氨氯地平及达爽对高血压患者血压昼夜变化规律的影响
안록지평급체상대고혈압환자혈압주야변화규률적영향
Effect of Norvasc and Tanatril on circadian rhythm of blood pressure in hypertensive patients
  • 万方数据
    中国地方病学杂志 중국지방병학잡지
    CHINESE JOURNAL OF ENDEMIOLOGY
    2010年 4期 457-460 ,共4页

    李莹%周泠淇%杜屏%郭吉伟%王大鹏%邓丽华%翟旭华%王观宇%孟繁超

    리형%주령기%두병%곽길위%왕대붕%산려화%적욱화%왕관우%맹번초

    高血压%络活喜%达爽%血压监测,便携式%治疗结果 高血壓%絡活喜%達爽%血壓鑑測,便攜式%治療結果
    고혈압%락활희%체상%혈압감측,편휴식%치료결과
    Hypertension%Norvasc%Tanatril%Blood pressure monitoring,ambulatory%Treatment outcome
    目的 观察高血压患者血压昼夜变化节律,并按照时间治疗学的原则,探讨氨氯地平(络活喜)及达爽在不同给药时间对高血压患者血压昼夜规律的影响.方法 130例2级或3级高血压患者来源于2008年5月-2009年11月在哈尔滨市第一医院心内科门诊及住院治疗的病人.在监测24 h动态血压后,根据动态血压昼夜变化节律将病人分为杓型和非杓型.杓型(n=34)血压者晨起(6:00)一次性给予达爽5mg、络活喜5mg;非杓型血压者均衡性别、年龄因素后分为3组,Ⅰ组(n=30)晨起(6:00)给予达爽5mg、络活喜5mg;Ⅱ组(n=32)晨起(6:00)给予达爽5 mg,晚间(18:00)给予络活喜5 mg;Ⅲ组(n=34)晨起(6:00)给予络活喜5 mg,晚间(18:00)给予达爽5 mg.4周后,复查24 h动态血压(1 Pa=13.3 mmHg),分析治疗前后24 h平均收缩压(24hSBP)、24 h平均舒张压(24 hDBP);白天、夜间平均收缩压(dSBP,nSBP);白天、夜间平均舒张压(dDBP,nDBP).结果 ①杓型血压者晨起一次给药,24 hSBP、24 hDBP和dSBP、dDBP分别由(154.3±5.6)、(95.4±3.1)mmHg和(158.7±6.5)、(99.6±3.7)mmHg下降至(137.2±3.9)、(82.5±2.7)mmHg和(139.7±3.8)、(85.2±3.5)mmHg(t值分别为2.124、2.356,2.278、2.449,P均<0.05).②非杓型Ⅰ、Ⅱ、Ⅲ组高血压患者治疗后24 hSBP[(139.6±4.1)、(134.5±4.6)、(133.4±3.5)mmHg]和24 hDBP[(83.5±4.2)、(80.8±5.6)、(81.6±4.7)mmHg]与治疗前[(154.4±6.1)、(156.7±6.7)、(156.6±5.2)mmHg和(95.8±2.8)、(94.9±3.8)、(95.7±3.2)mmHg]比较明显下降(t值分别为2.038、2.040、2.135,2.142、2.213、2.216,P均<0.05);治疗后dSBP[(138.9±5.4)、(136.7±4.1)、(137.4±6.4)mmHg]和dDBP[(85.8±5.3)、(83.6±5.1)、(83.9±5.2)mmHg]与治疗前[(158.6±3.5)、(158.4±5.6)、(159.5±4.3)mmHg和(98.4±3.7)、(99.6±3.7)、(83.9±5.2)mmHg]比较明显下降(t值分别为2.021、2.252、2.261,2.217、2.167、2.076,P均<0.05);治疗后nSBP[(133.7±4.6)、(129.8±5.7)、(127.6±2.8)mmHg]和nDBP[(87.8±2.9)、(78.5±6.4)、(77.8±4.8)mmHg]与治疗前[(146.7±6.9)、(149.8±3.9)、(150.2±4.1)mmHg和(93.7±4.2)、(95.7±4.3)、(93.4±3.3)mmHg]比较明显下降(t值分别为1.798、2.032、2.014,1.864、2.157、2.166,P均<0.05).治疗后nSBP、nDBP,Ⅰ、Ⅱ、Ⅲ组组间比较差异有统计学意义(F值分别为2.32、2.17,P均<0.05);其中Ⅱ组和Ⅲ组效果优于Ⅰ组(q值分别为3.17、4.03,3.32、4.19,P均<0.05),但Ⅱ组和Ⅲ组间效果相似(P>0.05).结论 高血压患者应重视血压节律的检测,杓型血压者晨起一次给药即可有效控制血压;非杓型者早晚分次给药较晨起顿服两种药物更能有效控制患者的夜间血压,达到有效平稳降压.
