硝苯地平控释片联合氯沙坦钾氢氯噻嗪片或吲达帕胺治疗老年顽固性单纯收缩期高血压疗效比较及对肾功能的影响

Efficacy of nifedipine controlled release tablets in combination with indapamide or hyzzar on elderly patients with refractory isolated systolic hypertention and the effect on renal function

目的评价硝苯地平控释片分别联合氯沙坦钾氢氯噻嗪片或吲达帕胺治疗老年顽固性单纯性收缩期高血压疗效及对肾功能的影响。方法选择顽固性老年单纯性收缩期高血压患者80例随机分为3组:硝苯地平控释片组(A组,n=27,硝苯地平控释片30mg,1次/d),硝苯地平控释片与吲达帕胺合用组(B组,n=26,硝苯地平控释片30mg,1次/d,吲达帕胺2.5mg,1次/d),硝苯地平控释片与氯沙坦钾氢氯噻嗪片合用组(C组,n=27,硝苯地平控释片30mg,1次/d,氯沙坦钾氢氯噻嗪片50mg,1次/d)。3组治疗疗程均为6月,观察3组治疗前后的血压及肾功能变化(血清肌酐、尿微量白蛋白、血清肌酐清除率)。结果 3组治疗后血压均有下降,但C组降压总有效率明显优于A组和B组(P<0.05);治疗前后3组血清肌酐、肌酐清除率及尿微量白蛋白检测结果为C组差异有统计学意义(P<0.05)。结论硝苯地平控释片联合氯沙坦钾氢氯噻嗪片降低老年顽固性收缩期高血压效果较单用硝苯地平控释片以及硝苯地平控释片联合吲达帕胺更有效,且能降低患者血清肌酐、尿微量白蛋白,提高肌酐清除率,改善肾功能。

Objective To investigate the efficacy of nifedipine GITS combined with Hyzzar or indapamide tablets on elderly patients with refractory isolated systolic hypertension and its effect on renal function.Methods Eighty cases of elderly refractory isolated systolic hypertension were randomized into three groups：nifedipine GITS group（group A,n=27,nifedipine GITS 30 mg,qd）,nifedipine GITS in combination with indapamide group（group B,n=26,nifedipine GITS 30 mg,qd;indapamide 2.5 mg,qd）,nifedipine GITS and Hyzzar combination group（group C,n=27,nifedipine GITS 30 mg,qd;Hyzzar,50 mg,qd）.The duration of treatment in the three groups was 6 months.Blood pressure and renal functional changes（serum creatinine,urinary micro-albumin,serum creatinine clearance）in the three groups were determined before and after the treatment.Results Blood pressure in the 3 groups decreased significantly after treatment,but the total effective rate of antihypertension in group C was obviously better than that in group A and group B（P0.05）.The difference of serum creatinine,serum creatinine clearance and urinary micro-albumin was notable in group C（P0.05）,but the difference of the above indices in the other 2 groups had no statistical significance before and after treatment.Conclusion The antihypertensive effect of nifedipine GITS combined with Hyzzar was more effective than that of nifedipine GITS alone or nifedipine GITS combined with indapamide,and this dosage regimen may reduce serum creatinine and urinary micro-albumin,increase creatinine clearance rate and improve renal function in the treatment of elderly patients with refractory isolated systolic hypertension.