缬沙坦联合氨氯地平或氢氯噻嗪治疗对老年高血压患者血压变异性及一氧化氮、内皮素的影响

Amlodipine or hydrochlorothiazide and valsartan combination therapy for the treatment of elderly patients with hypertension on BPV, nitric oxide, endothelin

目的：探讨缬沙坦联合氨氯地平或氢氯噻嗪治疗对老年高血压患者血压变异性（ BPV）及一氧化氮（ NO）、血浆内皮素的作用。方法选择552例老年高血压患者，采用随机数字表法将其分为观察组和对照组各276例，给予观察组氨氯地平联合缬沙坦进行治疗，对照组给予氢氯噻嗪联合缬沙坦进行治疗，连续治疗3个月，对两组患者治疗后的BPV及NO、血浆内皮素的含量进行对比分析。结果治疗后，观察组24 h SBPV、日SBPV、24 h DBPV、日DBPV均较治疗前明显下降（t＝20．09、15．97、9．31、9．41，均P＜0．05），对照组患者仅24 h SBPV及日SBPV[分别为（9．12±2．57）％，（8．43±1．97）％]显著低于治疗前（t＝12．31、9．53，均P＜0．05）；观察组治疗后日SBPV、24 h DBPV、日DBPV[分别为（7．21±1．34）％、（12．31±2．54）％、（10．59±2．73）％]显著低于对照组（t＝10．52、12．34、8．35，均P＜0．05），治疗后两组NO[分别为（66．12±23．57）％、（68．29±21．52）％]与血浆内皮素水平[分别为（34．43±7．97）％、（34．21±7．34）％]显著低于治疗前（t观察组＝31．39，11．79，t对照组＝28．31，9．35，均P＜0．05）。结论缬沙坦联合氨氯地平或氢氯噻嗪能有效控制血压，明显升高NO水平，降低血浆内皮素水平，值得在临床中推广应用。

Objective To investigate the amlodipine or hydrochlorothiazide and valsartan combination thera-py in elderly hypertensive patients with blood pressure variability （ BPV ） and nitric oxide （ NO ） , endothelin role. Methods 552 elderly patients with hypertension were divided into the observation group and control group,276 cases in each group,the observation group was given amlodipine valsartan for treatment,while the control group was received hydrochlorothiazide combined with valsartan for treatment,the two group were treated for three months,the content of BPV,NO and plasma endothelin were analyzed.Results After treatment,the 24hSBPV,day SBPV,24hDBPV,day DBPV of the observation group significantly decreased compared with pre-treatment, the difference was statistically significant（t=20.09,15.97,9.31,9.41,all P〈0.05）,patients in the control group only 24hSBPV and day SBPV [（9.12 ±2.57）%,（8.43 ±1.97）%]were significantly lower than before treatment（t=12.31,9.53,all P〈0.05）;The day SBPV,24hDBPV,day DBPV[（7.21 ±1.34）%,（12.31 ±2.54）%,（10.59 ±2.73）%]of the ob-servation group after treatment were significantly lower than those of the control group（t=10.52,12.34,8.35,all P〈0.05）;The NO[ （66.12 ±23.57）%,（68.29 ±21.52）%]and endothelin levels[（34.43 ±7.97）%,（34.21 ± 7.34）%]of the two groups after treatment were significantly lower than those of before treatment（tobservation grou P=31.39,11.79,tcontrol grouP=28.31,9.35,all P〈0.05）.Conclusion The amlodipine or valsartan hydrochlo-rothiazide used clinically can effectively control blood pressure, significantly increase NO levels, decrease plasma endothelin levels,which is worth to be used in the clinical.