严格血压控制对1级高血压合并糖尿病老老年患者尿微量白蛋白的影响  

The effects of strictly control blood pressure on microalbuminuria in very elderly patients with diabetes and grade 1 hypertension

作　　者：方砚[1] 马丽雅[1] 方金瑞[1] 马慧元[1] 苏鹏[1] 

机构地区：[1]甘肃省人民医院干3科,兰州730000

出　　处：《中华高血压杂志》2011年第12期1142-1146,共5页Chinese Journal of Hypertension

摘　　要：目的探讨将收缩压控制在140mmHg以下对1级高血压合并2型糖尿病80岁以上高龄老人尿微量白蛋白的影响。方法 1级高血压合并2型糖尿病伴尿微量白蛋白阳性老老年(≥80岁)门诊或住院患者70例,按就诊顺序随机分降压治疗组(35例)和常规治疗组(35例),降压治疗组在常规治疗的基础上加服厄贝沙坦(150mg/d),根据血压水平加用氨氯地平2.5～5.0mg/d,使血压平稳控制在120～140/60～80mmHg;常规治疗组仅常规治疗,常规治疗包括调脂(阿托伐他汀,10mg/d)、降糖等,不接受任何降压治疗。疗程6月。监测两组治疗前后血压、24h尿微量白蛋白、血钾、血肌酐结果。结果常规治疗组治疗前后血压、尿微量白蛋白、血肌酐差异无统计学意义(P>0.05)。降压治疗组血压较治疗前降低[收缩压(126.9±3.8)比(148.5±3.6)mmHg;舒张压(69.9±4.1)比(76.0±5.2)mmHg;P<0.01],降压治疗组尿微量白蛋白较治疗前降低[(63.1±15.6)比(130.8±35.3)mg/d,P<0.01],降压治疗组血肌酐较治疗前降低(P<0.05)。降压治疗组治疗前后收缩压差值与治疗前后尿微量白蛋白差值呈正相关(P<0.01)。两组治疗前后血钾比较,差异无统计学意义。结论以厄贝沙坦为基础的降压方案能改善1级高血压合并糖尿病的老老年患者的早期肾损害。Objective To investigate the effects of controlling strictly systolic blood pressure（SBP）under 140mm Hg on microalbuminuria（MAU）in very elderly patients with diabetes and grade 1hypertension and diabetes.Methods Seventy cases of very elderly（aged 80years and over）outpatients and inpatients with grade 1hypertension,type 2diabetes and positive MAU were randomized into antihypertensive treatment group（35cases）and routine treatment group（35cases）by their clinic sequences.The former subjects were treated with amlodipine（2.55.0mg/d）when necessary and irbesartan（150mg/d）besides routine treatment to maintain BP at the normal range 120-140/60-80 mm Hg.And the latter patients without antihypertensive therapy received atorvastatin（10mg/d）and hypoglycemic treatment only.The course lasted for 6months in both groups.The results of BP,24hMAU,blood potassium and blood creatinine were compared before and after treatment.Results In routine treatment group,no significant differences of BP,MAU and blood creatinine were found before and after treatment（P0.05）.In antihypertensive treatment group,BP and MAU after treatment were significantly lower as compared with those before treatment[SBP（126.9±3.8）vs（148.5±3.6）mm Hg;DBP（69.9±4.1）vs（76.0± 5.2）mm Hg;MAU（130.8±35.3）vs（63.1±15.6）,all P0.01],blood creatinine concentrations were also reduced after treatment than those before（P0.05）.BP difference was positively correlated with the decreased rate of MAU before and after treatment in antihypertensive treatment group（P0.01）.There were no significant difference in blood potassium levels before and after treatment in both groups.Conclusion Irbesartan-based antihypertensive treatment was effective in improving early renal damage in very elderly diabetic grade 1hypertensives.

关 键 词：1级高血压 尿微量白蛋白 糖尿病 降压治疗 老老年 

分 类 号：R544.1[医药卫生—心血管疾病] R587.1[医药卫生—内科学]