硝苯地平控释片不同时间给药对高血压患者血压变异性的影响

Administration time-dependent effects of nifedipine controlled release tablets on blood pressure variability in hypertensive patients

目的 观察硝苯地平控释片不同时间给药对血压、血压昼夜节律及血压晨峰的影响,进一步探讨清晨血压上升速度是否是发生心血管事件的危险因素。方法 选择初诊高血压患者110例,年龄32~76岁,随机分为两组：清晨服药组（n=55,6：00-8：00服硝苯地平控释片30mg）和夜间服药组（n=55,19：00-21：00服硝苯地平控释片30mg）,服药前及服药8周后由同一研究小组完成24h动态血压监测。分析两组动态血压的差异及动态血压与随访18月后心脑血管事件（心肌梗死或脑卒中）的关系。结果 夜间服药组24h平均收缩压（24hSBP）、白天收缩压（dSBP）、夜间收缩压（nSBP）低于清晨服药组（P〈0.01）。夜间服药组清晨收缩压上升速度较清晨服药组降低[（7.3±4.8）比（11.3±9.6）mm Hg/h,P〈0.01]。单因素相关分析显示,清晨收缩压上升速度与白天收缩压平台、dSBP及24hSBP呈正相关（分别r=0.383、0.206、0.212,均P〈0.05）。Logistic回归分析结果显示,清晨收缩压上升速度及白天收缩压平台是心脑血管事件发生的危险因素（OR=1.20,95%CI 1.06~1.35;OR=1.13,95%CI1.01~1.26;均P〈0.05）。结论 夜间服硝苯地平控释片能更有效地降低血压水平及清晨血压上升速度;清晨收缩压上升速度加快可能是心脑血管事件的危险因素。

Objective To study the effects of nifedipine controlled release tablets on blood pressure, circadian rhythm, and morning blood pressure surge in hypertensives who received nifedipine at different times of the day, and to further reveal the relationship between the increasing rate of morning systolic blood pressure （SBP） and cardio- cerebral vascular events. Methods One hundred and ten newly diagnosed hypertensive patients, aged from 32 to 76 years old, were randomly divided into two groups： morning group （n~ 55, received 30 mg nifedipine at 6：00--8：00 am） and bedtime group （n=55, received 30 mg nifediping at 19：00--21：00）. All patients underwent 24h ambula- tory blood pressure monitoring before and after 8 weeks of treatment. The difference of 24 h ambulatory blood pressure value between the two groups and its association with cardio-cerebral vascular events in the 18 months of following were analyzed. Results The levels of 24h mean systolic blood pressure（24hSBP）, daytime mean systolic blood pressure （dSBP） and nighttime mean systolic blood pressure （nSBP） in the bedtime group were significantly lower than morning group （P〈0.01）. The increasing rate of morning SBP at bedtime group were significantly lower than morning group [（7.3 ± 4.8） vs （11.3 ± 9.6）mm Hg/h, P〈0.01]. Single factor correlation analysis showed that the increasing rate of morning SBP was positively correlated with daytime SBP plateau, dSBP and 24hSBP （r=0. 383, 0. 206 and 0. 212, all P〈0.05）. Logistic regression analysis showed that the increasing rate of morning SBP and daytime SBP plateau were independent risk factors for cardio-cerehral vascular incidents （OR 1.20, 95% CI1.06-1.35; OR=1. 13, 95% CI 1.01-1.26, both P〈0.05）. Conclusion Administration of nifedipine controlled release tablets at bedtime could be more effectively reducing the level of blood pressure and in- creasing rate of morning blood pressure. The acceleration of increasing rate of morning SBP may be an important risk factor for eardio-cerebral vascular events.