缬沙坦／氨氯地平和依贝沙坦／双氢克尿噻联合治疗老龄高血压疗效的研究

Efficacy of two treatment combination on hypertension in very elderly patients

目的 比较缬沙坦/氨氯地平和依贝沙坦/双氢克尿噻两种联合用药对老龄高血压患者的疗效.方法 经过4周药物洗刷期,94例老龄高血压患者被随机分为缬沙坦160 mg/氨氯地平5 mg和依贝沙坦300 mg/双氢克尿噻12.5 mg两组,治疗周期为24周,对于药物治疗4周后无反应的患者氨氯地平或双氧克尿噻加倍剂量给药.观察期间测定卧位、坐位及立位血压（收缩压和舒张压）和心率,治疗结束后并测定尿酸和血钾数值.结果 用药后两组各自的血压值均明显下降（氨氯地平和双氢克尿噻剂量加倍者分别为9例和11例）,但两组间的比较差异无统计学意义（P＞0.05）,从卧位到站立血压下降在依贝沙坦/双氢克尿噻组中比缬沙坦/氨氯地平组更明显,分别为-17.2/-9.1 mmHg和-10.1/-1.9mmHg（SBP：t=2.14,P＜0.05,DBP：t=3.11,P＜0.01）.在依贝沙坦/双氢克尿噻组中,相对治疗前血钾水平明显降低（-0.4 mmol/L,t=2.33,P＜0.05）,尿酸明显升高（＋29.7 μmol/L,t=2.54,P＜0.05）.结论 两组药物均能显著降低老龄患者的高血压状况,但缬沙坦/氨氯地平组在对由体位改变引起的血压变化情况影响较小,且有较少的代谢副作用.

Objective To compare the clinical effect of valsartan/amlodipine combination or irbesartan/hydrochlorothiazide（HCTZ）combination in very elderly hypertensives.Methods After a 4-week placebo period,94 hypertensives,aged 75-89 years were random given valsartan 160 mg/amlodipine 5 mg or irbesartan 300 mg/HCTZ 12.5 mg for 24 weeks according to a prospective study.After 4 weeks,amlodipine or HCTZ was doubled in non-responders.Patients were checked every 4 weeks.At each visit,sitting,lying and standing blood pressure（BP）,systolic BP（SBP）and diastolic BP（DBP）were measured. At the end of placebo period and treatment period,electrolytes and uric acid were evaluated.Results Blood pressure was significantly decreased in both treatment groups,however,there was no statistical significance between two groups.BP changes from lying to standing position were significantly greater in the irbosartan/HCTZ group（-17.2/-9.1 mmHg）than that in the valsartan/amlodipine group（-10.1/-1.9 mmHg,t=2.14,P〈0.05 for SBP and t=3.11,P〈0.01 for DBP vs.irbesartan/HCTZ）.Potassium significantly decreased and uric acid significantly increased（-0.4 mmol/L,t = 2.33,P〈 0.05 and＋29.7μ mol/L,t =2.54,P〈0.05 vs.baseline,respectively）only in the irbesartan/HCTZ group.Conclusions Both combinations had similarly effective in reducing clinical BP in very elderly hypertensives.However,valsartan/amlodipine offered some advantage and less pronounced BP orthostatic changes and absence of metabolic adverse effects.