川芎天麻汤联合替米沙坦治疗老年非杓型高血压伴左心室舒张功能不全

Observation on the clinical effi cacy of Chuanxiong Tianma Decoction combined with telmisartan in the treatment of senile non-dipper hypertension accompanied by left ventricular diastolic dysfunction

目的观察川芎天麻汤联合替米沙坦治疗老年非杓型高血压伴左心室舒张功能不全的临床疗效。方法将80例老年非杓型高血压伴左心室舒张功能不全患者随机分为对照组与观察组,各40例。对照组给予替米沙坦治疗,观察组在对照组基础上予川芎天麻汤治疗,疗程8周。记录2组治疗前后24 h动态血压监测(ABPM)参数、夜间血压下降率、血压晨峰现象和超声心动图检查指标的变化。结果治疗后2组ABPM参数(24h MDBP、24h MSBP、dMDBP、dMSBP、nMDBP和nMSBP)均较治疗前明显降低(P<0.05),且治疗后观察组上述参数均低于对照组(P<0.05)。治疗后2组夜间收缩压(SBP)、舒张压(DBP)下降率均明显增加(P<0.05),且治疗后观察组上述血压下降率明显高于对照组(P<0.05);治疗后观察组血压昼夜节律恢复为杓型血压比率(70.00%,28/40)明显高于对照组(55.00%,22/40)(P<0.05);2组治疗后血压晨峰值、血压晨峰检出率较治疗前显著降低(P<0.05),且观察组低于对照组(P<0.05)。治疗后观察组Tei 指数和E/e′显著降低,E/A、e′显著提高(P<0.05);LVEF无明显变化(P> 0.05),治疗后观察组前4项指标改善情况均优于对照组(P<0.05)。结论川芎天麻汤联合替米沙坦可显著改善老年非杓型高血压患者血压昼夜节律,降压平稳,降低血压晨峰现象发生率,改善左心室舒张功能。

Objective To observe the clinical efficacy of Chuanxiong Tianma Decoction combined with telmisartan in the treatment of senile non-dipper hypertension accompanied by left ventricular diastolic dysfunction.Methods A total of 80 elderly patients with non-dipper hypertension accompanied by left ventricular diastolic dysfunction were randomly divided into a control group and an observation group,with 40 cases in each group.The control group was treated with telmisartan,while the observation group was treated with Chuanxiong Tianma Decoction on the basis of the control group,both for 8 weeks.The changes of the 24-hour ambulatory blood pressure monitoring(ABPM)parameters,nocturnal blood pressure drop rate,morning peak of blood pressure and echocardiographic indexes were recorded for the 2 groups before and after treatment.Results After treatment,the ABPM parameters(24h MDBP,24h MSBP,dMDBP,dMSBP,nMDBP and nMSBP)of the two groups were all significantly decreased(P<0.05),and the above parameters of the observation group were lower than those of the control group(P<0.05).After treatment,the decrease rates of nocturnal systolic blood pressure(SBP)and diastolic blood pressure(DBP)in the two groups increased significantly(P<0.05),and the above decrease rates of the observation group were significantly higher than those of the control group(P<0.05).After treatment,the rate of dipper type blood pressure in the observation group(70.00%,28/40)was significantly higher than that in the control group(55.00%,22/40)(P<0.05).The morning peak of blood pressure and its detection rate in the two groups after treatment were significantly lower than before treatment(P<0.05),and the observation group was lower than the control group(P<0.05).After treatment,the Tei index and E/e’of the observation group were significantly decreased,while E/A and e’were significantly increased(P<0.05).Though there was no significant change in LVEF(P>0.05),the improvement of the first 4 indexes in the observation group was better than that in the control group after treatment(P<0.05).Conclusion Chuanxiong Tianma Decoction combined with telmisartan can significantly improve the circadian rhythm of blood pressure,reduce blood pressure steadily,reduce the incidence of morning blood pressure peaks,and improve the left ventricular diastolic functions in elderly patients with non-dipper hypertension.