卡维地洛对原发性高血压的降压疗效及对血压变异的影响

The duration of carvedilol's efficacy and its influence on blood pressure variability

目的 :应用动态血压监测 (ABPM)评价每日口服一次卡维地洛降压疗效的持续性及对血压变异的影响。方法 :选择轻、中度高血压患者 2 0例 ,停用所有降压药物 7d、再服安慰剂 1 4d后 ,对坐位舒张压为 95～ 1 1 4mmHg、且HR≥ 60次 /min者进行ABPM。 2 4h平均舒张压 (MDBP)≥ 85mmHg者 ,(早 9时 )口服卡维地洛 1 0mg/d ,共 2周。对疗效满意 (舒张压 <90mmHg或下降 >2 0mmHg)者进行ABPM。如MDBP <85mmHg ,维持原剂量不变 ;若MDBP≥ 85mmHg ,每 2周剂量递增 1 0mg/d并进行疗效评价 ,增加至 40mg/d ,连用 4周后进行ABPM并结束观察。结果 :①诊室偶测血压和 2 4h、日间、夜间动态血压平均值及相应的血压负荷均显著降低 (P <0 .0 1 ) ,降压总有效率为 85 % ;②该药的收缩压和舒张压谷 /峰比值分别为 79.7%和 73 .4% ;③收缩压和舒张压的降压光滑指数分别为 1 .92和 2 .65 ;④治疗后 2 4h和日间的收缩压之长时血压变异减小 (P <0 .0 5 )。结论 :原发性高血压患者口服卡维地洛 1 0mg～ 40mgQd ,可平稳持续控制 2 4h血压 ,推荐为优选的降压药物。

Objective:To investigate the duration of carvedilol's effica cy and its influence on blood pressure variability.Methods:After 2 weeks of placebo run-in period,20 patients with mild to moderate hypertensio n were treated by carvedilol 2 to 10 weeks during which the dosage would be give n from 10 mg to 40 mg if the sitting diastolic blood pressure(DBP)above 90 mmHg .Ambulatory blood pressure monitoring was conducted at the end of placebo baseli ne and the end of 2,4,6,10 weeks if sitting clinic DBP was below 90 mmHg.The tre atment would stop until the 24 hour m ean DBP was below 85 mmHg.Results:① After treatment with carved ilol once a day for 10 weeks,the isolated clinic blood pressure,the mean blood pressures of 24-hour,daytime and nocturnal and their blood pressure load reduce d significantly compared with those before treatment.The ratios of SBP/DBP were reduced 5.8%/8.3%,6.6%/8.9% and 5.1%/8.3%,respectively(P<0.01).The total rat e of efficacy was 85% .②The trough:peak ratio of carvedilol for SBP and DBP were 79.7% and 73.4%, res pectively.③The smoothness index(SI)for SBP and DBP were 1.92 and 2.65,respectiv ely.④The long blood pressure variability (L-BPV) of both 24 hour and daytime S BP decreased compared with that before treatment(P<0.05),except for that of 24 hour-DBP and nocturnal SBP.Conclusion:Carvedilol could effec tively reduce the blood pressure during 24 hours in essential hypertension.It is of good smoothness beyond its homogeneity which reaches the standard of long ac ting antihypertensive agent suggested by FDA.Carvedilol could also decr ease the long blood pressure variability of 24 hour and daytime SBP slightly wit hout change of the pattern of blood pressure.