应用两种血压测量方法指导培哚普利抗高血压治疗的比较-中国APTH研究(中国动态血压监测与高血压治疗研究)

Comparison ABPM and CBP Value in Antihypertension Treatment-Chinese APTH Trial

目的 探讨应用动态血压监测 (ABPM)指导抗高血压治疗是否优于诊室血压 (CBP)。方法 采用随机双盲设计 ,经安慰剂洗脱 ,若CBP的舒张压 (DBP)为 95～ 114mmHg便可随机进入ABP组和CBP组 ,两组均测ABP与CBP ,但ABP组根据ABP血压值调整降压药 ,目标血压为白昼平均血压DBP 80～ 89mmHg ;CBP组为DBP 80～ 89mmHg。全部病人同时口服ACEI制剂培哚普利每日 2～ 8mg,疗程六个月。 结果 两组病人血压都有不同程度的下降 ,CBP下降幅度CBP组大于ABP组 (17 3/ 11 7:15 5 / 12 2mmHg,P >0 0 5 )。ABPM各时间段血压下降幅度ABP组均大于CBP组 ,白昼平均血压下降ABP组为 14 2 / 8 1,CBP组为 13 8/ 7 2mmHg ,两组间无显著差异 ;ABP组服用培哚普利 4mg的病人数多于CBP组 (P =0 0 4 ) ,药物副作用ABP组低于CBP组。结论 应用ABPM指导抗高血压治疗较CBP更科学合理。

Objective To verify if antihypertensive treatment guided by ABPM can be of greater accuracy than that by CBP. Methods After 8 weeks placebo run-in period,450 patients (≥18 year) whose diastolic blood pressure (DBP) on CBP was 95-114 mmHg was randomized to CBP ( n =227) or ABP group ( n =223). All patients received ACEI perindopril 4-8 mg/d for six months. The dose stepwise profile was based on either the average daytime DBP (ABP group) or CBP DBP (CBP group). Investigators were blinded to the patients' randomized group. Results The decline of the mean 24 h,day and night BP value were greater in the ABP group. In the CBP group,more patients were received perindopril 8 mg/d while in ABP group less perindopril (4 mg/d,P =0.04) was given. The major side effect was cough,which was more often found in the CBP group ( P <0.001). Conclusion ABPM is preferable to CBP in the guide of management of hypertension.