优化联合治疗老年单纯性收缩期高血压

Optimized combined treatment for senile isolated systolic hypertension

目的比较卡托普利单药、左旋氨氯地平(施慧达)单药、卡托普利+左旋氨氯地平、卡托普利+左旋氨氯地平+阿托伐他汀四种治疗方案治疗老年单纯性收缩期高血压(ISH)的临床疗效。方法纳入60岁以上ISH患者264例,平均分为4组。卡托普利组:口服卡托普利(12.5～50)mg(bid)。左旋氨氯地平组:晨起顿服左旋氨氯地平2.5mg(qd)。联合治疗组(联合组):卡托普利(12.5～50)mg(bid)+左旋氨氯地平2.5mg(qd)。优化联合组(优化组):在联合治疗组的基础上加用阿托伐他汀10mg(qd);共治疗12周。并分别比较治疗前、治疗后1周、3周、6周、12周4组血压、血脂水平及心电图变化。结果四组治疗后收缩压均有不同程度的降低,优化组和联合组与卡托普利组、左旋氨氯地平组比较差异具有统计学意义(P≤0.05)。优化组降压、降脂及心肌供血改善尤其显著,且4组治疗前后肝肾功能变化无明显差异。结论左旋氨氯地平联合卡托普利治疗老年ISH安全有效,可改善心肌缺血、降低血脂,联合阿托伐他汀治疗效果更佳。

Objective To compared the curative effects of captopril, levamlodipine （Shihuida）, captopril＋levamlodipine and captopril＋levamlodipine＋atorvastatin in the treatment of senile isolated systolic hypertension （ISH）. Methods There were 264 ISH patents aged over 60 were selected and divided into four groups, and captopril group was orally given captopril （12.5-50） mg （bid）, levamlodipine group, levamlodipine in the morning （2.5 mg, qd）, combining group, captopril （12.5-50） mg （bid） and levamlodipine （2.5 mg, qd）, and optimizing group, atorvastatin （10 mg, qd） on the base of the same treatment as combining group. The treatment was continued for 12 weeks. The changes of blood pressure, blood fat and ECG were compared before treatment, and 1 week, 3 weeks, 6 weeks and 12 weeks after treatment. Results The systolic pressure decreased in varying degrees in four groups after treatment. The comparison between optimizing group or combining group and captopril group or levamlodipine group showed the difference was statistically significant （P ~〈 0.05）. It was more significant in reducing blood pressure and blood fat and improving myocardial blood supplying in optimizing group. The changes of functions of liver and kidney had no significant difference in four groups before and after treatment. Conclusion Levamlodipine combining captopril is safe and effective, and can relief myocardial ischemia and reduce blood fat in the treatment of senile ISH. The curative effect is better when atorvastatin is combined.