高血压患者症状及药物不良反应的研究——附1026例报告

Hypertensive symptoms and adverse reaction in treatment of hypertension-A prospective randomized, double-blind study

目的 通过随机、双盲、大系列及设正常人对照的研究方法 ,区别常用降压药治疗后真正的不良反应抑或高血压本身的症状。方法 前瞻性、随机、双盲并行研究 ,10 2 6例患者分为A组 (卡托普利 ) ,B组 (氨酰心安 ) ,C组 (尼群地平 ) ,D组 (卡 +氨 ) ,E组 (氨 +尼 ) ,F组 (尼 +卡 )。观察药物降压效果、副作用、生活质量 ,观察期 6个月。以正常人40 0例作为对照组。结果 联合用药降压较单用效果更好 ,心率更稳定 ,撤药率更低。患者 80 %以上用药前存在各种症状 ,药后 1/ 2以上症状消失。同时出现两种以上症状者达74 4% ,最多达 12种症状 ,均非药物所致。有 88 6 %患者用药后出现新症状 ,药物不良反应仅指此类症状 ,药前性功能障碍男、女分别达 76 %、79 5 % ,药后为 5 2 7%及 6 7 0 %。结论 药物副作用及生活质量影响是选用药物的重要依据 ,并可影响患者依从性及疗效。目前尚无只有疗效而无不良反应的降压药物 ,熟悉其不良反应 。

Objective To evaluate the symptoms of hypertensives and adverse reaction of Nitrendipine, Captopril and Atenolol used alone and/or combination in treatment of hypertensions. Method In a prospective, randomized double blind study, 1026 patients with blood pressure (BP)≥140/90 mmHg, stratified by age(≥60 or <60),were subdivided into six groups: Captopril 56 mg/d (171 cases); atenolol 42 mg/d (168 cases); Nitrendipine 23 mg/d(172 cases). Captopril 45 mg/d+atenolol 26 mg/d (171 cases); Nitrendipine 18 mg/d+atenolol 26 mg/d (173 cases); Captopril 45 mg/d+nitrendipine 18 mg/d(173 cases). All patients were followed up to 6～12 months. All patients, 26 symptoms were evaluated before and 12 months later. 400 normotensives were observed as control. Result The control rate in three combination therapy groups was 71 2% which was higher than it in monotherapy (54.8% P <0 01), 82% untreated hypertensive patients complain symptoms. 74 4% hypertensives have had more than two symptons. Half of all symptoms disappear after treating. There were 88 6% patients associated with adverse reaction.Conclusion The most important causes of subjective symptoms in hypertensives may be come from the subjects or high blood pressure person, the “labelling phenomenon”, drug induced symptorms, and other social influences. In somedegree, the side effects would detected in any antihypertensive drugs, but the symptoms were different from drug to drug. The combination therapy in low dose was better than monotherapy in efficacy, safety and adverse reactions.