螺内酯治疗不同年龄难治性高血压的疗效差别

Different curative effect of spironolactone in patients with refractory hypertension at different age stages

目的 探讨螺内酯在不同年龄难治性高血压患者的疗效差别。方法 选择2012年9月~2014年5月于青岛大学医学院第二附属医院心内科门诊诊治的难治性高血压患者共144例,其中男性75例,女性69例,年龄53~78岁,平均（615±97）岁。根据就诊顺序,使用随机数字表,分为螺内酯组（71例）和对照组（73例）。按照年龄分为≤60岁组（72例）和〉60岁组（72例）。螺内酯组在原有治疗的基础上加用螺内酯,对照组加用安慰剂,连续给药12周。动态血压监测仪进行24 h动态血压监测,仪器测定后自动计算白天平均收缩压、舒张压、脉压;夜间平均收缩压、舒张压、脉压;24 h平均收缩压、舒张压和脉压。结果 与（≤60岁）螺内酯组比较,（〉60岁）螺内酯组白天平均收缩压、夜间平均收缩压、24 h平均收缩压、诊室收缩压、夜间平均脉压、24 h平均脉压下降幅度更高,差异有统计学意义（P均〈0.05）。对年龄〉60岁的患者,螺内酯组较安慰剂组白天平均收缩压、夜间平均收缩压、24 h平均收缩压、诊室收缩压、白天平均脉压、夜间平均脉压、24 h平均脉压下降幅度更高,差异有统计学意义（P均〈0.05）。结论 螺内酯能够降低难治性高血压患者（〉60岁）的收缩压。

Objective To discuss the difference in curative effect of spironolactone in patients with refractory hypertension at different age stages. Methods The patients （n=144, male 75, female 69, aged from 53 to 78 and average age=615±97） were chosen from Sept. 2012 to May 2014. The patients were divided, according to registration order, into spironolactone group （n=71） and control group （n=73） by using random digital table, and according to age, into age≤60 group （n=72） and age〉60 group （n=72）. The spironolactone group was additionally given spironolactone and control group was additionally given placebo on the base of original treatment for 12 w. The blood pressure monitor was used for monitoring 24-h ambulatory blood pressure, and after monitoring daytime average systolic blood pressure （SBP）, daytime average diastolic blood pressure （DBP） and daytime average pulse pressure （PP）, nighttime average SBP, nighttime average DBP and nighttime average PP, and 24-h average SBP, 24-h average DBP and 24-h average PP were calculated. Results The daytime average SBP, nighttime average SBP, 24-h average SBP, clinic SBP, nighttime average PP and 24-h average PP decreased significantly in age〉60 group compared with age≤60 group （all P〈0.05）. For patients aged〉60, daytime average SBP, nighttime average SBP, 24-h average SBP, clinic SBP, daytime average PP, nighttime average PP and 24-h average PP decreased significantly in spironolactone group compared with control group （all P〈0.05）. Conclusion Spironolactone can reduce SBP in patients with refractory hypertension.