联合降压治疗老年人糖尿病合并高血压临床疗效观察

Efficacy of combination of multiple drugs in the management of hypertension in elderly patients with type 2 diabetes mellitus

目的 探讨联合应用降压药治疗老年人 2型糖尿病合并高血压临床疗效。 方法 采取随机平行分组对照方法将患者分为 3组 ,A组 2 0例 ,单用硝苯地平控释片 (钙拮抗剂 ) 6 0mg/d ;B组 2 2例 ,硝苯地平控释片 30mg/d +缬沙坦 (血管紧张素Ⅱ受体阻滞剂 ,ARB) 80mg/d ;C组 2 3例 ,硝苯地平控释片 30mg/d +缬沙坦 80mg/d +小剂量吲哒帕胺 (利尿剂 )缓释片 1 5mg/d。 结果 治疗 8周后 ,C组收缩压 (SBP) <14 0mmHg和舒张压 (DBP) <90mmHg达标率分别为 6 0 9%和95 7% ,较A组SBP达标率 (15 0 % )和B组SBP(9 1% )和DBP(6 8 2 % )达标率高 (P <0 0 5 )。B组(4 5 % )或C组 (8 7% )总不良反应率较A组 (40 0 % )低 (P <0 0 5 )。 结论 钙拮抗剂联合ARB及小剂量利尿剂治疗老年人糖尿病合并高血压疗效理想 ,且不良反应低。

Objective To work out a proper treatment regimen for hypertension in elderly patients with type 2 diabetes mellitus. Methods Sixty-five elderly patients 〔aged (68.3±4.4) yrs old〕 with hypertension and type 2 diabetes were randomized into three arms of antihypertensive treatment: arm A, n=20, treated with nifedipine in long-acting gastrointestinal-transport system (nifedipine-GITS) 60 mg/d; arm B, n=22, treated with nifedipine-GITS 30 mg/d and valsartan (angiotensin Ⅱ receptor blocker, ARB) 80mg/d; and arm C, n=23, treated with nifedipine-GITS 30mg/d, Valsartan 80mg/d and sustained-releasing indapamide (diuretics)1.5 mg/d. Results Eight weeks later, both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were decreased significantly in all of the patients ( P <0.001). There were 15.0%, 9.1% and 60.9% of patients ( P <0.01 either as arm C and arm A or arm C and arm B was compared) reached the target SBP level of <140 mm Hg and 80.0%, 68.2% and 95.7% of patients ( P <0.05 as arm C and B were compared) reached the target DBP level of <90 mm Hg in arms A, B and C, respectively. Patients in arm A manifested significantly more side-effects (40%) than either in arm B (4.5%) or arm C (8.7%), P <0.05. Conclusions Treatment of hypertension in the elderly with type 2 diabetes mellitus by combining ARB and low-dose diuretics with reduced dose of nifedipine-GITS is either superior to the full dose of nifedipine-GITS alone or to the combining ARB with reduced dose of nifedipine-GITS.