小剂量左旋氨氯地平、替米沙坦和氢氯噻嗪同时或不同时给药对杓型高血压的影响

Efficacy of low doses of Levo-amlodipine, Telmisartan and Hydrochlorothiazide administered concurrently or not on the dipper hypertension

目的 探讨小剂量左旋氨氯地平、替米沙坦及氢氯噻嗪同时或不同时给药对杓型高血压的影响.方法 选择我院门诊及住院杓型高血压患者272例（收缩压＜ 180 mm Hg,舒张压91～109 mm Hg）,年龄＞45岁,男性179例,女性93例.随机分为两组：Ⅰ组（不同时给药组,135例）晨服替米沙坦40 mg和氢氯噻嗪10 mg,晚服左旋氨氯地平2.5 mg;Ⅱ组（同时给药组,137例）以上三种药物均晨服（剂量同Ⅰ组）.两组基线资料均衡可比.所有病例治疗前及治疗8周后进行动态血压监测.结果 治疗8周后,Ⅰ组和Ⅱ组的24h收缩压/舒张压均较治疗前降低[（128.64± 12.76）mm Hg/（82.46±7.18）mm Hg比（144.36±15.86）mm Hg/（92.34±7.86）mm Hg,P＜0.01,（127.54±13.06）mm Hg/（81.92±7.28）mm Hg比（143.68±15.58）mm Hg/（92.52±7.64）mm Hg,P＜0.01],两组间降低幅度差异无统计学意义（P＞0.05）;夜间收缩压/舒张压较治疗前降低[（134.28 ±13.36）mm Hg/（82.76±6.84）mm Hg比（116.42±12.14）mm Hg/（70.18±6.28）mm Hg,P＜0.01,（134.46±13.58）mm Hg/（82.48±6.72）mm Hg比（118.18±12.18）mm Hg/（71.82±6.86）mm Hg,P＜0.01],降低幅度差异无统计学意义（P＞0.05）.Ⅰ组治疗后收缩压昼夜差值高于治疗前[（21.10±4.88）mm Hg比（17.32±4.26）mm Hg,P＜0.05];Ⅱ组差异无统计学意义（P＞0.05）.治疗后Ⅰ组收缩压昼夜差值高于Ⅱ组[（21.10±4.88）mm Hg和（18.04±4.26）mm Hg,两组比较差异有统计学意义（P＜0.05）].结论 对于杓型高血压患者,小剂量左旋氨氯地平、替米沙坦和氢氯噻嗪无论同时或不同时给药均能有效地控制24h、日间和夜间血压,而同时一次给药患者的依从性会更好,还能减少深杓型血压的发生.

Objective To investigate the efficacy of low doses of Levo-amlodipine,Telmisartan and Hydrochlorothiazide administered concurrently with or not on the dipper hypertension.Methods Choose 272 patients （179 males and 93 females） of our hospital outpatient and inpatient with dipper hypertension of systolic blood pressure（SBP）〈180 mm Hg,diastolic blood pressure（DBP）91-109 mm Hg,whose age〉45 years,and those patients were randomly divided into two groups：Ⅰ group （without simultaneous administration group,n=135） taking Telmisartan 40 mg and Hydrochlorothiazide 10 mg orally in morning,and oral Levo-amlodipine 2.5 mg evening; Ⅱ group （simultaneous administration group,n=137） three drugs were taken in morning.Ambulatory blood pressure monitoring was given for all patients before treatment and after 8 weeks of treatment.Results After 8 weeks of treatment,SBP/DBP [（144.36±15.86）mm Hg/（92.34±7.86）mm Hg vs （128.64±12.76）mm Hg/（82.46±7.18） mm Hg,P〈0.01] and [（143.68±15.58）mm Hg/（92.52±7.64）mm Hg vs （127.54±13.06）mm Hg/（81.92±7.28） mm Hg,P〈0.01] were significantly lower than before treatment （P〈0.01） in Ⅰ group and Ⅱ 24 h respectively;the reduce of magnitude between the two groups was not statistically significant（P〉0.05）.Nighttime SBP/DBP before and after treatment were [（134.28±13.36）mm Hg/（82.76±6.84）mm Hg vs （116.42±12.14）mm Hg/（70.18±6.28）mm Hg,P〈0.01] and [（134.46±13.58）mm Hg/（82.48±6.72）mm Hg vs （118.18±12.18）mm Hg/（71.82±6.86）mm Hg,P〈0.01] was lower than before treatment （all P〈0.01） in group Ⅰ,but was no significant difference in group Ⅱ （P〉0.05）.The difference between day and night were（21.10±4.88）mm Hg and （17.32±4.26）mm Hg in group Ⅰ,was statistically significant（P〈0.05）,no significant difference in Ⅱ group（P〉0.05）.There were significantly difference in decreasing of BP after treatment between the two groups [（21.10±4.88）mm Hg vs （18.04±4.2）mm Hg,P〈0.05].Conclusion For dipper hypertensive patients,low dose of Levo-amlodipine,Telmisartan and Hydrochlorothiazide administered either simultaneously or not at the same time can effectively control blood pressure of 24 h,daytime and nighttime blood pressure,while at the same time administering the patient compliance will be better,and also reduce the incidence of deep-dipper blood pressure.