睡前服用坎地沙坦对高血压患者血压晨峰及尿微量白蛋白的影响

Effect of candesartan taken before going to bed on morning blood pressure surge and mALB in hypertensive patients

目的观察睡前服用坎地沙坦对高血压患者血压晨峰的影响及尿微量白蛋白的变化。方法选择162例存在血压晨峰的高血压患者,随机分为对照组54例、上午服药组54例和睡前服药组54例。对照组患者给予氢氯噻嗪25mg睡前（18：00-21：00）,上午服药组上午给予坎地沙坦4-8mg（08：00-10：00）,睡前服药组睡前给予坎地沙坦4-8mg（18：00-21：00）。3组患者均在服药4周后再次行24h动态血压监测,并记录昼间、夜间及晨起血压,并测量3组患者治疗前后尿微量白蛋白的变化。结果与对照组和上午服药组比较,睡前服药组治疗后血压晨峰明显降低[（19.6±2.3）mm Hg vs（38.5±4.8）mm Hg和（32.2±3.6）mm Hg,1 mm Hg=0.133kPa,P〈0.05],尿微量白蛋白明显降低[（35.2±6.1）mg/L vs（60.6±12.1）mg/L和（54.3±8.3）mg/L,P〈0.05]。结论睡前服用坎地沙坦可以有效改善患者的血压晨峰现象,并有效降低尿微量白蛋白,减少早期肾损害的发生。

Objective To study the effect of candesartan taken before going to bed on morning blood pressure surge（MBPS）and mALB in hypertensive patients.Methods One hundred and sixty-two hypertensive patients with MBPS were randomly divided into control group,morning treatment group and going to bed treatment group（54in each group）.Four weeks after the patients in control group were treated with 25 mg candesartan and those in morning treatment group and going to bed treatment group were treated with 4-8mg candesartan,their 24 hambulatory blood pressure,day,night and morning blood pressure,and serum mALB level were measured.Results No significant diffeence was found in blood pressure of the 3groups although it was lower after treatment than before treatment（P〉0.05）.The MBPS and serum mALB level were significantly lower in going to bed treatment group than in control group and morning treatment group（19.6±2.3mm Hg vs 38.5±4.8mm Hg,19.6±2.3mm Hg vs 32.2±3.6mm Hg,P〈0.05;35.2±6.1mg/L vs 60.6±12.1mg/L,35.2±6.1mg/L vs 54.3±8.3mg/L,P〈0.05）.Conclusion Candesartan taken before going to bed can effectively alleviate early renal damage in hypertensive patients by improving their MBPS and reducing their serum mALB level.