奥美沙坦联合硝苯地平控释片治疗中高危险度原发性高血压患者的效果观察

Observation of effects of Olmesartan combined with Nifedipine controlled-release tablets in the moderate- and high-risk patients with essential hypertension

目的:观察奥美沙坦联合硝苯地平控释片对中高危险度原发性高血压患者的治疗效果。方法:选取112例中高危险度原发性高血压2级患者作为研究对象,随机分为A、B、C、D 4组,A、B和C组患者,每组各30例,D组患者22例。其中A组患者给予联合服用依那普利+硝苯地平缓释片治疗;B组患者给予联合服用缬沙坦+氢氯噻嗪片治疗;C组患者给予联合服用奥美沙坦+硝苯地平控释片治疗;D组患者给予安慰剂。定期记录4组患者的血压、心率及超声心动图的变化情况。结果:A组患者平均收缩压由172.4 mmHg下降到138.83 mmHg;平均舒张压由106.2 mmHg下降到90.71 mmHg;治疗前后,心率未见明显变化。B组患者平均收缩压由170.6 mmHg下降到124.54 mmHg;平均舒张压由104.4 mmHg下降到84.69 mmHg;治疗前后,心率未见明显变化。C组患者平均收缩压由169.4 mmHg下降到120.08 mmHg;平均舒张压由105.1 mmHg下降到83.2 mmHg;治疗前后,平均心率由72.4次/分下降到64.3次/分。D组患者平均收缩压由171.3 mmHg下降到158mmHg;平均舒张压由105.4 mmHg下降到101.4 mmHg;治疗前后,心率未见明显变化。治疗前后,同组及组间指标差异具有统计学意义(P<0.05)。A组患者的降压总有效率达87%;B组患者的降压总有效率达93%;C组患者的降压总有效率达97%;D组患者的降压总有效率为55%;各组降压总有效率差异具有统计学意义(P<0.05)。治疗前后,A、B、D组患者的左心室肥厚(LVH)相关指标未见明显变化;C组患者左室质量指数(LVMI)平均由136.85 g/m^2下降到118.35 g/m^2,下降幅度明显。同组及组间治疗前后指标差异具有统计学意义(P<0.05)。A组患者的不良反应发生率为23.33%,B组为13.33%,C组为6.67%,D组为45.45%,4组患者的不良反应发生率差异具有统计学意义(P<0.05)。结论:奥美沙坦联合硝苯地平控释片治疗原发性高血压患者较其他治疗方案疗效更好,还有降低心血管危险度及保护靶器官的作用,不良反应少且轻微,安全性较好,值得推广使用。

Objective： To observe effects of Olmesartan combined with Nifedipine controlled-release tablets in the moderateand high-risk patients with essential hypertension. Methods： 112 moderate- and high-risk patients with essential hypertension（level 2） were selected as the study objects and randomly divided into A（ n = 30）,B（ n = 30）,C（ n = 30） and D group（ n = 22）. The A group was treated with Enalapril combined with Nifedipine controlled tablets,while the B,C and D groups were given with Valsartan combined with Hydrochlorothiazide tablets,Olmesartan combined with Nifedipine controlled-release tablets,and placebo,separately.The blood pressure,heart rate and echocardiography changes were recorded regularly. Results： For A group,the average systolic blood pressure fell from 172.4mmHg to 138.83 mmHg,the average diastolic blood pressure dropped from 106.2 mmHg to 90.71 mmHg,but the heart rate appeared no significant change before and after the treatment. For B group,the average systolic blood pressure fell from 170.6mmHg to 124.54 mmHg,the average diastolic blood pressure dropped from 104.4mmHg to 84.69 mmHg,but there was also no significant change in the performance of heart rate before and after the treatment. For C group,the average systolic blood pressure fell from169.4 mmHg to 120.08 mmHg,the average diastolic blood pressure dropped from 105.1 mmHg to 83.2 mmHg,and the heart rate decreased from 72.4 beats per minute to 64.3 per minute before and after the treatment. For D group,the average systolic blood pressure fell from 171.3 mmHg to 158 mmHg,the average diastolic blood pressure dropped from 105.4 mmHg to 101.4 mmHg,and the heart rate showed no statistically differences before and after the treatment. There were statistically significant differences among each group（ P〈0.05）. The total antihypertensive effective rates were 87%,93%,97%,and 55% in A,B,C,and D groups,separately,and there were statistically significant differences among each group（ P〈0.05）. The relative left ventricular hypertrophy（ LVH） index showed no obvious change in A,B,and D groups,but the average left ventricular mass index（ LVMI） decreased significantly from 136.85 g / m2 to 118.35 g / m2,and it showed significantly differences among each group（ P〈0.05）. The incidence of adverse reactions was 23.33% in A group,13.33% in B group,6.67% in C group and 45.45% in D group,and there were significant differences among each group（ P 〈0. 05）. Conclusions： The treatment effect of Olmesartan combined with Nifedipine controlled- release tablets in the moderate- and high-risk patients with essential hypertension is better than other treatment options. It also has a lower cardiovascular risk and target organ protection effects with mild adverse reactions and safety performance,and is worth to use in clinical practice.