苯磺酸氨氯地平联合缬沙坦夜间给药对夜间高血压患者的疗效及肾功能的影响  

Efficacy of Evening Medication of Valsartan on Blood Pressure and Renal Function in Patients With Abnormal Nocturnal Blood Pressure

作　　者：徐勤伟[1] 廉哲勋[2] 

机构地区：[1]青岛大学医院院,山东省青岛市266000 [2]青岛大学附属医院心内科

出　　处：《中国循环杂志》2017年第5期457-460,共4页Chinese Circulation Journal

摘　　要：目的:探讨苯磺酸氨氯地平联合缬沙坦夜间给药对夜间高血压患者的血压和肾功能指标的影响。方法:将87例服用4周苯磺酸氨氯地平疗效不佳的夜间高血压患者随机分为对照组(43例)和观察组(44例),对照组患者在服用磺酸氨氯地平的基础上早晨给予口服缬沙坦(80~160 mg/次,1次/d),观察组患者在服用磺酸氨氯地平的基础上晚上给予口服缬沙坦(80~160 mg/次,1次/d),均连续治疗8周。通过检测24 h动态血压观察两组患者治疗前后白天和夜间血压水平及肾功能指标的变化,并观察不良反应发生情况。结果:观察组患者白天和夜间平均收缩压(SBP)、舒张压(DBP)水平均较治疗前明显降低[白天平均SBP:(132.16±9.04)mmHg vs(152.52±10.73)mmHg;白天平均DBP:(83.06±8.04)mmHg vs(98.49±8.74)mmHg;夜间平均SBP:(131.73±10.10)mmHg vs(141.12±12.27)mmHg;夜间平均DBP:(75.87±7.47)mmHg vs(85.83±8.51)mmHg],并且治疗后,观察组患者夜间SBP、DBP水平低于对照组[SBP:(115.45±9.78)mmHg vs(131.73±10.10)mmHg,DBP:(67.26±7.15)mmHg vs(75.87±7.47)mmHg],差异有统计学意义(P<0.05);治疗后两组患者白天SBP和DBP无差异。治疗后观察组患者血清肾功能水平有明显改善,观察组患者血清尿素氮(BUN)、血肌酐(Cr)和尿β2-微球蛋白(β2-MG)水平均低于对照组[BUN:(4.47±0.95)mmol/L vs(5.06±1.08)mmol/L,血Cr(78.15±8.51)μmol/L vs(83.46±8.04)μmol/L,β2-MG:(2.78±0.74)mg/L vs(3.37±0.88)mg/L,P均<0.05],估计肾小球滤过率(eGFR)高于对照组[(81.57±9.54)ml/(min·1.73 m^2)vs(61.18±13.34)ml/(min·1.73 m^2),P<0.05];观察组患者不良反应发生率为6.82%,与对照组(4.65%)比较无明显差异(P>0.05)。结论:苯磺酸氨氯地平联合缬沙坦夜间药物治疗可有效控制夜间血压水平,改善肾功能,且不增加不良反应。Objective： To explore the efficacy of evening medication of amlodipine combining valsartan on blood pressure （BP） and renal function in patients with abnormal nocturnal blood pressure. Methods： A total of 87 abnormal nocturnal BP patients without ideal efficacy by 4 weeks amlodipine therapy were randomly divided into 2 groups： Control group, based on amlodipine therapy, the patients received morning valsartan （80-160） mg, qd, n=43 and Observation group, based on amlodipine therapy, the patients received evening valsartan （80-160） mg, qd, n=44. All patients were treated for 8 weeks. Pre- and post-medication BP at day and night were observed by 24h ambulatory BP monitoring, the renal function was measured and the incidence of adverse events was recorded. Results： In Observation group： compared with pre-medication, the average day and night systolic BP （SBP） and diastolic BP （DBP） were decrease at post-medication; compared with Control group, Observation group had the lower night SBP and DBP, P〈0.05; the day SBP and DBP were similar between 2 groups after medication. At post-medication, compared with Control group, Observation group presented improved renal function as decreased blood levels of BUN, Cr, D2-MG and increased eGFR, all P〈0.05. The incidence of adverse events were similar between Observation group and Control group （6.28% vs 4.65%）, P〉0.05. Conclusion： Evening medication of amlodipine combining valsartan may effectively control night BP and improve renal function in patients with abnormal nocturnal BP; it didn＇t elevate the incidence of adverse events.

关 键 词：高血压 血管紧张素受体拮抗药 钙通道阻滞剂 

分 类 号：R54[医药卫生—心血管疾病]