血压动态监测对原发性高血压病人服药时间指导价值

THE VALUE OF AMBULATORY BLOOD PRESSURE MONITORING IN GUIDING TIME OF TAKING MEDICINE FOR PATIENTS WITH ESSENTIAL HYPERTENSION

目的探讨血压动态监测对轻中度原发性高血压病人服药时间的指导价值。方法将48例病人随机分为3组，分别为晨起服药、睡前服药或时辰服药组，4周后随机换组，8周后换为剩下一组。分别在调整用药前及治疗后4、8、12周对病人血压进行监测。结果与服药前比较，3组病人24h平均收缩压、24h平均舒张压、24h平均动脉压均能够显著改善（F=6．37～8．65，P〈0．05）。时辰服药组和晨起服药组病人夜间平均收缩压、夜间平均动脉压、夜间平均收缩压相比差异有显著性（t=1．92～8．63，P〈0.05）。晨起服药组和时辰服药组高危时段平均收缩压、高危时段平均舒张压、高危时段平均动脉压比较差异无显著性（P〉0．05），但时辰服药组血压控制更优于晨起服药组。与服药前动态血压参数相比，3组均能显著增高病人夜间血压下降率（t=1．98～7．34，P〈0．05），降低24h收缩压负荷、24h舒张压负荷、谷峰比值（t=9．26～28．15，P〈0.01）。时辰服药组病人谷峰比值、夜间血压下降率与晨起服药或睡前服药组相比，差异有显著性（t=2．86～6．48，P〈0.05）。不同服药方式及不同服药时间之间病人剩余药片计数比较差异均无显著性（P〉0．05）。结论对轻中度高血压病人，睡前服药、晨起服药和时辰治疗均能显著改善病人血压水平。较睡前服药，时辰服药及晨起服药均能够显著改善病人夜间平均收缩压、夜间平均动脉压、高危时段的平均收缩压、高危时段的平均舒张压、夜间平均舒张压，时辰服药比其他两种方式能更好地控制谷峰比值，提高夜间血压下降率。本研究显示12周内病人依从性与服药方式及服药时间均无关。

Objective To assess the value of ambulatory blood pressure monitoring in guiding time of taking medicine for patients with mild to moderate essential hypertension. Methods The 48 patients in this study were evenly randomized to three groups as ehronos medication, bedtime medication, and morning medication. A mutual exchange among the three groups was made in random after 4 weeks, and 8 weeks later, combined into one group. The blood pressure （BP） in the patients was monitored be- fore ad）usting their medications and 4,8 and 12 weeks after therapy. Results After drug administration, the average systolic blood pressure （ASBP）, average diastolic blood pressure （ADBP） and average arterial blood pressure （AABP）, in 24 hours, of pa- tients in the three groups significantly improved （F ： 6.37- 8.65, P〈0.05）. There were significant differences between chronos medication and morning medication groups in terms of nighttime ASBP, AABP, and ADBP（t = 1.92-- 8.63, P %0.05）, no signifi- cant differences were noted between the two groups in regard to high-risk period ASBP, ADBP and AABP （P〉0.05）, but BP con- trol was better in morning medication group. Compared with the parameters before medication, the fall rate of nighttime BP in the three groups increased （t--1.98 7.34,P%0.05）, and 24 h systolic blood pressure loading （SBPL）, 24 h diastolic blood pressure loading （DBPL） and T/P ratio decreased （t- 9.26--28.15, P %0.01）. A comparison between the chronos medication group and the morning or bedtime medication group showed there were significant differences in T/P ratio and the fall rate of nighttime BP （t= 2.86--6.48 ,P〈0.05）. There were no significant differences in patients with residual tablet counting in those taking medicine in dif- ferent manners and different time （P〉0.05）. Conclusion For patients with mild to moderate essential hypertension, their blood pressure can be significantly improved by taking the medicine at bedtime, or in the morning or chronos medication. Compared with medication at bedtime, both chronos medication and morning medication can markedly improve patient＇s nighttime ASBP, AABP, high risk ASBP, ADBP, and nighttime ADBP. Chronos medication can better control T/P radio and increase the drop rate of nighttime BP than that of the other two approaches. The present research indicates that, in 12 weeks, the patient compliance is uncorrelated with the approach and time of medication.