适合农牧区的药物降压模式干预对高血压患者血压、血脂、血糖、肾功能影响的研究

Effects of antihypertensive medication model suitable for farming and pastoral areas on blood pressure, lipids,glucose and renal functions of hypertensive patients

目的探讨适合农牧区的药物降压模式干预对高血压患者血压、血脂、血糖、肾功能的影响。方法从新疆农牧区入选高血压患者200例(男性91例,女性109例)。按照本研究设计的阶梯降压方案对入选患者进行降压治疗,依据血压达标时患者所服用的降压药物,将患者分为双氢克尿噻组(A组,54例)、双氢克尿噻+卡托普利组(B组,82例)、双氢克尿噻+尼群地平组(C组,35例)、双氢克尿噻+卡托普利+尼群地平组(D组,29例)。在降压治疗的0周、2周、4周、6周和3个月对患者进行血压、心率监测,并填写问卷表和随访表。0周和3个月检测患者的血脂、空腹血糖、肾功能等指标。结果 (1)A、B、C、D四组患者的血压水平在降压干预3个月后均明显降低,分别下降了16.7/11.87 mm Hg、25.38/14.17 mm Hg、20.01/10.21 mm Hg、18.42/11.22 mm Hg,且每组患者血压水平在降压干预前后差异均具有统计学意义(P<0.05),但血压降低幅度在四组间比较差异无统计学意义(P>0.05);(2)降压干预前后,A、B、C、D四组患者的总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平相当,差异均无统计学意义(P>0.05);(3)D组患者高密度脂蛋白胆固醇水平在降压干预后增高,血糖水平在降压治疗后降低,差异均有统计学意义(P<0.05)。结论本研究设计的降压方案A、B、C、D组不仅可显著降低农牧区高血压患者的血压水平,而且对患者的血脂、血糖、肾功能无不良影响。

Objective To investigate the effect of antihypertensive medicine model which is suitable for agriculture and pastoral areas on blood pressure, blood lipids, blood glucose and renal function in patients with hypertension. Methods Two hundred patients（91 females and 109 males） with hypertension from pastoral areas of Xinjiang were divided into four groups according to the medicine used： group A（n=54, Hydrochlorothiazide）, group B（n=82,Hydrochlorothiazide＋Captopril）, group C（n=35, Hydrochlorothiazide＋Nitrendipine）, and group D（n=29, Hydrochlorothiazide＋Captopril＋Nitrendipine）. The blood pressure, heart rate were detected 0 week, 2, 4, 6, weeks, and 3 months after treatment. The patients were asked to fill in the questionnaire and follow-up questionnaire. Blood lipids, fasting blood-glucose, renal function were detected 0 week and 3 months after treatment. Results（1） The blood pressure levels of group A, B, C and D were significantly decreased 3 months after antihypertensive intervention, with a decrease of 16.7/11.87 mm Hg, 25.38/14.17 mm Hg, 20.01/10.21 mm Hg and 18.42/11.22 mm Hg, respectively. The differences of blood pressure levels in each group before and after intervention were statistically significant（P〈0.05）, while the differences in the decreases in the four groups were not statistically significant（P〉0.05）.（2） There were no significant difference in total cholesterol, triglycerides and low-density lipoprotein cholesterol levels before and after antihypertensive intervention（P〉0.05）.（3） The high-density lipoprotein cholesterol level of group D increased significantly after antihypertensive intervention（P〈0.05）, and the glucose level of group D decreased significantly after antihypertensive intervention（P〈0.05）. Conclusion Antihypertensive medication models designed in the current study not only significantly lower the blood pressure of hypertensive patients in farming and pastoral areas, but also cause no negative effects on blood lipid, blood glucose and renal function.