    목적 관찰고혈압환자혈압주야변화절률,병안조시간치료학적원칙,탐토안록지평(락활희)급체상재불동급약시간대고혈압환자혈압주야규률적영향.방법 130례2급혹3급고혈압환자래원우2008년5월-2009년11월재합이빈시제일의원심내과문진급주원치료적병인.재감측24 h동태혈압후,근거동태혈압주야변화절률장병인분위표형화비표형.표형(n=34)혈압자신기(6:00)일차성급여체상5mg、락활희5mg;비표형혈압자균형성별、년령인소후분위3조,Ⅰ조(n=30)신기(6:00)급여체상5mg、락활희5mg;Ⅱ조(n=32)신기(6:00)급여체상5 mg,만간(18:00)급여락활희5 mg;Ⅲ조(n=34)신기(6:00)급여락활희5 mg,만간(18:00)급여체상5 mg.4주후,복사24 h동태혈압(1 Pa=13.3 mmHg),분석치료전후24 h평균수축압(24hSBP)、24 h평균서장압(24 hDBP);백천、야간평균수축압(dSBP,nSBP);백천、야간평균서장압(dDBP,nDBP).결과 ①표형혈압자신기일차급약,24 hSBP、24 hDBP화dSBP、dDBP분별유(154.3±5.6)、(95.4±3.1)mmHg화(158.7±6.5)、(99.6±3.7)mmHg하강지(137.2±3.9)、(82.5±2.7)mmHg화(139.7±3.8)、(85.2±3.5)mmHg(t치분별위2.124、2.356,2.278、2.449,P균<0.05).②비표형Ⅰ、Ⅱ、Ⅲ조고혈압환자치료후24 hSBP[(139.6±4.1)、(134.5±4.6)、(133.4±3.5)mmHg]화24 hDBP[(83.5±4.2)、(80.8±5.6)、(81.6±4.7)mmHg]여치료전[(154.4±6.1)、(156.7±6.7)、(156.6±5.2)mmHg화(95.8±2.8)、(94.9±3.8)、(95.7±3.2)mmHg]비교명현하강(t치분별위2.038、2.040、2.135,2.142、2.213、2.216,P균<0.05);치료후dSBP[(138.9±5.4)、(136.7±4.1)、(137.4±6.4)mmHg]화dDBP[(85.8±5.3)、(83.6±5.1)、(83.9±5.2)mmHg]여치료전[(158.6±3.5)、(158.4±5.6)、(159.5±4.3)mmHg화(98.4±3.7)、(99.6±3.7)、(83.9±5.2)mmHg]비교명현하강(t치분별위2.021、2.252、2.261,2.217、2.167、2.076,P균<0.05);치료후nSBP[(133.7±4.6)、(129.8±5.7)、(127.6±2.8)mmHg]화nDBP[(87.8±2.9)、(78.5±6.4)、(77.8±4.8)mmHg]여치료전[(146.7±6.9)、(149.8±3.9)、(150.2±4.1)mmHg화(93.7±4.2)、(95.7±4.3)、(93.4±3.3)mmHg]비교명현하강(t치분별위1.798、2.032、2.014,1.864、2.157、2.166,P균<0.05).치료후nSBP、nDBP,Ⅰ、Ⅱ、Ⅲ조조간비교차이유통계학의의(F치분별위2.32、2.17,P균<0.05);기중Ⅱ조화Ⅲ조효과우우Ⅰ조(q치분별위3.17、4.03,3.32、4.19,P균<0.05),단Ⅱ조화Ⅲ조간효과상사(P>0.05).결론 고혈압환자응중시혈압절률적검측,표형혈압자신기일차급약즉가유효공제혈압;비표형자조만분차급약교신기돈복량충약물경능유효공제환자적야간혈압,체도유효평은강압.
