氨氯地平贝那普利片在老年高血压合并急性心肌梗死患者中的临床疗效分析

Clinical efficacy of amlodipine and benazepril tablets in elderly patients with hypertension complicated with acute myocardial infarction

目的探讨氨氯地平贝那普利片在老年高血压合并急性心肌梗死(AMI)患者中的临床疗效。方法回顾性分析2018年1月至2021年6月沈阳医学院附属第二医院收治的407例年龄>75岁的高血压合并AMI患者的临床资料,根据使用药物的不同分为氨氯地平贝那普利组(n=304)与贝那普利单药治疗组(n=103)。比较两组临床资料、实验室检查及彩色多普勒超声指标、不良心脑血管事件发生情况,并采用单因素及多因素Logistic回归分析院内死亡的危险因素。结果氨氯地平贝那普利组入院时血压、心率及硝酸酯类药物使用率均高于贝那普利组,但合并心房颤动占比低于贝那普利组,差异有统计学意义(P<0.05)。氨氯地平贝那普利组WBC、血肌酐、心肌肌钙蛋白I水平均低于贝那普利组,甘油三酯及估算的肾小球滤过率水平均高于贝那普利组,差异有统计学意义(P<0.05)。氨氯地平贝那普利组院内死亡率低于贝那普利组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,高B型脑钠肽(BNP)水平、心率较快及贝那普利单药治疗是院内死亡的独立危险因素(P<0.05)。结论氨氯地平贝那普利可降低老年高血压合并AMI患者院内死亡率,而高BNP水平及心率较快是院内死亡的独立危险因素,应用氨氯地平贝那普利可减少院内死亡事件的发生。

Objectives To detect clinical efficacy of amlodipine and benazepril tablets in elderly patients with hypertension complicated with acute myocardial infarction(AMI).Methods The clinical data of 407 patients with hypertension combined with AMI,aged>75 years old,admitted to the Second Affiliated Hospital of Shenyang Medical College from January 2018 to June 2021 were retrospectively analyzed,they were divided into amlodipine benazepril group(n=304)and the benazepril monotherapy group(n=103)according to the different drugs used.The clinical data,biochemical and color Doppler ultrasound indicators,and the indidence of adverse cardiovascular and cerebrovascular events were compared between the two groups,univariate and multivariate Logistic regression analysis were used to analyse the risk factors of hospital death.Results The blood pressure and heart rate in the amlodipine benazepril group were higher than those in the benazepril group at admission,but the proportion of atrial fibrillation was lower than that of the benazepril group,the differences were statistically significant(P<0.05).The WBC,serum creatinine(SCr)and cardiac troponin I(cTnI)levels in the amlodipine benazepril group were lower than those in the benazepril group,the levels of triglyceride(TG)and estimated glomerular filtration rate(eGFR)were higher than those in the benazepril group,with the differences were statistically significant(P<0.05).The utilization rate of nitrates in the amlodipine benazepril group was higher than that in the benazepril group,and the difference was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that high level of B-type natriuretic peptide(BNP),rapid heart rate and benazepril monotherapy were independent risk factors for hospital death(P<0.05).Conclusion Amlodipine and benazepril can reduce hospital death in elderly hypertensive patients with AMI,and high level of BNP and rapid heart rate were independent risk factors for hospital death,the application of amlodipine and benazepril can hinder the occurrence of hospital death events.