氨氯地平联合氯沙坦钾氢氯噻嗪治疗老年难治性高血压的临床效果观察

Observation of the clinical effects of amlodipine combine with losartan potassium/hydrochlorothiazide in the treatment of geriatric resistant hypertension

目的 观察氨氯地平联合氯沙坦钾氢氯噻嗪治疗老年难治性高血压的临床效果.方法 入选2011年10月至2013年10月首都医科大学附属北京同仁医院和首都医科大学附属北京安贞医院老年难治性高血压患者86例,采取病例自身治疗前后血压进行对照研究,给予患者氨氯地平5 mg/d或10 mg/d口服,同时氯沙坦钾氢氯噻嗪62.5 mg/d早起后口服;每天记录2次血压、心率、临床症状和不良反应等情况,疗程8周;期间4周左右可视血压情况调整氨氯地平至10 mg/d,或是加用其他药物;治疗前后检测血生化等指标;治疗前、治疗4周和治疗8周时行24 h动态血压监测评估血压情况.结果 本组86例老年难治性高血压患者经治疗8周后血压较治疗前均有明显下降[收缩压（135 ±7）mmHg（1 mmHg =0.133 kPa）比（168±11） mmHg,舒张压（79±8）mmHg比（91±10） mmHg] （P ＜0.05）,降压药物总有效率为80.2％（69/86）.心率差异无统计学意义[（71±5）次/min比（76±10）次/min] （P ＞0.05）.患者治疗前后血生化常规指标差异无统计学意义（P＞0.05）.结论 氨氯地平联合氯沙坦钾氢氯噻嗪是治疗老年难治性高血压的有效药物.

Objective To observe the clinical effects of amlodipine combined with losartan potassium/hydrochlorothiazide in the treatment of geriatric resistant hypertension.Methods A total of 86 patients with geriatric resistant hypertension were included and the pre-/post-treatment blood pressure were compared.Patients were given amlodipine 5 mg/d or 10 mg/d,combined with losartan potassium/hydrochlorothiazide 62.5 mg/d po in the morning; blood pressure,heart rate,clinical symptoms and adverse reaction were recorded.The course of treatment was 8 weeks.Amlodipine can be adjusted to 10 mg/d and other medicine can be added depending on patients blood pressure during the fourth week.We tested the comprehensive metabolic panel,blood routine and urine routine before and after treatment.24 hours ambulatory blood pressure monitoring was performed before the treatment,4 weeks and 8 weeks after the treatment.Results Eight weeks after treatment,totally 86 cases of elderly patients with refractory hypertension had significantly decreased blood pressure [systolic blood pressure （135 ± 7） mmHg vs （168 ± 11） mmHg,diastolic blood pressure （79 ± 8） mmHg vs （91 ± 10） mmHg] （P 〈 0.05）.No significant differences in heart rate variation （P 〉 0.05） were observed.Difference of blood biochemical indexes before and after treatment had no statistical significance （P 〉 0.05）.Conclusion Amlodipine combine with losartan potassium/hydrochlorothiazide is effective for the treatment of geriatric resistant hypertension.