降压药物联合使用三组方案的随机双盲研究  

A randomized and double-blind study on the combined use of three antihypertensive drugs

作　　者：朱轼[1] 

机构地区：[1]成都市第一人民医院心血管病研究室,610016

出　　处：《中华心血管病杂志》1999年第5期367-371,共5页Chinese Journal of Cardiology

基　　金：成都市科委重点资助课题

摘　　要：目的　观察不同降压药物小剂量联合使用的综合疗效。方法　采用前瞻性随机双盲研究 ,经 2周洗脱期后 ,随机分为 3组 :卡托普利 +尼群地平 (卡尼组 ,171例 ) ;卡托普利 +氨酰心安 (卡氨组 ,171组 ) ;尼群地平 +氨酰心安 (尼氨组 ,173例 )。平均每日剂量 :卡托普利 4 5mg ,氨酰心安 2 6mg ,尼群地平 18mg。随访 6个月 ,观察疗效、副作用及对生活质量的影响。结果　各组用药 1周即开始降压 ,1个月时已十分显著 ,3个月时达峰值 ,6个月时效果仍持续 ,无回升现象。但起效时间、降压幅度、降压绝对值有一定差异 ,以尼氨组最好 ,血压达标率 78 8%。累计不良反应发生率各组相近 ,但主要副作用各组间有明显差异。卡尼、卡氨组咳嗽发生率分别为 3 2 5 %、2 3 9% ,尼氨组乏力 15 %、面部潮红 13 5 % ,踝部水肿 12 %。三组药物对生活质量均无负面影响 ,卡尼组改善幅度最佳 ,依从性最好。结论　小剂量的三种组合均可有效降压 ,降压效果以尼氨组最佳 ,而卡尼组的累计药物副作用、生活质量改善及依从性相对更好。Objective To compare the antihyptensive efficacy and safety of various combination therapy for hypertensive patients, based on captopril, nitrendipine and atenolol Methods In a randomized, double blind study, after a placebo run in period, 515 men and women with blood pressure≥ 140/90 mm Hg (1 mm Hg=0 133 kPa) were assigned to one of the three treatment groups, stratified by age (≥60 yrs, <60 yrs) (1) Captopril (C) plus nitrendipine (N) group (CNG, n=171, mean dose C 45 mg/d, N 18 mg/d); (2) Captopril plus atenolol (A) group (CAG,n=171, mean dose C 45 mg/d, A 26 mg/d); (3) Nitrendipine plus atenolol group (NAG, n=173, mean dose N18 mg/d, A 26 mg/d) The antihypertensive efficacy, safety, adverse reactions, and QOL (guality of life) were investigated over a period of 6 months Results There were no significant differences of age and blood pressure between groups The blood pressures were reduced by (mm Hg, ±SD ) 35 0± 16 5/14 0±10 2, 31 6±13 6/14 2±10 5 and 37 2±15 2/16 1±9 7 in CNG, CAG and NAG, respectively with control rate (<140/90 mm Hg) of 70 6% (CNG), 64 3% (CAG) and 78 8%(NAG). The total side effects were similar and mild in all of the three groups, but the main symptoms and the percentage of withdrawal from drugs were significantly different between groups The compliance and quality of life in patients have been improved in all groups No significant changes were found in laboratory data Conclusion It is suggested that all of the three groups of low dose combination therapy in this study are safe, effective in lowcring blood pressure Both compliance and QOL are improved, and the side effects are mild The effect of CAG was relative less than CNG and NAG in a total

关 键 词：高血压 药物疗法 降压药 联合用药 

分 类 号：R544.105[医药卫生—心血管疾病] R972.4[医药卫生—内科学]