乌拉地尔与硝酸甘油注射液在老年高血压合并糖尿病患者发作急性心力衰竭的临床有效性与安全性

Efficacy and safety of urapidil and nitroglycerin injection for treatment of hypertension and diabetes mellitus in elderly patients with acute heart failure

目的研究对比乌拉地尔与硝酸甘油在老年高血压合并糖尿病患者发生急性心力衰竭时的疗效。方法将82名老年高血压合并糖尿病并发急性心力衰竭患者,采用数字表法将患者分为硝酸甘油组及乌拉地尔治疗组。观察不同时段2组患者血压、心率的变化情况,反映心功能指标的N末端B型利钠肽原(N terminal B type natriuretic peptide,NT-pro BNP)、射血分数等指标变化情况,观察血糖、血脂浓度及肝、肾功能的情况。结果乌拉地尔组对收缩压的控制及NT-pro BNP的改善明显优于硝酸甘油组。乌拉地尔组在治疗第7天,射血分数较硝酸甘油组明显升高,左室舒张末期容积减小。对心率及糖脂代谢无不良影响。治疗过程中乌拉地尔无不良事件发生。结论乌拉地尔在平稳降压,通过减轻心脏后负荷,从而改善心功能。对糖耐量、血脂代谢无不良影响。药效安全、可靠,未出现耐药反应。

Objective To evaluate whether the alpha-1 adrenoceptor blocker,urapidil,provides additional therapeutic benefits compared to nitroglycerin in treatment of non valvular heart failure complicated with hypertension and diabetes mellitus（ DM） in elderly patients. Methods Eighty-two elderly patients with non valvular heart failure complicated with hypertension and diabetes mellitus were randomized into two groups who received either urapidil or nitroglycerin,respectively. All patients were monitored for blood pressure（ BP）,heart rate（ HR）,and received tests for metabolic activity and cardiovascular function prior to and after treatment. Results Patients receiving urapidil had significantly lower systolic blood pressure（ SBP） than their counterparts in nitroglycerin group. Moreover,patients in urapidil group showed lower N-terminal B type natriuretic peptide（ NT-pro BNP） levels compared to patients in nitroglycerin group. While both urapidil and nitroglycerin decreased fasting plasma glucose（ FPG） levels,there was no significant difference in FPG levels between these two groups. Conclusion Urapidil demonstrated better efficacy than nitroglycerin on lowering and stabilizing SBP,attenuating cardiac afterload,and improving cardiac function. Urapidil is a therapeutic option for the elderly patients complicated with hypertension and DM.