沙库巴曲缬沙坦钠治疗难治性高血压的临床观察

Clinical observation of sacubactril/valsartan sodium in the treatment of resistant hypertension

目的探讨沙库巴曲缬沙坦钠治疗难治性高血压有效性与安全性。方法选取2020年1月至2021年12月上海中医药大学附属普陀医院收治的难治性高血压患者100例,经过4周的药物洗脱后采用随机信封法进行分组,分为治疗组与对照组各50例。治疗组服用沙库巴曲缬沙坦钠200 mg/d、苯磺酸氨氯地平5 mg/d、氢氯噻嗪12.5 mg/d,对照组服用缬沙坦80 mg/d、苯磺酸氨氯地平5 mg/d、氢氯噻嗪12.5 mg/d,治疗8周。观察比较两组24 h动态血压及诊室血压值、超声心动图指标。结果治疗后治疗组患者的诊室收缩压、诊室舒张压、24 h平均收缩压、24 h平均舒张压、白昼平均收缩压、白昼平均舒张压、夜间平均收缩压以及夜间平均舒张压较对照组均下降,差异有统计学意义(t=-5.204、-3.166、-5.521、-3.019、-4.325、-2.435、-6.042、-4.968,P<0.05),左心室射血分数提高,差异有统计学意义(t=2.411,P<0.05)。治疗组24 h平均血压达标率为收缩压52%(26例)和舒张压82%(41例),较对照组提高,差异有统计学意义(χ^(2)=4.110,P<0.05)。结论沙库巴曲缬沙坦钠联合降压治疗难治性高血压具有更好的降压效果,可以提高血压控制率和起到改善心脏功能的作用。

Objective To investigate the effectiveness and safety of sacubitril/valsartan sodium in the treatment of resistant hypertension.Methods One hundred patients with resistant hypertension at Putuo Hospital,Shanghai University of Traditional Chinese Medicine from January 2020 to December 2021 were randomly selected.After a 4-week drug washout period,they were divided into two groups(the treatment group and control group)of 50 each using the random envelope method.The treatment group received sacubitril/valsartan sodium 200 mg/d,amlodipine besylate tablet 5 mg/d,and hydrochlorothiazide 12.5 mg/d,while the control group received valsartan 80 mg/d,amlodipine besylate tablet 5 mg/d,and hydrochlorothiazide 12.5 mg/d.The treatment duration was 8 weeks.The study observed 24-hour ambulatory blood pressure,clinic blood pressure values,and echocardiographic parameters.Results After treatment,office systolic blood pressure,office diastolic blood pressure,24-hour average systolic blood pressure,24-hour average diastolic blood pressure,daytime average systolic blood pressure,daytime average diastolic blood pressure,as well as nighttime average systolic blood pressure and nighttime average diastolic blood pressure in the treatment groups were decreased compared with those in the control group,the differences were statistically significant(t=-5.204,-3.166,-5.521,-3.019,-4.325,-2.435,-6.042,-4.968;P<0.05);left ventricular ejection fraction was improved,the difference was statistically significant(t=2.411,P<0.05).The 24-hour average blood pressure control rate was 52%for systolic blood pressure(26 cases)and 82%for diastolic blood pressure(41 cases),which were higher than those in the control group,the difference was statistically significant(χ^(2)=4.110,P<0.05).Conclusion Sacubitril/valsartan sodium combined with antihypertensive treatment of resistant hypertension has better antihypertensive effect,can significantly increase blood pressure control rates,and may offer better cardiac protective effects.