不同时间服用缬沙坦氢氯噻嗪对高血压患者血压变异性、颈动脉内膜中层厚度及血浆一氧化氮、内皮素的影响

Efficacy of valsartan hydrochlorothiazide at the different time points on blood pressure variability,carotid intima media thickness,notric oxide and endothelin 1

目的观察不同时间应用缬沙坦氢氯噻嗪片对高血压患者血压变异性(BPV)、颈动脉内中膜厚度(CIMT)及血浆一氧化氮(NO)和内皮素-1(ET-1)的影响。方法选取2015年6月—2017年2月河北省人民医院心内科门诊或住院治疗的轻中度高血压患者80例作为研究对象,采用随机化编码表分为缬沙坦氢氯噻嗪片(每片含缬沙坦80 mg及氢氯噻嗪12.5 mg)晨起给药组(Ⅰ组)、睡前服药组(Ⅱ组)各40例。所有病例治疗前及治疗12周后进行动态血压、血浆NO、ET-1水平、CIMT的监测。结果治疗12周后,2组患者24小时平均收缩压(24 h MSBP)、24小时平均舒张压(24 h MDBP)、24小时收缩压变异性(24 h SBPV)、24小时舒张压变异性(24 h DBPV)、白昼SBPV、白昼DBPV、夜间SBPV、夜间DBPV较用药前均有下降,差异有统计学意义(t_(Ⅰ组)=8.61、9.84、14.270、12.840、13.820、12.890、12.350、13.020,P<0.01;tⅡ组=8.040、10.350、15.110、11.790、14.860、13.050、14.810、14.230,P<0.01);治疗2周后,2组血浆ET-1较用药前下降,NO较用药前升高,差异有统计学意义(t_(Ⅰ组)=13.402,13.573,P<0.01;t_(Ⅱ组)=14.291,14.941,P<0.01);2组患者CIMT比较,差异无统计学意义(P>0.05)。治疗后Ⅱ组夜间SBPV、夜间DBPV的改善优于Ⅰ组,差异有统计学意义(t=4.973、3.843,P<0.05)。结论不同时间服用缬沙坦氢氯噻嗪片均可有效降低高血压患者血压,改善BPV,降低血浆ET-1水平,升高血浆NO水平,睡前服用可更为有效改善夜间SBPV、DBPV。

Objective To investigate the efficacy of taking in valsartan hydrochlorothiazide at the different time points on a blood pressure variability（BPV）,carotid intima media thickness（CIMT）, notric oxide（NO）and endothelin 1（ET-1）.Methods Enrolled 80 hypertensive subjects with stage 1 to 2 essential hypertension,who were treated in Hebei general hospital between June 2015 and February 2017.These subjects were randomly assigned to receive valsartan hydrochlorothiaz-ide（80 mg/12.5 mg）either on awakening（Ⅰgroup）or at bedtime（Ⅱgroup）.All cases received 24 hours ambulatory blood pressure monitoring and CIMT before and after 12 weeks of treatment.NO and ET-1 were monitored before the treatment and 12 weeks after the treatment.Results Compared with the baseline level,24 h mean systolic blood pressure（24 h MSBP）, 24 h diastolic blood pressure（24 h MDBP）,24 h systolic blood pressure variability（24 h SBPV）,24 h diastolic blood pres-sure variability（24 h DBPV）,day SBPV,day DBPV,night SBPV,night DBPV, CIMT and ET-1 was dramatically reduced after treatment in both two groups; plasma level of NO was increased in both groups（tⅠ=8.61, 9.84, 14.27, 12.84, 13.82,12.89,12.35,13.02,13.402,13.573,P〈0.01;tⅡ=8.04,10.35,15.11,11.79,14.86,13.05,14.81,14.23, 14.291,14.941,P〈0.01）;there was no statistically significant difference in CIMT（tⅠ=0.262,PⅠ=0.414;tⅡ=0.145,PⅡ=0.598）.After treatment,there was no statistically significant difference the 24 h MSBP,24 h MDBP,24 h SBPV,24 h DBPV,dSBPV,dDBPV,CIMT,NO and ET-1 between two groups（t=0.173,0.204,1.832,2.041,1.531,1.394,0.103,1.948, 1.630,P〉0.05）.Compare with groupⅠ,the night SBPV,night DBPV of groupⅡsignificantly decreased（t=4.973,3.843,P〈0.05）.Conclusion The findings confirm that valsartan hydrochlorothiazide taken at the different time points could efficiently reduce blood pressure,24 hours SBPV/DBPV,daytime SBPV/DBPV,plasma level of ET-1,increase plasma level of NO.The improved efficacy in lowering the asleep BPV of hypertensive suggest that valsartan hydrochlorothiazide should be preferably ad -ministered at bedtime.