降压药物不同时间用药方案对高血压患者血压晨峰及变异性的影响

Influence of different time treatment regimen of antihypertensive medication on morning blood pressure surge and blood pressure variability in hypertension patients

目的探讨不同降压药物的不同时间用药对高血压患者血压晨峰及变异性(HPV)的影响。方法将312例高血压患者随机分为A、B、C、D 4组,每组78例。A组清晨顿服氨氯地平和氯沙坦钾;B组清晨服用氨氯地平,晚间服用氯沙坦钾;C组晚间顿服氨氯地平和氯沙坦钾;D组清晨服用氯沙坦钾,晚间服用氨氯地平,治疗前及治疗后每周分别测定患者诊室血压和24小时动态血压1次。比较治疗前后各组患者的血压、血压晨峰及HPV的变化。结果治疗后,各组患者24小时平均血压、昼夜血压、晨峰血压均明显下降(P<0.05),但B、D组24小时、日间、夜间的平均收缩压(24hSBP、dSBP、nSBP)分别较A、C组显著下降(P<0.05),且晨峰阳性率、晨峰程度显著下降也更为明显(P<0.05);各组治疗后24小时收缩压标准差(24hSSD)和舒张压标准差(24hDSD)均有所降低,B、D组治疗后上述HPV指标均显著低于A、C组(P<0.05)。结论早晚分服氨氯地平、氯沙坦钾联合治疗高血压较清晨顿服更能减轻血压晨峰现象,改善血压昼夜节律。

[Abstract] Objective To explore different time treatment regimen of antihypertensive medication on morning blood pressure surge （MBPs） and blood pressure variability （HPV） in hypertension patients. Methods 312 hypertensive pa- tients were equally divided into Group A, Group B, Group C, Group D. Group A was treated with a draught of amlodip- ine and losartan potassium in the early morning, and Group B was treated with amlodipine in the early morning and losar- tan potassium in the evening, Group C was treated with a draught of amlodipine and losartan potassium in the evening, Group D was treated with losartan potassium in the early morning and amlodipine in the evening respectively. The blood pressure, MBPs and HPV between the two groups were analyzed before and after treatment. Results After treatment, the 24h average blood pressure, blood press in day and night and MBPs were all reduced （P〈0.05）, while the level of 24hSBP, dSBP, nSBP, the positive rate of MBPs and degree of MBPs in Group 13 and Group D were reduced more re- markably than those of Group A and Group C （P〈0.05）. After treatment, the 24h SSD, 24h DSD were all reduced, while the indicators of HPV above in Group B and Group D were reduced more remarkably than those of Group A and Group C （P〈0.05）. Conclusion Combination use of amlodipine and losartan potassium in the morning and evening for hypertension can effectively relieve MBPs and improve the circadian blood pressure rhythms.