唑吡坦对睡眠障碍高血压患者血压以及血压形态的影响

Effect of zolpidem on blood pressure and blood pressure patterns in patients with hypertension complicated with insomnia

目的研究唑吡坦对睡眠障碍原发性高血压(高血压)患者血压以及血压形态的影响。方法选择2008年10月至2011年4月在广州市花都区人民医院心血管内科住院和部分门诊就诊,诊断为高血压伴睡眠障碍且为非杓型血压的患者91例为研究对象,根据电脑随机数字表法分为两组:强化治疗组46例,联合治疗组45例。强化治疗组口服苯磺酸左旋氨氯地平2.5 mg早、晚各1次;联合治疗组早上口服苯磺酸左旋氨氯地平2.5 mg,晚上口服酒石酸唑吡坦10 mg。治疗4周后行动态血压监测,评价血压及血压形态;行阿森斯失眠量表(Athensinsomnia scale,AIS)自测,评估睡眠质量。结果两组基线资料比较,差异无统计学意义(P>0.05)。经4周治疗,强化治疗组白昼收缩压以及黑夜收缩压均较治疗前明显降低,收缩压下降率(ΔSBP%)明显升高,差异有统计学意义(P<0.05)。联合治疗组黑夜收缩压以及黑夜舒张压均较治疗前明显降低,收缩压下降率及舒张压下降率(ΔDBP%)均明显升高,差异有统计学意义(P<0.05)。治疗后联合治疗组白昼收缩压、收缩压下降率及舒张压下降率显著高于强化治疗组,差异有统计学意义(P<0.05)。联合治疗组非杓型血压纠正为杓型血压的比例明显高于强化治疗组[47.7%(21/44)vs.22.7%(10/44),P<0.05]。结论对于伴有睡眠障碍的非杓型高血压患者,联合使用唑吡坦,能够显著降低夜间血压,纠正非杓型血压形态。

Objectives To explore the effect of zolpidem on blood pressure and blood pressure patterns in patients with hypertension complicated with insomnia. Methods Ninety one patients with non-scoop type of hypertension complicated with insomnia in Hospital from October 2008 to April 2011 were randomly divided into 2 groups： 46 patients in intensification therapy group and 45 patients in therapeutic alliance group. Patients in intensification therapy group orally took levamlodipine besylate 2.5 mg in the morning and at night, and patients in therapeutic alliance group orally took levamlodipine besylatc 2.5 mg in the morning and zolpidem 10 mg at night. After 4 weeks＇ treatment, blood pressure and blood pressure patterns were analyzed by the results of ambulatory blood pressure monitoring, and sleep quality was evaluated by the results of Athens insomnia scale （AIS）. Results Baseline characteristics between the two groups had no significant difference （P〉0.05）. After 4 weeks＇ treatment, day systolic blood pressure （SBP） and night SBP in intensification therapy group were significantly lower after treatment, and descent rate of SBP （ASBP%） obviously rose （/}〈0.05）; Night SBP and night diastolic blood pressure （DBP） in therapeutic alliance group were significantly lower after treatment, and descent rate of SBP and DBP （ADBP%） obviously rose （P〈0.05）. Day DBP, descent rate of SBP and DBP in therapeutic alliance group were significantly higher than those in intensification therapy group （P〈0.05）. The rate of retrieving non-scoop type of blood pressure to scoop type of blood pressure in therapeutic alliance group was significantly higher than that in intensification therapy group [47.7% （21/44） vs. 22.7% （10/44）,P〈0.05 ]. Conclusions Combining zolpidem and other drugs can effectively lower night blood pressure, retrieve non-scoop type of blood pressure in patients with non-scoop type of hypertension complicated with insomnia.