苯磺酸左旋氨氯地平不同时间给药对非杓型高血压患者血压及昼夜节律和血管内皮功能的影响  

Effects of Levamlodipine Besylate Administered at Different Times on Blood Pressure,Circadian Rhythm and Vascular Endothelial Function in Patients with Non-Dipper Hypertension

作　　者：彭金华 王平 颜友良[1] 王贵明[1] 邓雨晴[1] 郑丹[1] 杨桦 陈晖[1] PENG Jin-hua;WANG Ping;YAN You-liang;WANG Gui-ming;DENG Yu-qing;ZHENG-Dan;YANG-Hua;CHEN Hui(The First Department of Cardiology,the Third Affiliated Hospital of Nanchang University,Nanchang 330008,China)

机构地区：[1]南昌大学第三附属医院心内一科

出　　处：《南昌大学学报（医学版）》2019年第5期35-39,共5页Journal of Nanchang University：Medical Sciences

基　　金：南昌市指导性科技计划项目(洪科发计字[2016]233号第8项)

摘　　要：目的探讨不同时间苯磺酸左旋氨氯地平给药对非杓型高血压患者血压及昼夜节律和血管内皮功能的影响。方法入选100例非杓型高血压1—2级患者,按随机数字表法分为晨起服药组(A组,n=50例)和睡前服药组(B组,n=50例),所有患者服用苯磺酸左旋氨氯地平2.5 mg,连续服用24周。在服药前、服药第24周末进行24 h动态血压监测及血管内皮功能检测。结果1)与服药前比较,2组患者服药后均能降低24 h平均收缩压(24 h SBP)、24 h平均舒张压(24 h DBP)、白天平均收缩压(dSBP)、白天平均舒张压(dDBP)、夜间平均收缩压(nSBP)和夜间平均舒张压(nDBP),差异有统计学意义(均P<0.05);服药后B组患者nSBP、nDBP明显低于A组(均P<0.05)。2)A组服药后杓型血压恢复率(由非杓型纠正为杓型)为16.0%,B组服药后杓型血压恢复率为50.0%,组间比较差异有统计学意义(P<0.05)。3)与服药前比较,2组患者服药后血清一氧化氮(NO)水平均明显升高,血清内皮素(ET)水平明显降低,肱动脉血流介导的血管舒张功能(FMD)水平明显升高(均P<0.05);与A组比较,B组患者服药后NO水平升高、ET水平降低、FMD水平升高,差异均有统计学意义(均P<0.05)。结论非杓型高血压患者睡前服用苯磺酸左旋氨氯地平可以有效降低血压,改善高血压患者的血压昼夜节律,同时通过增加血管内皮NO的合成和释放及降低ET水平改善血管内皮功能。Objective To investigate the effects of levamlodipine besylate administered at different times on blood pressure,circadian rhythm and vascular endothelial function in patients with non-dipper hypertension.Methods A total of 100 patients with stage 1-2 non-dipper hypertension were randomly divided into two groups:early-morning medication group(group A,n=50)and bedtime medication group(group B,n=50).All patients received levamlodipine besylate 2.5 mg/day for 24 weeks.Vascular endothelial function detection and 24-hour ambulatory blood pressure monitoring were performed before medication and at the end of treatment for 24 weeks.Results After medication,both groups showed significant decrease in average 24-hour systolic blood pressure(SBP),24-hour diastolic blood pressure(DBP),daytime SBP(dSBP),daytime DBP(dDBP),nocturnal SBP(nSBP)and nocturnal DBP(nDBP)(P<0.05).Compared with group A,both nSBP and nDBP decreased in group B after medication(P<0.05).Furthermore,the rate of conversion from non-dipper to dipper hypertension in group A(16.0%)was lower than that in group B(50.0%)(P<0.05).After medication,serum nitric oxide(NO)levels and brachial artery blood flow-mediated dilation(FMD)increased but endothelin(ET)levels decreased in both groups(P<0.05).Compared with group A,serum NO levels and FMD were elevated but ET levels were reduced in group B(P<0.05).Conclusion Bedtime administration of levamlodipine besylate can lower blood pressure,improve circadian blood pressure rhythm,and ameliorate vascular endothelial function through increasing the synthesis and release of NO and reducing the levels of ET.

关 键 词：时间治疗学 苯磺酸左旋氨氯地平 非杓型高血压 血压 昼夜节律 血管内皮功能 

分 类 号：R544.1[医药卫生—心血管疾病]