不同时间给予替米沙坦对高血压患者左室质量指数及血压变异性的影响

Effects of telmisartan administration time on blood pressure variability and left ventricular mass index in hypertensive patients

目的:探讨替米沙坦不同时间给药对高血压患者血压变异性(blood pressure variability,BPV)以及左心室质量指数(left ventricular mass index,LVMI)的影响。方法:将300例轻、中度非杓型原发性高血压患者随机分为3组:晨服组于晨起早8时给予替米沙坦,一次40～80 mg;晚服组于睡前晚8时给予替米沙坦,一次40～80 mg;常规组维持常规用药(非血管紧张素II受体拮抗剂及血管紧张素转化酶抑制剂),不予干涉。24周后复查动态血压和超声心动图,比较治疗前后BPV和左心室指数的变化。结果:治疗24周后血压均达标。晨服组和晚服组将非杓型血压纠正为杓型血压、恢复昼夜节律的比例分别为为22%和52.2%;晚服组患者BPV明显减小,LVMI下降,优于晨服组和常规组(P<0.05)。治疗前后,替米沙坦组有显著改变(P<0.01),对照组无明显变化。结论:采用时辰药理学给予替米沙坦可更有效地改善高血压BPV以及左心室功能,值得在临床上进一步推广。

Objective： To observe the effect of telmisartan administrated at different times on blood pressure variability（BPV） and left ventricular mass index（LVMI） in patients with hypertension.Methods：A total of 300 patients with mild to moderate essential hypertension were randomly divided into three groups.They were treated with the angiotensinⅡreceptor antagonist telmisartan 40~80 mg at 8AM（control） or at 8PM（test）,as well as continued previous conventionl medication with an angiotensin II receptor antagonist and an angiotension-converting enzyme inhibitor.The change in 24-h BP and ultrasonic cardiography were determined.The values of BPV and LVMI were compared before treatment and 24 weeks after treatment.Results： The BP in all patients fit the standard 24 weeks after treatment.Circadian rhythm recovered from non-dipper variation in 22% and 52.2% patients,respectively,in 8AM and 8PM groups.BPV and LVMI decreased significantly larger in 8PM group than in 8AM and conventional groups（P〈0.05）.There was a significant difference between 8AM and 8PM groups after treatment with telmisartan（P〈0.01）.Conclusion： Administration of telmisartan based on chronopharmacology improves its efficacy on BPV and left ventricular function in hypertensive patients.