盐敏感性高血压与非盐敏感性高血压联合药物治疗的比较研究

Different combination of drugs regarding the damage on organs targeting salt sensitivity or non-salt-sensitive hypertension

目的探讨盐敏感性高血压和非盐敏感性高血压对靶器官损害及联合药物治疗的差异。方法选取120例轻中度高血压住院患者，经盐负荷试验测试，60例定为盐敏感性高血压组（SS），另选择60例为非盐敏感性高血压组（NSS），将此两组再分别随机分为两小组，每组30例，分别给予非洛地平片联合培哚普利片以及吲达帕胺缓释片联合培哚普利片治疗12周，测量治疗前后24h动态血压、空腹血糖（FPG）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA—IR）、左室重量指数（LVMI）、尿微量白蛋白（MAU）、BMI、血清肌酐（Cr）、血清尿酸（UA）的变化。结果SS组与NSS组相比，FPG和Cr水平的差异有统计学意义（P〈0．01），FINS、LVMI、MAU、BMI、HOMA—IR的差异亦有统计学意义（P〈0．05）；SS组中使用培哚普利联合吲达帕胺治疗的患者，各项相关检测指标更趋于正常范围，差异有统计学意义（P〈0．05）；NSS组中使用培哚普利联合非洛地平治疗的患者，其各项检测指标更趋于正常范围，差异有统计学意义（P〈0．05）。结论盐敏感性高血压患者的靶器官损害更明显，适于培哚普利与吲达帕胺联合药物治疗，而非盐敏感性患者适于培哚普利与非洛地平联合治疗。

Objective To study the damage on organs from salt sensitivity hypertension or non-salt-sensitive hypertension and the selection of drug combination. Methods 120 hypertensive patients including 60 cases salt-sensitive （SS） and 60 non-salt-sensitive （NSS） groups were selected in our hospital and their salt load tested. These two groups were randomly divided into two groups, each group with 30 patients, one was given felodipine and perindopril and the others were given indapamide sustained release tablets and peridopril to facilitate the 12-week treatment. Before and after the treatment, patients were tested for physiological indicators, such as sitting blood pressure, 24-hour ambulatory blood pressure, insulin resistance index, comparing changes of various sub-index etc. Results Significantly different were seen in indices as fasting blood glucose and serum creatinine （P 〈 0.01 ）, fasting insulin, left ventricular mass index, urinary albumin, body mass index, insulin resistance indices, while between the SS group and the NSS group（P〈0.05 ）. In the SS group, when patients with various sub-indicators were using perindopril combined with indapamide treatment, the related detected indicators tended to be normal and with statistically significant differences （P〈0.05）. In the NSS group, those related indexes also tended to be more normal when using felodipine combined with perindopril. However, there were statistically significant differences between the two groups （P〈0.05）. Conclusion On SS hypertensive patients with target organ damages, perindopril and indapamide seemed to be more effective in NSS patients, indicating that the use of perindopril and felodipine combination, seemed to be more suitable.