黛力新联合氨氯地平治疗有明显白大衣效应的原发性高血压患者的疗效

Curative effect of deanxit combined with Amlodipine on essential hypertensive patients with white coat effect

目的 探讨黛力新联合常规抗高血压治疗对有明显白大衣效应（WCE）的原发性高血压患者的疗效.方法 选取2014年、2015年我院心内科门诊原发性高血压患者130例,用汉密尔顿焦虑量表（HAMA）对这些患者进行评分,共有83例评分＞7分的患者入选.将入选者随机分成两组：观察组在使用常规降压药物氨氯地平的基础上加用黛力新;对照组使用氨氯地平及安慰剂.观察两组患者诊室血压值、动态血压值、WCE值、HAMA评分及血压节律的变化.结果 ①两组治疗后CBP、ABP分别较治疗前明显下降（P＜0.01）;治疗后两组组间比较,观察组cSBP、cDBP下降较对照组更明显[（139.19±5.24）mm Hg比（150.78±6.50）mm Hg,（87.24±4.96）mm Hg比（92.85±4.73）mm Hg,P＜0.01],观察组nSBP、nDBP较对照组也略有进一步下降[（118.14±4.68）mm Hg比（120.56±5.81）mm Hg,（73.93±3.83）mm Hg比（75.85±4.01）mm Hg,P＜0.05],而两组24 h SBP、24 h DBP、dSBP、dDBP下降程度未见统计学差异（P＞0.05）.②治疗后观察组WCE SBP、WCE DBP、HAMA评分均较治疗前明显缩小[（6.81±1.85）mm Hg比（18.36±3.89）mm Hg,（3.93±1.35）mm Hg比（9.31±2.67）mm Hg,（8.52±2.72）分比（19.62±6.25）分,P＜0.01],对照组治疗前、后无明显变化（P＞0.05）,两组组间比较差异有统计学意义（P＜0.01）.③与治疗前比较,治疗后观察组杓型血压昼夜节律的发生率明显升高（P＜0.01）,非杓型血压昼夜节律的发生率明显下降（P＜0.01）,对照组无明显变化（P＞0.05）,两组组间比较差异有统计学意义（P＜0.05）.结论 黛力新联合常规抗高血压治疗能有效缓解有WCE的原发性高血压患者的WCE,改善血压昼夜节律.

Objective To observe the influence of adding deanxit to routine antihypertensive treatment on essential hypertensive patients with white coat effect（WCE）. Methods From January 2014 to December 2015， a total of 130 hypertensive patients who admitted in the Cardiology Clinic of our hospital were enrolled in the study. All patients were scored by Hamilton anxiety scale（HAMA）， 83 patients whose scores exceeded seven points， were selected and randomly divided into two groups： observation group （amlodipine plus deanxit） and control group （amlodipine plus placebo）. The changes in ambulatory blood pressure（ABP）， clinic BP（CBP）， the value of WCE， HAMA scores and circadian rhythm of blood pressure were compared between two groups. Results ⑴After treatment， the CBP， ABP in two groups were significantly lower than before（P〈0.01）. After treatment， the cSBP， cDBP in observation group were significantly lower than those in control group［（139.19±5.24）mm Hg vs （150.78±6.50）mm Hg， （87.24±4.96）mm Hg vs （92.85±4.73）mm Hg， P〈0.01］， the nSBP， nDBP in observation group were slightly lower than those in control group［（118.14±4.68）mm Hg vs （120.56±5.81）mm Hg， （73.93±3.83）mm Hg vs （75.85±4.01）mm Hg， P〈0.05］， while the 24 h SBP， 24 h DBP dSBP， dDBP in two groups showed no statistical differences （P〉0.05）. ⑵After treatment， the value of WCE SBP， WCE DBP and HAMA scores in observation group were significantly lower than those before［（6.81±1.85）mm Hg vs （18.36±3.89）mm Hg， （3.93±1.35）mm Hg vs （9.31±2.67）mm Hg， （8.52±2.72）points vs （19.62±6.25）points， P〈0.01］， but control group no changed （P〉0.05）， and there were significant differences between the two groups（P〈0.01）． ⑶Compared to before， dipping circadian rhythm incidence of observation group increased significantly after treatment（P〈0.01）， nondipping of that decreased （P〈0.01）， but control group no changed（P〉0.05）， and there were significant differences between the two groups（P〈0.05）． Conclusion The using of deanxit combined with routine antihypertensive treatment in essential hypertensive patients with WCE can effectively reduce WCE and improve blood pressure circadian rhythm.