老年高血压患者联合使用缬沙坦和非洛地平降压治疗的时间治疗学研究

Chronotherapeutics study of felodipine and valsartan combination in elder hypertension patients

目的探讨在降压药物种类和数量相同的情况下,通过改变缬沙坦的服药时间对老年高血压患者血压周期性变化的影响。方法拟选择住院的非杓形老年高血压患者167例。随机、单盲的方法将入选患者随机分为2组,服用缬沙坦80 mg和非洛地平5 mg,1/日,1次1片。A组(n=82)服药时间选择在早7时,即两种降压药物均于清晨服用;而B组(n=85)服用缬沙坦的时间为晚7时,即非洛地平于清晨服用,缬沙坦夜间服用。治疗随访8周后复查24小时动态血压监测(ABPM)。结果 15例患者因失访或未能按要求服药而被退出,A组共74例、B组共78例患者完成治疗。B组患者夜间平均收缩压、舒张压及24 h平均收缩压、舒张压的降低程度均显著高于A组(P<0.01及P<0.05);夜间血压下降率的增加显著高于A组(P<0.01),非杓形血压的比例下降程度亦显著高于A组(P<0.01)。结论对于血压周期性形态为非杓形患者,将缬沙坦放在夜间服用可改善患者的夜间血压下降率,有助于纠正患者的血压节律。

Objective To investigate the effect of different valsartan medication time periodic blood pressure changes in elder hypertension patients without change types and dosage of antihypertensive drugs. Methods 167 elder inpatients with non-dipping hypertension were randomly divided into two groups. Both groups took valsartan80mg and felodipine 5mg, 1 pill once per day. Group A (n=85) took felodipine and valsartan at 7am, group B (n=85) took felodipine at 7am and valsartan at 7pm. 24-hour ambulatory blood pressure monitoring (ABPM) were conducted before and after 8 weeks of treatment. Results 15 subjects were quit because of loss of follow-up or had not taken medicine as required. 74 subjects in group A and 78 subjects in group B finished the therapy. Compared with group A,subjects in group B had a significant reduction in nocturnal systolic and diastolic blood pressure (P<0.01), as well as 24-hour mean systolic and diastolic blood pressure (P<0.05). The rates of nocturnal systolic and diastolic blood pressure decline were significantly higher than group A (P<0.01) as well as the degree of non-dippers blood pressure decline (P<0.01). Conclusion For elder patients with non-dipping hypertension, administration of valsartan at bedtime significantly increased the rates of nocturnal systolic and diastolic blood pressure decline, and normalized the circadian blood pressure pattern.