不同时间服用替米沙坦对轻中度原发性高血压患者动态血压及靶器官损伤的临床研究

The effect of different medication time of telmisartan on ambulatory blood pressure and target organ damage in patients with mild-moderate essential hypertension

目的 探讨不同时间服用替米沙坦对轻中度原发性高血压患者动态血压的影响及靶器官损伤的保护作用.方法 选取住院首次确诊为原发性高血压1,2级的患者67例,按随机数字表法分为晨起服药组35例和夜间服药组32例,晨起服药组6：00-8：00服用替米沙坦40/80 mg,夜间服药组18：00-20：00服药,可联合苯磺酸氨氯地平片5 mg/d晨服.随访8周,要求患者在随访过程中不更改药物剂量和种类,服药前和服药8周后行动态血压监测（ABPM）、心电图、尿微量白蛋白/肌酐（Ma/Cr）、脉搏波传导速度（PWV）和双侧踝/肱指数（ABI）检查,并进行对比研究.ABPM指标包括夜间平均收缩压（nMSBP）、夜间平均动脉压（nMAP）、清晨平均收缩压（mSBP）、夜间平均收缩压下降百分比（SBP％）、夜间平均舒张压下降百分比（DBP％）等.结果 治疗后总体及各组血压均呈下降趋势,其中两组治疗前后差值（△）变化的比较：晨起服药组△nMSBP、△nMAP和△mSBP低于夜间服药组,差异均有统计学意义（P＜ 0.01或＜0.05）.治疗后总体RV5＋ SV1和Ma/Cr显著降低[（2.2±0.8） mV比（2.4±0.9） mV,（17±14） mg/mmol比（23±17） mg/mmol],与治疗前比较差异有统计学意义（P＜0.01）.夜间服药组治疗后RV5＋ SV1显著降低,与治疗前比较差异有统计学意义[（2.2±0.9）mV比（2.4±1.0）mV]（P＜0.05）.夜间服药组治疗后右侧ABI显著降低,与治疗前比较差异有统计学意义（1.2±0.1比1.2±0.2）（P＜0.05）.结论 替米沙坦能够明显降低轻中度原发性高血压患者的血压值;夜间较晨起服药更有效地降低了nMSBP和nMAP,并使血压节律恢复正常勺型;夜间服药能更有效地降低mSBP,保护周围动脉。

Objective To investigate the effect of different medication time of telmisartan on ambulatory blood pressure and target organs damage in patients with mild-moderate essential hypertension.Methods A total of 67 patients with first diagnosis of essential hypertension level 1 or 2 were enrolled.They were divided into morning group （35 cases） and night group （32 cases） by random number table method.The patients in morning group were given telmisartan 40/80 mg at 6：00-8：00,and the patients in night group were given telmisartan 40/80 mg at 18：00-20：00 combined with amlodipine 5 mg/d in the morning.They were followed up for 8 weeks,and the patients didn＇t change the drug dosage and types.The ambulatory blood pressure monitoring（ABPM）,electrocardiogram,trace albumin/creatinine（Ma/Cr）,pulse wave velocity （PWV） and ankle brachial index （ABI） were done before and after treatment,and then compared.The ABPM index included nighttime mean systolic blood pressure （nMSBP）,nighttime mean arterial blood pressure（nMAP）,morning mean systolic blood pressure （mSBP）,the percentage of nocturnal decline in systolic blood pressure （SBP%） and the percentage of nocturnal decline in diastolic blood pressure （DBP%）.Results The blood pressure after treatment showed an obvious decline.Comparison of changes （△） before and after treatment in each group：the levels of △nMSBP,△nMAP and △mSBP in morning group were significantly lower than those in night group （P 〈 0.05 or 〈 0.01）.The levels of overall RV5 ＋ SV1 and Ma/Cr were significantly decreased after treatment than those before treatment：（2.2 ±0.8） mV vs.（2.4 ±0.9） mV,（17 ± 14）mg/mmol vs.（23 ± 17） mg/mmol,P 〈 0.01.The level of RV5 ＋ SV1 in night group was significantly decreased after treatment than that before treatment：（2.2 ± 0.9） mV vs.（2.4 ± 1.0） mV,P 〈 0.05.The level of right ABI in night group was significantly decreased after treatment than that before treatment：1.2 ± 0.1 vs.1.2 ± 0.2,P 〈 0.05.Conclusions Telmisartan can effectively reduce the blood pressure of patients with mild-moderate essential hypertension.Compared with morning group,taking telmisartan at night reduces nMSBP and nMAP more effectively,and more patients return the rhythm of blood pressure to normal dippers.mSBP can be reduced more effectively when taking telmisartan at night,and the improvement of the right ABI may lead to protection of peripheral arterial.