氨氯地平联合培哚普利对高血压患者血压变异性的影响

Effect of blood pressure variability in patients with hypertension treated by amlodipine combined with perindopril

目的 观察氨氯地平联合培哚普利对高血压患者血压变异性的影响.方法 选择2012年9月至2013年10月就诊的原发性高血压患者,均给予氨氯地平5 mg/d（4周）,4周后血压仍不能控制的患者（78例）,按随机数字表法分为A、B两组,每组39例,A组患者服用氨氯地平剂量加倍（10 mg/d）;B组在服用氨氯地平的基础上加服培哚普利4 mg/d.A、B两组患者均在加服药前与加服药8周后采用无创便携式动态血压监测仪检测24 h动态血压,以测量值的标准差和变异系数作为血压变异性的指标.结果 A组加服药8周后,24 h收缩压变异度（24 h SSD）、白天收缩压变异度（dSSD）、夜间收缩压变异度（nSSD）、夜间收缩压变异系数（nSCV）、24 h舒张压变异度（24h DSD）、白天舒张压变异度（dDSD）、夜间舒张压变异度（nDSD）均较加服药前降低[（13.22±1.10） mmHg（1 mmHg=0.133 kPa）比（15.97±1.65） mmHg、（12.04±2.21） mmHg比（15.15±2.89） mmHg、（10.22±3.29） mmHg比（12.23±3.21） mmHg、0.093±0.021比0.104±0.017、（11.33±2.09） mmHg比（13.27±1.43） mmHg、（10.64±1.81） mmHg比（12.57±1.43） mmHg、（9.56±1.32） mmHg比（11.23±2.26） mmHg],差异有统计学意义（P＜0.05）,但24 h收缩压变异系数（24 h SCV）、白天收缩压变异系数（dSCV）、24h舒张压变异系数（24 h DCV）、白天舒张压变异系数（dDCV）、夜间舒张压变异系数（nDCV）变化差异无统计学意义（P＞0.05）;B组加服药8周后,与加服药前比较,24 h SSD、24 h SCV、dSSD、dSCV、24 h DSD、24 h DCV、dDSD、dDCV、nDSD均显著下降[（10.23±4.72） mmHg比（15.27±3.23） mmHg、0.083±0.032比0.106±0.019、（10.85±3.29）mmHg比（15.09±3.21）mmHg、0.080±0.028比0.096±0.025、（10.13±2.43）mmHg比（13.37 ±3.13） mmHg、0.111±0.035比0.136±0.032、（9.58±2.49） mmHg比（12.29±3.27） mmHg、0.112±0.036比0.123±0.041、（9.46±2.78） mmHg比（11.19±4.26） mmHg],差异有统计学意义（P＜0.05）,但nSSD、nSCV及nDCV变化差异无统计学意义（P＞0.05）;加服药8周后,B组24 h SSD、24 h SCV、24 h DSD、24h DCV、dSSD、dDSD、dSCV及dDCV均显著低于A组,差异有统计学意义（P＜0.05）;两组nSSD、nDSD、nSCV及nDCV比较差异无统计学意义（P＞0.05）.结论 氨氯地平单药加倍剂量和氨氯地平联合培哚普利均能有效降低24 h收缩压及舒张压变异性,且联合治疗的效果更好,值得进一步推广使用.

Objective To observe the effect of blood pressure variability in patients with hypertension treated by amlodipine combined with perindopril.Methods From September 2012 to October 2013,patients with essential hypertension were given amlodipine 5 mg/d for 4 weeks,and 78 patients with blood pressure not reaching the standard after 4 weeks treatment were divided into group A and group B by random number table method,with 39 cases in each.Group A was given amlodipine 10 mg/d,and group B was given perindopril 4 mg/d on this basis （amlodipine 5 mg/d）.Twenty-four hour ambulatory blood pressure was monitored in 2 groups by noninvasive portable ambulatory blood pressure monitoring in medication and 8 weeks after medication,measured values of standard deviation and coefficient of variation was used as a measurement of blood pressure variability.Results After 8 weeks of medication plus,24 h systolic blood pressure variability （24 h SSD）,systolic blood pressure variability during the day （dSSD）,nocturnal systolic blood pressure variability （nSSD）,nocturnal systolic blood pressure variation coefficient （nSCV） and 24 h diastolic blood pressure variability（24 h DSD）,diastolic blood pressure variability during the day （dDSD）,nocturnal diastolic blood pressure variability （nDSD） in group A were significantly lower than those before medication plus[（13.22 ± 1.10） mmHg（1 mmHg =0.133 kPa） vs.（15.97 ± 1.65） mmHg,（12.04 ± 2.21） mmHg vs.（15.15 ±2.89） mmHg,（10.22 ±3.29） mmHg vs.（12.23 ±3.21） mmHg,0.093 ±0.021 vs.0.104 ± 0.017,（11.33 ± 2.09） mmHg vs.（13.27 ± 1.43） mmHg,（10.64 ± 1.81） mmHg vs.（12.57 ± 1.43） mmHg,（9.56 ± 1.32） mmHg vs.（11.23 ± 2.26） mmHg] （P 〈 0.05）,but there were no significant changes among 24 h systolic blood pressure variation coefficient （24 h SCV）,systolic blood pressure variation coefficient during the day （dSCV） and 24 h diastolic blood pressure variation coefficient （24 h DCV）,diastolic blood pressure variation coefficient during the day （dDCV）,nocturnal diastolic blood pressure variation coefficient （nDCV） （P 〉 0.05）.After 8 weeks of medication plus,24 h SSD,24 h SCV,dSSD,dSCV and 24 h DSD,24 hDCV,dDSD,dDCV,nDSD in group B were significandy decreased compared with before combination plus[（10.23 ± 4.72） mmHg vs.（15.27 ± 3.23） mmHg,0.083 ± 0.032 vs.0.106 ± 0.019,（10.85 ± 3.29） mmHg vs.（15.09 ± 3.21） mmHg,0.080 ± 0.028 vs.0.096 ± 0.025,（10.13 ± 2.43） mmHg vs.（13.37 ±3.13） mmHg,0.111 ±0.035 vs.0.136 ±0.032,（9.58 ±2.49） mmHg vs.（12.29 ±3.27） mmHg,0.112 ± 0.036 vs.0.123 ± 0.04 1,（9.46 ± 2.78） mmHg vs.（11.19 ± 4.26） mmHg] （P 〈 0.05）,but there were no significant changes among nSSD,nSCV and nDCV （P 〉 0.05）.After 8 weeks of medication plus,24 h SSD,24 h SCV and 24 h DSD,24 h DCV,dSSD,dDSD,dSCV and dDCV in group B were significantly lower than those in group A （P 〈 0.05）.The nSSD,nDSD,nSCV and nDCV between 2 groups had no significant difference （P 〉 0.05）.Conclusions Amlodipine double dose or amlodipine single dose combined with perindopril can all effectively reduce the 24 hours＇ systolic and diastolic blood pressure variability,and the combined treatment is better and worthy of further promotion in clinic.