厄贝沙坦不同时间用药对血压昼夜节律的影响研究

The Pharmaco-chronological Effects of Irbesartan on Day-night Rhythm of Blood Pressure in Hypertensive Patients

目的按照时间药物学的原则,探讨不同用药时间服用厄贝沙坦对非杓型高血压患者血压昼夜节律的影响。方法采用动态血压检测的方法筛选出83例非杓型高血压患者,随机分为厄贝沙坦晨起服药组(41例)和晚上服药组(42例),均给以厄贝沙坦150～300mg口服,1次/d,共治疗24周。药物治疗前后分别进行诊室血压和动态血压监测的检查。结果两组的诊室收缩压(SBP)在治疗后均明显降低,两组的诊室收缩压(SBP)在治疗前后差异无统计学意义(P>0.05)。动态血压结果显示,两组均能降低夜间SBP(P<0.05,P<0.01),夜间服药更能有效地降低夜间的SBP。晨起服药组的白天血压达标率(SBP<135mmHg)为36.5%,晚上服药组的白天血压达标率为33.3%,差异无统计学意义(P>0.05)。晨起服药组的夜间血压达标率(SBP<125mmHg)为29.2%,晚上服药组的夜间血压达标率为61.9%,差异有显著意义(P<0.01)。晨起服药组血压昼夜节律纠正率为19.5%,晚上服药组血压昼夜节律纠正率为52.4%,差异有显著意义(P<0.01)。结论对于非杓型高血压患者,厄贝沙坦晚上服药可以有效地纠正夜间的高负荷血压,提高夜间血压达标率,改善血压昼夜节律。

Objective To investigate the pharmaco-chronological effects of irbesartan on day-night rhythm of blood pressure in non-dipper hypertensive patients.Methods Eighty-three non-dipper hypertensive patients were divided into two classes：morning dose（n=41） and evening dose program（n=42）.All patients were treated with irbesartan（150～300mg/d） for 24 weeks.Results Both programs decreased office SBP with no differences between them.ABPM showed that both programs effectively decreased night SBP,while evening program reduced night SBP more pronouncedly.Although The target day-time SBP（135 mmHg） was of no differences between the two programs（36.5% vs 33.3%,P0.05）,the target night-time SBP（125 mmHg） was achieved by evening program in52.4% patients which was greatly higher than that by morning program（29.2%,P0.01）.Circadian rhythm transformed from non-dipper to dipper was found in 19.5% in morning program versus 52.4% in the evening program（P0.01）.Conclusion The evening programs of irbesartan administration were effective in decreasing night BP and improving day-night rhythm of blood pressure.