小剂量氢氯噻嗪降压疗效影响因素分析  

Factors affecting antihyperteusive efficacy of low dose of hydrochiorthiazide.

作　　者：周永[1] 苗丽娟[2] 尹娜[3] 牛建清[4] 吴寿岭[4] 袁聚祥[2] 徐应军[2] 梁万年[2] 

机构地区：[1]首都医科大学公共卫生与家庭医学院,北京100069 [2]华北煤炭医学院 [3]首都医科大学卫生管理与教育学院 [4]华北煤炭医学院附属开滦医院

出　　处：《中国综合临床》2007年第4期297-299,共3页Clinical Medicine of China

摘　　要：目的 探讨影响小剂量氢氯噻嗪（HCTZ）降压疗效的因素。方法 829例高血压患者服用HCTZ12．5mg，1次／d，共6周。以资料完整的805例患者为对象分析影响HCTZ降压疗效的因素。结果 Ⅱ、ID、DD基因型患者收缩压下降值分别为5．4、4．4和12．2mmHg，DD基因型患者收缩压下降值大于Ⅱ及ID两型患者，差异有统计学意义（P〈0．05）。Ⅱ、ID、DD基因型患者平均动脉压下降值分别为3．9、3．6和6．9millHg，3组差异有统计学意义（P〈0．05）；3组患者舒张压下降值差异无统计学意义（P〉0．05）；DD型患者总有效率最高；DD型患者的显效率、有效率高于Ⅱ、ID两型患者（P〈0．05）；多元线性回归结果表明治疗前收缩压水平、DD基因型、治疗前醛固酮浓度影响收缩压下降水平；治疗前舒张压水平、治疗前醛固酮浓度、DD基因型影响舒张压下降值；治疗前平均动脉压水平、DD基因型、治疗前醛固酮浓度影响平均动脉压下降值。结论 不同ACE基因型患者对HCTZ的疗效存在差异，DD基因型患者降压疗效好于Ⅱ、ID两型患者；治疗前血压水平、醛固酮浓度与HCTZ的降压疗效有关。Objective To study the factors affecting antihyportensive efficacy of low dose of hydrochlorthiazide （HCTZ）. Methods 829 patients took HCTZ 12.5 mg once a day for six weeks. The factors affecting the efficacy were analyzed in 805 patients with full records. Results After 6 weeks treatment,the decrease in SBP of patients of DD genotypo was greater than those in other groups with Ⅱ or ID genotypes （ 12.2 mm Hg vs 5.4 mm Hg , 12.2 vs 4.4 mm Hg,respoctively,P 〈0.05 ）. The decrease in MAP of patients with DD genotypo was greater than that in other groups with Ⅱ or ID genotype （ 6.9 mm Hg vs 3.9 mm Hg ,6.9 mm Hg vs 3. 6mm Hg, respectively, P 〈 0.05 ）. There was no significant difference in the decrease of DBP （ P 〉 0.05 ）. The overall efficacy was the greatest in patients with DD genotype. In addition, the rate for showing efficacy and efficacy in patients with DD genotype were higher than those in patients with Ⅱ and ID genotypo （ P 〈 0.05 ）. The multilinear regression results showed that the SBP , DD genotypo and aldosterone level before treatment would influence the decrease level of SBP while the pretreatment DBP,aldosterone levels and DD genotype would influence the decrease level of DBP. The pre-treatment MAP, DD genotype,and aldosterone levels might affect the reduction of MAP. Conclusion The ACE genotypo is associated with hypotensive response to HCTZ. The response of DD genotypo patients is superior to those of Ⅱ and ID genotypo patients. The blood pressure and aldosterone level before treatment are associated with the response to HCTZ.

关 键 词：高血压 氢氯噻嗪 血管紧张素转换酶 基因型 

分 类 号：R544[医药卫生—心血管疾病]