卡托普利联合非洛地平缓释片治疗原发性老年高血压患者血压变异性的效果评价

Clinical curative effects of captopril combined with felodipine sustained-release tablets on blood pressure variability in elderly patients with essential hypertension

目的评价非洛地平缓释片联合卡托普利治疗原发性老年高血压患者血压变异性(blood pressure variability,BPV)的临床效果。方法收集2015年6月至2016年12月收治的144例原发性老年高血压患者,按入院顺序随机分为观察组和对照组,每组72例。对照组予以卡托普利联合氢氯噻嗪治疗,观察组采用卡托普利联合非洛地平缓释片治疗。监测2组患者24 h动态血压,观察治疗前、治疗第6周和第12周2组患者BPV的变化,统计治疗效果,分析治疗前、后糖脂代谢及肝肾功能指标的变化,并记录治疗过程中出现的不良反应。结果 2组患者治疗6周和12周后,24 h平均收缩压(SBP)、d SBP、n SBP、晨峰SBP、24 h收缩压变异性(SBPV)、24 h DBPV、d SBPV和d DBPV显著降低,与治疗前比较,差异有统计学意义(P<0.01);24 h DBP和d DBP仅在观察组治疗12周后明显低于治疗前,差异有统计学意义(P<0.05)。与对照组比较,观察组治疗6周和12周后,24 h SBP、d SBP、n SBP、晨峰SBP和晨峰DBP明显降低,差异有统计学意义(P<0.05);观察组患者治疗12周后,24 h SBPV、24 h DBPV、d SBPV和d DBPV明显降低,差异有统计学意义(P<0.05或P<0.01)。观察组治疗12周后,与治疗6周时比较,24 h SBPV、24 h DBPV、d SBPV和d DBPV明显降低,差异有统计学意义(P<0.05或P<0.01)。观察组和对照组治疗总有效率分别为86.11%和93.06%,差异无统计学意义(χ2=1.860,P>0.05)。治疗前后2组血糖、血脂及肝肾功能指标均无明显变化,不良反应发生率差异均无统计学意义(χ2=0.067,P=1.000)。结论非洛地平缓释片联合卡托普利可有效降低老年高血压,特别是可以控制BPV,且不影响糖脂代谢及肝肾功能,是一种安全有效的治疗方案。

Objective To investigate the curative effects of captopril combined with felodipine sustained-release tablets on essential hypertension in the eldrly,and to observe its efffects on blood pressure variability（ BPV）. Methods One hundred and forty-four elderly patients with essential hypertension who were treated in our hospital from June 2015 to December2016 were enrolled in the study. According to the order of hospitalization,these patients were randomly divided into observation group and control group,with 72 patients in each group. The patients in control group were treated by captopril combined with hydrochlorothiazide,however,the patients in observation group were treated by captopril combined with felodipine sustained release tablets. The ambulatory blood pressure in 24 hours,and the changes of BPV before treatment and on 6 w,12 w after treatment,the therapeutic effects and the changes of glucose and lipid metabolism,indexes of liver and kidney function before and after treatment,the adverse reactions during treatment were statistically analyzed and compared between two groups. Results At 6 weeks and 12 weeks after treatment,the 24 hours mean systolic blood pressure（ SBP）,d SBP,n SBP,morning peak SBP,24 h systolic blood pressure variability（ SBPV）,24 h DBPV,d SBPV and d DBPV were significantly decreased in both groups,as compared with those before treatment（ P〈0. 01）. The 24 h DBP and the d DBP after12-week treatment in observation group were significant lower than those before treatment（ P〈0. 05）. As compared with those in control group,the 24 h SBP,d SBP,n SBP,morning peak SBP and DBP were significantly decreased in observation group on 6 w,12 w after treatment（ P〈0. 05）. On 12 w after treatment,the 24 h SBPV,24 h DBPV,d SBPV and d DBPV were significantly decreased in observation group,as compared with those in control group（ P〈0. 05 or P〈0. 01）. The total effective rates in observation group and control group were 86. 11% and 93. 06% respectively,there was a significant difference between two groups（ χ2= 1. 860,P〈0. 05）. However there were no significant differences in blood glucose,blood lipid,liver and kidney functions before and after treatment between two groups,moreover,there was no significant difference in incidence rate of adverse reactions between two groups（ χ2= 0. 067,P〈0. 05）. Conclusion The felodipine sustained-release tablets combined with captopril can effectively reduce the blood pressure in elderly patients with essential hypertension,moreover,which can control BPV,without affecting glycolipid metabolism,liver and kidney functions,therefor,which is a safe and effective treatment scheme.