加倍剂量缬沙坦治疗老年高血压合并微量蛋白尿的临床疗效观察

Clinical efficacy of double dose valsartan on hypertension complicated with microalbuminuria in elderly

目的探讨加倍剂量缬沙坦治疗老年高血压患者合并微量蛋白尿的疗效和安全性。方法选择老年高血压合并微量蛋白尿患者89例,单药治疗血压均未达标,随机分为对照组48例和治疗组41例,对照组给予缬沙坦80 mg/d+氨氯地平5 mg/d,治疗组给予缬沙坦160 mg/d,疗程12周。观察治疗前后血压、24 h尿微量白蛋白(m Alb)、肝肾功能及电解质变化情况。结果随访12周,对照组血压控制达标率为83.33%,24 h m Alb从(115.20±12.32)mg/24 h下降至(53.79±9.35)mg/24 h(P<0.02);治疗组血压控制达标率为85.37%,24 h m Alb从(118.81±10.27)mg/24 h下降至(51.75±8.49)mg/24 h(P<0.05);2组间治疗后血压达标率、m Alb差异无统计学意义(P>0.05);且2组治疗前后尿素氮(BUN)、血肌酐、胱抑素、电解质差异无统计学意义(P>0.05)。结论对老年高血压合并微量蛋白尿患者,加倍剂量缬沙坦与缬沙坦联合氨氯地平均具有良好的降压达标率和降低尿微量蛋白作用,且无明显的不良反应。

Objective To assess the therapeutic effect and safety of double dose valsartan on hypertension complicated with microalbuminuria in elderly patients. Methods Eighty-nine elderly hypertensive patients complicated with microalbuminuria were randomly divided into control group（ n = 48） and treatment group（ n = 41）,whose blood pressure were not up to standard by single drug. The control group was treated with valsartan 80 mg / d ＋ amlodipine 5 mg / d,and the treatment group was treated with valsartan 160 mg / d for 12 weeks. The blood pressure,24 h uric microalbuminuria,function of liver and kidney,electrolyte were observed before and after treatment. Results After follow-up of 12 weeks,in the control group,blood pressure control rate was 83. 33%,and the level of 24 h uric microalbuminuria decreased from（ 115. 20 ± 12. 32） mg/24 h to（ 53. 79 ± 9. 35） mg/24 h（ P〈0. 05）; In the treatment group,blood pressure control rate was 85. 37%,and the level of 24 h urinary protein decreased from（ 118. 81 ± 10. 27） mg /24 h to（ 51. 75 ± 8. 49）mg /24 h（ P〈0. 05）. There was no significant difference in blood pressure control rate and the level of uric microalbuminuria after treatment between the two groups（ P〉0. 05）. There were no significant differences in the levels of urea nitrogen,serum creatinine,cystatin,electrolytes before and after treatment between two groups. Conclusions Double dose of valsartan,as well as amlodipine combined with valsartan not only decreases blood pressure,but also significantly reduces the level of uric microalbuminuria on hypertension complicated with microalbuminuria in elderly patients,with no significant adverse reactions.