阿托伐他汀钙联合降压药物对高血压患者动态血压及脉压指数和降压平稳性的影响

Effect of atorvastatin plus antihypertensive drugs on ambulatory blood pressure,pulse index and blood pressure stability in patients with hypertension

目的探讨阿托伐他汀钙联合降压药物治疗对动态血压、脉压指数(pulse pressure index,PPI)及降压平稳性的影响。方法 220例高血压病患者随机分为对照组103例和观察组117例。对照组采用血管紧张素转化酶抑制剂和钙拮抗剂联合降压,观察组在降压基础上加用阿托伐他汀20mg,每晚1次,2组患者均于治疗前、治疗后6个月行动态血压检查,记录24h平均收缩压(24-hour systolic blood pressure,24hSBP)和24h平均舒张压(24-hour diastolic blood pressure,24hDBP),计算24h动态脉压(24-hour pulse pressure,24hPP)、PPI、收缩压平滑指数(smoothness index of SBP,SISBP)、舒张压平滑指数(smoothness index of DBP,SIDBP),比较2组患者治疗前、后血脂、动态血压值及其降压稳定性变化。结果治疗前2组患者动态血压、脉压、PPI比较差异均无统计学意义(P>0.05);治疗6个月后观察组24hPP[(44±7)mm Hg]、PPI(0.34±0.08)明显低于对照组[(52±10)mm Hg、0.38±0.04]和治疗前[(61±13)mm Hg、0.39±0.09](P<0.05),SISBP(1.36±0.15)和SIDBP(1.24±0.15)明显高于对照组(1.27±0.21和1.19±0.22)(P<0.05),24hSBP[(129±10)mm Hg]和24hDBP[(83±6)mm Hg]与对照组[(134±19)、(82±6)mm Hg]比较差异均无统计学意义(P>0.05)。结论原发性高血压患者降压协同阿托伐他汀调脂治疗能明显降低患者脉压和PPI,提高降压药物的平滑指数,使降压更平稳,可改善患者预后。

Objective To investigate the effect of atorvastatin plus antihypertensive drugs on ambulatory blood pressure, pulse index and the stability of blood pressure in patients with hypertension. Methods A total 220 patients with essential hypertension were randomly divided into control group （n= 103） and observation group （n = 117）. Both groups were treated with antihypertensive drugs （angiotensin converting enzyme inhibitors and calcium channel blockers）, and observation group was added atorvastatin 20 mg/d once at night. Both two groups received ambulatory blood pressure monitoring before and after 6-month treatment to record 24-hour systolic blood pressure （24hSBP） and 24-hour diastolic blood pressure （24hDBP）, and calculated 24-hour pulse pressure （24hPP）, pulse pressure index （PPI）, smoothness index of SBP （SISBP） and smoothness index of DBP （SIDBP）. The changes of lipid, ambulatory blood pressure and stability of blood pressure were compared before and after operation between two groups. Results After 6-month treatment, there were no significant differences in the changes of ambulatory blood pressure, pulse pressure and PPI between two groups before treatment （P〉0.05）. The levels of 24hPP （（44±7） mm Hg） and PPI （0. 34±0. 08） in observation group were significantly lower after 6-month treatment than those before treatment （（61±13） mmHg, 0. 39±0. 09） in observation group and in control group （（52±10） mm Hg, 0. 38±0. 04） after 6-month treatment （P〈 0.05）, the levels of SISBP （1.36±0.15） and SIDBP （1.24±0. 15） in observation group were significantly higher than those in control group （1.27±0.21, 1.19±0.22） （P〈0.05）, and there were no significant differences in the changes of 24hSBP and 24hDBP between observation group （（129±10）, （83±6） mm Hg） and control group （（134±19）, （82±6） mm Hg） （P〉0.05）. Conclusion Atorvastatin plus antihypertensive drugs can decrease the pulse pressure and PPI, and increase smoothness index and stability of blood pressure so as to improve the prognosis.