奥美沙坦酯联合氨氯地平与奥美沙坦酯联合氢氯噻嗪治疗原发性高血压的对比

Comparative study between olmesartan medoxomil combined with amlodipine and olmesartan medoxomil combined with hydrochlorothiazide in treatment of primary hypertension

目的比较奥美沙坦酯联合氨氯地平与奥美沙坦酯联合氢氯噻嗪在治疗原发性高血压中的降压疗效。方法 80例原发性高血压患者随机分为奥美沙坦-氨氯地平组和奥美沙坦-氢氯噻嗪组,每组40例。奥美沙坦-氨氯地平组给予奥美沙坦酯20 mg和氨氯地平5 mg,口服,qd;奥美沙坦-氢氯噻嗪组给予奥美沙坦酯20 mg和氢氯噻嗪12.5 mg,口服,qd;疗程均为8周。观察患者24 h动态血压变化情况、血压昼夜波动节律,检测治疗前后实验室指标并记录不良反应发生情况。结果两组患者治疗后白昼、夜间平均收缩压和舒张压均降低(P<0.05),两组降低幅度无显著差异(P>0.05)。奥美沙坦-氨氯地平组治疗后白昼、夜间收缩压和舒张压变异均低于奥美沙坦-氢氯噻嗪组(P<0.05)。奥美沙坦-氨氯地平组血压昼夜节律异常逆转率为79%(11/14),高于奥美沙坦-氢氯噻嗪组(25%,4/16,P<0.05)。两组实验室指标均无明显变化。两组均无明显不良反应发生。结论奥美沙坦酯联合氨氯地平与奥美沙坦酯联合氢氯噻嗪治疗原发性高血压的降压效果相当,但前者在降低血压变异性、改善高血压患者血压昼夜节律变化方面效果更佳,具有平稳降压的作用。

AIM To compare the antihypertensive effect between olmesartan medoxomil combined with amlodipine and olmesartan medoxomil combined with hydrochlorothiazide in treatment of primary hypertension. METHODS A total of 80 patients with primary hypertension were randomly divided into olmesartan-amlodipine （O/A） group and olmesartan-hydrochlorothiazide （O/H） group, with 40 patients in each group. O/A group received oral administration of olmesartan medoxomil （20 mg） and amlodipine （5 mg） once per day for 8 weeks. O/H group was given olmesartan （20 mg） and hydrochlorothiazide （12.5 mg） once per day for 8 weeks. Ambulatory blood pressure, day/night average systolic/diastolic blood pressure and variations before and after the treatment, and adverse reactions were monitored. Other outcomes were circadian rhythms of fluctuation and blood biochemical index. RESULTS There were significant decreases in day/night average systolic/diastolic blood pressure in both groups （P 〈 0.05）, with no significant difference between the two groups （P 〉 0.05）. The variations in day/night average systolic/diastolic blood pressure were less in the O/A group than those in the O/H group, with significant difference （P 〈 0.05） . The ratio of abnormal to normal circadian rhythms of fluctuation in the O/A group was 79% （11/14）, significant higher than that in the O/H group （25%, 4/16, P 〈 0.05）. There were no obvious changes of blood biochemical index in both groups. No obvious adverse reactions occurred. CONCLUSION Jointed therapy with olmesartan medoxomil and amlodipine shows similar antihypertensive effect as olmesartan medoxomil and hydrochlorothiazide. However, olmesartan medoxomil combined with amlodipine is more effective in preventing blood pressure variability and stabilizing blood pressure.