非杓型高血压应用厄贝沙坦氢氯噻嗪的时间治疗学研究

The time therapy study of Irbesartan Hydrochlorothiazide used in non-dipper hypertension

目的:观察非杓型高血压患者不同时间应用厄贝沙坦氢氯噻嗪胶囊后各血压参数的变化,探讨其最佳用药时间。方法:采用随机排列表将80例非杓型高血压患者随机分为A、B两组,每组各40例:A组每晨7:00服用厄贝沙坦氢氯噻嗪胶囊,B组每晚19:00服用厄贝沙坦氢氯噻嗪胶囊,剂量均为1粒/d。随访6个月,于治疗前及治疗后8周、6个月3个时点分别进行诊室血压和24 h动态血压监测检查,以收缩压为观察指标,计算并比较两组的诊室收缩压下降均值、白昼收缩压下降均值、夜间收缩压下降均值、谷峰比值、平滑指数、白昼和夜间收缩压达标率、杓型血压转变率。结果:①治疗后各时点两组的诊室收缩压、白昼收缩压、夜间收缩压均值均较治疗前明显降低,差异均有统计学意义(均P<0.01);②两组各时点谷峰比值均>70%;平滑指数均>1;③治疗后8周A、B两组的夜间收缩压的下降均值分别为(14.66±4.37)、(16.47±3.14)mm Hg(1 mm Hg=0.133 kPa),两组比较差异有统计学意义(P<0.05);夜间收缩压达标率分别为25.00%、47.50%,两组比较差异有统计学意义(P<0.05);杓型血压转变率分别为20.00%、42.50%,两组比较差异有统计学意义(P<0.05);④治疗后6个月A、B两组的夜间收缩压的下降均值分别为(20.15±4.59)、(22.45±3.76)mm Hg,两组比较差异有统计学意义(P<0.05);夜间收缩压达标率分别为42.50%、67.50%,两组比较差异有统计学意义(P<0.05);杓型血压转变率分别为45.00%、67.50%,两组比较差异有统计学意义(P<0.05)。结论:厄贝沙坦氢氯噻嗪胶囊无论何时用药均能平稳有效降压,但对非杓型高血压患者采用晚间给药效果更佳,更有利于控制夜间血压水平,并使其血压的昼夜节律由非杓型纠正为正常的杓型。

Objective： To investigate the changes of BP parameters after non-dipper hypertension patients with different time applications Irbesartan Hydrochlorothiazide Capsules, and to explore the best treatment time. Methods： 80 cases of non-dipper hypertension patients were randomly divided into A, B groups by list of random row （each of the 40 cases）： Group A 7：00 every morning taking Irbesartan Hydrochlorothiazide Capsules. Group B 19：00 every night taking Irbesartan Hydrochlorothiazide Capsules. Daily dose was a capsule. There were followed-up for 6 months. Before treatment and 8 weeks and 6 months after treatment, clinic BP and 24-hour ambulatory BP were detected respectively. SBP was selected as indicators of the observed. To calculated and compared decreased means of clinic SBP, decreased means of daytime SBP, decreased means of nighttime SBP, trough peak ratio, smoothness index, daytime and nighttime SBP standard rate, dipper blood pressure change rate between the two groups. Results： （1） The means of clinic SBP and daytime SBP and night time SBP after treatment each time point lower than significantly before treatment, differences were statistically significant （P〈0.01）.（2） Trough peak ratio of the two groups at each time point〉70%, smoothness index〉1.（3）8 weeks After treatment, the decreased means of nighttime SBP of two groups were （14.66＋4.37）mm Hg （l mm Hg=0.133 kPa） and （16.47±3.14）mm Hg, difference was statistically significant （P〈0.05）.The night time SBP standard rate were 25.00% and 47.50%, difference was statistically significant （P〈0.05）. The dipper blood pressure change rate were 20.00% and 42.50%, difference was statistically significant （P〈0.05）.（4）After treatment 6 months, the decreased means of nighttime SBP of two groups were （20.15±4.59）mm Hg and （22.45±3.76） mm Hg, difference was statistically significant （P〈0.05）. The nighttime SBP standard rate were 42.50% and 67.50%,difference was statistically significant （P〈0.05）. The dipper blood pressure change rate were 45.00% and 67.50%,difference was statistically significant （P〈0.05）. Conclusion： To application drug whenever, the Irbesartan Hydrochlorothiazide Capsules can be reduced BP smoothly and efficiently. But the effect of medication in the evening will be better for non-dipper hypertension patients. More conducive to control BP levels at night. More conducive to change the non-dipper hypertension into dipper hypertension.