166例难治性高血压患者的临床治疗与效果研究

Clinical study on the treatment and efficacy of 166 patients with refractory hypertension

目的评价不同治疗手段在难治性高血压治疗中的临床效果及安全性。方法选择我院2009年3月—2013年3月间收治的166例难治性高血压患者采取随机对照原则分为A、B两组,每组83例,两组患者均嘱改善生活方式,同时A组患者应用双氢克尿噻12.5 mg,每日1次;氯化钾缓释片1.0 g、硝苯地平缓释片10 mg及马来酸依那普利片10 mg,每日各2次;B组患者应用双氢克尿噻12.5 mg及螺内酯20 mg,每日各1次;硝苯地平缓释片10 mg及马来酸依那普利片10 mg,每日各2次;并采取t检验和χ2检验分别对两组患者的治疗前后的舒张压、收缩压及治疗总有效率进行比较分析,并对用药安全性进行观察。结果 A、B两组患者经过药物治疗后,舒张压及收缩压显著低于治疗前(t舒张压1=3.2325,t收缩压1=2.7163,P<0.05)。而B组患者经过治疗后,其舒张压及收缩压下降水平显著低于A组(t舒张压2=2.1902,t收缩压2=2.1219,P<0.05)。在总有效率上,B组患者显著高于A组患者(92.8%VS 60.2%,χ2=24.43,P<0.01)。且治疗后全部患者血糖、血脂及血钾水平经检测均正常。结论继发性高醛固酮血症则与难以控制的血压关系密切,采取非选择性醛固酮受体拮抗剂螺内酯联合常规高血压治疗药物能有效的控制难治性高血压,且安全性较好,在临床上难治性高血压的应用上意义重大。

Objective To evaluate the clinical＇efficacy and security of different therapy in the treatment of refractory hypertension. Methods 166 patients with refractory hypertension from march 2009 to march 2013 were divided into group A and B, with 83cases in each group, all the patients were followed the doctors＂ advise to change the way of life. Patients in group A were given hydrochlorothiazide 12.5 rag,once a day, potassium chloride sustained-release tablets 1.0 g, extended release nifedipine tablets 10 rag, enalapril maleate tablets 10 mg, twice a day. Patients in group B were give,,, hydrochlorothiazide 12.5 rag, spirolactone 20 mg, once a day, extended release nifedipine tablets 10 mg, enalapril maleate tablets 10 mg, twice a day. Diastolic and systolic blood pressure and total efficiency of treatment were analyzed by t andx2 test, the security of drug were observed. Results Of all the patients in two groups, diastofic and systolic blood pressure after treatment were lower than before treatment,（t diastolic t=3.2325,t systolict=2.7163,P〈0.05 ）.diastolic and systolic blood pressure in group B were lower than group A significantly. （t diastolic2= 2.1902,t systolic 2=2.1219P〈0.05 ）. total efficiency of group B were higher than group A （92.8% VS 60.2%,x2=24.43,P〈0.01）. The level of blood lipid, blood glucose and potassium of the two groups were normal. Conclusion Secondary hyperaldosteronism has close relationship with unmanageable blood pressure, Non selective aldosterone receptor antagonist spironolactone combined with conventional antihypertensive drug can effectively control refractory hypertension, it？has an important significance in clinical for its effectiveness and security.