    Objective To observe the circadian rhythm of blood pressure and investigate the impact of Norvasc and Tanatril administrated at different time points based on the theory of time therapeutics in hypertensive patients. Methods The 24-hour ambulatory blood pressure was monitored in 130 inpatients and outpatients with grade 3 or 2 hypertension from May 2008 to November 2009. A total of 34 dipper hypertensive patients were grouped into dipper blood pressure group and 5 mg/d of Norvasc and Tanatril were taken by them at 6:00 AM. A total of 96 nondipper hypertensive patients were further divided into three subgroups after adjustment for age and gender: 5 mg/d of Norvasc and Tanatril were taken by group I (n = 30) at 6:00 AM; 5 mg/d of Tanatril at 6:00 AM and 5 mg/d of Norvasc at 18:00 PM by group Ⅱ (n = 32); 5 mg/d of Norvasc at 6:00 AM and 5 mg/d of Tanatrilat 18:00 PM by group Ⅲ(n=34).The 24-hour ambulatory blood pressure monitoring was performed again after four weeks treatment and 24-hour mean systolic blood pressure(24 hSBP),24-hour mean diastolic blood pressure(24 hDBP),daytime and nighttime mean systolic blood pressure(dSBP,nSBP)and daytime and nighttime mean diastolic blood pressure(dDBP,nDBP),were analyzed.Results The 24 hSBP,24 hDBP and dSBP,and dDBP were reduced from(154.3±5.6),(95.4±3.1),(158.7±6.5),(99.6±3.7)mmHg to(137.2±3.9),(82.5±2.7),(139.7±3.8),(85.2±3.5)mmHg,respectively,in dipper blood pressure group(t=2.124,2.356,2.278,2.449,all P<0.05).The 24 hSBP and 24 hDBP of the three groups in nondipper blood pressure were decreased from(154.4±6.1),(156.7±6.7),(156.6±5.2),(95.8±2.8),(94.9±3.8),(95.7±3.2)mmHg to (139.6±4.1),(134.5±4.6),(133.4±3.5),(83.5±4.2),(80.8±5.6),(81.6±4.7)mmHg,respectively(t=2.038,2.040,2.135,2.142,2.213,2.216,all P<0.05).dSBP and dDBP were decreased from(158.6±3.50),(158.4±5.6),(159.5±4.),(98.4±3.7),(99.6±3.7),(83.9±5.2)mmHg to(138.9±5.4),(136.7±4.1),(137.4±6.4),(85.8±5.3),(83.6±5.1),(83.9±5.2)mmHg,respectively(t=2.021,2.252,2.261,2.217,2.167,2.076,all P<0.05).nSBP and nDBP were decreased from(146.7±6.9),(149.8±3.9),(150.2±4.1),(93.7±4.2),(95.7±4.3),(93.4±3.3)mmHg to(133.7±4.6),(129.8±5.7),(127.6±2.8),(87.8±2.9),(78.5±6.4),(77.8±4.8)mmHg,respectively(t=1.798,2.032,2.014,1.864,2.157,2.166,all P<0.05).There were significant differences in nSBP and nDBP among all groups after treatment(F=2.32,2.17,all P<0.05),and the effect of the drugs was better in groug Ⅱ and Ⅲ than in group Ⅰ(q=3.17,4.03,3.32,4.19,all P<0.05),but there were no significant differences between group Ⅱ and Ⅲ(P>0.05).Conclusions Blood pressure can be controlled effectively by taking two antihypertensive medictions in the morning in hypertensive dipper patient but the blood pressure of nondipper hypertensive patients were able to be controlled more efficiently by taking the two antihypertensive medictions separately in the morning and at the evening compared with that taking the two drugs together in the morning.
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