不同类型降压药对肝阳上亢型初发高血压患者脉压差的影响研究

Effect of different types of antihypertensive drugs on pulse pressure difference in patients with early-onset hypertension of syndrome of liver-yang hyperactivity

目的观察不同类型降压药治疗肝阳上亢型初发高血压患者的临床疗效。方法将40例肝阳上亢型初发高血压患者随机分为2组,RAS抑制剂组20例予血管紧张素转换酶抑制剂(普利类)或血管紧张素Ⅱ受体拮抗剂(沙坦类)口服,根据血压调整剂量;β受体阻滞剂组20例予美托洛尔或比索洛尔或卡维地洛口服,根据血压、心率调整剂量。2组均干预6周,观察2组治疗后动态血压、24 h平均脉压差变化,统计2组西医疗效、中医证候疗效及不良反应发生情况。结果治疗后RAS抑制剂组、β受体阻滞剂组(夜间平均收缩压变化不明显)动态血压均较治疗前明显降低(P均<0.05),但2组间动态血压比较差异均无统计学意义(P均>0.05)。治疗后RAS抑制剂组24 h平均脉压差明显低于治疗前及β受体阻滞剂组治疗后(P均<0.05),β受体阻滞剂组治疗后24 h平均脉压差变化不明显(P>0.05)。RAS抑制剂组西医总有效率为75%、中医证候总有效率为95%,β受体阻滞剂组西医总有效率为50%、中医证候总有效率为100%,RAS抑制剂组西医总有效率明显高于β受体阻滞剂组(P<0.05),2组中医证候总有效率比较差异无统计学意义(P>0.05)。结论RAS抑制剂降压疗效优于β受体阻滞剂,且RAS抑制剂更能有效降低脉压差。

Objective It is to observe the clinical efficacy of different types of antihypertensive drugs in the treatment of patients with early-onset hypertension of syndrome of liver-yang hyperactivity.Methods Forty patients with first-onset hypertension of syndrome of liver-yang hyperactivity were randomly divided into two groups,20 patients in the RAS inhibitor group were given an angiotensin-converting enzyme inhibitor(Pulsin)or an angiotensin II receptor antagonist(Sartans)by oral administration,and the dose was adjusted according to blood pressure;20 patients in theβ-blocker group were given metoprolol or bisoprolol or carvedilol by oral administration,and the dose was adjusted according to blood pressure and heart rate.The two groups were treated for 6 weeks.The changes of dynamic blood pressure and 24h mean pulse pressure difference after treatment were observed in the two groups.The curative effects of western medicine and the symptoms of traditional Chinese medicine and the occurrence of adverse reactions were statistically analyzed.Results After treatment,the dynamic blood pressure of the RAS inhibitor group and theβ-blocker group(no change in mean nighttime systolic blood pressure)was significantly lower than that before treatment(P<0.05),but there was no statistical difference in dynamic blood pressure between the two groups(P>0.05).After treatment,the mean pulse pressure difference of RAS inhibitor group was significantly lower than that of pre-treatment andβ-blocker group(P<0.05).The mean pulse pressure difference was not obvious after 24 h treatment inβ-blocker group(P>0.05).The total effective rate of western medicine in the RAS inhibitor group was 75%,the total effective rate of TCM syndrome was 95%,the total effective rate of western medicine in theβ-blocker group was 50%,and the total effective rate of TCM syndrome was 100%.The total effective rate of western medicine was significantly higher in the RAS inhibitor group than that of theβ-blocker group(P<0.05).There was no significant difference in the total effective rate between the two groups(P>0.05).Conclusion RAS inhibitors are superior toβ-blockers in reducing blood pressure,and RAS inhibitors are more effective in reducing pulse pressure difference.