厄贝沙坦氢氯噻嗪与美托洛尔联合治疗对老年高血压患者血压变异性和心肾功能的影响

Effect of irbesartan hydrochlorothiazide combined with metoprolol on blood pressure variability and cardiorenal function in elderly patients with hypertension

目的:探讨厄贝沙坦氢氯噻嗪片联合美托洛尔治疗对老年高血压患者血压变异性(blood pressure variability, BPV)及心肾功能的影响。方法:前瞻性选取110例老年高血压患者作为研究对象,按数字随机表法分为2组:氨氯地平联合组(55例,厄贝沙坦氢氯噻嗪片联合氨氯地平片)及美托洛尔联合组(55例,厄贝沙坦氢氯噻嗪片联合美托洛尔缓释片);选择同期体检的正常老年人55例为正常血压组;比较血压、BPV、心肾功能及炎症指标,评价临床疗效和安全性。结果:美托洛尔联合组总有效率为89.09%。用药8周后,美托洛尔联合组24 h SBP、24 h DBP、24 h SBPV和24 h DBPV较治疗前均显著降低(P<0.01),LVEF明显上升(P<0.05),NT-proBNP、Cys-C、Scr和hs-CRP均显著下降(P<0.05,P<0.01),不良反应发生率为5.46%。上述指标与氨氯地平联合组比较差异无统计学意义。多元逐步回归分析显示,24 h SBPV是NT-proBNP和LVEF的独立影响因素,也是Cys-C和Scr的最大影响变量。结论:厄贝沙坦氢氯噻嗪片联合美托洛尔治疗能改善老年高血压患者心肾功能,这种改善作用可能主要与降低BPV和抑制炎症有关。

OBJECTIVE To investigate the effects of irbesartan hydrochlorothiazide tablets combined with metoprolol on blood pressure variability(BPV)and cardiorenal function in elderly patients with hypertension.METHODS One hundred and ten elderly patients with hypertension were prospectively selected as the hypertension group and randomly divided into two groups: amlodipine combined group(55 cases, irbesartan hydrochlorothiazide tablets combined with amlodipine tablets)and metoprolol combined group(55 cases, irbesartan hydrochlorothiazide tablets combined with metoprolol delayed release tablets).Fifty-five normal elderly people who underwent physical examination at the same time were selected as the normal blood pressure group.The differences of blood pressure, BPV and cardiac and renal function between the three groups before and after treatment were compared.The clinical efficacy and safety in two groups of hypertension were also evaluated.RESULTS The total effective rates of metoprolol combined group was 89.09%.After 8 weeks of treatment in metoprolol combined group, 24 h SBP,24 h DBP,24 h SBPV and 24 h DBPV were significantly lower than those before treatment(P<0.01),LVEF was significantly higher(P<0.05),while NT-proBNP,Cys-C,Scr and hs-CRP were significantly lower(P<0.05,P<0.01),and the incidence of adverse reactions was 5.46%.But there were no significant differences of the above indicators between the metoprolol combined group and amlodipine combined group.Multiple stepwise regression analysis showed that 24 h SBPV was an independent factor of NT-proBNP and LVEF,and was also the largest influencing variable of Cys-C and Scr.CONCLUSION Irbesartan hydrochlorothiazide tablets combined with metoprolol can improve the cardiac and renal function of elderly patients with hypertension, which may be related to the reduction of BPV and inhibition of inflammation.