小剂量缬沙坦、氨氯地平、吲哒帕胺三联治疗对高血压患者微量白蛋白尿的抑制作用

Suppressive effect of small doses of triple combination therapy of valsartan,amlodipine and indapamide on microalbuminuria in hypertensive patients

目的：观察小剂量缬沙坦、氨氯地平、吲哒帕胺三联组合对于高血压患者的血压及微量白蛋白尿（MAU）的影响。方法：选择2015年4月至2016年4月间,我院心内科门诊的152例合并MAU的高血压患者,随机分为四组,每组38例,分别接受4种抗高血压方案治疗：A组：缬沙坦（80mg/d）＋氨氯地平（5mg/d）;B组：缬沙坦（80mg/d）＋吲哒帕胺（2.5mg/d）,C组：氨氯地平（5mg/d）＋吲哒帕胺（2.5mg/d）;D组：缬沙坦（40mg/d）＋氨氯地平（2.5mg/d）＋吲哒帕胺（1.25mg/d）。观察四组患者治疗前后血压及MAU的变化。在12周的治疗观察期间,每组均有4-6例患者由于不良反应明显或失访中断观察,最后共有131例患者完成观察全程。结果：四组患者治疗后血压均较治疗前均明显下降（P〈0.05）;治疗后血压四组间相互比较差异无统计学意义（P〉0.05）。四组患者治疗后MAU均较治疗前有所下降（P〈0.05）;四组间MAU比较,三药联合组较其他两药联合组下降更明显（P〈0.05）。治疗期间,四组均有少数患者出现轻微不良反应,各组间差异无统计学意义（P〉0.05）。结论：小剂量缬沙坦、氨氯地平、吲哒帕胺三联治疗能有效抑制高血压患者MAU,且不良反应少,耐受良好。

Objective：To observe the impact of small doses of triple combination therapy （valsartan, amlodipine and indapamide）on blood pressure and microalbuminuria （MAU） in hypertensive patients. Methods：A total of 152 hypertensive patients with MAU in Cardiology Clinic of our hospital from April 2015 to April 2016 were enrolled in this study. All cases were randomly divided into four groups with 38 cases per group to receive 4 different classes of antihypertensive treatment ： A group ： valsartan （ 80mg/d） plus amlodipine （ 5 mg/ d） ; B group ： valsartan（ 80mg/d） plus indapamide（2. 5mg/d） ; C group ： amlodipine（Smg/d） plus indapamide （2. 5mg/d） ; D group： valsartan （ 40mg /d ） plus amlodipine （ 2. 5mg/d ） and indapamide （ 1.25mg/d ）. The changes in blood pressure and MAU were determined before and after treatment. During 12 weeks treatment period, 4 to 6 participants in each group were discontinued owing to adverse events or owing to loss to follow-up, leaving 131 csses analysed. Results： After treatment, the value of blood pressure in four groups were signifi- cantly lower than before （ P 〈 0. 01 ）, and there were no statistical difference among them（ P 〉 0. 05 ） ; all various groups decreased MAU （ P 〈 0. 05 ）, however the triple combination therapy group decreased MAU more significantly than those by two drugs combination （ P 〈 0. 05 ）. During the study, a few case had mild adverse events in all four groups, and there were no significant differences among them（ P 〉 0.05 ）. Conclusion： Small doses of triple combination therapy of valsartan, amlodipine and indapamide could effectively reduce microalbuminuria in hypertensive patients, and was well toleratated with few adverse events.