睡前服药对原发性高血压患者血压昼夜节律的影响  

Impact of taking medicine before sleeping on circadian rhythm of blood pressure of primary hypertension patients

作　　者：杜屏[1] 王观宇[1] 高海来[1] 

机构地区：[1]哈尔滨市第一医院心内科,黑龙江哈尔滨150010

出　　处：《中国急救医学》2013年第3期243-245,共3页Chinese Journal of Critical Care Medicine

基　　金：黑龙江省卫生厅资助项目（2011-511）

摘　　要：目的评价睡前服药对原发性高血压患者血压昼夜节律的影响。方法选择符合中国高血压指南2005年版高血压诊断标准、除外继发性高血压、确诊为原发性高血压的患者，根据24小时动态血压监测结果，分为杓型血压模式60例（A组）和非杓型血压模式60例（B组）。每组再随机分为晨起一次给药组30例（1组）、睡前给药或早晚分次给药组30例（2组）。根据诊室血压调整降压药物种类及剂量，目标血压为140／90mmHg以下。8周后复查24h动态血压，观察各组用药前后24h动态血压参数及夜间血压下降百分率变化。结果无论杓型血压组及非杓型血压组，两种给药方法均能显著降低dSBP、dDBP、nSBP、nDBP（P〈0．05）。治疗后仍保持杓型血压节律的比例A1组为36．6％，A2组为66．6％（P〈0．05）。夜间血压下降百分率呈升高趋势的比例B1组为43．3％，B2组为73．3％（P〈0．05）。结论对于非杓型血压模式的原发性高血压患者，睡前服药有利于其向杓型血压模式转换；而对于杓型血压模式的原发性高血压患者，在维持杓型节律方面，睡前给药或早晚分次给药优于晨起一次给药。Objective To evaluate the impact of taking medicine before sleeping on the circadian rhythm of blood pressure of primary hypertension patients. Methods The primary hypertension patients were diagnosed according to the hypertension standards in China 2005 edition without secondary hypertension. These primary hypertension patients accepted the ambulatory blood pressure monitoring, then were randomly divided into two groups： dipper pressure group （group A） and non- dipper pressure group （group B ）. Each group had 60 subjects. Each group was divided to 2 groups, one group taking the medicine in the morning （ A1, B1 ）, the other group taking medicine before sleeping or both morning and before sleeping （ A2, B2 ）. The types and doses of the medicine were adjusted to control the blood pressure lower than 140/90 mm Hg. Ambulatory blood pressure monitoring was applied again after 8 weeks. The changes of 24 h ambulatory blood pressure index and decreased ratio of night blood pressure were observed. Results In dipper group and non - dipper group, two methods of taking medicine could decrease dSBP, dDBP, nSBP, nDBP significantly （P 〈 0.05 ）. After the chronotherapy, 36.6% patients in A1 group still kept dipper pattern, while 66.6% in the A2 group （P 〈0.05 ）. 43.3% in B1 group showed the ratio of decreasing percentage of night blood pressure increased, while 73.3% in B2 group （ P 〈 0.05 ）. Conclusion Taking medicine before sleeping can help the non - dipper primary hypertension patients change to dipper pattern. While in the dipper pattern primary hypertension group, taking medicine before sleeping or beth morning and before sleeping are better than taking medicine in the morning in keeping the dipper pattern.

关 键 词：时间治疗学 血压昼夜节律 晨起服药 睡前服药 

分 类 号：R544.1[医药卫生—心血管疾病]