不同降压药物联合治疗对老年高血压合并慢性心衰患者血压变异性及心衰疗效的影响

Effects of combined treatment of different anti-hypertensive drugs on blood pressure variability and treatment of heart failure in elderly patients with hypertension and chronic heart failure

目的比较倍他乐克、缬沙坦、螺内酯再分别联合氨氯地平或氢氯噻嗪对老年高血压并发慢性心衰患者血压变异性及心衰疗效的作用。方法120例老年高血压合并慢性心衰患者随机分为两组,分别给予倍他乐克、缬沙坦、螺内酯再联合氨氯地平(氨氯地平组)或倍他乐克、缬沙坦、螺内酯再联合氢氯噻嗪(氢氯噻嗪组)抗心衰控制血压治疗,通过监测两组患者24 h动态血压,观察治疗前及治疗第6周和第12周两组心衰疗效、血压及血压变异性的变化。同时观察两组6周末血压达标率及N-末端B型利钠肽原(NT-proBNP)水平下降情况。同时记录治疗过程中的不良反应情况。结果两组患者治疗6周和12周的24 h平均收缩压(SBP)、24 h收缩压变异性(SBPV)、白昼SBP、夜间SBP、晨峰SBP、NT-proBNP水平与治疗前比较均有明显降低,慢性心衰(CHF)疗效较治疗前亦明显改善(P<0.05)。24 hSBP、24 hSBPV、白昼SBP、白昼SBPV及夜间SBP在两组患者分组及时间因素差异有统计学意义(P<0.05)。治疗后第6周和第12周,氨氯地平组24 h平均SBP、白昼SBP、白昼SBPV、夜间SBP及NT-proBNP水平较氢氯噻嗪组下降的多(P<0.05),治疗第12周,氨氯地平组24 hSBPV及NT-proBNP水平下降显著多于氢氯噻嗪组(P<0.01)。在心衰疗效上两组差异有统计学意义(P<0.01),在血压达标率和不良反应发生率差异无统计学意义(P>0.05)。结论倍他乐克、缬沙坦、螺内酯再分别联合氨氯地平或氢氯噻嗪对老年高血压并发慢性心衰患者可良好控制血压变异性及改善心衰症状,而前者在控制血压、改善血压变异性及治疗心衰作用更强。

[Objective]To observe the impacts of betaloc,valsartan,spironolactone combined with amlodipine or hydrochlorothiazide regimen on blood pressure variability(BPV)and treatment of chronic heart failure(CHF)in elderly hypertensive patients.[Methods]One hundred and twenty elderly patients with hypertension and CHF were randomized into betaloc,valsartan,spironolactone combined with amlodipine(the amlodipine group,n=57)or betaloc,valsartan,spironolactone and hydrochlorothiazide(the hydrochlorothiazide group,n=57)group.The 24-hour dynamic blood pressure was monitored and the changes of CHF blood pressure and BPV at baseline,6-week and 12-week after treatment were observed.The control rate of blood pressure and the decrease of N-terminal pro-B-type natriuretic peptide(NT-proBNP)level was calculated at 6-week after treatment,and side effects were observed during the treatment.[Results]Values of 24-hour systolic blood pressure(SBP),24-hour systolic blood pressure variability(SBPV),daytime SBP,nighttime SBP,morning SBP,and the decrease of NT-proBNP level were significantly lower at 6-week and 12-week than those of baseline in both two groups(P<0.05).The curative effect of CHF was also improved significantly compared with that before treatment,there was an interaction between the grouping factors and time on 24-hour SBP,24-hour SBPV,daytime SBP,daytime SBPV,and nighttime SBP(P<0.05).At the 6-week and 12-week treatment,24-hour SBP, daytime SBP, nighttime SBP, daytime SBPV and the decrease of NT-proBNP level were significantly lower in amlodipinegroup than those in hydrochlorothiazide group (P<0.05). At 12-week treatment, 24-hour SBPV and the decrease of NT-proBNP levelwas significantly lower in amlodipine group than that in hydrochlorothiazide group (P<0.01). There were significant differences (P<0.01)on the treatment of CHF while there were no significant differences in control rate of blood pressure and side effects between twogroups. [Conclusion]Betaloc, valsartan spironolactone in combination with amlodipine or hydrochlorothiazide can botheffectively control BPV and treat CHF in elderly hypertensive patients, and betaloc, valsartan spironolactone combined withamlodipine has better effects on lowering blood pressure, BPV and controlling CHF.