卡维地洛联合替米沙坦或吲达帕胺对顽固性高血压的治疗效果及药物不良反应的比较

Comparison of clinical efficacy and safety of carvedilol combined with telmisartan or indapamide in treatment of patients with resistant hypertension

目的:比较卡维地洛联合替米沙坦或吲达帕胺2种方案对顽固性高血压的治疗效果和药物不良反应情况。方法:入选顽固性高血压患者62例,所有患者被随机分为卡维地洛联合替米沙坦组(A组)和卡维地洛联合吲达帕胺组(B组);其中A组纳入患者32例,B组30例。接受药物治疗的同时,所有患者均进行生活方式干预。于治疗3个月及6个月时观察患者的血压、心率、肝功能、肾功能、血糖、血脂、血钾和血尿酸。结果:治疗3个月和6个月时,2组患者的收缩压和舒张压与治疗前比较均显著降低,差异有统计学意义(P<0.05);2组患者治疗后的收缩压和舒张压比较,差异无统计学意义(P>0.05)。2组患者治疗前后的肝功能、肾功能、血糖、血脂等指标无明显变化(P>0.05)。A组患者治疗6个月后血钾较治疗前升高,差异有统计学意义(P<0.05)。B组患者治疗3个月及6个月出现血钾降低;治疗6月血尿酸较前升高,差异均有统计学意义(均P<0.05)。研究结束,A组较B组不良反应低,差异有统计学意义(P<0.05)。结论:卡维地洛联合替米沙坦或吲达帕胺均能有效治疗顽固性高血压,用药时应监测血尿酸及血钾变化,卡维地洛联合替米沙坦不良反应少,是更优组合。

OBJECTIVE To evaluate the efficacy and safety of carvedilol combined with telmisartan or indapamide in patients with resistant hypertension.METHODS Sixty-two patients with resistant hypertension were randomly divided into two groups.Patients in group A（n= 32） were given carvedilol combined with telmisartan and those in group B（n= 32） were administered with carvedilol and indapamide.All the patients received drug treatment and lifestyle intervention.Their blood pressure,heart rate,liver function,kidney function,blood glucose,blood lipids,serum potassium and blood uric acid were detected at the third and sixth months.RESULTS The systolic and diastolic blood pressure lowered in patients of the two groups than that of before treatment（P〈0.05）,but there was no significant difference between the two groups of them（P〈0.05）.Their liver function,renal function,blood glucose and blood lipids had no significant difference compared with that of before treatment in the two groups.Serum potassium of patients in group A increased after treatment of six months（P〈0.05）.Serum potassium of patients in group B significantly decreased after treatment of three and six months（P〈0.05）,and uric acid significantly increased after treatment of six months（P〈0.05）.The incidence of adverse drug reactions of Group A were lower than that of Group B（P〈0.05）.CONCLUSION Carvedilol combined with telmisartan or indapamide is effective on resistant hypertension,but serum uric acid and serum potassium should be monitored.Carvedilol combined with telmisartan is the better combination because of the fewer adverse reactions.