厄贝沙坦片联合苯磺酸氨氯地平片治疗难治性高血压的疗效观察

Observation on efficacy of irbesartan tablets combined with amlodipine besylate tablets in the treatment of refractory hypertension

目的探讨难治性高血压患者在苯磺酸氨氯地平片用药基础上取厄贝沙坦片联用的效果。方法选取难治性高血压患者80例,随机分为对照组及观察组,各40例。对照组患者单用苯磺酸氨氯地平片治疗,观察组患者同时取厄贝沙坦片药物联用。对比两组患者的临床治疗效果,治疗前后的血压(收缩压、舒张压)、肾功能指标[尿酸(UA)、尿素氮(BUN)、肌酐(Scr)]、内皮功能指标[一氧化氮(NO)、内皮素-1(ET-1)、血管紧张素(Ang)]、血清炎性因子[肿瘤坏死因子-α(TNF-α)、血清白细胞介素-6(IL-6)、血清白细胞介素-1β(IL-1β)]水平,不良反应发生率。结果观察组患者总有效率为97.50%,高于对照组的80.00%(P<0.05)。治疗后,两组收缩压、舒张压均降低,且观察组收缩压(131.29±19.83)mm Hg(1 mm Hg=0.133 kPa)、舒张压(74.29±11.39)mm Hg低于对照组的(149.39±20.82)、(82.79±11.73)mm Hg(P<0.05)。治疗后,两组UA、BUN、Scr均降低,且观察组UA(324.29±28.39)μmol/L、BUN(5.38±1.02)mmol/L、Scr(62.93±4.92)μmol/L低于对照组的(343.92±29.39)μmol/L、(6.45±0.82)mmol/L、(70.72±4.05)μmol/L(P<0.05)。治疗后,两组NO均上升,ET-1、Ang均降低,且观察组NO(132.31±10.39)μmol/L高于对照组的(113.94±10.28)μmol/L,ET-1(63.23±7.31)ng/L、Ang(49.23±8.19)ng/L低于对照组的(68.34±6.91)、(55.49±8.93)ng/L(P<0.05)。治疗后,两组TNF-α、IL-6、IL-1β均降低,且观察组TNF-α(27.39±3.92)ng/L、IL-6(79.34±10.39)ng/L、IL-1β(328.39±19.34)ng/ml低于对照组的(34.45±4.01)ng/L、(98.39±9.34)ng/L、(384.29±20.94)ng/ml(P<0.05)。两组患者不良反应发生率对比,未见差异(P>0.05)。结论针对难治性高血压患者,在苯磺酸氨氯地平片给药基础上取厄贝沙坦片药物加用,可显著提高总有效率,降低血压检测值,改善肾功能、内皮功能水平,降低炎性反应程度,且具有一定的安全性。

Objective To explore the effect of irbesartan tablets combined with amlodipine besylate tablets in the treatment of patients with refractory hypertension.Results A total of 80 patients with refractory hypertension were randomly divided into a control group and an observation group,with 40 patients in each group.The control group was treated with amlodipine besylate tablet alone,and the observation group was treated with irbesartan tablet simultaneously.Patients in both groups were compared in terms of clinical treatment effect,blood pressure(systolic blood pressure,diastolic blood pressure),renal function indicators[uric acid(UA),blood urea nitrogen(BUN),serum creatinine(Scr)],endothelial function indicators[nitric oxide(NO),endothelin-1(ET-1),angiotensin(Ang)],serum inflammatory factors[tumor necrosis factor-α(TNF-α),serum interleukin-6(IL-6),serum interleukin-1β(IL-1β)]before and after treatment,and incidence of adverse reactions.Results The total effective rate of the observation group was 97.50%,which was higher than the control group's 80.00%(P<0.05).After treatment,the systolic blood pressure and diastolic blood pressure decreased in both groups;the observation group had systolic blood pressure of(131.29±19.83)mm Hg(1 mm Hg=0.133 kPa)and diastolic blood pressure of(74.29±11.39)mm Hg,which were lower than(149.39±20.82)and(82.79±11.73)mm Hg in the control group(P<0.05).After treatment,UA,BUN and Scr decreased in both groups;the observation group had UA of(324.29±28.39)μmol/L,BUN of(5.38±1.02)mmol/L and Scr of(62.93±4.92)μmol/L,which were lower than(343.92±29.39)μmol/L,(6.45±0.82)mmol/L and(70.72±4.05)μmol/L in the control group(P<0.05).After treatment,NO increased,ET-1 and Ang decreased in both groups;the observation group had higher NO of(132.31±10.39)μmol/L than(113.94±10.28)μmol/L in the control group;the observation group had ET-1 of(63.23±7.31)ng/L and Ang of(49.23±8.19)ng/L,which were lower than(68.34±6.91)and(55.49±8.93)ng/L in the control group(P<0.05).After treatment,TNF-α,IL-6 and IL-1βdecreased in both groups;the observation group had TNF-αof(27.39±3.92)ng/L,IL-6 of(79.34±10.39)ng/L and IL-1βof(328.39±19.34)ng/ml,which were lower than(34.45±4.01)ng/L,(98.39±9.34)ng/L and(384.29±20.94)ng/ml in the control group(P<0.05).There was no difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion For patients with refractory hypertension,administration of irbesartan tablets and amlodipine besylate tablets can significantly improve the total effective rate,reduce blood pressure detection value,improve the level of renal function and endothelial function,and reduce the degree of inflammatory response,and has a certain safety.