动态血压监测评价卡维地洛的降压作用

Effects of carvedilol on patients with essential hypertension by 24-hour blood pressure monitoring

目的 应用动态血压监测法 ,评价卡维地洛对原发性高血压患者的疗效。方法 2 0例WHOI～II期原发性高血压患者 ,经安慰剂洗脱 2周后 ,口服卡维地洛 4周 ,剂量为 2 0～ 40mg/d ,一次服。治疗前后用动态血压监测仪 (Spacelab 90 2 0 7型 )各测 1次动态血压 ,并计算谷 /峰 (T/P)比值。结果卡维地洛主要降低白天血压 ,收缩压 (SBP)和舒张压 (DBP)分别下降8 2 %和 8 5 %。对夜间血压降压作用不明显 ,清晨血压基本回复治疗前水平。卡维地洛给药后心率减慢 ,降低幅度也是白天大于夜间。 2 0例病例中 ,有效病例 9例 ,SBP和DBP的T/P比值分别为 6 1 3%和 39 8% ,未达到美国食品与药品管理局(FDA)对每日一次给药的降压药规定的T/P比值标准。结论卡维地洛能有效地控制白天血压 ,但在清晨降压作用不明显。建议给药剂量最好每日两次 ,每次 10～ 2

Objective To assess the efficacy of carvedilol in treating essential hypertension by 24-h blood pressure monitoring Method Twenty patients with WHO stage I or II essential hypertension were enrolled in this study After a washout phase with placebo, patients received 4 weeks of treatment with carvedilol at a dose of 20 ～ 40 mg once daily Twenty-four hours ambulatory blood pressure was measured before and after treatment, and the trough-to-peak ratio (T/P ratio) was calculated Results Carvedilol induced a significant reduction in 24-h ambulatory blood pressure in the daytime The average reductions were 8 2 % in SBP and 8 5 % in DBP in daytime No significant reduction was seen in 24-h ambulatory blood pressure at night Morning blood pressure returned to the level before treatment The reduction of heart rate in daytime was also greater than that of patients at night Among the 20 cases, 9 cases had effective reduction in blood pressure, and the T/P ratio of SBP and DBP were 61 3 % and 39 8 %, respectively The T/P ratio did not meet the standard of FDA for antihypertensive drug with once-a-day administration Conclusion Carvedilol can control hypertension effectively in the daytime, but it induces no significant reduction in morning blood pressure suggesting that the dosage of 10～20 mg twice a day is optimal