药物干预恢复非杓型高血压患者血压昼夜节律对血浆内皮素的影响  

The effects of pharmacotherapy to reconvert non-dipper essential hypertensive patients circadian rhythm of blood pressure on plasma concentration of endothelin

作　　者：周万兴[1] 张卫[1] 文薇[2] 靳晨亭[1] 马虹[3] 

机构地区：[1]广州铁路中心医院心内科,广州市510080 [2]广州铁路中心医院放免室,广州市510080 [3]中山医科大学附属第一医院心内科

出　　处：《岭南心血管病杂志》2001年第5期335-338,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的　探讨通过药物干预使非杓型高血压患者恢复杓型血压昼夜节律后对血浆内皮素 (ET)的影响。方法　 30例 (年龄 6 4 8岁± 11 38岁 ,男 2 2例 ,女 8例 )符合WHO 1999年原发性高血压标准 ,并经动态血压检查定义为非杓型的高血压患者 (非杓型组 )随机分成两组 ,采用自身对照交叉试验法 ,在总剂量及药物种类 (硝苯吡啶缓释片及依那普利 )不变的前提下 ,通过调整用药时间加强夜间降压恢复杓型节律 (a处理 )或按常规的日间降压不恢复 (或保持 )杓型节律 (b处理 )。第一阶段两组分别接受其中一种处理 ,第二阶段分别接受另一种处理。用放免法同步测定每一处理前后的夜间 (2 :0 0 )、日间 (8:0 0 )血浆ET并复查动态血压。同期的健康体检者 45例 (健康对照组 )以及 2 1例同期住院的杓型高血压患者 (杓型组 )作为对照组。比较非杓型组血压昼夜节律恢复后前后ET的水平。结果　与健康对照组比 ,非杓型高血压患者白天及夜间平均血压、ET均显著增高〔分别为 (97 93± 11 6 7)mmHgvs (92 0 0± 7 34)mmHg ;P =0 0 17;(96 96± 12 31)mmHgvs(77 82± 6 35 )mmHg ;(85 2 5± 2 6 97)pg/mLvs (5 9 32± 2 7 6 1)pg/mL ;(78 6 2± 31 17)pg/mLvs(49 89± 2 3 6 4)pg/mL ;P均 <0 .0 1〕。血压恢复杓型后 ,夜间平均?Objective To invesigate the effects of pharmacotherapy to reconvert non dipper essential hypertensive patients circadian rhythm of blood pressure on plasma concentration of endothelin(ET). Methods A randomized two stage cross over trial covering 10 days was used in the study. 30 patients (age 64.8±11.38 years, 22 male and 8 female) with essential hypertension (according with the criteria issued by WHO in 1999) and non dipper circadian rhythm of blood pressure defined by 24 hours ambulatory blood pressure monitoring(ABPM), were randomized to two groups. Each group in stage 1, first received one of the two regimens: reconverted or notreconverted dipper circadian rhythm by adjustment of medicine (used nifedepine SR and enalapril) in nighttime without changing the total amount during the whole day. In stage 2, each group took the other regimen for another 10 days. The daytime(8AM) and nighttime (2AM) ET were measured by radioimmunoassay and 24 hour blood pressures were measured before and after each regimen. 45 healthy subjects and 21 inpatients with dipper essential hypertension were included in healthy and dipper control groups respectively.Results The levels of daytime and nighttime mean blood pressure and ET were higher signifi cantly in non dipper essential hypertensive patients than those of healthy control group [(97.93±11.67) mmHg vs (92.00±7.34) mmHg; P =0.017; (96.96±12 31) mmHg vs (77.82±6.35) mmHg; (85.25±26 97) pg/mL vs (59.32±27.61) pg/mL; (78.62±31.17) pg/mL vs (49.89±23.64) pg/mL; P <0.01, respectively]. The levels of nighttime and daytime ET were higher significantly in non dipper essential hypertensive patients than those in dipper essential hypertensive patients. The level of ET in non dipper group was higher than that in dipper group, but the difference was not statistically significant ( P =0.17, P =0.23, respectively). With the non dippers converting to the dippers, mean blood pressures and ET on nighttime were decreased significantly ( P <0.01), but t

关 键 词：非杓型高血压 血压昼夜节律 血浆内皮素 药物治疗 ET 

分 类 号：R544.1[医药卫生—心血管疾病]