时辰药理学指导下替米沙坦对非杓型伴清晨高血压患者疗效及药理机制分析

Efficacy and Pharmacological Mechanism of Telmisartan in Patients with Non-dipper Hypertension and Morning Hypertension Guided by Chronopharmacology

目的:探讨时辰药理学指导下替米沙坦对非杓型伴清晨高血压患者疗效及药理机制。方法:以2020年10月—2021年5月本院住院部收治的高血压患者87例为研究对象进行临床随机对照研究,设为睡前服药组(44例)与清晨服药组(43例)。前者予以时辰药理学指导下替米沙坦口服(晚上19:00-21:00),后者在清晨时段口服米沙坦口服(清晨7:00-9:00),两组均干预12周。比较两组血管内皮功能[血浆NO、血浆内皮素1(ET-1)、血浆血管紧张素Ⅱ(AngⅡ)]及24h血压变化,并评估血压分型。结果:治疗后,睡前服药组NO、ET-1均高于清晨服药组,AngⅡ水平低于清晨服药组(P<0.05);睡前服药组清晨平均收缩压、舒张压均低于清晨服药组(P<0.05),但两组24h平均收缩压、舒张压比较,差异无统计学意义(P>0.05);干预后,睡前服药组非杓型伴清晨高血压占比低于清晨服药组(P<0.05)。结论:在时辰药理学指导下,非杓型伴清晨高血压患者在夜间19:00-21:00服用替米沙坦效果较好,有助于改善血管内皮功能,并达到良好的降压效果,逆转非杓型高血压。

Objective:To investigate the efficacy and pharmacological mechanism of telmisartan under the guidance of chronopharmacology in patients with non-dipper type and morning hypertension.Methods:A randomized controlled clinical study was conducted on 87 hypertensive patients admitted to the inpatient department of our hospital from October 2020 to May 2021.They were divided into the pre-bed medication group(44 cases)and the morning medication group(43 cases).The former was given telmisartan orally under the guidance of chronopharmacology(19:00-21:00 p.m.),and the latter was given telmisartan orally in the morning(7:00-9:00 p.m.).The endothelial function[plasma NO,plasma endothelin-1(ET-1),plasma angiotensin II(Ang II)]and 24 h blood pressure changes in the two groups were evaluated,and the blood pressure classification was evaluated.Results:After treatment,NO and ET-1 in the pre-sleep medication group were higher than those in the morning medication group,while Ang II level was lower than that in the morning medication group(P<0.05).The morning average systolic and diastolic blood pressure in the pre-sleep medication group were lower than those in the morning medication group(P>0.05);but there was no significant difference in 24 h systolic blood pressure and diastolic blood pressure between the two groups(P>0.05).After intervention,the proportion of non dipper type with morning hypertension in the presleep medication group was significantly lower than that in the morning medication group(P<0.05).Conclusion:Under the guidance of chronopharmacology,telmisartan is effective in patients with non-dipper hypertension and morning hypertension at night 19:00-21:00,which helps to improve vascular endothelial function,achieve good antihypertensive effect and reverse non-dipper hypertension.