改善原发性高血压患者血压昼夜节律对缓解肾损害的作用

Alleviation of primary hypertension patient's renal damage by improving the abnormal circadian rhythm of blood pressure

目的探讨改善血压昼夜节律异常能否缓解原发性高血压(PH)患者的肾损害。方法选取非杓型PH患者90例,随机分为观察组和对照组,各45例。对照组采用硝苯地平控释片早晨顿服,观察组采用硝苯地平控释片早晨顿服+尼群地平睡前顿服,治疗为期3个月。比较两组患者治疗前后24 h动态血压及肾功能相关指标(尿素氮、肌酐、胱抑素和微量尿白蛋白)。结果治疗后,观察组患者在血压降低的同时,血压昼夜节律由治疗前的非杓型变为杓型,同时胱抑素和微量尿白蛋白水平均低于对照组,且差异具有统计学意义(P<0.01)。结论硝苯地平控释片联合尼群地平可改善PH患者昼夜血压节律异常,有助于缓解甚至逆转患者肾损害进程。

Objective To discuss the alleviation of the renal damage in patients with primary hypertension （PH） through improving abnormal circadian rhythm of blood pressure. Methods A total of 90 PH patients whose circadian rhythm of blood pressure were in non-dipper type were randomly divided into two groups, 45 cases each group. The patients in control group were taking nifedipine GITS in the morning. The patients in experimental group were taking nifedipine in the morning and taking nitrendipine at the bed time. The treatment needed 3 months. The 24-hour ambulatory blood pressure and renal indexes of two groups＇ patients including blood urea nitrogen, creatinine, cystatin, urinary albumin before and after the treatment were compared. Results After treatment, the blood pressure of experimental group was decreased, and circadian rhythm of blood pressure of experimental group was changed from non-dipper type to dipper type. At the same time, cystatin and urinary albumin of experimental group were lower than those of the control group （P〈 0.01）. Conclusion Nifedipine GITS combined with nitrendipine can improve the abnormal circadian rhythm of blood pressure and alleviate PH patient＇s renal damage.