以钙拮抗剂为基础的联合降压对高血压患者中心动脉压和脉搏波传导速度的对比研究

Comparison of different calcium channel blocker-based combination therapies on central blood pressure and pulse wave velocity in hypertensive patients

目的探讨氨氯地平联合复方阿米洛利或联合替米沙坦对高血压患者中心动脉压(CAP)和脉搏波传导速度(PWV)的影响。方法采用随机抽样方法选取2008-03-2011-02济南4个社区查体人群中高血压患者275例,年龄50～79岁。随机分为氨氯地平联合复方阿米洛利组(A组,134例)或联合替米沙坦组(B组,141例)。排除68例应用调脂药物的患者后,对207例(A组,102例;B组,105例)患者进行分析。在基线、治疗12、24月,分别应用动脉脉搏波分析仪测量CAP和增强指数,应用PWV测定仪测定颈桡动脉PWV(crPWV)。结果两组治疗12月后,中心动脉收缩压、舒张压、脉压,增强指数及crPWV均明显降低。24月时,B组crPWV较12月时进一步降低[(8.9±2.0)比(9.5±2.2)m/s,P<0.05],然而A组患者的crPWV并未随着时间的延长进一步改善(P>0.05)。治疗12和24月后,B组crPWV下降幅度[12月(-3.5±2.1)m/s,24月(-4.1±2.3)m/s]均较A组[12月(-2.3±1.6)m/s,24月(-2.5±1.8)m/s]更明显(均P<0.01)。结论以钙拮抗剂氨氯地平为基础,联合替米沙坦或复方阿米洛利均能够降低CAP、增强指数和改善大动脉顺应性,其中氨氯地平联合替米沙坦改善动脉弹性更明显,并且随着治疗时间的延长,效果更佳。

Objective To investigate the effects of amlodipine combined with amiloride（amlodipine/amiloride） or with telmisartan（amlodipine/telmisartan） on central aortic pressure（CAP） and pulse wave velocity in hypertensive patients.Methods From 2008-03-2011-02,275 hypertensive patients aged 50 to 79 years old from four community groups in Jinan were randomly assigned to amlodipine/amiloride（group A,134 cases） or amlodipine/telmisartan（group B,141 cases）.Sixty-eight cases treatmented with lipid-lowering drugs were excluded.Two hundred and seven cases（group A,102 cases;group B 105 cases） were enrolled in our study.CAP and augmentation index（AI）,carotid-radial pulse wave velocity（crPWV） were measured in baseline,after 12 and 24 months of treatment respectively.Results Central systolic blood pressure,diastolic blood pressure,pulse pressure,augmentation index and crPWV all significantly decreased after 12 months therapy in two groups.The crPWV [（8.9±2.0） vs（9.5±2.2）m/s,P0.05] in group B further reduced in 24 months,but there was no change in group A with time prolonged（P0.05）.Treatment for 12 and 24 months,the decreases of crPWV in group B [12 months（-3.5±2.1）m/s;24 months（-4.1±2.3）m/s] were markedly significant compared with group A [12 months（-2.3±1.6）m/s;24 months（-2.5±1.8）m/s,P0.01].Conclusion CAP,AI and crPWV in hypertensive patients could be significantly reduced by the treatment with amlodipine/amiloride or amlodipine/telmisartan whereas amlodipine/telmisartan therapy shows more effective in the improvement of arterial flexibility than amlodipine/amiloride.