氨氯地平不同时间服药对高血压患者血压昼夜节律的影响

Influence of different administration time of amlodipine on circadian rhythm of blood pressure in hypertensive patients

目的:探讨氨氯地平不同时间服药对高血压患者血压昼夜节律的影响。方法:2015年5月-2020年3月我科收治的128例高血压患者被随机均分为日间服药组(7:00-9:00)和夜间服药组(19:00-21:00),两组在对应时间段内服用氨氯地平5mg,1次/天,疗程1个月。治疗前后均行24h动态血压监测,比较两组治疗前后的血压水平及非杓型血压比例。结果:与治疗前比较,治疗1个月后两组白天平均收缩压(dMSBP)、白天平均舒张压(dMDBP)、夜间平均收缩压(nMSBP)、夜间平均舒张压(nMDBP)均显著降低,P<0.05或<0.01;与日间服药组比较,夜间服药组治疗1个月后nMSBP[(124.69±10.04)mmHg比(120.06±12.63)mmHg]和nMDBP[(80.58±11.06)mmHg比(76.95±9.03)mmHg]降低更显著,P均<0.05。夜间服药组治疗1个月后非杓型血压患者比例显著低于日间服药组(7.8%比20.3%),P=0.042。结论:对于轻中度高血压患者,氨氯地平能显著控制血压,晚上服药能更显著地降低非杓型高血压患者夜间血压,维持血压正常的昼夜节律。

Objective:To explore influence of different administration time of amlodipine on circadian rhythm of blood pressure in hypertensive patients.Methods:A total of 128 hypertensive patients,who were treated in our department from May 2015 to Mar 2020,were randomly and equally divided into daytime administration group(7:00-9:00,daytime group)and nighttime administration group(19:00-21:00,nighttime group).Both groups received amlodipine 5mg,once/day during corresponding period for one month.All patients received 24h ambulatory blood pressure monitor before and after treatment.Blood pressure level and percentage of non-dipper blood pressure patients were compared between two groups before and after treatment.Results:Compared with before treatment,there were significant reductions in daytime mean systolic blood pressure(dMSBP),daytime mean diastolic blood pressure(dMDBP),nighttime mean systolic blood pressure(nMSBP)and nighttime mean diastolic blood pressure(nMDBP)in two groups after one-month treatment,P<0.05 or<0.01;compared with daytime group after one-month treatment,there were significant reductions in nMSBP[(124.69±10.04)mmHg vs.(120.06±12.63)mmHg]and nMDBP[(80.58±11.06)mmHg vs.(76.95±9.03)mmHg]in nighttime group,P<0.05 both.After one-month treatment,percentage of non-dipper blood pressure patients in nighttime group was significantly lower than that of daytime group(7.8%vs.20.3%),P=0.042.Conclusion:For mild to moderate hypertensive patients,amlodipine can significantly control blood pressure;for those patients with non-dipper hypertension,amlodipine administration at night can more significantly reduce nocturnal blood pressure,and maintain normal circadian rhythm of blood pressure.