动态血压监测评估四种不同时间联合治疗方案的降压效果

Blood pressure lowering efficacy of telmisartan and amlodipine taking on the morning or at bedtime： ABPM results

目的探讨不同时间联合用药对高血压患者降压疗效和血压变异的影响。方法对108例2级及以上原发性高血压患者随机分为早晨（A组26例）、夜间（B组28例）顿服替米沙坦／氨氯地平，晨服替米沙坦晚服氨氯地平（C组27例），晨服氨氯地平晚服替米沙坦（D组27例）四组。夜间服药均于睡前2～3h前。服药前及服药8周后进行动态血压监测。结果各组服药前后比较，收缩压／舒张压差异均有统计学意义（P〈0．01）。治疗后四组24h收缩压／舒张压下降值分别为29．94／16．32、31．37／18．35、29．49／17．30、25．80／15．51mmHg（1mmHg=0．133kPa）；24h收缩压／舒张压的平滑指数各为：1．79／1．34、2．07／1．54、1．70／1．43、1．55／1．32。四组间24h收缩压／舒张压下降值及平滑指数比较差异无统计学意义（P〉0．05）。各组治疗前后夜间血压下降率及杓型、非杓型、超杓型、反杓型分布差异无统计学意义（P〉0．05）。A、C、D组治疗前后晨峰血压分布差异无统计学意义（P〉0．05），B组治疗后晨峰血压增高例数较治疗前降低，差异有统计学意义（P〈0．05）。结论早晨、夜间顿服或早晚分次服药均有明显降压作用，且独立于服药时间；夜间顿服有降压效果较好、血压变异较小的趋势，能更好地降低晨峰血压，且无夜间低血压发生率的增高。夜间服药应在睡前2。3h为宜。

Objective To observe the blood lowering effect of telmisartan and amlodipine taking on the morning or at bedtime in hypertensive patients. Methods A total of 108 individuals with hypertension （grade 2 or above ） were randomized to receive telmisartan and amlodipine in one of the following four therapeutic schemes： Group A （26 cases） ： both medications taken on the morning; Group B （28 cases） ： both medication taken at bedtime; Group C （27 cases ）： telmisartan on the morning and amlodipine at bedtime; or Group D （27 cases ） ： amlodipine on the morning and telmisartan at bedtime. ABPM was performed before and after 8 weeks treatment. Results BP was significantly reduced in 4 groups and the value of 24 hours SBP/DBP decline for each group after treatment was 29. 94/16. 32, 31.37/18.35, 29.49/ 17.30 and25.80/15.51 mm Hg （1 mm Hg =0. 133 kPa） respectively （P〈0.05 vs. baseline）. SI （smooth index） of 24 hours SBP/DBP was 1.79/1.34, 2.07/1.54, 1.70/1.43 and 1.55/1.32 respectively （ P 〉 O. 05 ）. The night-time BP decline and the distributive difference of dipper, non-dipper, extreme dipper and reverse dipper pattern were similar among groups at both baseline and after various treatment regimens （ all P 〉 0.05 ）. Morning blood pressure surge （ MBPS ） after treatment in group B declined more significantly than other groups （ P 〈 O. 05 ）. Conclusion Telmisartan/amlodipine administered either on the morning or at bedtime can effectively reduce blood pressure. The efficacy of BP lowering is independent of the drug taking time. There is a trend both in better BP lowering and less BP variability when two medications are administered at bedtime.