睡前服药在非杓型原发性高血压伴清晨高血压的高龄老年患者中的疗效及安全性观察

Efficacy and safety of ingesting medication at bedtime in the very elderly patients with non-dipper essential hypertension and morning hypertension

目的探讨睡前服药在非杓型原发性高血压伴清晨高血压的高龄老年患者中的降压效果及安全性。方法回顾性收集上海健康医学院附属嘉定区中心医院自2018年1月至2019年12月老年科收治的原发性高血压患者。从中筛选出非杓型节律伴清晨高血压且降压方案中1种药物在睡前服药的高龄患者共32例作为观察组。选择同期治疗的32例具有相同血压特点且所有降压药均在清晨一次给药的高龄患者作为对照组。比较2组治疗后6~12周期间的动态血压各参数以及不良事件发生率。结果2组治疗后的24 h动态血压显示:观察组的杓型血压比例明显多于对照组,分别为31.2%和9.4%,差异有统计学意义(P=0.030)。观察组的24 h平均收缩压、夜间平均收缩压,、夜间平均舒张压、清晨平均收缩压、清晨平均舒张压均低于对照组,差异均有统计学意义(P均<0.05)。2组在住院治疗期间发生跌倒和症状性低血压方面差异无统计学意义(P均>0.05)。结论在对非杓型节律伴清晨高血压的高龄老年患者降压治疗中,可以调整其中至少一种药物于睡前服用,从而提高降压质量并且具有一定的安全性。

Objective To investigate the quality and safety of ingesting medication at bedtime in the very elderly patients with non-dipper essential hypertension and morning hypertension.Methods Patients with essential hypertension admitted to the Geriatric Department of Jiading District Central Hospital Affiliated to Shanghai Health Medical College from January 2018 to December 2019 were retrospectively collected.A total of 32 elderly patients with non-dipper associated with morning hypertension and ingesting≥1 kind of drugs at bedtime were selected as the observation group.Thirty-two elderly patients with the same blood pressure characteristics ingesting all medication in the morning were selected as the control group.The parameters of ambulatory blood pressure and adverse events were compared between the two groups after 6-12 weeks of treatment.Results The 24-hour ambulatory blood pressure of the two groups after treatment showed that the proportion of dipper hypertension in the observation group(31.2%)was significantly higher than that in the control group(9.4%),and the difference was statistically significant(P=0.030).The 24-hour mean systolic blood pressure,night mean systolic blood pressure,night mean diastolic blood pressure,morning mean systolic blood pressure and morning mean diastolic blood pressure of patients in the observation group were lower than those of the control group,and the differences between the two groups were statistically significant(all P<0.05).There was no significant difference in the incidence of falls and symptomatic hypotension between the two groups during hospitalization(all P>0.05).Conclusion In the treatment of the very elderly patients with non-dipper and morning hypertension,ingesting≥1 kind of drugs at bedtime can improve the quality of blood pressure control and have a certain degree of security.