不同时间缬沙坦与氨氯地平联合用药对高血压患者降压效果和血压变异的影响

Impact of valsartan with amlodipine at different time on antihypertensive effect and blood pressure variability in hypertensive patients

目的通过动态血压监测评价不同时间段缬沙坦与氨氯地平联合用药对原发性高血压(高血压)患者降压疗效和血压变异的影响。方法选择2012年1月至2013年12月在眉山市中医医院内科门诊新诊断的188例2级及2级以上高血压患者为研究对象。按随机数字表法随机分为A组(早晨顿服)、B组(夜间顿服)缬沙坦/氨氯地平,C组(晨服缬沙坦晚服氨氯地平)、D组(晨服氨氯地平晚服缬沙坦)。于用药前及用药后8周进行24 h动态血压监测。结果 4组治疗后收缩压/舒张压(白天、夜间及24 h)均较同组治疗前明显下降,差异具有统计学意义(P<0.05)。A组、C组和D组之间治疗前、后晨峰血压比较,差异无统计学意义(P>0.05);B组治疗后晨峰血压增高人数较治疗前减少,差异具有统计学意义(P<0.05)。A^D组之间治疗后收缩压/舒张压下降值(白天、夜间及24 h)及平滑指数比较,差异无统计学意义(P>0.05)。结论早晨及夜间或早晚分次缬沙坦与氨氯地平联合用药均有较好的降压效果,不受服药时间影响,夜间顿服具有血压变异小的趋势,可以有效降低晨峰血压。

Objectives To observe the impact of antihypertensive medication timing on clinical efficacy and variability of blood pressure in patients with essential hypertension, Methods A total of 188 patients with hypertension （grade 2 or above）were randomly assigned to four groups： group A administered valsartan with amlodipine together in the morming, group B administered at bedtime, group C took valsartan in the morning and amlodipine at bedtime, group D took amlodipine in the morning and valsartan at bedtime. Ambulatory blood pressure monitoring （ABPM） was performed before and 8 weeks after treatment. Results Blood pressure reduced significantly in the 4 groups after treatment （P〈 0.05）. Morning blood pressure surge after treatment declined more significantly in group B than in other groups （P〈 0.05）. The smoothness index of blood pressure was similar among the 4 groups （P〉0.05）. Conclusions Valsartan / amlodipine administered either in the morning or at bedtime can effectively reduce blood pressure. More significant and stable antihypertensive effects can be achieved by taking the two medications together at bedtim.