缬沙坦联合氨氯地平或氢氯噻嗪对老年高血压患者血压变异性的影响

Effect of valsartan combined with amlodipine or hydrochlorothiazide on blood pressure variability in elderly with hypertension

目的 观察比较缬沙坦分别联合氨氯地平或氢氯噻嗪对老年高血压患者血压及其变异性的影响.方法 选取138例老年高血压患者,随机分为两组,A组70例给予口服缬沙坦80 mg联合氨氯地平5mg qd;B组68例给予口服缬沙坦80 mg联合氢氯噻嗪12.5 mg qd.分别在治疗前、治疗8w时进行24 h动态血压监测,观察24 h、白天与夜间收缩压变异性（systolic blood pressure variability,SBPV）和舒张压变异性（diastolic blood pressure variability,DBPV）;24h、白天与夜间平均收缩压（systolic blood pressure,SBP）和平均舒张压（diastolic blood pressure,DBP）.结果 与治疗前比较治疗后第8周A组与B组24 h、白天、夜间SBP、DBP、SBPV均下降（P＜0.05）,A组下降幅度均大于B组（P＜0.05）.A组治疗8w后,DBPV均有下降（分别地,P＜0.05）,而B组无变化,组间比较差异有统计学意义（P＜0.05）.结论 缬沙坦联合氨氯地平或氢氯噻嗪治疗均能有效控制老年高血压患者的血压,但缬沙坦联合氨氯地平具有更佳的血压达标率和更低的血压变异性.

Objective To observe and compare the effect of angiotensin II receptor antagonist valsartan combined with calcium antagonists, amlodipine or a thiazide diuretic hydrochlorothiazide on elderly hypertensive blood pressure and blood pressure variability. Methods One hundred and thirty eight elderly patients with hypertension were randomly divided into two groups： Seventy patients of group A was treated with 80 mg valsartan and amlodipine 5 mg in the morning ; Sixty eight patients of group Baccepted 80 mg valsartan and 12.5 mg hydrochlorothiazide in the morning. Twenty four hours ABPM, daytime and nighttime systolic blood pressure variability （SBPV） and diastolic blood pressure variability （DBPV）, daytime and nighttime mean systolic blood pressure （SBP） and mean diastolic blood pressure （DBP） was measured before and after eight weeks treatment. Results Compared with pre-treatment, after 8 weeks of treatment, daytime, nighttime SBP and DBP, SBPV decreased in both groups （P〈0.05）, group A declines greater than group B （P〈0.05）. DBPV of group A decreased significantly （P〈0.05）, but that of group B did not change significantly, and the difference between both groups was significant （P〈0.05）. Conclusion Both valsartan combined with amlodipine and with hydrochlorothiazide therapy can effectively control blood pressure in elderly hypertensive patients, but valsartan combined with amlodipine is better.