不同血压控制目标和用药方案对老年心衰合并高血压患者预后的影响研究  

Study on influence of different blood pressure control goals and medication regimens on prognosis of elderly patients with heart failure complicated with hypertension

作　　者：单秀娟 袁培 SHAN Xiu-juan;YUAN Pei(Internal Medicine Department,Xuzhou Rehabilitation Hospital,Xuzhou 221000,China)

机构地区：[1]徐州市康复医院内科,221000

出　　处：《中国现代药物应用》2024年第13期23-27,共5页Chinese Journal of Modern Drug Application

摘　　要：目的分析不同血压控制目标和用药方案对老年心力衰竭(心衰)合并高血压患者预后的影响。方法选取150例老年心衰合并高血压患者,其中118例获得有效随访,按照入院时血压控制目标将118例患者分别纳入强化降压组[入院1 h内降压目标:收缩压<130 mm Hg(1 mm Hg=0.133 kPa);74例]、非强化降压组(入院1 h内降压目标:收缩压130~150 mm Hg;44例);另外按照出院时口服降压药物不同将其分别纳入A组(22例)、B组(27例)、C组(24例)、D组(25例)、E组(20例)。A组接受钙离子拮抗剂(CCB)联合血管紧张素转化酶抑制剂(ACEI)治疗,B组接受CCB联合血管紧张素Ⅱ受体拮抗剂(ARB)治疗,C组接受ACEI联合利尿剂治疗,D组接受ARB联合利尿剂治疗,E组接受CCB联合β受体阻滞剂(β-B)治疗。分析不同血压控制目标对患者预后的影响,以及不同用药方案对患者预后的影响。结果强化降压组与非强化降压组入组时左室射血分数(LVEF)、左室舒张末期内径(LVEDd)、左室收缩末期内径(LVESd)、氨基末端脑钠肽前体(NT-proBNP)、收缩压、舒张压、日间收缩压标准差(dSSD)、日间舒张压标准差(dDSD)、夜间收缩压标准差(nSSD)及夜间舒张压标准差(nDSD)比较,差异无统计学意义(P>0.05);随访6个月时,两组LVEF均较入组时升高,LVEDd、LVESd、NT-proBNP、收缩压、舒张压、dSSD、dDSD、nSSD、nDSD均较入组时下降,强化降压组LVEF(45.41±2.53)%高于非强化降压组的(42.08±2.96)%,LVEDd(46.51±2.44)mm、LVESd(32.98±1.89)mm、NT-proBNP(360.15±33.14)pg/ml、收缩压(133.28±16.47)mm Hg、舒张压(82.93±6.95)mm Hg、dSSD(8.67±1.62)mm Hg、dDSD(8.14±0.29)mm Hg、nSSD(7.28±2.03)mm Hg、nDSD(8.09±1.46)mm Hg均低于非强化降压组的(51.44±4.07)mm、(38.03±1.49)mm、(577.14±35.60)pg/ml、(145.23±12.39)mm Hg、(87.71±7.16)mm Hg、(10.62±2.45)mm Hg、(8.27±0.33)mm Hg、(9.51±1.37)mm Hg、(8.79±1.35)mm Hg,差异有统计学意义(P<0.05)。强化降压组随访1年内�Objective To analyze the influence of different blood pressure control goals and medication regimens on prognosis of elderly patients with heart failure complicated with hypertension.Methods A total of 150 elderly patients with heart failure combined with hypertension were selected,of which 118 cases were effectively followed up.According to the blood pressure control goals at the time of admission,the 118 patients were included in the intensive antihypertensive group[antihypertensive goal within 1 h of admission:systolic blood pressure<130 mm Hg(1 mm Hg=0.133 kPa);74 cases]and the non-intensive antihypertensive group(antihypertensive goal within 1 h of admission:systolic blood pressure 130-150 mm Hg;44 cases);in addition,they were included in group A(22 cases),group B(27 cases),group C(24 cases),group D(25 cases),and group E(20 cases)according to the difference of antihypertensive medications taken at the time of discharge.Group A received calcium channel blocker(CCB)combined with angiotensin-converting enzyme inhibitor(ACEI),group B received CCB combined with angiotensinⅡreceptor blockers(ARB),group C received ACEI combined with diuretic,group D received ARB combined with diuretic,and group E received CCB combined withβ-blocker(β-B).The influence of different blood pressure control objectives on the prognosis of patients was analyzed,and the influence of different medication regimens on the prognosis of patients.Results The left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd),amino-terminal pro-brain natriuretic peptide(NT-proBNP),systolic blood pressure,day systolic blood pressure standard deviation(dSSD),day diastolic blood pressure standard deviation(dDSD),night systolic blood pressure standard deviation(nSSD)and night diastolic blood pressure standard deviation(nDSD)were compared between the intensive antihypertensive group and the non-intensive antihypertensive group,and there was no significant difference(P>0.05).At 6 mon

关 键 词：血压控制目标 用药方案 心力衰竭合并高血压 预后 老年 

分 类 号：R544.1[医药卫生—心血管疾病] R541.6[医药卫生—内科学]