night in group B were significantly larger than the values in group A 4weeks after medication（P0.01）.The smoothness index of mean systolic blood pressure and mean arterial pressure in group B was significantly higher than group A（P0.05）.The smoothness index of mean systolic blood pressure,mean diastolic blood pressure and mean arterial pressure at night in group B was significantly higher than group A（P0.01）.The circadian rhythm of blood pressure was changed from nondipper to dipper at 18case patients in group B after treatment,which was 4/30 in group A,（P0.01）.Conclusion：Compared one time a day with two time a day,the method of taking medicine with combination long-effect antihypertensive drugs was better for the patients in stage 2and stage 3 non-dipper hypertension;blood pressure drop was more stable,and the circadian rhythm of blood pressure was better to resume to normal.