硝苯地平缓释剂联合利尿剂治疗173例老年高血压患者安全性与有效性临床观察

Safety and efficacy of dual therapy with nifedipine SR and diuretic in 173 aged hypertensive patients

目的探讨硝苯地平缓释剂联合不同利尿剂(氢氯噻嗪和吲达帕胺)的治疗方案对老年高血压患者的降压安全性及有效性,以寻找适合我国老年高血压患者的降压方案。方法将173例老年高血压患者随机分为3组,Nif组服硝苯地平缓释片10 mg/次,2次?d-1;Nif+HCTZ组在服用硝苯地平基础上加服氢氯噻嗪,剂量为12.5 mg/次,1次?d-1,Nif+ID组在服用硝苯地平基础上加服吲达帕胺,剂量为2.5 mg/次,1次?d-1,疗程8周,考察用药期间血压的变化,进而评价3种用药方案的有效率及安全性。结果 Nif组平均坐位血压从(172.4±12.3)/(101.4±8.6)mmHg降为(150.9±11.6)/(86.4±7.1)mmHg;Nif+HCTZ组平均坐位血压从(176.7±13.6)/(100.8±7.65)mmHg降为(139.7±12.7)/(81.3±8.2)mmHg;Nif+ID组平均坐位血压从(175.4±11.8)/(105.2±9.03)mmHg降为(142.5±10.8)/(81.6±8.6)mmHg。2种联合用药方案有效率与Nif组降压有效率相比,差异有统计学意义(P<0.01),对血钾和肾功能影响差异无统计学意义。主要不良反应为颜面潮红和踝部水肿,Nif+HCTZ组及Nif+ID组比Nif组老年患者不良反应明显减少。结论硝苯地平缓释剂联合利尿剂氢氯噻嗪或吲达帕胺,降压有效率高于单用硝苯地平缓释剂,对老年高血压患者代谢无影响,是老年高血压的有效治疗方案。

Objective To evaluate the safety and efficacy of dual therapy with nifedipine ＋ hydrochlomthiazide or nifedipine ＋ indapamide in aged hypertensive patients in China Methods A total of 173 of aged hypertensive patients were randomly divided into 3 groups receiving monotherapy with nifedipine （Nif） （10 mg, 2 times ·d^-1 ） , dual therapy with nifedipine plus hydrochlorothiazide （Nif ＋ HCTZ） （12.5 mg, 1 time·d^-1） and nifedipine plus indapamide （Nif ＋ ID） （2.5 mg, 1 time ·d^-1） for 8 weeks respectively. Blood pressure was measured weekly and blood potassium and uric acid were tested before and after the treatment. Results Blood pressure in the 3 groups decreased from （172.4± 12.3）/（ 101.4± 8.6） mmHg to （150.9±11.6）/（86.4±7.1） mmHg; （176.7±13.6）/（100.8±7.65） mmHg to （139.7±12.7b）/（81.3± 8.2） mmHg; and （175.4± 11.8）/（105.2±9.03） mmHg to （142.5±10.8）/（81.6±8.6） mmHg, respectively. Nif ＋ HCTZ and Nif ＋ ID reduced the blood pressure more from the base-line to week 8 than did Nif （P 〈 0.01）. Treatments were well tolerated with similar overall. Conclusion Nifedipine ＋ hydrochlorothiazide or nifedipine ＋ indapamide significantly and safely decrease the blood pressure with no significant adverse effect in elderly hypertentive patients.