不同服药方法对高血压患者降压有效性和平稳性的影响  

Impact of antihypertensive medication timing on degree and stability of blood pressure lowering in patients with essential hypertension

作　　者：穆春苓[1] 赵翠萍[1] 侯洁宁[1] 姜丽丝[1] 崔同强[1] 白冰[1] 

机构地区：[1]哈尔滨医科大学附属第一医院心内科,150001

出　　处：《中华心血管病杂志》2009年第11期1010-1013,共4页Chinese Journal of Cardiology

基　　金：基金项目：黑龙江省教育厅教育资助项目（11521157）

摘　　要：目的探讨不同服药方法对于高血压治疗有效性和平稳性的影响。方法采用随机、单盲、平行对照设计，对90例2级及以上原发性高血压患者，随机分为早晨服用非洛地平和缬沙坦组（A组30例，男15例，女15例），早晨服用缬沙坦晚上服非洛地平组（B组30例，男17例，女13例），早晨服用非洛地平晚上服缬沙坦组（C组30例，男16例，女14例），患者均于服药前及服药后2周进行动态血压监测求得平滑指数等指标。结果服药2周后，各组夜间时段及24h的平均收缩压的下降值依此为：19．3、28．8、30．5、22．9、28．3及29．1mmHg（1mmHg=0．133kPa）。组间比较，A组〈B组（P〈0．01），A组〈C组（P〈0．01），各组夜间时段及24h的平均动脉雎的下降值依次为：16．8、19．1、20．7、17．1、19．2及19．9mmHg。组间比较，A组〈B组（P〈0．05），A组〈C组（P〈0．01），以上各值A组与B组、A组与C组均有统计学意义，而B组与C组间数值上虽有差异，却无统计学意义（P〉0．05）。夜间及24h平均收缩压平滑指数各组依次为：2．43，3．12，3．22及1．92，2．49，2．27，组间比较，夜间平均收缩骶平滑指数A组〈B组（P〈0．01），A组〈C组（P〈0．01）；24h平均收缩压平滑指数A组〈C组（P〈0．01），A组〈B组（P〈0．01）；夜间及24h平均动脉压平滑指数依次为：4．20、4．74、4．91、2．69、3．08及3．26。组间比较A组〈B组（P〈0．05），A组〈C组（P〈0．01）；夜间舒张膻平滑指数分别为：2．52、3．66、3．12，组间比较A组〈B组（P〈0．01），A组〈C组（｜p〈0．05），以上各值A组与B组、A组与C组均有统计学意义，而以上各项平滑指数比较B组与C组间差异无统计学意义（P〉0．05）。结论联合用药的降压效果显著，甲晚分次服药较宁晨顿服两种约物能吏有效控制夜间血压，早晚分次服药使夜间及2Objective To investigate the impact of antihypertensive medication timing on degree and stability of blood pressure （BP） lowering in patients with moderate and severe essential hypertension. Methods Ninety patients were randomly assigned to take Valsartan and Felodiping together in the morning （group A）, Valsartan in the morning and Felodiping in the evening （group B） or Felodiping in the morning and Valsartan in the evening （ group C, n = 30 each）. The morning dosage was titrated if the goal blood pressure was not achieved. Ambulatory blood pressure monitoring （ABPM） was performed on the first and 14^th day of medication. Results The BP reductions during nighttime and twenty-four in group B and Chours were similar （P〉0.05） but were significant more than those in group A （P 〈0.05）. The smoothness indexes of mean systolic, mean arterial blood pressure during nighttime and twenty-four in group B and C were similar but significantly higher than that in group A （ P 〈 0.05 ）. The smoothness index of diastolic pressure at nighttime in group B and C was similar but significantly higher than that in group A （P 〈0. 05）. Conclusion More significant and stable antihypertensive effects could be achieved by taking the two antihypertensive medications separately in the morning and at evening compared that taken the two drugs together in the morning.

关 键 词：高血压 择时服药 治疗结果 

分 类 号：R686[医药卫生—骨科学]