联合大剂量缬沙坦对透析充分后顽固性高血压的疗效观察  

Efficacy of combined treatment with high dose of Valsartan in patients with resistant hypertension after fully hemodialysis

作　　者：李文宏[1] 殷玉敏[1] 何芸[1] 李慧[1] 刘军平[2] 

机构地区：[1]昆明医科大学附属延安医院肾内科,昆明650051 [2]昆明医科大学附属延安医院老年病科

出　　处：《临床心血管病杂志》2015年第3期314-317,共4页Journal of Clinical Cardiology

摘　　要：目的:探讨维持血透(MHD)患者透析充分后联合大剂量缬沙坦治疗顽固性高血压(RH)的临床疗效及安全性。方法:选取MHD合并透析充分后的RH患者60例,随机分为试验组和对照组,对照组给予足量硝苯地平控释片、美托洛尔缓释片、大剂量贝那普利(40mg/d)联合降压,试验组给予足量硝苯地平控释片、美托洛尔缓释片及大剂量缬沙坦(320mg/d)联合降压;比较两组第2、4、6周时收缩压(SBP)、舒张压(DBP)、收缩压下降幅度(ΔSBP)、舒张压下降幅度(ΔDBP)及血压控制达标情况。结果:两组第2周血压达标和未达标无差异(P>0.05),第4周和第6周试验组血压达标情况(第4周:50.0%;第6周:76.7%)优于对照组(第4周:33.3%;第6周:46.7%)(P<0.05),血红蛋白(HGB)和尿素清除指数(KT/V)的主体内效应检验和主体间效应检验比较,差异无统计学意义(P>0.05),收缩压下降幅度、舒张压下降幅度、收缩压及舒张压的主体内效应检验和主体间效应检验比较,差异有统计学意义(P<0.05),试验组高钾血症发生(6.7%)和对照组(20.0%)比较,差异无统计学意义(P>0.05)。结论:联合大剂量缬沙坦治疗MHD患者透析充分后RH,降压效果明显、安全性高,第4周后疗效尤为显著,为MHD患者透析充分后的RH治疗提供一个重要方案。Objective：To observer the efficacy and safety of combined with high dose of valsartan in maintain hemodialysis（MHD）patients with resistant hypertension（RH）therapy after dialysis fully.Method：To choose 60 patients of MHD with RH after dialysis fully,randomly divided into experimental group and control group.For experimental group,we give enough nifedipine,metoprolol extended release tablets,a large dose of valsartan（320mg/d）combining step-down.For control group,we give enough nifedipine,metoprolol extended release tablets,a large dose of benner pury（40 mg/d）combining step-down,to compare systolic blood pressure（SBP）,diastolic blood pressure（DBP）,systolic blood pressure decrease（ΔSBP）,diastolic blood pressure decrease（ΔDBP）,blood pressure compliance of two weeks,four weeks and six weeks.Result：Two weeks blood pressure compliance and non-compliance of experimental group and control group（P〈0.05）,four weeks and six weeks blood pressure compliance of experimental group（Rate of 4weeks：50.0%,rate of 6weeks：76.7%）are better than that of control group（Rate of 4weeks：33.3%,rate of 6weeks：46.7%）（P〈0.05）,Hemoglobin（HGB）and KT/V：inspection body effect test and main effect test have no significant differences（P〉0.05）,systolic blood pressure decrease,diastolic blood pressure decrease,systolic blood pressure and diastolic blood pressure：inspection body effect test and main effect test have significant differences（P〈0.050）,occur of hyperkalemia in experimental group（6.7%）and hyperkalemia in control group（20.0%）have no significant difference（P〉0.05）.Conclusion：The clinical efficacy of combined with high dose of valsartan in MHD patients with resistant hypertension therapy after dialysis fully is significant and safe,in particular,a significant effect after 4weeks,providing an important solution to treat MHD patients with resistant hypertension.

关 键 词：大剂量缬沙坦 维持血透 顽固性高血压 联合用药 

分 类 号：R544.1[医药卫生—心血管疾病]