氨氯地平或氢氯噻嗪联合依那普利治疗老年高血压患者对血压昼夜节律的影响

The effect of amlodipine or hydrochlorothiazide combined with enalapril on the circadian rhythm of blood pressure in elderly hypertensive patients

目的探究氨氯地平或氢氯噻嗪联合依那普利治疗老年高血压患者对血压昼夜节律的影响。方法选取2019年7月至2021年6月期间武警河南总队医院收治的156例老年高血压患者,根据随机数字表法将其分为观察组78例,对照组78例,对照组采用氢氯噻嗪与依那普利联合进行治疗,观察组采用氨氯地平联合依那普利进行治疗,比较两组患者的疗效,血压昼夜节律、血管功能[颈动脉内膜中层厚度(IMT)水平及反应性肱动脉内径变化率(EDD%)]、给药后肾功能[24 h微量白蛋白尿(24 h MAU)及内生肌酐清除率(Ccr)]及安全性。结果治疗后,观察组治疗有效率为91.03%,高于对照组的79.49%(P<0.05);治疗前,两组患者收缩压(SBP)昼夜节律及舒张压(DBP)昼夜比较,差异无统计学意义(P>0.05),治疗后SBP、DBP昼夜节律均改善,且观察组优于对照组(P<0.05);治疗前,两组患者IMT、EDD比较差异无统计学意义(P>0.05);治疗后两组患者IMT水平均低于治疗前,EDD水平均高于治疗前(P<0.05);观察组IMT水平低于对照组,EDD水平高于对照组(P<0.05);治疗前,两组患者24 h MAU、Ccr比较差异无统计学意义(P>0.05);治疗后两组患者Ccr水平均低于治疗前,24 h MAU水平均高于治疗前(P<0.05);观察组24 h MAU水平低于对照组,Ccr水平高于对照组(P<0.05);观察组出现头痛、干咳各3例,头晕2例,不良反应发生率为10.26%;对照组出现头痛、干咳各2例,头晕1例,低血钾1例,不良反应率为6.98%,两组不良反应发生率比较差异无统计学意义(P>0.05)。结论氨氯地平联合依那普利能够改善老年高血压患者血压昼夜节律,未增加不良反应发生率,安全性较高,疗效更佳。

Objective To explore the effect of amlodipine or hydrochlorothiazide combined with enalapril on the circadian rhythm of blood pressure in elderly hypertensive patients.Methods Selected 156 elderly hypertensive patients admitted to our hospital from July 2019 to June 2021,and divided them into an observation group of 78 cases,a control group of 78 cases,and a control group of hydrochlorothiazide and enalapril according to the random number table method.,Combined treatment,the observation group was treated with amlodipine,and the same combined with enalapril for treatment,comparing the curative effect of the two groups of patients,blood pressure circadian rhythm,vascular function[carotid artery intima-media thickness(IMT)level and reactive brachial artery Inner diameter change rate(EDD%)],renal function after administration[24 h microalbuminuria(24 h MAU)and endogenous creatinine clearance(Ccr)]and safety.Results After treatment,the total effective rate of treatment in the observation group was 91.03%,which was higher than 79.49%in the control group(P<0.05);before treatment,the circadian rhythms of systolic blood pressure(SBP)and diastolic blood pressure(DBP)of the two groups were not significantly compared during the day and night.Difference(P>0.05),SBP,DBP circadian rhythms were improved after treatment,and the observation group was better than the control group(P<0.05);before treatment,the difference between the two groups of patients in IMT and EDD was not significant(P>0.05);The IMT level of the latter two groups was lower than before treatment,and the EDD level was higher than before treatment(P<0.05);the IMT level of the observation group was lower than the control group,and the EDD level was higher than that of the control group(P<0.05);There was no significant difference in 24 h MAU and Ccr of patients in the group(P>0.05);after treatment,the Ccr levels of the two groups were lower than before treatment,and the 24 h MAU levels were higher than before treatment(P<0.05);observation group 24 h MAU The level was lower than the control group,and the Ccr level was higher than that of the control group(P<0.05);the observation group had headache,3 cases of dry cough,and 2 cases of dizziness.The adverse reaction rate was 10.26%;the control group had headache,2 cases of dry cough,and dizziness.There was 1 case and 1 case of hypokalemia.The adverse reaction rate was 6.98%.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Amlodipine combined with enalapril can improve the circadian rhythm of blood pressure in elderly hypertensive patients,without increasing the incidence of adverse reactions,with higher safety and better curative effect,and it is worthy of wide application.