高龄高血压患者血压昼夜节律及血管舒张功能与服药时间的关系

Relationship between circadian rhythm of blood pressure,vasodilation function with medication time in elderly patients with hypertension

目的探讨高龄高血压患者血压昼夜节律及血管舒张功能与服药时间的关系。方法将144例≥80岁非杓型高血压患者均分为晨起服药组和夜间服药组,分别于每日8∶00和20∶00服用苯磺酸左旋氨氯地平2.5 mg,连续服用24周;记录2组患者治疗前后的动态血压指标[24 h平均收缩压(24hSBP)、24 h平均舒张压(24hDBP)、白昼平均收缩压(dSBP)、夜间平均收缩压(nSBP)、白昼平均舒张压(dDBP)、夜间平均舒张压(nDBP)];分析2组患者治疗后血压的昼夜节律变化,观察治疗前后2组患者的血清一氧化氮(NO)、内皮素(ET)、同型半胱氨酸(Hcy)水平及肱动脉血流介导的血管舒张功能(FMD)。结果2组患者治疗后24hSBP、24hDBP、dSBP、nSBP、dDBP、nDBP均低于治疗前(P<0.05),夜间服药组治疗后nSBP、nDBP低于晨起服药组(P<0.05),杓型血压所占比例高于晨起服药组(P<0.05);治疗后,2组患者血清ET、Hcy水平低于治疗前(P<0.05),NO水平及FMD高于治疗前(P<0.05),夜间服药组治疗后血清ET水平低于晨起服药组(P<0.05),NO水平及FMD高于晨起服药组(P<0.05)。结论高龄非杓型高血压患者夜间服用苯磺酸左旋氨氯地平降压效果优于晨起服药,能纠正非杓型血压节律,其机制可能与增加血管内皮NO合成和释放、上调FMD值及降低ET水平有关。

Objective To investigate the relationship between the circadian rhythm of blood pressure and vasodilation function with medication time in elderly patients with hypertension.Methods One hundred and forty-four patients with non-dipping hypertension≥80 years old were divided into morning medication and night medication groups.They took 2.5 mg of levamlodipine besylate at 8∶00(morning medication)or 20∶00(night medication)daily for continuous 24 weeks,respectively.We recorded the ambulate blood pressure parameters of the two groups before and after treatment,including 24 h average systolic blood pressure(24hSBP),24 h average diastolic blood pressure(24hDBP),daytime average systolic blood pressure(dSBP),nighttime average systolic blood pressure(nSBP),daytime average diastolic blood pressure(dDBP),night-time mean diastolic blood pressure(nDBP).The circadian rhythm changes of blood pressure were analyzed between the two groups after treatment.The serum nitric oxide(NO),endothelin(ET),homocystine(Hcy),and brachial artery blood flow-mediated vasodilation(FMD)were observed between the two groups before and after treatment.Results After treatment,24hSBP,24hDBP,dSBP,nSBP,dDBP,and nDBP in the two groups were significantly lower than before treatment(P<0.05),but nSBP and nDBP were lower in the night-time medication group than those in the morning medication group(P<0.05).After treatment,the proportion of dipping blood pressure in the night medication group was higher than that in the morning medication group(P<0.05),After treatment,the serum ET and Hcy levels of the two groups were lower than before treatment(P<0.05),but the NO level and FMD were higher than before the treatment(P<0.05),After the treatment,the serum ET level was significantly lower in night medication group than those in morning medication group(P<0.05),but the NO level and FMD were higher in night medication group than those in morning medication group.Conclusion The antihypertensive effect of levamlodipine besylate taken at night in elderly patients with non-dipping hypertension is better than that of morning medication.It corrects the non-dipping blood pressure rhythm.The mechanism may be related to the increase of vascular endothelial NO synthesis and release,upregulation of FMD and reduced ET levels.