不同服药方式对糖尿病伴夜间高血压患者降压效果评价

Evaluation of antihypertensive effect of different medicine ways on diabetic patients with nocturnal hypertension

目的:评价睡前和晨起服药降压药物对糖尿病伴夜间高血压患者的降压效果。方法:选择2015年9月至2017年2月,在我院就诊的糖尿病患者48例,要求夜间收缩压≥120mm Hg(1mm Hg=0.133k Pa),随机分为两组,A组晨起服用降压药,B组睡前服药,治疗8周后转换至另外一组继续服药8周,评价治疗前后院内血压、动态血压,同时测量血肌酐、肾素、血管紧张素Ⅱ、醛固酮、C反应蛋白(CRP)、纤维蛋白原,收集尿样测量尿白蛋白、肌酐、钠、钾和渗透压。结果:睡前服药时夜间收缩压、24h收缩压、夜间舒张压、24h舒张压、夜间脉压差、24h脉压差、夜间平均动脉压、24h平均动脉压和院内脉压差均低于晨起服药,组间比较差异有统计学意义(P<0.05);睡前服药时CRP、尿肌酐和尿渗透压低于晨起服药组间比较,差异有统计学意义(P<0.05),而纤维蛋白原、肾素、血管紧张素Ⅱ、醛固酮、尿钠、尿钾、尿蛋白/肌酐比值组间比较,差异无统计学意义(P>0.05)。结论:糖尿病合并高血压患者睡前服用降压药时夜间血压、24h血压和CRP低于晨起服药。

Objective： To evaluate the effect of antihypertensive drugs on diabetic patients with nocturnal hypertension between bedtime administration and morning administration. Methods： From September 2015 to February 2017,48 diabetic patients who combined with nighttime systolic blood pressure≥120 mm Hg in our hospital were randomly divided into two groups,Group A took antihypertensive drugs in morning and group B in bedtime. After 8 weeks treatment,they switched to the other group and medication to be continued for 8 weeks.Office blood pressure,ambulatory blood pressure were evaluated before and after treatment. Serum creatinine,renin,angiotensin,aldosterone,C reactive protein（ CRP）,fibrinogen,urine albumin,creatinine,sodium,potassium and osmotic pressure were detected at the same time. Results： Nocturnal systolic blood pressure,24 h systolic blood pressure,nighttime diastolic blood pressure,24 h diastolic blood pressure,night pulse pressure,24 h pulse pressure,night mean arterial pressure,24 h mean arterial pressure and hospital pulse pressure of bedtime administration were lower than morning administration（ P〈0.05） CRP,urine creatinine and urine osmotic pressure of bedtime administration were lower than morning administration（ P〈0.05） There was no significant difference of fibrinogen,renin,angiotensin,aldosterone,urinary sodium and potassium,urine protein/creatinine ratio between two groups（ P〈0.05） Conclusion： In diabetic patients with hypertension,nighttime blood pressure,24 h blood pressure and CRP of whose antihypertensive drugs taken in bedtime were lower than those in morning.