补充不同剂量维生素D对高龄原发性高血压血压变异性的影响

Effects of different dosages of Vitamin D on blood pressure variability in elderly patients with essential hypertension

目的观察补充不同剂量维生素D对高龄原发性高血压患者的血压变异性（BPV）的影响。方法选取高龄原发性高血压合并维生索D缺乏（或不足）患者80例，随机分为对照组20例，低剂量组30例，高剂量组30例。三组均测定血钙、血清25（OH）D3、全段甲状旁腺激素（iPTH）及24小时动态血压，以变异系数（CV）表示BPV。在三组原有降压治疗方案不变的情况下，对照组给予安慰剂，低剂量组给予骨化三醇（0．25μg，每日一次），高剂量组给予骨化三醇（0．25μg，每日两次），连续服用12周后，比较服药前后血钙、血清25（OH）D3、iPTH、24小时动态血压及CV的变化。结果12周低剂量组及高剂量组血钙、血清25（OH）D，较同组0剧及对照组12周升高（P均〈0．05），高剂量组比低剂量组上述指标改善更显著（P均〈0．05）；12周低剂毓组及高剂量组iPTH较同组0周[（27．38±4．82）pg／L比（36.31±7．39）pg／L；（22．12±6．34）pg／L比（36．01±462）pg／L，P〈0．05]及对照组12周[（27．38±4．82）pg／L、（22．12±6．34）pg／L比（36．12±6．34）pg／L，P〈0．05]降低，高刺请绀比低利量组下降更明显[（22．12±6．34）pg／L比（27.38±4．82）pg／L，P〈0．05]；低剂量组及高剂量组24hSBP、24hDBP、24hSBP—CV、dSBP—CV、nSBP—CV下降差值均大于对照组下降水平[（4．51±1．04）mmHg、（6．84±2．01）mmHg比（1．15±0．95）mmHg；（2．80±1．64）mmHg、（4．08±1．04）mmHg比（1．17±0．36）mmHg；（2．22±0．53）％、（4．13±0．62）％比（0．33±0．06）％；（2．19±1．78）％、（3．71±2．06）％比（0．45±1．53）％；（1．86±0．95）％、（2．88±0．95）％比（1．25±0．75）％；P均〈0．05]；12周低剂量和高剂量组24hDBP-CV、dDBP-CV、nDBP—CV较0周有所降低，但差值末见统计学差异（P均〉0．05）。结论补充维生素D能够降低高龄原发性高血压患者的血压水平，减小BPV，作用呈剂量依赖性，尤其对收缩压及其变异性的降低效果明显，对高血压靶器官损害有一定的保护作用。

Objective To observe the effect of different doses of Vitamin D supplementation on blood pressure variability in elderly patients with essential hypertension. Methods Eighty elderly patients with essential hypertension with Vitamin D deficiency were randomly divided into control group （20 cases ）, low-dose group （30 cases ） and high-dose group （ 30 cases）. Blood calcium Serum 25 （ OH ） D3, full-parathyroid hormone （iPTH） and 24-hour ambulatory blood pressure were measured in all three groups, coefficient of variation （CV） for blood pressure variability. In the three groups of the original antihypertensive treatment program unchanged, the control group was given placebo, low-dose group was given calcitriol （0.25 μg, once daily）, high-dose group was given calcitriol （0.25μg, twice daily）. After taking 12 weeks of continuous administration, blood calcium, serum 25 （OH） D3, iPTH, 24-hour ambulatory blood pressure and CV change were compared before and after administration. Results The serum calcium and serum 25 （OH）D3 in the 12-week low-dose group and high-dose group were higher than those in the 0-week and the control group （P〈0.05）. The above indexes in the high-dose group were more significantly improved than those in the low-dose group （P〈0.05）. The 12-week low-dose group and high-dose group had lower iPTH than the 0-week group [ （ 27.38±4.82 ） pg/L vs. （ 36.31±7.39 ） pg/L; （ 22.12± 6.34）pg/L vs. （36.01±4.62）pg/L; P〈0.05] and the control group[ （27.38±4.82）pg/L vs. （36.31±7.39）pg/L; （22.12±6.34）pg/L vs. （36.01±4.62）pg/L; P〈0.05]. The high-dose group decreased more significantly than the low-dose group[ （27.38±4.82）pg/L vs. （36.31±7.39）pg/L; （22.12±6.34）pg/L vs. （36.01±4.62）pg/L; P〈0.05]. The decrease of 24 h SBP, 24 h DBP, 24 h SBP-CV, dSBP-CV, nSBP-CV of the 12-week low-dose group and high-dose group were greater than those at 0 week and the same time control group [ （4.51 ± 1.04 ）mm Hg, （6.84±2.01 ）ram Hg vs. （ 1.15±0.95）mm Hg; （2.80±1.64）mm Hg, （4.08±1.04）mm Hg vs. （ 1.17±0.36）mm Hg; （2.22± 0.53）%, （4.13±0.62）% vs. （0.33±0.06）% ; （2.19±1.78）%, （3.71±2.06）% vs. （0.45±1.53）% ; （ 1.86±0.95）%, （2.88±0.95） % vs. （1.25±0.75）% ;P〈0.05 ]. The 24 h DBP-CV, dDBP-CV and nDBP-CV levels were lower than those at 0 week, but the difference was not statistically significant （P〉0.05）. Conclusion Vitamin D supplementation can reduce blood pressure and blood pressure variability in elderly patients with essential hypertension, and the effect is dose-dependent, especially for systolic blood pressure and its variability. It has a certain protective effect on target organ damage of hypertension.